2012-04-06T14:53:28-05:00 2011-08-31 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2010-09-01 390868982 RIVERVIEW HOSPITAL ASSOCIATION RIVE 7154217463 410 Dewey Street Wisconsin Rapids WI 54494 MICHAEL BOVEE 7154217463 2012-03-30 1 Kathleen J LaBrake CPA 7158453111 2012-03-30 2010 2016-02-24 21:20:13Z Michael Bovee 410 Dewey Street Wisconsin Rapids WI 54494 111492484 0 X www.rhahealthcare.org X 1912 WI To provide compassionate, affordable, state-of-the-art healthcare to our communities. 15 14 729 425 823850 -589502 367457 259801 81628202 85270022 583453 3248255 -37821 25856 82541291 88803934 0 0 0 0 37461910 40153677 0 0 0 38179095 40417664 75641005 80571341 6900286 8232593 172595461 186452276 56442716 57524453 116152745 128927823 X To provide compassionate, affordable, state-of-the-art healthcare to our communities. 0 0 59149813 83910216 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 4,260 persons benefited from this program.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 2,689 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 400 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 4,260 persons benefited from this program in 2011. 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 2011, 18,665 meals were delivered. 92% of them were modified to meet specific dietary needs. The Boys and Girls Club of Wisconsin of the Wisconsin Rapids Area will begin the planting of their Community Garden Thursday June 16 at 10:30 am. The Garden is part of the collaboration with Wood County Health Department, Riverview Hospital, and The Neighborhood Table. The Garden Project will be paired with a new morning breakfast program and summer food program. Crops will be utilized in both of these programs as well as part of the "Cooking Show from the Club Kitchen" and the "Gardening Show", both broadcast on local public access. Funding for the Garden was made possible by the US Department of Health and Human Services, Wisconsin Department of Health Services and the Wood County Health Department. Additional funding for the breakfast program and garden was provided by Riverview Hospital through the Champions for Healthy Kids grant form General Mills. Approximately 450 school age children benefited from the project. 59149813 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 75 1 1 729 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 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 ROBB SIGLER 2.00 X X 0 0 0 DOUGLAS WENZLAFF 1.00 X X 0 0 0 DAWN NEUMAN 2.00 X X 0 0 0 JOHN CLARK MD 2.00 X X 0 0 0 STEVEN BELL 1.00 X 0 0 0 MERCEDES DE LAS ALAS MD 41.00 X 391381 0 54215 ROBERT BENKOWSKI 1.00 X 0 0 0 COLLEEN DICKMAN 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 DR MARJORIE MILLER 1.00 X 0 0 0 GREGORY NETTESHEIM 1.00 X 0 0 0 LAWRENCE LEIBERT MD 1.00 X 0 0 0 MARY WOLOSEK 1.00 X 0 0 0 CELSE BERARD 40.00 X 434433 0 46053 PEGGY OSE 40.00 X 159210 0 29410 MIKE BOVEE 40.00 X 182640 0 27236 RONNIE KIRSCHLING 40.00 X 1106918 0 76278 CRAIG FLINDERS 40.00 X 401178 0 50349 THOMAS FERK 40.00 X 450859 0 58920 CHESTON PRICE 40.00 X 353359 0 46503 RICHARD CLASEN 40.00 X 347533 0 41427 3827511 0 430391 19 0 1 0 HMP OF WISCONSIN RAPIDS LTD 4535 DRESSLER ROAD NW CANTON OH 44718 HOSPITALISTS - MTHLY SUBSIDY & MGMT FEE 944207 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 LABORATORY SERVICES 574450 INFINITY HEALTHCARE SC 111 E WISCONSIN AVENUE SUTIE 2100 MILWAUKEE WI 53202 Emergency Room Physicians & Medical Dire 445703 NATIIONAL WOUND CARE & HYPERBARIC PO BOX 850001 DEPT 0775 ORLANDO FL 32885 WOUND CARE & HYPERBARIC FEE 394183 OMNI GLASS & PAINT PO BOX 2186 OSHKOSH WI 54903 REPLACING WINDOWS 385560 19 52401 207400 259801 PATIENT SERVICES 900099 83405659 83405659 LAB SERVICE FOR NON PA 621500 823850 823850 FOOD 900099 276855 276855 INCOME RECEIVED FROM O 900099 259101 259101 HEALTH RELATED PROGRAM 900099 237061 237061 267496 267496 85270022 2062603 2062603 825622 811047 14575 14575 14575 22958159 86432 21829553 29386 1128606 57046 1185652 1185652 7284 52401 7284 0 22561 11280 11281 11281 88803934 83910216 823850 3810067 878982 878982 29530985 25769083 3761902 885854 664390 221464 6758597 5068948 1689649 2099259 1574444 524815 182281 97306 84975 55934 55934 250326 250326 6022660 5055158 967502 388196 325836 62360 1000416 614356 386060 1511745 1506104 5641 93633 27988 65645 90896 27170 63726 2470752 2470752 6529046 497826 6031220 379940 108485 271455 SUPPLIES 8795595 8594778 200817 DRUGS 4741644 4730359 11285 OTHER 3107341 644130 2463211 BAD DEBT 2653948 2653948 PROFESSIONAL FEES 1417617 786613 631004 725694 402891 322803 80571341 59149813 21421528 0 10514926 6681930 13076058 21287584 14138848 13562309 1722285 1825816 476064 441357 131166032 68101419 65839336 63064613 66160586 78841449 667358 747218 172595461 186452276 9565520 10934100 45365253 46590353 1511943 0 56442716 57524453 X 115635468 128271971 517277 655852 116152745 128927823 172595461 186452276 X 8232593 4542485 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 11070 11070 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Percentage of AHA dues used for lobbying in 2011 - $5,110 Percentage of WHA dues used for lobbying in 2011 - $5,960 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. 1843661 1843661 65174247 18776197 46398050 2068313 1510690 557623 61851503 47814532 14036971 228308 228308 63064613 88803934 80571341 8232593 3889863 652622 4542485 12775078 89307609 811047 811047 88496562 250326 57046 307372 88803934 81075016 811047 811047 80263969 250326 57046 307372 80571341 Description of Uncertain Tax Positions Under FIN 48: Part X: In order to account for any uncertain income tax positions, ASC Topic 740-10, Accounting for Uncertainty in Income Taxes, requires an organization to assess whether it is more likley than not that a tax position will be sustained upon examination of the technical merits of the position, assuming the tax 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 recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits in 2011 and 2010. Federal returns for years ended August 31, 2010, 2009 and 2008 remain subject to examination by the Internal Revenue Service. Part XI, Line 8 - Other Adjustments: RECLASSIFICATION OF ACCUMULATED LOSS ON DESIGNATED CASHFLOW HEDGE 652,622. Part XII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV 757,722. RENT EXPENSES NET WITH REV 53,325. Part XII, Line 4b - Other Adjustments: GAIN ON DISPOSAL OF ASSETS 57,046. Part XIII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV 757,722. RENT EXPENSES NET WITH REV 53,325. Part XIII, Line 4b - Other Adjustments: GAIN ON DISPOSAL OF ASSETS 57,046. Love Lights 41812 40746 1066 1066 Christmas at the Ridges 17873 11655 6218 6218 59685 52401 7284 7284 7284 0 22561 11280 1 1.00000 22561 11280 11280 11281 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 668955 668955 0.00860 14579669 12989230 1590439 0.02040 15248624 12989230 2259394 0.02900 46659 46659 0.00060 121897 121897 0.00160 397019 278689 118330 0.00150 54808 22583 32225 0.00040 620383 301272 319111 0.00410 15869007 13290502 2578505 0.03310 1 1332020 18108633 21557046 -3448413 X 1 1 1 1 Riverview Hospital Association

410 Dewey Street Wisconsin Rapids WI 54495

X X X RIVERVIEW HOSPITAL ASSOCIATION 1 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 Nekossa WI 54457

Clinic Riverview Family Clinic Lakes Area

1160 Rome Center Drive Town of Rome Nekossa 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. All amounts in Part I, line 7f were reduced by the bad debt amount of $2,653,948. 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 $ 2653948. 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. 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. 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. 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 4,260 persons benefited from this program.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 12.8% of all admissions between April 2010 and March 2011 came from the counties alongside this corridor. For the UW Cancer Center-Riverview over the same period, over 14% 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 6: SEE ABOVE FOR ADDITIONAL DETAIL Reports Filed With States Part VI, Line 7 WI X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 MERCEDES DE LAS ALAS MD 302756 0 71552 0 17073 0 32402 0 21813 0 445596 0 0 0 CELSE BERARD 397757 0 0 0 36676 0 29517 0 16536 0 480486 0 0 0 PEGGY OSE 118904 0 0 0 40306 0 8402 0 21008 0 188620 0 0 0 MIKE BOVEE 170894 0 0 0 11746 0 9569 0 17667 0 209876 0 0 0 RONNIE KIRSCHLING 1072737 0 0 0 34181 0 56963 0 19315 0 1183196 0 0 0 CRAIG FLINDERS 269168 0 105403 0 26607 0 33215 0 17134 0 451527 0 0 0 THOMAS FERK 313568 0 133502 0 3789 0 38743 0 20177 0 509779 0 0 0 CHESTON PRICE 275992 0 47066 0 30301 0 28189 0 18314 0 399862 0 0 0 RICHARD CLASEN 308407 0 0 0 39126 0 25276 0 16151 0 388960 0 0 0 Part I, Line 4b Kirschling - $87,803 Ferk - $117,995 De las Alas - $113,504 Berard - $158,004 Price - $108,763 Wisconsin Health and Educational Facilities Authority 391337855 97710V8S0 2008-04-16 27266182 Hospital addition 0 0 0 Wisconsin Health and Educational Facilities Authority 391337855 97710BZW5 2010-12-16 20296089 Refinance 2001 Bond 0 0 0 27266182 2648998 304939 2009 0 0 1 1 20296089 1663538 319948 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 2010 CUSIP IDENTIFICATION THE SERIES 2001 BONDS WERE REFIANCED IN 2010 AND EACH SEPERATE PRINCIPAL AMOUNT WAS ASSIGNED AN INDIVIDUAL CUSIP. THE CUSIPS RANGE FROM 97710BZW5 TO 97710BA93. WOOD TRUST BANK STEVEN BELL IS A BOARD MEMBER AND OWNER OF WOOD TRUST BANK 253807 RIVERVIEW HOSPITAL PAID INVESTMENT MANAGEMENT FEES TO WOOD TRUST BANK. 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 re-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 Gloria Costello, Administrative Secretary. In November of 2011, the Board of Directors named Lisa Rowe-Peplinski, Vice President - Quality Improvement to serve as RHA's Compliance Officer. Over the course of the next year additional education related to conflict of interest will be provided to management with signed agreement forms to be completed. 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: 3,889,863. RECLASSIFICATION OF ACCUMULATED LOSS ON DESIGNATED CASHFLOW HEDGE 652,622. Total to Form 990, Part XI, Line 5: 4,542,485. 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 1 0 1 1 0 1 0 1