RICHLAND HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- RICHLAND HOSPITAL (EIN 39-0808498)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-08
- IRS object ID
- 201303129349301860
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-08T13:46:10-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 OAKWOOD HILLS PARKWAY | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 54701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390808498 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE RICHLAND HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RICH | NameControl |
| Phone | 6086476321 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 EAST SECOND STREET | AddressLine1 |
| City | RICHLAND CENTER | City |
| State | WI | State |
| ZIP Code | 53581 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KAREN TRAYNOR | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 6086476321 | Phone |
| Date Signed | 2013-11-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT | Name |
| PTIN | P00449155 | PTIN |
| Phone | 7158323407 | Phone |
| Date Prepared | 2013-11-06 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL DELFS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 EAST SECOND STREET | AddressLine1 |
| City | RICHLAND CENTER | City |
| State | WI | State |
| ZIP Code | 53581 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 39964924 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.RICHLANDHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1937 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S "FIRST CHOICE FOR BETTER HEALTH." | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 331 | TotalNbrEmployees |
| Total Nbr Volunteers | 169 | TotalNbrVolunteers |
| Total Gross UBI | 235877 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -100994 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 594253 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 614320 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 34415151 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 35378393 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 411710 | InvestmentIncomePriorYear |
| Investment Income Current Year | 473096 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -316519 | OtherRevenuePriorYear |
| Other Revenue Current Year | -259438 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 35104595 | TotalRevenuePriorYear |
| Total Revenue Current Year | 36206371 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 13313 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 18250 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 19835483 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18558356 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 100998 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14907029 | OtherExpensePriorYear |
| Other Expenses Current Year | 14516404 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 34755825 | TotalExpensesPriorYear |
| Total Expenses Current Year | 33093010 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 348770 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3113361 | RevenuesLessExpensesCY |
| Total Assets BOY | 64146616 | TotalAssetsBOY |
| Total Assets EOY | 66440832 | TotalAssetsEOY |
| Total Liabilities BOY | 20980864 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20027574 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 43165752 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 46413258 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S "FIRST CHOICE FOR BETTER HEALTH." | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 27773301 | Expense |
| Grants | 18250 | Grants |
| Revenue | 33424211 | Revenue |
| Description | 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 IN 2012 INCLUDED 3,415 ADULTS AND PEDIATRICS INPATIENT DAYS, 536 SWING BED PATIENT DAYS, 308 NEWBORN PATIENT DAYS, 35,615 TOTAL OUTPATIENT VISITS, AND 5,323 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 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 MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. IN THE CURRENT YEAR, THE ESTIMATED COST OF PROVIDING CARE UNDER THE COMMUNITY CARE POLICY AGGREGATED APPROXIMATELY $1,299,774 IN TOTAL CHARGES. THE ESTIMATED COST OF PROVIDING CARE TO PATIENTS UNDER THE COMMUNITY CARE POLICY WAS $652,000. IN ADDITION, THE RICHLAND HOSPITAL 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 2012 AGGREGATED APPROXIMATELY $4,820,000. (FOR ADDITIONAL INFORMATION ON THE HOSPITAL'S CHARITY CARE PROGRAM AND PRACTICES AND PARTICIPATION IN THE WISCONSIN MEDICAL ASSISTANCE PROGRAM, PLEASE REFER TO SCHEDULE H OF THE FORM 990.)IN 2012, THE RICHLAND HOSPITAL HOSTED HEALTH FAIRS, PARTICIPATED IN LOCAL WELLNESS EVENTS, PROVIDED SCREENINGS AND ASSESSMENTS, 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 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 WERE 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 PROVIDED FREE SCREENINGS, CLASSES, AND SUPPORT GROUP MEETINGS THAT INCLUDED: BLOOD PRESSURE SCREENING, CORONARY RISK ASSESSMENTS, PULSE OXIMETRY, PEAK FLOW ANALYSIS, GLUCOSE SCREENINGS, AND MORE. EDUCATIONAL MATERIALS WERE PROVIDED FREE OF CHARGE AND COVERED A WIDE RANGE OF HEALTHCARE TOPICS INDLUDING: CANCER, DIABETES, HEART DISEASE, INFANT AND CHILD DEVELOPMENT, NUTRITION, EXERCISE, SMOKING CESSATION, BREAST HEALTH, ADVANCED DIRECTIVES, COLONOSCOPIES, JOINT AND MUSCLE DEGENERATION, AND MORE. HEALTHCARE PROFESSIONALS SPOKE TO THE PUBLIC AT EVENTS THAT WERE FREE AND OPEN TO THE PUBLIC AND THEY PROVIDED INDIVIDUAL COUNSELING AS WELL TO HELP PEOPLE UNDERSTAND THE SERVICES ARE AVAILABLE LOCALLY.FREE CORONARY RISK ASSESSMENTS WERE CONDUCTED FOR THE PUBLIC EACH MORNING FOR ONE WEEK DURING THE MONTH OF FEBRUARY. MORE THAN 300 PEOPLE TOOK ADVANTAGE OF THIS FREE OPPORTUNITY.THE BLOOD CENTER OF WISCONSIN HELD MULTIPLE DRIVES IN THE HOSPITAL'S LOWER LEVEL AT NO COST. IN ADDITION, EMPLOYEES COULD DONATE WHILE ON WORK TIME AND DID NOT HAVE TO PUNCH OUT TO DONATE.IN 2012, RICHLAND HOSPITAL DONATED EQUIPMENT TO HERO HEALTHCARE EQUIPMENT RECYCLING. THE EQUIPMENT DONATION VALUE WAS $25,645.THE RICHLAND HOSPITAL, AS ALWAYS, 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1548280 | Expense |
| Revenue | 1684795 | Revenue |
| Description | THE RICHLAND HOSPITAL, INC. ALSO OPERATES TWO RURAL HEALTH CLINICS LOCATED IN SPRING GREEN AND MUSCODA, WI. DURING 2012 THESE TWO CLINICS PROVIDED A TOTAL OF 8,272 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 HEALTH CARE 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 29321581 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 50 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 331 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KAREN TRAYNOR | NamePerson |
| Telephone Number | 6086476321 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 EAST SECOND STREET | AddressLine1 |
| City | RICHLAND CENTER | City |
| State | WI | State |
| ZIP Code | 53581 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| V CHARLES GOCHENAUR | |||||||
| PRESIDENT (THROUGH 4/30/12) | 0.50 | X | X | 0 | 0 | 0 | |
| DENNIS HAMILTON | |||||||
| PRESIDENT (EFFECTIVE 5/1/12) | 0.50 | X | X | 0 | 0 | 0 | |
| BRYAN MYERS MD | |||||||
| CHIEF OF STAFF | 10.00 | X | X | 12000 | 0 | 0 | |
| DOTTIE BEHLING | |||||||
| SECRETARY | 0.50 | X | X | 0 | 0 | 0 | |
| DWAYNE HILTBRAND | |||||||
| TREASURER | 0.50 | X | X | 0 | 0 | 0 | |
| KEVIN WHITNEY MD | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| RICHARD MARSHALL | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| DEB LIEGEL | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| ROBERT NUGENT | |||||||
| VICE PRESIDENT | 0.50 | X | X | 0 | 0 | 0 | |
| MELISSA SPRECHER | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| JERRY GANDER | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| STEVEN NOCKERTS | |||||||
| CEO (THROUGH 5/17/12) | 40.00 | X | 172937 | 0 | 10014 | ||
| KAREN TRAYNOR | |||||||
| CFO | 40.00 | X | 140266 | 0 | 10182 | ||
| MICHAEL DELFS | |||||||
| CEO (EFFECTIVE 5/17/12) | 40.00 | X | 101778 | 0 | 14312 | ||
| JEREL BERRES MD | |||||||
| ER DIRECTOR | 35.00 | 285228 | 0 | 35284 | X | ||
| E RACHEL SHANNON-GOODRICH CRNA | |||||||
| ANESTHETIST | 40.00 | 263133 | 0 | 32662 | X | ||
| BRUCE MOTHS MD | |||||||
| ER PHYSICIAN | 37.00 | 263970 | 0 | 32623 | X | ||
| MUHAMMAD S KHAN MD | |||||||
| ER PHYSICIAN | 44.50 | 310061 | 0 | 32355 | X | ||
| BRYAN MCCARVEL | |||||||
| ANESTHESIA DIRECTOR | 40.00 | 296922 | 0 | 25715 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1846295 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 193147 | TotalOtherCompensation |
| Number Individuals GT100 K | 20 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| RICHLAND MEDICAL CENTER LTD | |||||
| 301 EAST SECOND STREET | RICHLAND CENTER | WI | 53581 | PHYSICIANS/CLINIC MGMT SERVICES | 934112 |
| SHARED IMAGING SERVICES INC | |||||
| PO BOX 44719 | MADISON | WI | 53744 | NUCLEAR MEDICINE | 440755 |
| RURAL WI HOSPITAL COOPERATIVE | |||||
| 880 INDEPENDENCE LANE | SAUK CITY | WI | 53583 | SPEECH THERAPISTS / LEGAL | 201753 |
| WIPFLI LLP | |||||
| PO BOX 8010 | WAUSAU | WI | 54402 | ACCTG/COMPLIANCE/AUDIT/CONSULTING SVCS | 168757 |
| MERITER LABORATORIES | |||||
| 36 SOUTH BROOKS ST | MILWAUKEE | WI | 53288 | LAB SERVICES | 166303 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 576145 | RelatedOrganizations |
| Government Grants | 9878 | GovernmentGrants |
| All Other Contributions | 28297 | AllOtherContributions |
| Total Contributions | 614320 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | 34580529 | 34495672 | 84857 | |
| CONTRACTED THERAPY | 621990 | 255033 | 255033 | ||
| MEDICAL RECORDS | 621990 | 207156 | 134891 | 72265 | |
| MEALS | 722320 | 146953 | 82151 | 64802 | |
| DAY CARE REVENUE | 624410 | 47463 | 12963 | $34,500 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 141259 | TotalRevenueColumn |
| Related Or Exempt Function Income | 141259 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 35378393 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 354008 | TotalRevenueColumn |
| Exclusion | $354,008 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 811603 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1071041 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -259438 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -259438 | TotalRevenueColumn |
| Unrelated Business Revenue | 990 | UnrelatedBusinessRevenue |
| Exclusion | -$260,428 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2784944 | Securities |
| Other | 21656 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2662255 | Securities |
| Other | 25257 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 122689 | Securities |
| Other | -3601 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 119088 | TotalRevenueColumn |
| Exclusion | $119,088 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36206371 | TotalRevenueColumn |
| Related Or Exempt Function Income | 35109006 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 235877 | UnrelatedBusinessRevenue |
| Exclusion | $247,168 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18250 | Total |
| Program Services | 18250 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 461488 | Total |
| Management And General | 461488 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14411184 | Total |
| Program Services | 12945759 | ProgramServices |
| Management And General | 1391869 | ManagementAndGeneral |
| Fundraising | 73556 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 522606 | Total |
| Program Services | 469464 | ProgramServices |
| Management And General | 50475 | ManagementAndGeneral |
| Fundraising | 2667 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2138706 | Total |
| Program Services | 1921228 | ProgramServices |
| Management And General | 206562 | ManagementAndGeneral |
| Fundraising | 10916 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1024372 | Total |
| Program Services | 893727 | ProgramServices |
| Management And General | 125567 | ManagementAndGeneral |
| Fundraising | 5078 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118276 | Total |
| Management And General | 118276 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83200 | Total |
| Management And General | 83200 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3004247 | Total |
| Program Services | 2420417 | ProgramServices |
| Management And General | 576215 | ManagementAndGeneral |
| Fundraising | 7615 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153803 | Total |
| Program Services | 28403 | ProgramServices |
| Management And General | 125400 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 335855 | Total |
| Program Services | 209169 | ProgramServices |
| Management And General | 125520 | ManagementAndGeneral |
| Fundraising | 1166 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175848 | Total |
| Management And General | 175848 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1575380 | Total |
| Program Services | 1536689 | ProgramServices |
| Management And General | 38691 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43197 | Total |
| Program Services | 38021 | ProgramServices |
| Management And General | 5176 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33060 | Total |
| Program Services | 26826 | ProgramServices |
| Management And General | 6234 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3080951 | Total |
| Program Services | 3080951 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102497 | Total |
| Management And General | 102497 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 4732764 | 4677470 | 55294 |
| PROVISION FOR BAD DEBT | 888735 | 888735 | |
| EQUIPMENT RENTAL & MAIN | 784919 | 762800 | 22119 |
| STATE HOSPITAL ASSESSME | 246151 | 246151 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -842479 | Total |
| Program Services | -842479 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33093010 | Total |
| Program Services | 29321581 | ProgramServices |
| Management And General | 3670431 | ManagementAndGeneral |
| Fundraising | 100998 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1915 | BOY |
| EOY | 1721 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8376015 | BOY |
| EOY | 11241353 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8120848 | BOY |
| EOY | 7742948 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 268816 | BOY |
| EOY | 242615 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1134625 | BOY |
| EOY | 1273808 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 327248 | BOY |
| EOY | 301636 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 56555615 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 25386097 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32261971 | BOY |
| EOY | 31169518 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6175717 | BOY |
| EOY | 6643681 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3783460 | BOY |
| EOY | 3867867 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3696001 | BOY |
| EOY | 3955685 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64146616 | BOY |
| EOY | 66440832 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3456972 | BOY |
| EOY | 3173174 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17190000 | BOY |
| EOY | 16495000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 333892 | BOY |
| EOY | 359400 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20980864 | BOY |
| EOY | 20027574 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42432991 | BOY |
| EOY | 45776690 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 672761 | BOY |
| EOY | 576568 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60000 | BOY |
| EOY | 60000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43165752 | BOY |
| EOY | 46413258 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64146616 | BOY |
| EOY | 66440832 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3113361 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 182181 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -48036 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,382 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4382 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE RICHLAND HOSPITAL, INC. 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. WHA HAD NOTIFIED THE RICHLAND 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 RICHLAND HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE RICHLAND HOSPITAL PAYS MEMBERSHIP FEES TO RWHC. 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 $2,380 OF THE FEES PAID BY THE RICHLAND HOSPITAL IN 2012 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 69671 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 334 | InvestmentEarningsOrLosses |
| End Of Year Balance | 70005 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 69549 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 122 | InvestmentEarningsOrLosses |
| End Of Year Balance | 69671 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 69400 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 149 | InvestmentEarningsOrLosses |
| End Of Year Balance | 69549 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 69240 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 160 | InvestmentEarningsOrLosses |
| End Of Year Balance | 69400 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 68099 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1141 | InvestmentEarningsOrLosses |
| End Of Year Balance | 69240 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.85710 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.14290 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 941726 | OtherCostOrOtherBasis |
| Book Value | 941726 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41331703 | OtherCostOrOtherBasis |
| Depreciation | 15608014 | Depreciation |
| Book Value | 25723689 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 609073 | OtherCostOrOtherBasis |
| Depreciation | 187174 | Depreciation |
| Book Value | 421899 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12938580 | OtherCostOrOtherBasis |
| Depreciation | 9356636 | Depreciation |
| Book Value | 3581944 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 734533 | OtherCostOrOtherBasis |
| Depreciation | 234273 | Depreciation |
| Book Value | 500260 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 31169518 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (5 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| UNDER BOND INDENTURE AGREEMENT | 2658152 | F |
| FUNDED DEPRECIATION | 949222 | F |
| UNEMPLOYMENT RESERVE | 149864 | F |
| RESTRICTED INVESTMENTS | 80574 | F |
| LONG TERM CD INVESTMENTS | 30055 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3867867 | TotalOfBookValueSecurities |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| UNAMORTIZED BOND INSURANCE PREMIUM AND ISSUANCE COSTS | 777550 |
| INTEREST IN NET ASSETS OF SUPPORTING ORGANIZATIONS | 1714035 |
| DEFERRED COMPENSATION PLAN ASSETS | 359400 |
| AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | 1104700 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3955685 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DEFERRED COMPENSATION PLAN LIABILITY | Description |
| Amount | $359,400 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 359400 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 36692389 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 1071041 | OtherRevenues |
| Revenue Not Rptd F990 | 1071041 | RevenueNotRptdF990 |
| Revenue Subtotal | 35621348 | RevenueSubtotal |
| Other Revenues Not Included | 585023 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 585023 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 36206371 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 34136923 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 1071041 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1071041 | ExpensesNotRptdF990 |
| Expenses Subtotal | 33065882 | ExpensesSubtotal |
| Other Expenses Not Included | 27128 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 27128 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 33093010 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | 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. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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. 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 IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES THAT THE INTERNAL REVENUE SERVICE CONSIDERS UNRELATED TO THE HOSPITAL'S EXEMPT PURPOSE AND, THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, ANNUALLY RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. THE HOSPITAL DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASES OF REPORTING THE HOSPITAL'S ASSETS AND LIABILITIES. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE HOSPITAL IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2012 AND 2011. FEDERAL TAX RETURNS FOR TAX YEARS 2008 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 1,071,041. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS FROM RELATED ORGANIZATIONS 576,145. GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENTS 8,878. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 1,071,041. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | DISTRIBUTIONS FROM SCHOLARSHIP FUNDS 18,250. GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENTS 8,878. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 661429 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 661429 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3595164 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2016305 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1578859 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04770 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23236 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 22831 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 405 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4279829 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2039136 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2240693 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06770 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 122516 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 27202 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 95314 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2417076 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2105529 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 311547 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00940 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105853 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105853 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00320 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2645445 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2132731 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 512714 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01550 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6925274 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4171867 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2753407 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08320 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2724 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2724 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2724 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2724 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $452,259 | BadDebtExpenseAmount |
| Amount Attributable To | 226130 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11948676 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11833656 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 115020 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 0 | WrittenDebtCollectionPolicy |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE RICHLAND HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 EAST SECOND STREET | AddressLine1 |
| City | RICHLAND CENTER | City |
| State | WI | State |
| ZIP Code | 53581 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE RICHLAND HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 AND THE INTENSIVE CARE INPATIENT UNIT. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH THE RICHLAND HOSPITAL 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. IT IS THE GOAL OF THE RICHLAND HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY. | ||
| PART II: 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 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. THESE ACTIVITIES WERE DETERMINED BY MEMBERS OF THE COMMUNITY OR ASKED BY COMMUNITY REPRESENTATIVES OF THE RICHLAND HOSPITAL 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 HEALTH CARE 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 A VALUATION ALLOWANCE 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. 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 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 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. | THE RICHLAND HOSPITAL, INC. | |
| PART V, SECTION B, LINE 20D: THE HOSPITAL FOLLOWS ITS NORMAL PROCEDURES FOR COLLECTION OF THESE ACCOUNTS, INCLUDING DISCOUNTS BASED ON INCOME/ASSET LEVELS, MEDICAL INDIGENCE, INSURANCE STATUS, AND PROMPT PAYMENT. PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY THAT DO NOT COMPLETE THE REQUIRED APPLICATION MAY BE CHARGED THE RATE THAT IS CHARGED TO ALL UNINSURED PATIENTS. AT A MINIMUM, ALL UNINSURED PATIENTS OF THE RICHLAND HOSPITAL, INC. RECEIVE A 10 PERCENT DISCOUNT ON ALL HOSPITAL SERVICES. AN ADDITIONAL 5 PERCENT PROMPT PAY DISCOUNT IS ALSO AVAILABLE TO UNINSURED PATIENTS, AS WELL AS A SLIDING SCALE DISCOUNT PROGRAM BASED ON INCOME AND ASSET LEVELS OF PATIENTS AND COMPLETION AND REVIEW OF AN APPLICATION UNDER THE HOSPITAL'S COMMUNITY CARE POLICY. | THE RICHLAND HOSPITAL, INC. | |
| PART VI, LINE 2: THE RICHLAND HOSPITAL, INC. ASSESSES THE HEALTH CARE 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 ALSO REVIEWS HOSPITAL STATISTICS OF PATIENT VISITS TO DETERMINE WHAT TYPES OF SERVICES OFFERED BY THE FACILITY ARE BEING UTILIZED. A FEW EXAMPLES OF PROJECTS THAT THE HOSPITAL HAS COMPLETED RECENTLY INCLUDE A LARGE RENOVATION PROJECT AND ELECTRONIC HEALTH RECORDS. STARTING IN 2009 AND COMPLETED IN 2012, THE HOSPITAL INSTALLED AND IMPLEMENTED AN ELECTRONIC HEALTH RECORD SYSTEM. ONE OF THE MAIN GOALS OF THIS SYSTEM IS TO PROVIDE ACCESS TO PATIENT MEDICAL HISTORIES IN A MORE UP TO DATE MANNER, WHICH WILL PROVIDE FOR A MORE EFFICIENT AND EFFECTIVE PATIENT EXPERIENCE BOTH WHEN PATIENTS ARE SEEN AT THE RICHLAND HOSPITAL AND ALSO WHEN THEIR INFORMATION IS NEEDED FOR TREATMENT AT OTHER HEALTHCARE FACILITIES. BEGINNING IN 2011 AND COMPLETED IN 2012, THE HOSPITAL ALSO COMPLETED CONSTRUCTION OF A REPLACEMENT CLINIC FACILITY IN MUSCODA, WISCONSIN TO BETTER SERVE THE NEEDS OF PATIENTS IN THE COMMUNITY OF MUSCODA. | ||
| 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, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR THOSE WHO ARE UNDERINSURED. WHEN A PATIENT'S INCOME IS LESS THAN 150 TO 200% OF THE FEDERAL POVERTY LEVEL, THEY ARE PROVIDED CARE WITHOUT CHARGE OR AT A REDUCED RATE. THE HOSPITAL ALSO OFFERS A 10% DISCOUNT ON ALL PRIVATE PAY ACCOUNTS FOR INCOME LEVELS BETWEEN 201 TO 300% OF FPG. THIS IS DETERMINED UPON APPROVAL BY THE BUSINESS OFFICE MANAGER AND THE CHIEF FINANCIAL OFFICER AT THE FACILITY AFTER THE PATIENT HAS MET WITH A PATIENT FINANCIAL COUNSELOR AT THE FACILITY AND HAS COMPLETED A FINANCIAL APPLICATION, AND SUPPLIED THE NECESSARY DOCUMENTATION TO SUPPORT A FINANCIAL NEED FOR CARE UNDER THE HOSPITAL'S COMMUNITY CARE POLICY. 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.INFORMATION ON THE HOSPITAL'S CHARITY CARE POLICIES IS POSTED AT THE HOSPITAL PATIENT REGISTRATION DESK AS WELL AS ON THE HOSPITAL WEBSITE. REGISTRATION CLERKS AT THE HOSPITAL 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 MAKES AN EFFORT TO ALSO PROVIDE INFORMATION AND SEND CHARITY CARE APPLICATION INFORMATION TO THE MAJORITY OF PRIVATE PAY OR SELF-PAY PATIENTS THAT DO NOT RESPOND WITH PAYMENT ON THE SECOND OR THIRD PATIENT STATEMENT THAT IS SENT ITEMIZING THE BALANCE OF THEIR HOSPITAL BILL. SOCIAL SERVICES AND BUSINESS OFFICE STAFF AT THE HOSPITAL ARE ALSO AVAILABLE TO PROVIDE INFORMATION TO PATIENTS ON OTHER GOVERNMENT PROGRAMS SUCH AS THE MEDICAL ASSISTANCE PROGRAM OR TO REFER PATIENTS TO PERSONNEL AT RICHLAND COUNTY OR OTHER STATE OF WISCONSIN OR COUNTY AGENCIES THAT MAY PROVIDE ACCESS TO CARE FOR ELIGIBLE PATIENTS OR PROVIDE OTHER INFORMATION TO PATIENTS. | ||
| 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 FACILITY OPERATES A 25-BED, ACUTE CARE CRITICAL ACCESS HOSPITAL AND TWO RURAL HEALTH CLINICS LOCATED IN NEIGHBORING COMMUNITIES. THE RICHLAND HOSPITAL 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 SPECIALITY SERVICES, WHICH INCLUDES, 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. DURING 2012, MEDICARE AND MEDICARE ADVANTAGE PLAN BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 45 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE AT THE RICHLAND HOSPITAL AND MEDICAID BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 12 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 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 HEALTH CARE. 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 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 PRIVILEDGES 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.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 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 ORGANIZATION 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). | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS FOR HEALTHCARE EDUCATION | TypeOfGrant |
| Number Of Recipients | 25 | NumberOfRecipients |
| Amount Of Cash Grant | 18250 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, 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, THE RICHLAND HOSPITAL FOUNDATION, AND THE PARTNERS OF THE RICHLAND HOSPITAL. 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.) | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 0 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN NOCKERTS | ||||||||||||||
| CEO (THROUGH 5/17/12) | 144986 | 0 | 2174 | 0 | 25777 | 0 | 5921 | 0 | 4093 | 0 | 182951 | 0 | 0 | 0 |
| KAREN TRAYNOR | ||||||||||||||
| CFO | 138087 | 0 | 1398 | 0 | 781 | 0 | 5656 | 0 | 4526 | 0 | 150448 | 0 | 0 | 0 |
| JEREL BERRES MD | ||||||||||||||
| ER DIRECTOR | 271218 | 0 | 2562 | 0 | 11448 | 0 | 10000 | 0 | 25284 | 0 | 320512 | 0 | 0 | 0 |
| E RACHEL SHANNON-GOODRICH CRNA | ||||||||||||||
| ANESTHETIST | 188607 | 0 | 1807 | 0 | 72719 | 0 | 10000 | 0 | 22662 | 0 | 295795 | 0 | 0 | 0 |
| BRUCE MOTHS MD | ||||||||||||||
| ER PHYSICIAN | 260826 | 0 | 2189 | 0 | 955 | 0 | 10000 | 0 | 22623 | 0 | 296593 | 0 | 0 | 0 |
| MUHAMMAD S KHAN MD | ||||||||||||||
| ER PHYSICIAN | 307289 | 0 | 2160 | 0 | 612 | 0 | 10000 | 0 | 22355 | 0 | 342416 | 0 | 0 | 0 |
| BRYAN MCCARVEL | ||||||||||||||
| ANESTHESIA DIRECTOR | 224997 | 0 | 1335 | 0 | 70590 | 0 | 950 | 0 | 24765 | 0 | 322637 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | HEALTH CLUB DUE GROSS UPS, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. |
| PART I, LINE 4B | PART I, LINE 4B: STEVEN NOCKERTS, 457 PLAN CONTRIBUTION BY THE HOSPITAL: $7,594 JEREL BERRES, 457 PLAN CONTRIBUTION BY THE HOSPITAL: $8,125 BRYAN MCCARVEL, 457 PLAN CONTRIBUTION BY THE HOSPITAL: $5,000 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 SOURCE 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: 413,537. NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION: 96,322. DISTRIBUTIONS FROM SCHOLARSHIP FUNDS INCLUDED IN CHANGE IN NET ASSETS: 18,250. CONTRIBUTIONS FROM RELATED ORGANIZATIONS: -576,145. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | THE RICHLAND HOSPITAL'S FINANCE COMMITTEE WHICH IS A SUB-COMMITTEE TO THE HOSPITAL'S BOARD OF DIRECTORS REVIEWS THE ANNUAL AUDIT PROCESS WITH THE INDEPENDENT ACCOUNTANTS ANNUALLY. 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. | SELECTION OF INDEPENDENT ACCOUNTANT |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| THE RICHLAND HOSPITAL FOUNDATION INC | ||
| C | 574284 | COST |
| PARTNERS OF RICHLAND HOSPITAL INC | ||
| Q | 64802 | COST |
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