2011-06-28T07:27:41-05:00 2010-08-31 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2009-09-01 390868982 Riverview Hospital Association RIVE 7154217463 410 Dewey Street Wisconsin Rapids WI 54494 MICHAEL BOVEE 7154217463 2011-06-16 1 Kathleen J LaBrake CPA 7158453111 2011-06-16 2009 2016-02-24 21:20:13Z Michael Bovee 410 Dewey Street Wisconsin Rapids WI 54494 96734416 0 X www.rhahealthcare.org X 1912 WI To provide compassionate, affordable, state-of-the-art healthcare to our communities. 15 15 742 425 810786 -473516 419825 367457 79218017 81628202 -513438 583453 -161123 -37821 78963281 82541291 0 0 38974015 37461910 0 0 33937371 38179095 72911386 75641005 6051895 6900286 163088074 172595461 58315105 56442716 104772969 116152745 To provide compassionate, affordable, state-of-the-art healthcare to our communities. 0 0 58684036 80219140 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.Breastfeeding Education is a free appointment provided to all new moms. Prior to discharge, the mom is able to meet with a IBCLC (International Board Certified Lactation Consultant) or the CLC (Certified Lactation Consultant). The mom then returns to the hospital 2 to 4 days after discharge to receive breastfeeding assistance. Both the IBCLC and CLC are Family Birthplace registered nurses so they are able to answer additional questions as well. The IBCLC and CLC check the weight of the baby, look the baby over for signs of jaundice, and will order lab draws if necessary. The RN then follows up with the physician. The IBCLC and CLC also make phone calls and follow up with the mom as needed. Some moms are seen 4 or 5 times as outpatients free of charge. On average, there are 3 contacts with mom (in-house, outpatient, and one phone call). Approximately 181 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 form these coalitions. 58684036 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 56 0 1 742 1 1 1 0 0 0 0 0 0 0 0 15 15 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 1.30 X X 0 0 0 DOUGLAS WENZLAFF 1.30 X X 0 0 0 JOHN CLARK 1.30 X X 0 0 0 DAWN NEUMAN 1.30 X X 0 0 0 GREGORY NETTESHEIM 1.30 X 0 0 0 MERCEDES DE LAS ATLAS 1.30 X 0 0 0 ROBERT BENKOWSKI 1.30 X 0 0 0 COLLEEN DICKMAN 1.30 X 0 0 0 LAWRENCE LEIBERT 1.30 X 0 0 0 ROY BRANDELL 1.30 X 0 0 0 KALIN LAMP 1.30 X 0 0 0 TIMOTHY MANCL 1.30 X 0 0 0 MARJORIE MILLER 1.30 X 0 0 0 MARY WOLOSEK 1.30 X 0 0 0 STEVEN BELL 1.30 X 0 0 0 CELSE BERARD 40.00 X 278376 0 44440 PEGGY OSE 40.00 X 167098 0 27487 MIKE BOVEE 40.00 X 199137 0 26156 RONNIE KIRSCHLING 40.00 X 1010365 0 78412 CRAIG FLINDERS 40.00 X 265968 0 45944 RON GREENBERG 40.00 X 330740 0 32589 ETTA LOVITT 40.00 X 294932 0 36190 ALLEN TETER 40.00 X 271135 0 34377 2817751 0 325595 11 0 1 0 MIRON CONSTRUCTION CO INC 1471 MCMAHON DRIVE NEENAH WI 54957 CONSTRUCTION CONTRACTOR 2083285 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 LABORATORY SERVICES 561984 EAGLE CONSTRUCTION 3031 SARATOGA STREET WISCONSIN RAPIDS WI 54495 CONSTRUCTION CONTRACTOR 553659 HMP OF WISCONSIN RAPIDS LTD 4535 DRESSLER ROAD NW CANTON OH 44718 HOSPITALISTS - MTHLY SUBSIDY & MGMT FEE 442670 INFINITY HEALTHCARE SC 111 E WISCONSIN AVENUE SUTIE 2100 MILWAUKEE WI 53202 MEDICAL DIRECTOR 413922 16 367457 367457 PATIENT SERVICES 900099 79683439 79683439 LAB SERVICE FOR NON PA 621500 810786 810786 FOOD 900099 304632 304632 INCOME RECEIVED FROM O 900099 293644 293644 HEALTH RELATED PROGRAM 900099 206307 206307 329394 329394 81628202 1525418 1525418 929541 967362 -37821 -37821 -37821 12028303 255495 13126080 99683 -1097777 155812 -941965 -941965 82541291 80219140 810786 1143908 742694 742694 27824289 24640520 3183769 921792 755869 165923 5983697 5285132 698565 1989438 1631339 358099 64669 34737 29932 55858 55858 222720 222720 356952 292854 64098 1008528 642250 366278 95254 66270 28984 76590 53285 23305 2199424 2199424 6027123 525003 5502120 384590 71759 312831 SUPPLIES 8804456 8504854 299602 PURCHASED SERVICES 5478826 4494322 984504 DRUGS 4263717 4253535 10182 OTHER 2891579 1886251 1005328 BAD DEBT 2284507 2284507 3964302 3261549 702753 75641005 58684036 16956969 0 5278102 10514926 14673475 14138848 1629378 1722285 495300 476064 127590251 61750915 63908362 65839336 77103457 79904002 163088074 172595461 10442747 10385520 47872358 46057196 58315105 56442716 X 104509435 115635468 263534 517277 104772969 116152745 163088074 172595461 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10659 10659 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Percentage of AHA dues used for lobbying in 2010 - $4,972 Percentage of WHA dues used for lobbying in 2010 - $5,687 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. 1713833 1713833 63641980 16350171 47291809 2068313 1412751 655562 60020017 43987993 16032024 146108 146108 65839336 ASSETS WHOSE USE IS LIMITED 79236644 DEFERRED BOND ISSUANCE COSTS 519854 INVESTMENT IN UNCONSOLIDATED AFFILIATE 147504 79904002 HOSPITAL REVENUE BONDS 44545253 INTEREST RATE SWAP AGREEMENT VALUATION 1511943 46057196 82541291 75641005 6900286 4425105 54385 4479490 11379776 83130120 967362 967362 82162758 222720 155813 378533 82541291 76229834 967362 967362 75262472 222720 155813 378533 75641005 Part X: Description of Uncertain Tax Positions Under FIN 48: 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 2010 and 2009. Federal returns for years ended August 31, 2009, 2008 and 2007 remain subject to examination by the Internal Revenue Service. Part XI, Line 8 - Other Adjustments: RECLASSIFICATION OF ACCUMULATED LOSS ON DESIGNATED CASHFLOW HEDGE: 54385. Part XII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV: 879857. RENT EXPENSES NET WITH REV: 87505. Part XII, Line 4b - Other Adjustments: GAIN ON DISPOSAL OF ASSETS: 155813. Part XIII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV: 879857. RENT EXPENSES NET WITH REV: 87505. Part XIII, Line 4b - Other Adjustments: GAIN ON DISPOSAL OF ASSETS: 155813. Love Lights 53867 53867 3273 Christmas at the Ridges 15422 15422 5006 1 8870 8870 78159 78159 8279 8279 69880 1 1 1 X 1 X 1 1 0 1 1 618715 618715 0.00840 13682383 12177879 1504504 0.02050 14301098 12177879 2123219 0.02890 84443 1330 83113 0.00110 109809 0 109809 0.00150 390410 302490 87920 0.00120 63685 12985 50700 0.00070 648347 316805 331542 0.00450 14949445 12494684 2454761 0.03340 1 1168341 0 16260609 19175669 -2915060 X 1 1 Riverview Hospital Association

410 Dewey Street Wisconsin Rapids WI 54495

X X X 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 $2,284,507. 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 unisured 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 4,717 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 10.1% of all admissions between January 2007 and March 2010 came from the counties alongside this corridor. For the UW Cancer Center-Riverview over the same period, over 17% 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). 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: 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. WI X 1 1 X X X 0 1 0 0 0 0 0 0 0 CELSE BERARD 242444 0 0 0 35932 0 27014 0 17426 0 322816 0 0 0 PEGGY OSE 130404 0 0 0 36694 0 6803 0 20684 0 194585 0 0 0 MIKE BOVEE 189288 0 0 0 9849 0 7314 0 18842 0 225293 0 0 0 RONNIE KIRSCHLING 973671 0 0 0 36694 0 53085 0 25327 0 1088777 0 0 0 CRAIG FLINDERS 253363 0 0 0 12605 0 26275 0 19669 0 311912 0 0 0 RON GREENBERG 298152 0 0 0 32588 0 19470 0 13119 0 363329 0 0 0 ETTA LOVITT 280727 0 0 0 14205 0 23760 0 12430 0 331122 0 0 0 ALLEN TETER 263575 0 0 0 7560 0 18194 0 16183 0 305512 0 0 0 Part I, Line 4a Greenberg - $147,607 Lovitt - $70,096 Teter - $103,198 Wisconsin Health and Educational Facilities Authority 391337855 97710V8S0 2008-04-16 27266182 Hospital addition 0 0 27266182 2648998 304939 2009 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 STEVEN BELL STEVEN BELL IS A BOARD MEMBER AND OWNER OF WOOD TRUST BANK 222720 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). Paula Cook, Ethics and Compliance Officer, manages this process and Gloria Costello, Admin Secretary, files the attestations. Paula is expanding the attestation process to include Administrative Council and all managers very soon. She is also writing a net-learning session for managers about COI that includes signatures of agreements to comply with conflict of interest(COI) policy. This will be renewed on an annual basis (mandatory) by managers. 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. 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 1 1 1 1 0 1 0 1