2013-04-12T18:54:01-05:00 2012-08-31 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2011-09-01 390868982 Riverview Hospital Association RIVE 7154217462 410 Dewey Street Wisconsin Rapids WI 54494 MICHAEL BOVEE 7154217462 2013-04-03 1 Kathleen J LaBrake CPA P00164006 7158453111 2013-04-03 2011 2016-03-07 17:11:31Z Michael Bovee 410 Dewey Street Wisconsin Rapids WI 54494 130538648 0 X www.rhahealthcare.org X 1912 WI To provide compassionate, affordable, state-of-the-art healthcare to our communities. 15 12 712 512 1206760 -906281 259801 322648 85270022 90608869 3248255 2533784 25856 122685 88803934 93587986 0 0 0 0 40153677 41923325 0 0 0 40417664 43900421 80571341 85823746 8232593 7764240 186452276 197234446 57524453 56172562 128927823 141061884 X To provide compassionate, affordable, state-of-the-art healthcare to our communities. 0 0 64973147 89106778 Riverview Hospital Association owns and operates the following entities: (1) Riverview Hospital, established in 1912; (2) the outpatient Riverview Rehabilitation Center; (3) Riverview Family Clinic - this service includes clinics in Wisconsin Rapids, Nekoosa, and the Rome-Lakes area; (4) the UW Cancer Center Riverview. UWCC-R opened in 2003 in cooperation with UW Comprehensive Cancer Center, Madison; and (5) Riverview Community Dental Clinic. RHA established this clinic in 2009 to serve residents of South Wood County. Riverview Hospital Association provides community benefits programs and services that address identified community health needs regardless of source or availability of payment, and it provides measurable improvement in health access, health status, and the use of health care resources. In addition, the programs and services considered community benefits should meet one or more of the following criteria: *Supports the organization's community-based mission *Targets the problems of the poor or medically underserved *Impacts the health status of the identified community *Reduces community health costs *Is accessible to the entire target community regardless of their ability to pay *Stimulates external community partnershipsFONEMED is a free, confidential telephone service the community can call after the clinics are closed to get routine health advice or general health information from a Registered Nurse. Approximately 1,437 persons benefited from this program.Coalition Building: The Heatlhy People Wood County Obesity Prevention Team is focusing efforts on building environments and policies which can support healthy behavior change in terms of diet and exercise. Riverview's Health Promotion Coordinator also represents Riverview on the Safe Kids Coalition, working to prevent injury and death in children aged 0-14. The Health Promotion Coordinator represents Riverview on the 3-0 Day Committee (Our Bodies, Our Responsibilities). The Committee organizes a teen conference annually focusing on reducing at-risk behavior in junior and senior high students. Approximately 340 persons benefited from these coalitions.Riverview Dental Clinic in Wisconsin Rapids is open to patients who have Medicaid or Badger Care insurance coverage. This insurance is not typically accepted by independent dental clinics. Approximately 4,301 persons benefited from this program in 2012. Riverview Family Clinic physicians are helping educate area junior high students about sexual responsibility. Two physicians took part in several Wisconsin Rapids East Junior High School health classes, sharing information on the topics of sexually transmitted diseases, pregnancy, and pregnancy prevention. Prior to their visits each semester, the physicians share their presentation with the students' parents during a parent meeting and respond to any questions or concerns that may arise. The physicians' visits have been very well received and greatly appreciated by the students, parents, health class instructor and school administration. Approximately 200-250 students attended this program.The Lifeline program is a 24 hour a day personal response system. A Lifeline unit is installed in the "subscriber's" home and operates through their phone line. He/She wears a "personal help button", which they use to alert Lifeline simply by pressing the button. There is also an Auto Alert personal help button, which alerts Lifeline automatically if the subscriber falls. A Lifeline "Monitor" answers the call through the Lifeline unit and they call the subscriber's. After they determine what kind of help is needed, they call the subscriber's "responders", which are friends, neighbors, or relatives that can check on the subscriber, or if the subscriber needs more professional help the Monitor will call for it immediately. The Lifeline program helps people that would otherwise by unable to remain in their homes. It provides them with freedom and security to do so, while also putting their family at ease. Our program helps many people in Wisconsin Rapids and the surrounding area. This past year approximately 300 people benefited from the Lifeline program that Riverview Medical Center offers.Vulnerable people of all ages including the elderly can remain in their home and be self-sufficient by receiving a home delivered meal that meets their specific nutrition requirements. Health conditions or physical disabilities restrict the ability of individuals to remain independent. The Home Delivered Meals Program provides nutrition that is medically therapeutic to address the special needs of clients diagnosed with diabetes, cardiac and pulmonary issues, retinal disease, gluten intolerance, weight loss due to cancer and chewing and swallowing problems. The program also meets the needs of caretakers of the mentally and physically handicapped or Alzheimer's or other dementia disorders by providing meals to allow them to care for their loved ones. Nutrition education is also offered. Community volunteers deliver hot lunches Monday - Friday as well as brown bag meals for weekends. Food is prepared with consideration for each client's personal preferences as well as dietary restrictions. In 2012, 19,130 meals were delivered. 9,347 of the meals delivered were modified to meet specific dietary needs.In an effort to meet the community needs of students in the Wisconsin Rapids area, Riverview Hospital Association offers the opportunity for interested students to experience a glimpse of the role of its professional staff. This service is made available to students who are interested in learning more about health careers. In 2012, Riverview had 85 job shadow participants.Riverview offered a free seminar entitled Understand Your Joint Pain. This seminar discussed what you can do about knee, hip, and other joint pain. Attendants also learned about arthritis, the causes and symptoms, and treatment options including medications, nutrition, exercise, alternative treatments, and new concepts in joint replacement. In 2012, Riverview presented this seminar to 73 individuals. Riverview's Infection Control Nurse presented to some area schools about the importance of good infection prevention and why it is so important. Discussed at these meetings were proper hand washing techniques, other infection prevention basics (nail biting, bathroom etiquette), education about multi-drug resistant organisms, and infectious diseases in our area. Videos were shown portraying real-life cases of surgical site infection. Approximately 85 students benefited from the presentation in 2012.Pooh Visits Riverview is a program sponsored by Riverview Hospital Auxiliary that gives hospital tours to kindergarten children of the Wisconsin Rapids area (including special needs children and home-schooled children). The tours are 1.5 hours long and include a video showing someone calling 9-1-1, an ambulance, the pediatric area of the Emergency Room, the operating room, a patient room in the hospital, the nursery, a hand-washing station, show x-rays of various body parts and provide a gift bag at the end of the tour. The program is offered in the spring and serves 600 young children. 64973147 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 75 1 1 712 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MICHAEL BOVEE 7154217462 410 DEWEY ST WI RAPIDS WI 54494 DOUGLAS WENZLAFF 2.00 X X 0 0 0 JOHN CLARK PHD 2.00 X X 0 0 0 DAWN NEUMAN 2.00 X X 0 0 0 GREGORY NETTESHEIM 2.00 X X 0 0 0 MERCEDES DE LAS ALAS MD 41.00 X 266123 0 45482 ROBERT BENKOWSKI 1.00 X 0 0 0 COLLEEN DICKMANN 1.00 X 0 0 0 ROY BRANDELL MD 1.00 X 0 0 0 KALIN LAMP 1.00 X 0 0 0 TIMOTHY MANCL 1.00 X 0 0 0 MARJORIE MILLER MD 1.00 X 0 0 0 LAWRENCE LEIBERT MD 1.00 X 0 0 0 JASON DEITZ 1.00 X 0 0 0 JAY GRODE 1.00 X 0 0 0 SUSAN KUNFERMAN 1.00 X 0 0 0 CELSE BERARD 40.00 X 293485 0 50458 PEGGY OSE 40.00 X 161586 0 33899 MICHAEL BOVEE 40.00 X 194050 0 33465 RICHARD BAILEY MD FACP 40.00 X 268515 0 33814 RONNIE KIRSCHLING MD 40.00 X 1060090 0 47836 CRAIG FLINDERS DO 40.00 X 312120 0 46622 THOMAS FERK DO 40.00 X 353253 0 51020 JENNIFER MCELROY DO 40.00 X 280526 0 32122 CHESTON PRICE MD 40.00 X 263549 0 43912 3453297 0 418630 24 0 1 0 ELLIS STONE CONSTRUCTION CO PO BOX 366 STEVENS POINT WI 54481 BUILDING CONSTRUCTION SERVICES 1849425 HMP OF WISCONSIN RAPIDS LTD PO BOX 645037 CINCINATI OH 45264 HOSPITALISTS - MTHLY SUBSIDY & MGMT FEE 888812 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 LABORATORY SERVICES 592863 INFINITY HEALTHCARE SC 111 E WISCONSIN AVENUE SUTIE 2100 MILWAUKEE WI 53202 Emergency Room Physicians & Medical Dire 570788 NATIONAL WOUND CARE & HYPERBARIC 3087 MOMENTUM PLACE CHICAGO IL 60689 WOUND CARE & HYPERBARIC FEE 466494 18 44878 153269 124501 322648 PATIENT SERVICES 900099 88305167 88305167 LAB SERVICE FOR NON PA 621500 915665 915665 HEALTH RELATED PROGRAM 900099 609834 609834 FOOD 900099 207653 207653 INCOME RECEIVED FROM R 900099 149976 149976 420574 41801 291095 87678 90608869 2288439 2288439 677119 557220 119899 119899 119899 36553377 78698 36343269 43461 210108 35237 245345 245345 4427 44878 4427 0 5071 2285 2786 2786 93587986 89106778 1206760 2951800 1384267 311605 1072662 30695433 26860158 3835275 992033 898936 93097 6667201 5770789 896412 2184391 1856732 327659 136877 61764 75113 83903 83903 269411 269411 6827620 5634574 1193046 427073 352447 74626 1010759 550503 460256 1341992 1337717 4275 163960 53705 110255 2384794 2384794 6431522 497418 5934104 341800 106912 234888 SUPPLIES 8763633 8552491 211142 DRUGS 5134488 5118087 16401 BAD DEBT 4675777 4675777 OTHER 3547072 1007901 2539171 2359740 1325631 1034109 85823746 64973147 20850599 0 458542 10273 27510972 29347913 13562309 12224636 1825816 1761627 441357 646744 129880034 68887427 63064613 60992607 78841449 90780478 747218 1470168 186452276 197234446 10934100 9758693 46590353 45663869 0 750000 57524453 56172562 X 128271971 140308395 655852 753489 128927823 141061884 186452276 197234446 X 7764240 4369821 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7940 7940 0 Explanation of Lobbying Activities: Part II-B, Line 1: Percentage of AHA dues used for lobbying in 2012 - $5,250 Percentage of WHA dues used for lobbying in 2012 - $2,690 Part IV, Supplemental Information: Riverview Hospital Association is a member of the Wisconsin Hospital Association (WHA) and American Hospital Assocation (AHA). A portion of the dues paid to these organizations were utilized for lobbying activities. That amount is reported in part II-B. 2355951 2355951 66659280 21007344 45651936 2348781 1602148 746633 58461143 46277935 12183208 54879 54879 60992607 MALPRACTICE INSURANCE LIABILITY 750000 750000 93587986 85823746 7764240 4369821 4369821 12134061 89164781 -4118557 -4118557 93283338 269411 35237 304648 93587986 81400541 557220 557220 80843321 269411 4711014 4980425 85823746 Description of Uncertain Tax Positions Under FIN 48: Part X: In order to account for any uncertain income tax positions, the Association 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 Association is also engaged, to a limited extent, in activities that the Internal Revenue Service (IRS) considers unrelated to its exempt purpose and, therefore, taxable. If these activities result in net operating income for income tax purposes, the Association recognizes the anticipated tax liability and expense. If these activities result in net operating losses for income tax purposes, the Association does not recognize the tax benefit from the net operating losses that would be realized in the future unless it can be determined that it is reasonable that such an estimated benefit will be realized in the future. Currently, 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 liabilites have been recognized since no other differences exist between the financial tax bases of reporting the Association's assets and liabilities. The Association's policy is to recognize interest and penalties related to income tax matters in income tax expense when incurred. In 2012 and 2011, there were no payments of income tax, tax penalties, or interest related to tax penalties recorded by the Association in the financial statements. The Association recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits in 2012 and 2011. Federal returns for years ended August 31, 2011, 2010 and 2009 remain subject to examination by the Internal Revenue Service. Part XII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV 467,406. RENT EXPENSES NET WITH REV 89,814. PROVISION FOR BAD DEBTS - FASB ISSUED ASU 2011-07 -4,675,777. Part XII, Line 4b - Other Adjustments: GAIN ON DISPOSAL OF ASSETS 35,237. Part XIII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV 467,406. RENT EXPENSES NET WITH REV 89,814. Part XIII, Line 4b - Other Adjustments: GAIN ON DISPOSAL OF ASSETS 35,237. PROVISION FOR BAD DEBTS - FASB ISSUED ASU 2011-07 4,675,777. Love Lights 35410 35359 51 51 Christmas at the Ridges 13895 9519 4376 4376 49305 44878 4427 4427 4427 0 5071 2285 1 1.00000 5071 2285 2285 2786 WI 1 0 1 0 1.00000 Dianne Pokrandt 5849 Sarah Circle Wisconsin Rapids WI 54494 0 Elaine Semrow Treasurer of Auxiliary Fundraising Events X 0 1 1 1 X 1 X 1 1 0 1 1 1113334 1113334 0.01370 14863351 14433778 429573 0.00530 15976685 14433778 1542907 0.01900 712110 228557 483553 0.00600 100124 100124 0.00120 3671027 2436740 1234287 0.01520 54869 17810 37059 0.00050 4538130 2683107 1855023 0.02290 20514815 17116885 3397930 0.04190 1 2305868 16789722 20146229 -3356507 X 1 1 1 1 Riverview Hospital Association

410 Dewey Street Wisconsin Rapids WI 54495

X X X RIVERVIEW HOSPITAL ASSOCIATION 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 5 UW Cancer Center Riverview

410 Dewey Street Wisconsin Rapids WI 54495

Cancer Center Riverview Family Clinic Wisconsin Rapids

420 Dewey Street PO Box 8080 Wisconsin Rapids WI 54495

Clinic Riverview Family Clinic Nekoosa

1015 Angelus Drive Nekoosa WI 54457

Clinic Riverview Family Clinic Lakes Area

1160 Rome Center Drive Town of Rome Nekoosa WI 54457

Clinic Riverview Community Dental Clinic

820 Two Mile Avenue Wisconsin Rapids WI 54494

Dental Clinic Part I, Line 7: Riverview Hospital utilizes a cost to charge ratio to report the information in Part I except for the Subsidized Health Services. See comment in Part I, Line 7g for costing method used to calculate the Subsidized Health Services community benefit expense. All amounts in Part I, line 7f were reduced by the bad debt amount of $4,675,777. Part I, Line 7g: The above costs of Subsidized Health Services are related to the Dental Clinic, Lakes Family Clinic, and Nekoosa Family Clinic. Riverview Hospital utilized an internal departmental financial statement to report the cost and direct offsetting revenue that calculates the community benefit expense. The Dental Clinic reported costs of $340,959 with offsetting revenue of $287,138. The Lakes Family Clinic reported costs of $1,401,855 with offsetting revenue of $847,333. The Nekoosa Family Clinic reported costs of $1,928,213 with offsetting revenue of $1,302,369. None of the costs indicated above are attributable to a physician clinic. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4675777. Part II: Riverview Hospital Association collaborates with community partners to perform a needs assessment to drive the development of programs provided to the community. Initiatives include: Improving access to dental care, preventing obesity through policy development and environmental change, and reducing at-risk behavior in teens. The Association also offers low-cost lab screenings, childbirth education, cancer education, and Ask-a-Nurse assistance.The information needed to complete the total community building expense for the table in Schedule H Part II is difficult to obtain, although the activites we provide to the communinity are explained above. Part III, Line 4: Riverview Hospital applies cost to charge ratio to bad debt expense as reported on the financial statements. The carrying amounts of accounts receivable are reduced by allowances that reflect management's best estimate of the amounts that will not be collected. Management provides for uncollectible amounts under terms of third-party reimbursement agreements through a reduction of gross revenue and a credit to accounts receivable. In addition, management provides for probable uncollectible amounts, primarily from uninsured patients and amounts for which patients are personally responsible, through a charge to operations and a credit to a valuation allowance based on its assessment of historical collection likelihood and a current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to accounts receivable. Part III, Line 8: Amount of Medicare allowable costs was taken directly from the Medicare cost report.Whether there is a shortfall or surplus on services to Medicare beneficiaries, these patients, 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. The total Medicare revenue shown on Schedule H is based on the IRS 990 Instructions and includes only the charges from Medicare program beneficiaries that are reported on the hospital's Medicare Cost Report. The amount listed for Medicare revenue does not include physician services for the coverage of the emgerency department at Riverview Hospital, physician services provided at the outlying clinic locations, and a significant portion of lab services which are reimbursed by the Medicare program under another methodology. Physician coverage and outpatient lab services are reimbursed primarily on a fee schedule reimbursement at rates that are often below the costs of caring for patients. Emergency physician 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 Riverview Hospital provides to the community and the surrounding areas. The costing method used above for IRS 990 compliance reporting is also based on the overall average cost to charge ratio and does not consider Medicare non-allowable expenses as it is based on total operating expenses less the provision for bad debt expense divided by the hospital patient service revenue (ignoring contractual adjustments on fee schedule reimbursed items and non-allowable Medicare expenses as noted above). This ratio is then multiplied by the total Medicare services, which are reimbursed based on Medicare regulations. Including the fee schedule items, such as physician services, would produce a larger loss or shortfall on these services to be reported on the Form 990 in any given year. Part III, Line 9b: For patients qualifying for financial assistance patients will only be billed if they have not provided current proof of eligibility, a spenddown has not been met or there is a private third party payor also on the patient's record.For patients qualifying for charity care, arrangements for reduced or free care are made with a financial counselor. Should the patient default on this arrangement, standard collection practices would apply. RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 19d: Per Policy #0260110 the discount will be determined annually at the start of the fiscal year and will be the average discount offered on our commerical insurance contracts. Part VI, Line 2: RHA actively participates in Healthy People Wood County (HPWC). The purpose of HPWC is to establish priorities and recommend strategies to enhance the quality of life, health status, and the environment in Wood County. In order to accomplish this, multiple partners work together to analyze health data, quality of life indicators and the community's perception of health. Part VI, Line 3: Community Care information is provided on both the website (riverviewhospital.net) and the back of the patient statement. Financial Counselors offer Community Care applications to patients whom they discover during conversations of attempting to establish payment plan arrangement would potentially meet the program qualifications. Part VI, Line 4: Riverview Hospital Association owns and operates the following entities: (1) Riverview Hospital, established in 1912; (2) the outpatient Riverview Rehabilitation Center; (3) Riverview Family Clinic, This service includes clinics in Wisconsin Rapids, Nekoosa, and the Rome-Lakes area; (4) the UW Cancer Center Riverview. UWCC-R opened in 2003 in cooperation with UW Comprehensive Cancer Center, Madison; and (5) Riverview Community Dental Clinic. RHA established this clinic in 2009 to serve residents of South Wood County. Riverview Dental Clinic in Wisconsin Rapids is open to patients who have Medicaid or Badger Care insurance coverage. This insurance is not typically accepted by independent dental clinics. Approximately 4,301 persons benefited from this program in 2012.While many Riverview patients come from Wood County, an increasing number are coming to us from surrounding counties - specifically those along the Interstate 39 corridor: Marathon, Portage, Waupaca, Adams, Juneau, Waushara, Marquette, Columbia, Sauk, and Dane. For the Hospital, over 12.3% of all admissions between July 2011 and June 2012 came from the counties alongside this corridor. For the UW Cancer Center-Riverview over the same period, over 16% of all patients came from these same counties-not including our "home" county of Wood.In the Riverview "service area" there are several federally designated "medically underserved areas." They are Wood County (the central part between Marshfield and Wisc. Rapids), Portage County (part), Adams County (all), Waushara County (all), Marquette County (all), Juneau County (about half, the Northern half), Marathon County (part), and Clark County (all). We have scattered Indian tribal lands in Wood County, Juneau County, and Adams County (all Ho Chunk). These would be considered "medically underserved populations" per federal designation.Other hospitals in our service area include: St. Joseph's Hospital in Marshfield, St. Michael's Hospital in Stevens Point, Moundview Memorial Hospital in Friendship, and Hess Memorial Hospital in Mauston. Part VI, Line 5: SEE ABOVE FOR ADDITIONAL DETAIL Reports Filed With States Part VI, Line 7 WI X X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 MERCEDES DE LAS ALAS MD 251852 0 13641 0 630 0 23901 0 21581 0 311605 0 0 0 CELSE BERARD 292261 0 0 0 1224 0 28175 0 22283 0 343943 0 0 0 PEGGY OSE 159408 0 0 0 2178 0 11403 0 22496 0 195485 0 0 0 MICHAEL BOVEE 193420 0 0 0 630 0 13679 0 23176 0 230905 0 0 0 RICHARD BAILEY MD FACP 267982 0 0 0 533 0 16500 0 17314 0 302329 0 0 0 RONNIE KIRSCHLING MD 1058284 0 0 0 1806 0 28175 0 19661 0 1107926 0 0 0 CRAIG FLINDERS DO 251386 0 60329 0 405 0 28175 0 18447 0 358742 0 0 0 THOMAS FERK DO 266279 0 86554 0 420 0 28175 0 22845 0 404273 0 0 0 JENNIFER MCELROY DO 266425 0 13825 0 276 0 16500 0 15622 0 312648 0 0 0 CHESTON PRICE MD 258749 0 4412 0 388 0 26435 0 17477 0 307461 0 0 0 Part I, Line 1a Tax gross-up payments were paid on behalf of Mercedes De Las Alas and Craig Flinders. The amounts paid were as follows: Mercedes De Las Alas - $2.94 Craig Flinders - $.66 Riverview Hospital provided a housing allowance of $300 to Jennifer McElroy. All of the payments above were included in taxable income to the respective employee. Health and social club dues were paid on behalf of Celse Berard and Michael Bovee. The amounts paid were as follows: Celse Berard - $3,576.45 Michael Bovee - $3,390 Part I, Line 4b The following individuals received payments during the year for a supplemental non-qualifed retirement plan: Kirschling - $8,758 Ferk - $11,770 De las Alas - $11,236 Berard - $15,635 Price - $9,704 Flinders - $9,006 Wisconsin Health and Educational Facilities Authority 391337855 97710V8S0 2008-04-16 27077182 Hospital addition 0 0 0 Wisconsin Health and Educational Facilities Authority 391337855 97710BZW5 2010-12-16 20296089 Refinance 2001 Bond 0 0 0 1150000 24078184 2648998 350000 2009 0 0 1 1 665000 18285000 1663538 347551 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 0.00900 0.00900 1 0 0 0 0 0 0 0 0 0 0 0 0 2010 CUSIP Identification The Series 2001 Bonds were refinanced in 2010 and each separate principal amount was assigned an individual CUSIP. The CUSIPs range from 97710BZW5 to 97710BA93. Wood Trust Bank Jason Dietz is a board member and a Senior Vice President at Wood Trust Ban 273329 Riverview Hospital paid investment management fees to Wood Trust Bank. 0 Surgical Associates of Wisconsin Rapids SC Dr. Marjorie Miller is a board member and is a owner of Surgical Associates 195200 Riverver Hospital paid Surgical Associates call pay for physician services. 0 Form 990, Part VI, Section A, line 6 Members are those community members who have purchased a membership to Riverview Hospital Association. These are life time memberships once purchased, and each year there is very minimal activity related to the purchase of a membership. Form 990, Part VI, Section A, line 7a Members of Riverview Hospital Association are able to nominate and vote candidates to the Board of Directors. Form 990, Part VI, Section A, line 7b At the annual meeting with the community members, the members vote whether or not they approve the actions of the board. Form 990, Part VI, Section B, line 11 A copy of the 990 is presented to the board at a monthly board meeting and is reviewed in detail with them. Any questions are then answered at that time. Once reviewed, it is then mailed/submitted. Form 990, Part VI, Section B, line 12c The Board of Directors of the hospital annually sign their pledge to adhere to the conflict of interest policy here at Riverview Hospital Association (RHA). The signed attestations are filed and maintained by the Compliance Officer. Lisa Rowe-Peplinski, the Vice President - Quality Improvement serves as RHA's Compliance Officer. Over the next year, the hospital is working to further expand the conflict of interest policy to not only include the Board of Directors and administration but also medical staff and department directors. Form 990, Part VI, Section B, line 15 The following process describes Riverview Hospital Associations (RHA's) compensation practices: Each non-union and non-physician position is evaluated and assigned to a salary grade based on that evaluation. Evaluation criteria include a position's decision-making impact, thinking challenges, thinking problem solving challenges, work environment and entry qualifications. Each salary grade is assigned a pay range based on the market data for the positions in that salary grade. The entire salary range structure will be reviewed at least annually, and based on market data and the Association's budgetary goal's may be adjusted. Such adjustments will occur on or about the start of the Association's fiscal year. This policy covers all non-physicians and non-union positions within Riverview Hospital Association. In addition, salaries of the CEO, Key Employees, and Physicians are determined in conjunction with an independent compensation consultant and industry studies to determine the proper levels of compensation. These results are approved by the Compensation Committee before finalized. Physician compensation is usually based on market data and productivity via an RVU-based approach. Pay for employees in Riverview's three unions is determined via collective bargaining. All approvals are completed by individuals that do not have a conflict of interest with the transaction. Form 990, Part VI, Section C, line 19 Available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 4,369,821. Form 990, Part XI, Line 2c The process is consistent with prior years. RIVERVIEW HEALTH CARE FOUNDATION INC PO BOX 8080 WISCONSIN RAPIDS WI 544958080 391509239 THE FOUNDATION IS OPERATED PRIMARILY FOR THE BENEFIT OF RIVERVIEW HOSPITAL WI 501 (C) 3 Line 11c, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1