2014-11-17T14:58:55-06:00 2013-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2013-01-01 390808498 THE RICHLAND HOSPITAL INC RICH 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 KAREN TRAYNOR CHIEF FINANCIAL OFFICER 6086476321 2014-11-14 1 PAUL M TRACZEK CPA P01368830 7158323407 2014-11-13 2013 2015-11-30 17:44:51Z TERRI POTTER 333 EAST SECOND STREET RICHLAND CENTER WI 53581 46661810 0 X WWW.RICHLANDHOSPITAL.COM X 1937 WI THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S "FIRST CHOICE FOR BETTER HEALTH." 10 10 329 146 215845 -81913 614320 570826 35378393 38020875 473096 552022 -259438 -255738 36206371 38887985 18250 23290 0 0 18558356 19925735 0 0 111923 14516404 15844801 33093010 35793826 3113361 3094159 66440832 70035131 20027574 20600044 46413258 49435087 X THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S "FIRST CHOICE FOR BETTER HEALTH." 0 0 30356499 23290 35654643 THE RICHLAND HOSPITAL, INC. (THE HOSPITAL) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN RICHLAND CENTER, WI. OUR MISSION IS, "THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S FIRST CHOICE FOR BETTER HEALTH."PATIENTS SERVED BY THE RICHLAND HOSPITAL, INC. IN 2013 INCLUDED 3,154 ADULTS AND PEDIATRICS INPATIENT DAYS, 658 SWING BED PATIENT DAYS, 301 NEWBORN PATIENT DAYS, 37,325 TOTAL OUTPATIENT VISITS, AND 5,522 EMERGENCY ROOM VISITS.AS A PART OF THE HOSPITAL'S MISSION AS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION IN THE COMMUNITIES SERVED, THE RICHLAND HOSPITAL, INC. PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS COMMUNITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE RICHLAND HOSPITAL, INC. MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. IN THE CURRENT YEAR, THE TOTAL CHARGES PROVIDED TO PARENTS UNDER THE COMMUNITY CARE POLICY AGGREGATED APPROXIMATELY $516,227 IN TOTAL CHARGES. THE ESTIMATED COST OF PROVIDING CARE TO PATIENTS UNDER THE COMMUNITY CARE POLICY WAS APPROXIMATELY $480,000. IN ADDITION, THE RICHLAND HOSPITAL, INC. IS A PROVIDER UNDER THE WISCONSIN MEDICAL ASSISTANCE PROGRAM. UNDER THIS PROGRAM, THE HOSPITAL IS LEGALLY BOUND TO ACCEPT THE AMOUNT DETERMINED BY THE STATE OF WISCONSIN AS PAYMENT IN FULL FOR EACH PATIENT'S CHARGES. THE CHARGE REDUCTIONS POSTED BY THE HOSPITAL IN ACCEPTANCE OF LOWER PAYMENTS BY THE MEDICAL ASSISTANCE PROGRAM IN 2013 AGGREGATED APPROXIMATELY $5.4 MILLION. (FOR ADDITIONAL INFORMATION ON THE HOSPITAL'S CHARITY CARE PROGRAM AND PARTICIPATION IN THE WISCONSIN MEDICAL ASSISTANCE PROGRAM, PLEASE REFER TO SCHEDULE H OF THE FORM 990.)THE RICHLAND HOSPITAL, INC. ALSO ENGAGES IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES THAT WOULD NOT OTHERWISE, WITHOUT THE EFFORTS AND SPECIALIZED KNOWLEDGE OF THE LOCAL COMMUNITY HOSPITAL, BE PROVIDED FOR THE BENEFIT OF THE RESIDENTS OF RICHLAND CENTER, WISCONSIN AND THE SURROUNDING COMMUNITIES THAT ARE SERVED. IN 2013, THE RICHLAND HOSPITAL, INC. HOSTED HEALTH FAIRS, PARTICIPATED IN LOCAL WELLNESS EVENTS, CONDUCTED EDUCATIONAL SEMINARS, AND PROVIDED INFORMATIONAL PACKETS FOR MEMBERS OF OUR COMMUNITY. OUR TARGET AUDIENCE WAS THE ENTIRE FAMILY: MEN, WOMEN, CHILDREN, AND INFANTS. THE RICHLAND HOSPITAL, INC. HOSTED A WOMEN'S HEALTH FAIR AND A TODDLER WELLNESS EVENT IN RICHLAND CENTER. IT ALSO SPONSORED A WELLNESS EVENT IN SPRING GREEN FOR SCHOOL AGE CHILDREN. EACH OF THE EVENTS WAS FREE TO ATTEND, OPEN TO THE PUBLIC, AND DREW MORE THAN 75 PEOPLE EACH. ITEMS DONATED INCLUDED: STAFF TIME, MATERIALS, SPACE, GIVEAWAYS, AND EQUIPMENT.THE RICHLAND HOSPITAL, INC. PROVIDED FREE BREASTFEEDING AND DIABETES SUPPORT GROUP MEETINGS. EDUCATIONAL MATERIALS WERE PROVIDED FREE OF CHARGE. HEALTHCARE PROFESSIONALS SPOKE TO THE PUBLIC AT COMMUNITY EVENTS THAT WERE FREE AND OPEN TO THE PUBLIC AND THEY PROVIDED INDIVIDUAL COUNSELING AS WELL TO HELP PEOPLE UNDERSTAND THE SERVICES AVAILABLE LOCALLY. EDUCATIONAL MATERIALS WERE PROVIDED FREE OF CHARGE IN A VARIETY OF VENUES. THEY COVERED A WIDE RANGE OF HEALTHCARE TOPICS INCLUDING: CANCER, DIABETES, HEART DISEASE, INFANT AND CHILD DEVELOPMENT, NUTRITION, EXERCISE, SMOKING CESSATION, BREAST HEALTH, ADVANCED DIRECTIVES, COLONOSCOPIES, JOINT AND MUSCLE DEGENERATION, AND MORE.THE BLOOD CENTER OF WISCONSIN HELD MULTIPLE DRIVES IN THE HOSPITAL'S LOWER LEVEL AT NO COST. IN ADDITION, EMPLOYEES COULD DONATE BLOOD WHILE ON WORK TIME AND DID NOT HAVE TO PUNCH OUT. HOME HEALTH UNITED HELD MULTIPLE GRIEF SUPPORT GROUP MEETINGS IN THE HOSPITAL'S LOWER LEVEL AT NO COST. THESE MEETINGS WERE OPEN TO EVERYONE AND FREE OF CHARGE. THE RICHLAND HOSPITAL, INC. PROVIDED PROMOTIONS, SNACKS, AND BEVERAGES AS WELL.THE HOSPITAL ALSO PARTICIPATES IN HEALTH EDUCATION AWARENESS AND CAREER BUILDING ACTIVITIES SUCH AS CLINICAL TRAINING EXPERIENCE, SPEAKERS AT LOCAL SCHOOLS, AND PARTICIPATION IN CAREER FAIRS FOR AREA MIDDLE AND HIGH SCHOOLS AND FOR ADULTS. THE HOSPITAL RECOGNIZES THAT IT IS IMPORTANT TO EDUCATE LOCAL COMMUNITY MEMBERS ON THESE CAREERS AS A CAREER BUILDING INITIATIVE SO THAT LOCAL PRIMARY CARE AND ACCESS TO CARE WILL BE CONTINUED IN THE FUTURE WITH WELL-TRAINED AND EDUCATED COMMUNITY MEMBERS IN HEALTHCARE RELATED FIELDS.FINALLY, WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THIS REMAINS A WORK IN PROGRESS. THE RICHLAND HOSPITAL, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT EASILY ABLE TO BE QUANTIFIED. THROUGH ITS HOSPITAL SERVICES, LIKE MOST RURAL HOSPITALS, THE RICHLAND HOSPITAL, INC. WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY. WITHHOUT THIS HOSPITAL, THIS CARE WOULD NOT BE AVAILABLE LOCALLY AND THE ECONOMIC WELL-BEING OF THE SURROUNDING COMMUNITIES WOULD BE NEGATIVELY AFFECTED BY THE LOSS OF PROFESSIONAL, TECHNICAL, AND SERVICE JOBS.THE RICHLAND HOSPITAL, INC. IS COMMITTED TO WORKING CLOSELY WITH COMMUNITY PARTNERS TO IMPROVE THE OVERALL HEALTH OF THE PEOPLE IN OUR COMMUNITY. WE ARE DEDICATED TO CARING, EDUCATING, AND HEALING WE WANT TO BE THE COMMUNITY'S FIRST CHOICE FOR BETTER HEALTH. 1536696 2151657 THE RICHLAND HOSPITAL, INC. ALSO OPERATES TWO RURAL HEALTH CLINICS LOCATED IN SPRING GREEN AND MUSCODA, WI. DURING 2013, THESE TWO CLINICS PROVIDED A TOTAL OF 8,017 VISITS TO PATIENTS IN BOTH COMMUNITIES. THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL OR UNDERSERVED AREAS OF THE COUNTRY BY HEALTHCARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FARTHER DISTANCES FOR QUALITY HEALTHCARE. 31893195 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 40 0 1 329 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X KAREN TRAYNOR 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 BRYAN MYERS MD CHIEF OF STAFF 5.00 X 0 0 0 KEVIN WHITNEY MD DIRECTOR 1.50 X 0 0 0 RICHARD MARSHALL DIRECTOR 1.50 X 0 0 0 MELISSA SPRECHER DIRECTOR 1.50 X 0 0 0 JERRY GANDER DIRECTOR 1.50 X 0 0 0 GERALD MCCAULEY DIRECTOR 1.50 X 0 0 0 DENNIS HAMILTON PRESIDENT 1.50 X X 0 0 0 ROBERT NUGENT VICE PRESIDENT 1.50 X X 0 0 0 DOROTHY BEHLING SECRETARY 1.50 X X 0 0 0 DWAYNE HILTBRAND TREASURER 1.50 X X 0 0 0 MICHAEL DELFS CEO 40.00 X 201718 0 30320 KAREN TRAYNOR CFO 40.00 X 138614 0 11000 JEREL BERRES MD ER DIRECTOR 40.00 X 290248 0 38704 E RACHEL SHANNON-GOODRICH CRNA ANESTHETIST 40.00 X 297788 0 41965 MUHAMMAD S KHAN MD ER PHYSICIAN 44.40 X 289877 0 35213 BRYAN MCCARVEL ANESTHESIA DIRECTOR 40.00 X 311036 0 37589 ALEX PASQUARIELLO MD ER PHYSICIAN 40.00 X 262495 0 24980 1791776 0 219771 18 0 1 0 THE RICHLAND MEDICAL CENTER LTD 301 EAST SECOND STREET RICHLAND CENTER WI 53581 PHYSICIANS/CLINIC MGMT SERVICES 843328 MERITER LABORATORIES 36 SOUTH BROOKS ST MILWAUKEE WI 53288 LAB SERVICES 185337 ALBET J ALTER JR W9107 SR 39 BLANCHARDVILLE WI 53516 RADIOLOGY SERVICES 139500 WHITNEY SLEEP DIAGNOSTIC & CONSULTANT 119 GRAYSTONE PLAZA STE 102 DETROIT LAKES MN 56501 SLEEP STUDY SERVICES 131200 WIPFLI LLP PO BOX 8010 WAUSAU WI 54402 ACCTG/COMPLIANCE/AUDIT/CONSULTING SVCS 111438 6 531831 16303 22692 570826 PATIENT SERVICE REVENUE 621990 37379616 37299828 79788 CONTRACTED THERAPY 621990 256657 256657 MEDICAL RECORDS 621990 206480 134215 72265 MEALS 722320 142610 80088 62522 35512 35512 38020875 407252 407252 818890 1074628 -255738 -255738 1270 -257008 6843967 6691457 7740 152510 -7740 144770 144770 38887985 37806300 215845 295014 2915 2915 20375 20375 381652 381652 14146947 12706075 1367052 73820 514857 462680 49489 2688 3910053 3513800 375839 20414 972226 852691 114581 4954 293876 293876 89195 89195 3008536 2495236 505463 7837 82124 5283 76841 318498 221751 94537 2210 211736 211736 1597066 1549879 47187 38234 33296 4938 39718 34551 5167 3044987 3044987 100040 100040 SUPPLIES 4882467 4823281 59186 PROVISION FOR BAD DEBT 2020897 2020897 EQUIPMENT RENTAL & MAIN 737348 725419 11929 FOOD 235765 235765 -855686 -855686 35793826 31893195 3788708 111923 1721 1496 11241353 11729525 7742948 7047123 242615 214580 1273808 1292890 301636 384773 57198533 28094678 31169518 29103855 6643681 11456167 3867867 4918751 3955685 3885971 66440832 70035131 3173174 3966776 482419 16495000 15755000 359400 395849 20027574 20600044 X 45776690 48814806 576568 560281 60000 60000 46413258 49435087 66440832 70035131 X 3094159 260987 -333317 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4516 4516 0 PART II-B, LINE 1: THE RICHLAND HOSPITAL, INC. (THE "HOSPITAL") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAD NOTIFIED THE HOSPITAL THAT APPROXIMATELY $2,002 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE HOSPITAL PAYS MEMBERSHIP FEES TO RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN SECURING GRANT FUNDING FOR NEW OR EXISTING HEALTHCARE PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, RWHC ALSO DOES PROVIDE ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON BEHALF OF THE MEMBER ORGANIZATIONS. IT WAS DETERMINED THAT APPROXIMATELY $2,514 OF THE FEES PAID BY THE HOSPITAL IN 2013 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. 70005 468 70473 69671 334 70005 69549 122 69671 69400 149 69549 69240 160 69400 0.00000 0.85140 0.14860 0 0 941726 941726 41331703 17189719 24141984 609073 281466 327607 13637272 10351151 3286121 678759 272342 406417 29103855 UNDER BOND INDENTURE AGREEMENT 2582789 F FUNDED DEPRECIATION 2094984 F UNEMPLOYMENT RESERVE 159933 F RESTRICTED INVESTMENTS 81045 F 4918751 UNAMORTIZED BOND INSURANCE PREMIUM AND ISSUANCE COSTS 706302 INTEREST IN NET ASSETS OF SUPPORTING ORGANIZATIONS 1380718 DEFERRED COMPENSATION PLAN ASSETS 395849 AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 1403102 3885971 DEFERRED COMPENSATION PLAN LIABILITY 395849 395849 X 37379745 1075274 1075274 36304471 2583514 2583514 38887985 34816771 1074628 1074628 33742143 2051683 2051683 35793826 PART V, LINE 4: THE ENDOWMENT FUNDS MAINTAINED BY THE RICHLAND HOSPITAL, INC. HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED IN PERPETUITY, THE INCOME OF WHICH IS EXPENDABLE TO SUPPORT SCHOLARSHIP PROGRAMS OF THE HOSPITAL. PART X, LINE 2: THE HOSPITAL IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF WISCONSIN TAX LAWS. THE HOSPITAL IS ALSO ENGAGED TO A LIMITED EXTENT IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). UBI IS NOT SIGNIFICANT. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2013 AND 2012. FEDERAL TAX RETURNS FOR TAX YEARS 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 1,074,628. NET ASSETS RELEASED FROM RESTRICTIONS 646. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS FROM RELATED ORGANIZATIONS 531,831. SCHOLARSHIP & GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENT 30,786. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 2,020,897. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 1,074,628. PART XII, LINE 4B - OTHER ADJUSTMENTS: DISTRIBUTIONS FROM SCHOLARSHIP FUNDS SCHOLARSHIP & GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENT 30,786. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 2,020,897. 1 1 1 X 1 X 1 1 1 0 1 1 480238 480238 0.01340 4049155 2610602 1438553 0.04020 41731 41459 272 0.00000 4571124 2652061 1919063 0.05360 73528 15898 57630 0.00160 4544266 3107554 1436712 0.04010 8548 8548 0.00020 4626342 3123452 1502890 0.04190 9197466 5775513 3421953 0.09550 1100 1100 0.00000 1100 1100 0 1017085 508542 13088895 13122381 -33486 X 0 1 1 THE RICHLAND HOSPITAL INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 1045 X X X X THE RICHLAND HOSPITAL INC 1 1 X X X X X X X X X 13 1 0 1 X HTTP://WWW.RICHLANDHOSPITAL.COM X X X X X X X 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X X X X 1 X 1 X X X X X 1 X 0 0 THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 3: THE RICHLAND HOSPITAL, INC. ENGAGED IN AN EXTENSIVE ASSESSMENT OF THE HEALTH NEEDS OF THE COMMUNITY IN ITS STRATEGIC PLANNING PROCESS. THE ASSESSMENT INCLUDED DIRECT FEEDBACK FROM THE RESIDENTS OF THE MARKET AREA SERVED AS WELL AS USE OF OTHER SOURCES OF DATA RELATED TO COMMUNITY HEALTH NEEDS. IT INCLUDED PERFORMING PROJECTIONS OF DEMAND FOR HEALTHCARE SERVICES AND ASSESSING WHAT IS AVAILABLE IN THE MARKET AREA TO MEET THOSE DEMANDS.IN ADDITION, THE RICHLAND MEDICAL CENTER, LTD. PHYSICIANS AND PROVIDERS WHO OFFER PRIMARY AND SECONDARY LEVEL CARE, INCLUDING PREVENTIVE HEALTHCARE FOR THE PERSONS RESIDING IN THE MARKET AREA, PARTICIPATED IN A PLANNING SESSION WHERE DATA GATHERED WAS REVIEWED AND PROVIDED THEIR INPUT INTO NEEDS OF THE PATIENTS THEY SERVE. THE PLAN WAS PROVIDED IN DRAFT FORM TO PERSONS REPRESENTING THE AGING AND DISABILITIES RESOURCE CENTER, RICHLAND COUNTY PUBLIC HEALTH, RICHLAND FIT, RICHLAND FREE CLINIC, AND RICHLAND COUNTY HEALTH AND HUMAN SERVICES. WE THEN MET WITH THESE PERSONS TO DISCUSS OUR PLANS AND COMMUNITY PRIORITIES. APPENDIX B CONTAINS A FULL SUMMARY OF THEIR COMMENTS.STUDIES THAT HAVE BEEN DONE WERE ALSO USED AND INCLUDED THE RICHALND COUNTY COMMUNITY ASSESSMENT REPORT DONE IN 2011, BY RICHLAND COUNTY PUBLIC HEALTH AND COUNTY HEALTH RANKINGS AND ROADMAPS COMPLETED BY THE POPULATION HEALTH INSTITUTE, UNIVERSITY OF WISCONSIN STARTING IN 2010 AND DONE ANNUALLY.THE RICHALND HOSPITAL IS A COMMUNITY PARTNER IN THE RICHLAND FIT PROGRAM. A COMMUNITY HEALTH NEED ASSESSMENT AS WELL AS A STRATEGIC AND IMPLEMENTATION PLAN WAS DEVELOPED FOCUSING ON THE HIGH OBESITY RATES IN RICHLAND COUNTY. THE EFFORTS TO DEVELOP THE PLAN AND DO NECESSARY RELATED RESEARCH WAS FUNDED BY THE UNIVERSITY OF WISCONSIN PARTNERSHIP PROGRAM IN 2011, AND IMPLEMENTATION AND MEASUREMENT OF OUTCOMES IS IN PROCESS.RANDOM SAMPLE TELEPHONE SURVEY OF RESIDENTS OF THE MARKET AREA SERVED BY THE RICHLAND HOSPITAL, INC. RANDOMLY SURVEYED 250 HOUSEHOLDS IN ITS MARKET AREA REGARDING HEALTHCARE SERVICES AND NEEDS. PERSONS OF ALL INCOME LEVELS WERE INCLUDED IN THE SURVEY PROCESS. THIS PRODUCED SURVEY RESULTS THAT ARE AT THE 94 PERCENT CONFIDENCE LEVEL WITH A MARGIN OF ERROR OF + SIX PERCENTAGE POINTS. THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 5D: THE CHNA WAS ALSO ADVERTISED TO THE PUBLIC WHEN IT WAS COMPLETE AND AVAILABLE AT HOSPITAL-BASED LOCATIONS AS WELL AS THROUGH FACEBOOK AND BREWER PUBLIC LIBRARY IN RICHLAND CENTER. THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 6I: THE HOSPITAL ALSO IDENTIFIED OTHER HEALTH NEEDS BY PARTNERING WITH OTHER ORGANIZATIONS TO DEVELOP A SHARED COMMUNITY-WIDE HEALTH NEEDS ASSESMENT IN THE FUTURE. THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 14G: THE HOSPITAL ALSO PROVIDED FINANCIAL ASSISTANCE INFORMATION IN BROCHURES LOCATED IN THE CASHIERS OFFICE. BROCHURES CAN ALSO BE FOUND AT BOTH OF THE RURAL HEALTH CLINICS. FURTHER INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE THROUGH PHONE CONVERSATIONS WITH FINANCIAL COUNSELORS AT THE HOSPITAL. BROCHURES ARE ALSO AVAILABLE AT THE REHAB DEPARTMENT, FREE CLINIC, AND RICHLAND COUNTY RESOURCE AND DISABILITY OFFICE. THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 18E: THE HOSPITAL'S BUSINESS OFFICE STAFF ALSO MAKES AN ATTEMPT TO CONTACT EACH PATIENT WITH A BALANCE GREATER THAN $300 AND THE COMMUNITY CARE PROGRAM IS MENTIONED ON THE PHONE CALL. THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 20D: THE HOSPITAL FOLLOWS A CALCULATION TO DETERMINE AN AMOUNT GENERALLY BILLED ("AGB") TO CHARGE UNINSURED PATIENTS. THE CALCULATION OF ABG SHALL EQUAL AMOUNTS GENERALLY BILLED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AGB SHALL BE CALCULATED ANNUALLY AND WILL BE BASED ON THE IMMEDIATELY PRECEDING 12-MONTH PERIOD SPANNING DECEMBER THROUGH NOVEMBER. CALCULATIONS INCLUDE PAYMENTS FOR DEDUCTIBLES AND CO-PAYMENTS. THE AGB AS CALCULATED SHALL BE EFFECTIVE ON THE 14TH DAY OF JANUARY OF EACH YEAR AND APPLIED TO ANY APPLICATION DETERMINATIONS MADE ON OR AFTER THAT DATE REGARDLESS OF THE ORIGINAL DATE OF SERVICE OR THE ORIGINAL DATE OF APPLICATION. THE AGB PERCENTAGE IS EQUAL TO THE SUM OF ALL CLAIMS PAYMENTS FOR MEDICALLY NECESSARY CARE FOR HEALTHCARE COVERED BY MEDICARE AND PRIVATE INSURERS DIVIDED BY GROSS CHARGES RELATED TO CLAIMS. 2 MUSCODA HEALTH CENTER 1075 NORTH WISCONSIN AVENUE MUSCODA WI 53573 RURAL HEALTH CLINIC SPRING GREEN MEDICAL CENTER 150 EAST JEFFERSON STREET SPRING GREEN WI 53588 RURAL HEALTH CLINIC PART I, LINE 6A: THE RICHLAND HOSPITAL, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S DATABASE AND WEBSITE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT THE RICHLAND HOSPITAL, INC. INCLUDES THE OPERATION OF THE HOSPITAL EMERGENCY ROOM DEPARTMENT, THE INTENSIVE CARE INPATIENT UNIT, AND THE OPERATION OF TWO RURAL HEALTH CLINICS. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH THE RICHLAND HOSPITAL, INC. AND ARE PRIMARILY UTILIZED FOR EMERGENCY SERVICES. THE EMERGENCY ROOM DEPARTMENT OPERATES 24 HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED BY PRIMARILY BOARD CERTIFIED EMERGENCY ROOM PHYSICIANS. THE HOSPITAL ALSO WORKS IN CONJUNCTION WITH A LOCAL CLINIC ORGANIZATION TO PROVIDE A THIRD YEAR RESIDENT PHYSICIAN AN OPPORTUNITY TO PROVIDE SERVICES TO PATIENTS IN THE EMERGENCY MEDICAL SETTING AS PART OF THEIR PHYSICIAN TRAINING EXPERIENCE. AS PART OF THE PATIENT SERVICES PROVIDED TO THE COMMUNITY, THE HOSPITAL HAS DESIGNATED A PORTION OF ITS INPATIENT UNIT AS A CERTIFIED INTENSIVE CARE UNIT KNOWN AS THE "SPECIAL CARE UNIT." THIS UNIT REQUIRES A HIGHER ACUITY OF NURSING AND HAS DEDICATED STAFF TO PROVIDE THIS CARE TO PATIENTS. A SIGNIFICANT PORTION OF THE ADMISSIONS TO THE UNIT COME FROM EMERGENCY ADMISSIONS TO THE HOSPITAL SO IT IS CONSIDERED A SUBSIDIZED HEALTH SERVICE PROVIDED TO THE COMMUNITY BY THE HOSPITAL. THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL OR UNDERSERVED AREAS OF THE COUNTRY BY HEALTHCARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FARTHER DISTANCES FOR QUALITY HEALTHCARE. IT IS THE GOAL OF THE RICHLAND HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY. PART II, COMMUNITY BUILDING ACTIVITIES: THE RICHLAND HOSPITAL, INC. ENGAGES IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES THAT WOULD OTHERWISE NOT BE MET OR PROVIDED WITHOUT THE EFFORTS AND SPECIALIZED KNOWLEDGE OF THE LOCAL COMMUNITY HOSPITAL TO THE RESIDENTS OF RICHLAND CENTER, WISCONSIN AND THE SURROUNDING AREAS. SOME OF THE COMMUNITY BUILDING ACTIVITIES THAT THE HOSPITAL PARTICIPATES IN ARE THE LOCAL HEALTH AND WELLNESS FAIRS, SUPPORT GROUPS, PROVIDING EDUCATIONAL MATERIALS TO COMMUNITY MEMBERS, SAFE SITTER CLASSES, AND LOCAL BLOOD PRESSURE SCREENINGS TO NAME A FEW OF THESE ACTIVITIES. IN ADDITION, THE HOSPITAL IS A COMMUNITY PARTNER AND ACTIVE MEMBER OF THE RICHLAND FIT PROGRAM. RICHLAND FIT CONDUCTED A STUDY WHICH CREATED A STRATEGIC AND IMPLEMENTATION PLAN FOCUSING ON THE HIGH OBESITY RATES IN RICHLAND COUNTY. THE EFFORT TO DEVELOP THE PLAN AND DO NECESSARY RELATED RESEARCH WAS FUNDED BY THE UNIVERSITY OF WISCONSIN PARTNERSHIP PROGRAM IN 2011, AND IMPLEMENTATION AND MEASUREMENT OF OUTCOMES IS IN PROCESS. THE HOSPITAL ALSO TAKES AN ACTIVE ROLE IN WELLNESS THROUGH ITS SUPPORT OF LOCAL ATHLETES AND MAINTAINS CONTRACTS WITH AREA SCHOOL SYSTEM TO PROVIDE ATHLETIC TRAINERS FOR COVERAGE AT SCHEDULED SPORTING EVENTS. THIS SPORTS MEDICINE PROGRAM PROVIDES OUTREACH SERVICES TO RICHLAND CENTER, RIVERDALE (MUSCODA), AND ITHACA SCHOOL DISTRICTS AS WELL AS TO THE LOCAL UW-RICHLAND CENTER CAMPUS. SERVICES PROVIDED INCLUDE IN-SCHOOL INJURY PREVENTION / ASSESSMENTS CLINICS, DAILY PRACTICE COVERAGE (FREQUENCY VARIES WITH EACH SCHOOL), "HOME" EVENT COVERAGE AS REQUESTED BY SCHOOLS, AND EMERGENCY ACTION PLAN DEVELOPMENT FOR EACH SCHOOL. THE PROGRAM PROVIDES SKINFOLD TESTING FOR THE WRESTLING PROGRAMS IN ACCORDANCE WITH WIAA MANDATES AND IMPACT CONCUSSION SCREENING SERVICES TO ESTABLISH A BASELINE FOR ATHLETES. FINALLY, THE PROGRAM PROVIDES EDUCATION FOR LOCAL EMS SQUADS ON THE APPROPRIATE TRANSPORT OF INJURED ATHLETES. THE RICHLAND HOSPITAL, INC.'S SPORTS MEDICINE PROGRAM IS OPERATED AT A LOSS EACH YEAR, AN INVESTMENT IN THE COMMUNITY THAT WAS IN EXCESS OF $100,000 IN 2013. THE PROGRAM HAS DIRECT TIES TO ONE OF THE PRIORITIES IDENTIFIED BOTH BY THE RICHLAND FIT NEEDS ASSESSMENT BUT ALSO BY THE HOSPITAL'S 2013 CHNA, THE HIGH OBESITY RATE FOR YOUTH AND YOUNG ADULTS IN RICHLAND COUNTY.COMMUNITY BUILDING ACTIVITIES WERE DETERMINED BY MEMBERS OF THE COMMUNITY OR ASKED BY COMMUNITY REPRESENTATIVES OF THE RICHLAND HOSPITAL, INC. TO PROVIDE THESE SERVICES SINCE THE HOSPITAL HAS THE EXPERTISE IN THESE AREAS. THE HOSPITAL ALSO PARTICIPATES IN HEALTH EDUCATION AWARENESS AND CAREER BUILDING ACTIVITIES SUCH AS CLINICAL TRAINING EXPERIENCE, SPEAKERS AT LOCAL SCHOOLS, AND CAREER FAIRS. THE HOSPITAL RECOGNIZES THAT IT IS IMPORTANT TO EDUCATE LOCAL COMMUNITY MEMBERS ON THESE CAREERS AS A CAREER BUILDING INITIATIVE SO THAT LOCAL PRIMARY CARE AND ACCESS TO CARE WILL BE CONTINUED IN THE FUTURE WITH WELL-TRAINED AND EDUCATED COMMUNITY MEMBERS IN HEALTHCARE RELATED FIELDS. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. PART III, LINE 8: THE RICHLAND HOSPITAL, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH, A PORTION OF ITS REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES ONLY A PORTION OF THE TOTAL MEDICARE REVENUE OF THE HOSPITAL. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, RADIOLOGIST SERVICES, AND SURGICAL ANESTHESIA SERVICES AT THE RICHLAND HOSPITAL, INC. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE RICHLAND HOSPITAL, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF RICHLAND COUNTY, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART VI, LINE 2: IN ADDITION TO THE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIBED IN SCHEDULE H, PART V, SECTION B, THE RICHLAND HOSPITAL, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES BY LOOKING AT LOCAL AND SURROUNDING COMMUNITY DEMOGRAPHICS TO DETERMINE THE SERVICES THAT ARE MOST NECESSARY IN ORDER TO FULFILL ITS MISSION. THE FACILITY ACTIVELY SEEKS INPUT FROM MEMBERS OF THE MEDICAL STAFF REGARDING EXISTING SERVICES, POTENTIAL NEED FOR EXPANDED SERVICES, AND THE POTENTIAL NEED FOR NEW SERVICE LINES NOT OFFERED LOCALLY. THE FACILITY ALSO REVIEWS HOSPITAL STATISTICS OF PATIENT VISITS TO DETERMINE WHAT TYPES OF SERVICES OFFERED BY THE FACILITY ARE BEING UTILIZED. THE HOSPITAL HAS CONTINUED TO USE FOCUS GROUPS FOR SPECIFIC SERVICE LINE ENHANCEMENT, MEETING DIRECTLY WITH TARGETED MEMBERS OF THE MARKET TO UNDERSTAND THEIR HEALTHCARE SERVICE DELIVERY NEEDS AND EXPECTATIONS TIED TO SPECIFIC AREAS OF CARE. IN PLANNING TO MEET COMMUNITY NEEDS, THE AGING OF THE POPULATION IS SIGNIFICANT BECAUSE PERSONS IN THE AGE CATEGORIES THAT ARE GROWING FACE MORE CHALLENGES RELATED TO HEALTHCARE THAN YOUNGER POPULATIONS. IN THE OLDER POPULATION GROUPS, PERSONS VISIT PRIMARY CARE PHYSICIANS MORE FREQUENTLY, HAVE HIGHER INCIDENT RATES OF HEART DISEASE, CANCER, AND RELATED ILLNESSES. THE ONSET OF CHRONIC DISEASES ARE HIGHER IN THIS AGE CATEGORY, E.G., ONSET OF DIABETES, COPD, OR HEART PROBLEMS, AND MUST BE MANAGED WITH ASSISTANCE FROM THE HEALTHCARE PROVIDERS FOR THE REMAINDER OF THE PERSON'S LIFE. IMPORTANT TO NOTE IS THAT AS A PERSON AGES, TRAVEL BECOMES MORE CHALLENGING, SO THE ABILITY TO GET AS MUCH OF THEIR HEALTHCARE NEEDS MET LOCALLY GROWS IN IMPORTANCE. HAVING VISITING SPECIALISTS, FOR EXAMPLE, ELIMINATES THE NEED FOR A TRIP TO A MAJOR MEDICAL CENTER FOR MANY. IN ADDITION, IT ENSURES THAT PERSONS GET THE CARE THAT THEY NEED.AN EXAMPLE OF A SOMEWHAT RECENT SERVICE ADDITION CAME IN 2011 WHEN THE HOSPITAL ADDED A LOCALLY MANAGED SLEEP STUDY SERVICE WHICH HAS BEEN WELL RECEIVED BY PATIENTS AND PHYSICIANS ALIKE. THE HOSPITAL CONTINUES TO MORE FULLY DEVELOP THE ELECTRONIC HEALTH RECORD SYSTEM WITH ONE OF THE MAIN GOALS BEING IMPROVED ACCESS TO STRONG CLINICAL DOCUMENTATION INCLUDING PATIENT MEDICAL HISTORIES AS A MEANS TO SUPPORT A MORE EFFICIENT AND EFFECTIVE PATIENT EXPERIENCE. IN TURN, THE ELECTRONIC HEALTH RECORD SYSTEM PROVIDES FOR A MORE COMPLETE MEDICAL HISTORY SHOULD THAT PATIENT REQUIRE TREATMENT AT OTHER HEALTHCARE FACILITIES. IN RESPONSE TO INCREASED PATIENT DEMANDS FOR ACCESS TO PRIMARY AMBULATORY CLINIC CARE, THE HOSPITAL COMPLETED CONSTRUCTION OF A REPLACEMENT CLINIC FACILITY IN MUSCODA, WISCONSIN, IN 2012 AS A MEANS TO BETTER SERVE THE NEEDS OF THE PATIENTS IN MUSCODA AND THE SURROUNDING RURAL COMMUNITIES. PART VI, LINE 3: CONSISTENT WITH THE MISSION OF THE RICHLAND HOSPITAL, INC., HEALTH-RELATED SERVICES ARE PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL IS COMMITTED TO PROVIDING FREE OR DISCOUNTED CARE TO QUALIFIED INDIVIDUALS THAT ARE IN NEED OF MEDICALLY NECESSARY TREATMENT EVEN IF THAT PERSON IS UNINSURED, UNDERINSURED, HIE QUALIFIED, INELIGIBLE FOR OTHER GOVERNMENT PROGRAMS, OR UNABLE TO PAY BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. WHEN A PATIENT'S ADJUSTED GROSS INCOME IS LESS THAN 150 PERCENT OF THE FEDERAL POVERTY LEVEL, THEY ARE PROVIDED CARE WITHOUT CHARGE. WHEN AN UNINSURED OR HEALTH INSURANCE EXCHANGE ELIGIBLE PATIENT'S ADJUSTED GROSS INCOME IS 151% TO 300% OF THE FEDERAL POVERTY LEVEL, THEY ARE PROVIDED CARE AT THE AMOUNT GENERALLY BILLED RATE. UNDERINSURED PATIENTS AT 150% TO 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR A DISCOUNT BASED ON A SLIDING SCALE. TO BE ELIGIBLE UNDER THIS PROGRAM, PATIENTS MUST COOPERATE WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE AND IF NECESSARY, INCLUDING APPLICATION OR ACTIONS NEEDED TO SECURE COVERAGE BY MEDICARE, MEDICAID, AND THE MARKETPLACE. PATIENTS WILL BE REQUIRED TO PROVIDE NECESSARY INFORMATION AND DOCUMENTATION WHEN APPLYING FOR A PROGRAM DISCOUNT, OR FOR OTHER PRIVATE OR PUBLIC PAYMENT PROGRAMS. THE FACILITY'S FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS WITH THE APPLICATION PROCESS. APPLICATIONS AND ALL SUPPORTING DOCUMENTATION IS REVIEWED BY THE FACILITY'S FINANCIAL COUNSELOR FOR ELIGIBILITY AND APPROVED BY THE PATIENT ACCOUNTING SUPERVISOR. FREE RADIOLOGY, LABORATORY, AND OTHER DIAGNOSTIC ANCILLARY SERVICES ARE ALSO PROVIDED TO PATIENTS WHO ARE REFERRED TO THE HOSPITAL BY THE RICHLAND CENTER FREE CLINIC. THE HOSPITAL ALSO OFFERS AN AUTOMATIC 10% DISCOUNT ON ALL PRIVATE PAY ACCOUNTS. A PROMPT PAY DISCOUNT OF AN ADDITIONAL 5% IS ALSO AVAILABLE. THE RICHLAND HOSPITAL, INC. COMMUNICATES THE AVAILABILITY AND TERMS OF THE PROGRAM TO ALL PATIENTS, THROUGH MEANS WHICH INCLUDE, BUT ARE NOT LIMITED TO:-POSTED SIGNS WITHIN WAITING ROOMS, EMERGENCY ROOMS, AND FINANCIAL SERVICES DEPARTMENTS-COMMUNITY CARE PROGRAM APPLICATION OFFERED TO INDIVIDUAL PRIOR TO DISCHARGE-PERIODIC NOTIFICATIONS WITH PATIENT BILLS OR STATEMENTS AND OTHER ORAL AND WRITTEN CORRESPONDENCE INCLUDING "PLAIN LANGUAGE SUMMARY" OF THE PROGRAM-POSTED POLICIES ON THE HOSPITAL'S WEBSITE-BROCHURES WRITTEN IN PLAIN LANGUAGE ARE AVAILABLE FOR PATIENTS TO TAKE WITH THEM OR TO BE GIVEN TO PATIENTS BY HOSPITAL TEAM MEMBERS AND WILL BE MADE AVAILABLE FOR USE BY THE LOCAL AGING AND DISABILITY RESOURCE CENTER PERSONNEL AND AT THE RICHLAND COMMUNITY FREE CLINIC-DESIGNATED STAFF KNOWLEDGEABLE ON THE PROGRAM WILL BE AVAILABLE AT DEFINED HOURS TO ANSWER PATIENT QUESTIONS AND/OR MAY REFER PATIENTS TO THE PROGRAMREGISTRATION CLERKS AT THE HOSPITAL, AND AT THE TWO HOSPITAL-OWNED CLINICS, ARE TRAINED TO INQUIRE WITH SELF-PAY PATIENTS UPON REGISTRATION IF THEY WOULD LIKE FURTHER INFORMATION ON THESE POLICIES OR WOULD LIKE TO MEET WITH A MEMBER OF THE BUSINESS OFFICE STAFF. DURING THE COLLECTION PROCESS, THE RICHLAND HOSPITAL, INC. MAKES AN EFFORT TO PROVIDE INFORMATION AND INCLUDES CHARITY CARE PROGRAM MATERIALS WITH EACH STATEMENT THAT IS SENT. SOCIAL SERVICES AND BUSINESS OFFICE STAFF AT THE HOSPITAL ARE ALSO AVAILABLE TO PROVIDE INFORMATION TO PATIENTS ON OTHER GOVERNMENT PROGRAMS SUCH AS THE MEDICAID PROGRAM OR TO REFER PATIENTS TO PERSONNEL AT RICHLAND COUNTY OR OTHER STATE OF WISCONSIN OR COUNTY AGENCIES THAT MAY PROVIDE ACCESS TO CARE. PART VI, LINE 4: THE RICHLAND HOSPITAL, INC. IS LOCATED IN RICHLAND CENTER, WISCONSIN, WHICH IS A COMMUNITY OF APPROXIMATELY 5,000 PEOPLE AND IS LOCATED 50 MINUTES FROM MADISON, WISCONSIN. THE HOSPITAL OPERATES A 25-BED, ACUTE CARE CRITICAL ACCESS HOSPITAL AND TWO RURAL HEALTH CLINICS LOCATED IN NEIGHBORING COMMUNITIES. THE RICHLAND HOSPITAL, INC. OFFERS A WIDE VARIETY OF SERVICES IN ORDER TO FULFILL MANY OF THE NEEDS OF THE INDIVIDUALS IN THE LOCAL COMMUNITY. AMONG SERVICES PROVIDED ARE: DIAGNOSTIC CARE, 24-HOUR EMERGENCY ROOM, OBSTETRICS, REHABILITATION, SURGICAL CARE, AND DIABETES SELF-CARE PROGRAMS, ALONG WITH OTHER SPECIALTY SERVICES, WHICH INCLUDE: AUDIOLOGY, CARDIOLOGY, ORTHOPEDICS, CHEMOTHERAPY, CLINICAL SERVICES, AMONG OTHERS. CARE IS OFFERED TO PATIENTS REGARDLESS OF PAY SOURCE AND REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COMMUNITIES SERVED BY THE RICHLAND HOSPITAL ARE DEFINED BY THE FOLLOWING ZIP CODES: 53506 AVOCA53556 LONE ROCK53518 BLUE RIVER53573 MUSCODA53581 RICHLAND CENTER53588 SPRING GREENTHEY ARE GEOGRAPHICALLY CONTIGUOUS COMMUNITIES. ACCORDING TO DATA PUBLISHED BY INTELLIMED, THE RICHLAND HOSPITAL, INC. HAD AN OVERALL INPATIENT MARKET SHARE OF 51.7 PERCENT AND OUTPATIENT MARKET SHARE OF 40.8 PERCENT IN THESE ZIP CODES. NO OTHER HEALTHCARE PROVIDER PROVIDING THE SAME SERVICES HAD A MARKET SHARE AS HIGH AS OR HIGHER THAN THE RICHLAND HOSPITAL, INC. (INTELLIMED COMBINES STATEWIDE HEALTHCARE DATA FROM WISCONSIN HOSPITAL ASSOCIATION IN A WEB-BASED SUPPORT ENGINE THAT ALLOWS US TO ANALYZE OUR MARKET.)SOCIO-DEMOGRAPHIC PROFILE OF THE MARKET AREA SERVED BYTHE RICHLAND HOSPITAL, INC. SERVES PERSONS WHO ARE REPRESENTATIVE OF THE POPULATION OF THE MARKET AREA. A HIGHER PERCENTAGE OF THE POPULATION SERVED IS ELDERLY; THIS IS DUE TO THE FACT THAT PERSONS 65 YEARS OF AGE AND OLDER ARE HOSPITALIZED AT NEARLY THREE TIMES THE OVERALL RATE. SOMETHINGS TO NOTE RELATED TO PLANNING FOR MEETING COMMUNITY HEALTH NEEDS INCLUDES THE FOLLOWING:THE OVERALL POPULATION OF THE MARKET AREA IS PROJECTED TO REMAIN VERY STABLE, WITH NEGLIGIBLE GROWTH OR DECLINE PROJECTED OVER THE NEXT FIVE YEARS.THE RESIDENTS OF THE MARKET AREA ARE AGING SIGNIFICANTLY. THERE IS A PROJECTED 6.3 PERCENT GROWTH IN THE POPULATION AGED 45 TO 64 AND A PROJECTED 5.1 PERCENT GROWTH IN THE POPULATION AGED 65 YEARS OF AGE AND OLDER. THERE IS A CORRESPONDING 11.5 PERCENT PROJECTED DECLINE IN THE 25 TO 44 YEAR OLD POPULATION. PERSONS IN THE 0 TO 14 AGE GROUP ARE ALSO PROJECTED TO DECREASE BY 0.7 PERCENT.DURING 2013, MEDICARE AND MEDICARE ADVANTAGE PLAN BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 47 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE AT THE RICHLAND HOSPITAL, INC. AND MEDICAID BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 13 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE. MEDICARE AND MEDICAID BENEFICIARIES MAKE UP THE LARGEST PORTION OF PATIENTS THAT ARE SERVED BY THE RICHLAND HOSPITAL, INC. OVER THE PREVIOUS FEW YEARS. PART VI, LINE 5: THE RICHLAND HOSPITAL, INC. IS ACCREDITED THROUGH THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. THE JOINT COMMISSION IS AN ORGANIZATION THAT EVALUATES HOSPITAL PERFORMANCE STANDARDS, FOCUSING ON THE QUALITY OF HEALTHCARE. ACCREDITATION THROUGH THE JOINT COMMISSION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY, AS IT REQUIRES RIGOROUS PERFORMANCE STANDARDS. TO EARN AND MAINTAIN ACCREDITATION, THE HOSPITAL IS EVALUATED THROUGH AN UNANNOUNCED SURVEY PROCESS COVERING NEARLY 600 STANDARDS RELATED TO QUALITY PATIENT CARE, SAFETY, INFECTION CONTROL, AND ONGOING PERFORMANCE-IMPROVEMENT ACTIVITIES, AMONG OTHERS. ALL HOSPITALS SURVEYED BY THE JOINT COMMISSION ARE EVALUATED AGAINST THE SAME CRITERIA, REGARDLESS OF SIZE OR LOCATION.THE ACTIVITIES OF THE RICHLAND HOSPITAL, INC. ARE SUPPORTED LOCALLY BY A VOLUNTEER BOARD OF DIRECTORS WHICH OVERSEE THE OPERATIONS OF THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS WHICH RESIDE IN RICHLAND CENTER, WI AND THE SURROUNDING AREA WHICH IS THE HOSPITAL'S PRIMARY PATIENT SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO A MAJORITY OF ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS WHO WISH TO BETTER SERVE THEIR PATIENTS BY PROVIDING CARE AT THE RICHLAND HOSPITAL, INC. ANY SURPLUSES IN OPERATIONS THAT ARE ACHIEVED BY THE ORGANIZATION OPERATING IN AN EFFECTIVE MANNER AND CONTROLLING THE COST OF HEALTHCARE ARE PRIMARILY RESERVED FOR FUTURE BUILDING AND CAPITAL PURCHASE NEEDS. THE RICHLAND HOSPITAL, INC. RECOGNIZES THAT IT IS IMPORTANT TO SAVE THESE RESERVES DURING YEARS OF SURPLUS SO THAT IN TIMES OF ECONOMIC DOWNTURN, IF A LARGE CAPITAL ADDITION IS NEEDED, THE HOSPITAL WILL NOT HAVE TO PASS HIGHER COSTS ON TO MEMBERS OF THE COMMUNITY. THE HOSPITAL FURTHER ACHIEVES ITS GOAL OF PROVIDING TRUE COMMUNITY SUPPORT BY PROVIDING CHARITY CARE AS DESCRIBED THROUGHOUT SCHEDULE H AND PROVIDING SERVICES TO MEMBERS OF OTHER PROGRAMS WHICH OFTEN REIMBURSE THE HOSPITAL BELOW THE COST OF PROVIDING THIS CARE SUCH AS CHAMPUS, TRICARE, AND THE WISCONSIN HEALTH INSURANCE RISK SHARING PROGRAM OR "HIRSP" (THE HIRSP PROGRAM REIMBURSES THE HOSPITAL AT RATES SIMILAR TO THE MEDICAID PROGRAM AND IS FOR PATIENTS THAT HAVE PRE-EXISTING ILLNESSES WHICH MAKE IT DIFFICULT TO OBTAIN INSURANCE FROM COMMERCIAL INSURANCE CARRIERS IN THE MARKETPLACE). PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 SCHOLARSHIPS FOR HEALTHCARE EDUCATION 31 20375 0 PART I, LINE 2: THE RICHLAND HOSPITAL, INC. FOLLOWS A STANDARD PROCEDURE ON ISSUANCE OF SCHOLARSHIP FUNDS WHICH IS DETERMINATED BY THE BOARD OF DIRECTORS AND MANAGEMENT OF THE RICHLAND HOSPITAL, INC. THE RICHLAND HOSPITAL FOUNDATION, INC. AND THE PARTNERS OF THE RICHLAND HOSPITAL, INC. THESE THREE SEPARATE ORGANIZATIONS HAVE ESTABLISHED CRITERIA FOR REVIEW OF APPLICATIONS FOR PROSPECTIVE SCHOLARSHIP RECIPIENTS TO ENSURE THAT SCHOLARSHIPS ARE BEING GRANTED FOR HEALTH EDUCATION RELATED PURPOSES AND TO A QUALIFIED STUDENT STUDYING AT AN ACCREDITED TECHNICAL COLLEGE, COLLEGE, OR UNIVERSITY. (A LARGE PORTION OF THE FUNDING FOR SCHOLARSHIPS IS ALSO GOVERNED BY DONOR AGREEMENTS AS NOTED IN SCHEDULE D TO THE FORM 990 RELATED TO ENDOWMENT FUNDS.) X 0 0 X X X X 0 1 0 0 0 0 0 0 0 MICHAEL DELFS CEO 200574 0 0 0 1144 0 4648 0 25672 0 232038 0 0 0 JEREL BERRES MD ER DIRECTOR 280047 0 0 0 10201 0 10200 0 28504 0 328952 0 0 0 E RACHEL SHANNON-GOODRICH CRNA ANESTHETIST 203016 0 0 0 94772 0 10200 0 31765 0 339753 0 0 0 MUHAMMAD S KHAN MD ER PHYSICIAN 289044 0 0 0 833 0 10200 0 25013 0 325090 0 0 0 BRYAN MCCARVEL ANESTHESIA DIRECTOR 225698 0 0 0 85338 0 10200 0 27389 0 348625 0 0 0 ALEX PASQUARIELLO MD ER PHYSICIAN 260411 0 0 0 2084 0 10200 0 14780 0 287475 0 0 0 PART I, LINE 1A HEALTH CLUB DUES GROSS UPS, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. PART I, LINE 4B JEREL BERRES, 457 PLAN CONTRIBUTION BY THE HOSPITAL: $6,875 FORM 990, PART VI, SECTION A, LINE 4 DURING 2013, THE BOARD OF DIRECTORS OF THE RICHLAND HOSPITAL, INC. APPROVED AN AMENDED VERSION OF THE HOSPITAL'S BYLAWS. THERE WERE SEVERAL UPDATES TO THE BYLAWS WHICH WERE PRIMARILY TO UPDATE THE LANGUAGE TO CURRENT PRACTICES OF THE HOSPITAL. THE MOST SIGNFICANT CHANGES TO THE BYLAWS WHICH IMPACT THE OPERATIONS OF THE HOSPITAL WERE THAT MEMBERS OF THE BOARD OF DIRECTORS CAN SERVE BEYOND A MAXIMUM OF A 3 YEAR TERM, 3 CONSECTIVE TIMES, ONLY IF THEY HAVE ONE YEAR ABSENT FROM THE BOARD OF DIRECTORS FOLLOWING THE NINE YEARS OF SERVING AND THAT MEMBERS OF THE BOARD OF DIRECTORS WILL NOT BE COMPENSATED FOR SERVING ON THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 WAS EMAILED OR MAILED TO ALL MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS BEFORE IT WAS FILED. ALL BOARD MEMBERS WERE GIVEN THE OPPORTUNITY TO RESPOND WITH COMMENTS PRIOR TO THE FINAL SUBMISSION OF THE FORM 990 TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE RICHLAND HOSPITAL, INC. REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST-COMPENSATED EMPLOYEES, AND HIGHEST-COMPENSATED PROFESSIONAL OR INDEPENDENT CONTRACTORS TO COMPLETE ITS ANNUAL DISCLOSURE STATEMENT. THESE QUESTIONNAIRES ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. ANY INDIVIDUALS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING OR ACTING ON THOSE MATTERS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS HAS AN ESTABLISHED PROCESS TO ANNUALLY REVIEW THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND TO DEFINE APPROPRIATE MARKET AND PERFORMANCE BASED ADJUSTMENTS. COMPARATIVE DATA IS OBTAINED FROM EITHER THE WISCONSIN HOSPITAL ASSOCIATION EXECUTIVE COMPENSATION SURVEY OR OTHER REPUTABLE THIRD-PARTY HEALTHCARE DATA SOURCES TO USE IN THE ESTABLISHMENT OF A MARKET FOR THIS KEY POSITION. THE PERSONNEL COMMITTEE OF THE BOARD OF DIRECTORS FULFILLS THIS ROLE. THE BOARD OF DIRECTORS HAS DELEGATED THE AUTHORITY AND RESPONSIBILITY FOR THE ONGOING MAINTENANCE OF THE OVERALL ORGANIZATIONAL COMPENSATION MODEL TO THE CHIEF EXECUTIVE OFFICER. COMPARIATIVE MARKET DATA IS OBTAINED VIA THE RURAL WISCONSIN HEALTH COOPERATIVE AND THE WISCONSIN SOCIETY OF HOSPITAL HUMAN RESOURCE ADMINISTRATORS VIA INDEPENDENT SALARY SURVEYS THAT PROVIDE BENCHMARK INFORMATION FOR HEALTHCARE JOB CLASSES. THIS DATA IS USED TO ESTABLISH SALARY RANGES FOR ALL JOB CLASSES WITHIN THE ORGANIZATION. THE BOARD OF DIRECTORS ANNUALLY AUTHORIZES THE OVERALL INCREASE TO THE SALARY BUDGET FOR THE ORGANIZATION WITH THE CEO MAINTAINING DELEGATED AUTHORITY FOR IMPLEMENTATION WITHIN THE ORGANIZATIONAL COMPENSATION MODEL. DURING THE REVIEW PROCESS, DECISIONS AFFECTING COMPENSATION AND CONTRACTS ARE ONLY REVIEWED AND APPROVED BY INDIVIDUALS WHO DO NOT HAVE NOTED CONFLICTS. FORM 990, PART VI, SECTION C, LINE 19 THE RICHLAND HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS HOSPITAL BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. FORM 990, PART XI, LINE 9: NET CHANGE IN UNRESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS: 214,627. NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION: -16,113. DISTRIBUTIONS FROM SCHOLARSHIP FUNDS INCLUDED IN CHANGE IN NET ASSETS: CONTRIBUTIONS FROM RELATED ORGANIZATIONS: -531,831. FORM 990, PART XII, LINE 2C: SELECTION OF INDEPENDENT ACCOUNTANT THE FINANCE COMMITTEE OF THE RICHLAND HOSPITAL, INC., WHICH IS A SUB-COMMITTEE TO THE HOSPITAL'S BOARD OF DIRECTORS, REVIEWS THE ANNUAL AUDIT PROCESS WITH THE INDEPENDENT ACCOUNTANTS. BOARD MEMBERS ARE ALSO GIVEN THE NAMES AND CONTACT INFORMATION OF THE INDEPENDENT ACCOUNTANTS AT THE ANNUAL FINANCE COMMITTEE'S REVIEW MEETING OF THE AUDITED FINANCIAL STATEMENTS SO THAT THEY MAY INQUIRE, IF NEEDED, WITH THE ACCOUNTANTS THROUGHOUT THE YEAR. A BOARD MEMBER IS ALSO SELECTED ANNUALLY FOR REVIEW AND INQUIRY BY THE INDEPENDENT ACCOUNTANTS FOR SEPARATE AND PRIVATE INTERVIEW AS A PART OF THE AUDIT PROCESS. THESE FUNCTIONS ALLOW A GREATER AMOUNT OF OVERSIGHT BY THE BOARD INTO THE ANNUAL AUDIT PROCESS. THERE HAS BEEN NO CHANGE TO THESE PROCEDURES DURING THE PAST YEAR. THE RICHLAND HOSPITAL FOUNDATION INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391567249 FOUNDATION WI 501(C)(3) LINE 9 N/A 0 PARTNERS OF RICHLAND HOSPITAL INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391693458 AUXILIARY WI 501(C)(3) LINE 9 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 THE RICHLAND HOSPITAL FOUNDATION INC C 531831 COST PARTNERS OF RICHLAND HOSPITAL INC Q 62522 COST