RICHLAND HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: RICHLAND HOSPITAL (EIN 39-0808498)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-11-15
IRS object ID: 202223199349301637
Schema version: 2021v4.2
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 J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-11-15T06:51:37-06:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390758449	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WIPFLI LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1502 LONDON ROAD SUITE 200	AddressLine1Txt
City	DULUTH	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55812	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390808498	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	THE RICHLAND HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	RICH	BusinessNameControlTxt
Phone	6086476321	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	333 EAST SECOND STREET	AddressLine1Txt
City	RICHLAND CENTER	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53581	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ELIZABETH MOORE	PersonNm
Person Title	CHIEF FINANCIAL OFFICER	PersonTitleTxt
Phone	6086476321	PhoneNum
Signature	2022-11-11	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	ELIZABETH	PersonFirstNm
Person Last	MOORE	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MICHAEL J PETERSON CPA	PreparerPersonNm
PTIN	P01833529	PTIN
Phone	2187224705	PhoneNum
Preparation	2022-11-09	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	BRUCE ROESLER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	333 EAST SECOND STREET	AddressLine1Txt
City	RICHLAND CENTER	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53581	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$78,785,128	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.RICHLANDHOSPITAL.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1937	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING.	ActivityOrMissionDesc
Voting Members Governing Body	10	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	512	TotalEmployeeCnt
Total Volunteers	118	TotalVolunteersCnt
Total Gross UBI	$991	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$4,932,664	PYContributionsGrantsAmt
CY Contributions Grants	$5,487,617	CYContributionsGrantsAmt
PY Program Service Revenue	$56,612,144	PYProgramServiceRevenueAmt
CY Program Service Revenue	$65,303,983	CYProgramServiceRevenueAmt
PY Investment Income	$739,122	PYInvestmentIncomeAmt
CY Investment Income	$956,218	CYInvestmentIncomeAmt
PY Other Revenue	$274,676	PYOtherRevenueAmt
CY Other Revenue	$415,537	CYOtherRevenueAmt
PY Total Revenue	$62,558,606	PYTotalRevenueAmt
CY Total Revenue	$72,163,355	CYTotalRevenueAmt
PY Grants And Similar Paid	$35,056	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$36,103,810	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$36,229,250	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$117,305	CYTotalFundraisingExpenseAmt
PY Other Expenses	$23,293,993	PYOtherExpensesAmt
CY Other Expenses	$25,807,841	CYOtherExpensesAmt
PY Total Expenses	$59,432,859	PYTotalExpensesAmt
CY Total Expenses	$62,037,091	CYTotalExpensesAmt
PY Revenues Less Expenses	$3,125,747	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$10,126,264	CYRevenuesLessExpensesAmt
Total Assets BOY	$84,065,288	TotalAssetsBOYAmt
Total Assets EOY	$90,295,177	TotalAssetsEOYAmt
Total Liabilities BOY	$13,165,800	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$8,950,106	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$70,899,488	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$81,345,071	NetAssetsOrFundBalancesEOYAmt
Mission	THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S FIRST CHOICE FOR BETTER HEATH.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$47,319,845	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$47,304,830	RevenueAmt
Desc	THE RICHLAND HOSPITAL, INC. (THE HOSPITAL) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN RICHLAND CENTER, WI. PATIENTS SERVED BY THE RICHLAND HOSPITAL IN 2021 INCLUDED 3,314 ADULTS AND PEDIATRICS INPATIENT DAYS, 383 SWING BED PATIENT DAYS, 215 NEWBORN PATIENT DAYS, 66,160 TOTAL OUTPATIENT VISITS, AND 6,474 EMERGENCY ROOM VISITS. THE HOSPITAL ALSO OPERATES A PHYSICIAN CLINIC PROVIDING PRIMARY CARE PROCEDURES SUCH AS CARDIAC TESTS AND ULTRASOUNDS. THE HOSPITAL ENGAGES IN SEVERAL EFFORTS THAT ARE DESCRIBED IN DETAIL ON THE SCHEDULE H ATTACHED TO THE RETURN.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$3,243,819	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$17,691,403	RevenueAmt
Desc	THE RICHLAND HOSPITAL, INC. ALSO OPERATES TWO RURAL HEALTH CLINICS LOCATED IN SPRING GREEN AND MUSCODA, WI. DURING 2021 THESE TWO CLINICS PROVIDED OVER 7,396 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.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$50,563,664	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	48	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	512	EmployeeCnt
Employment Tax Returns Filed	0	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	0	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ELIZABETH MOORE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6086476321	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	333 EAST SECOND STREET	AddressLine1Txt
City	RICHLAND CENTER	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53581	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
CHRISTINE RICHARDS MD
CHIEF OF STAFF	40.00	Yes (X)	$302,995	$0	$28,744
JOHN POOLE
CHAIR	3.00	Yes (X)	$0	$0	$0	Yes (X)
MARILYN RINEHART
VICE-CHAIR	2.00	Yes (X)	$0	$0	$0	Yes (X)
TRACI PETERSON
SECRETARY	2.00	Yes (X)	$0	$0	$0	Yes (X)
JOHN ANNEAR
TREASURER	2.00	Yes (X)	$0	$0	$0	Yes (X)
KAY BALINK MD
DIRECTOR (& EMPLOYEE)	40.00	Yes (X)	$189,001	$0	$40,166
STEVE BAUER
DIRECTOR	1.50	Yes (X)	$0	$0	$0		1.00
DOROTHY BEHLING
DIRECTOR	1.50	Yes (X)	$0	$0	$0
JERRY GANDER
DIRECTOR	1.50	Yes (X)	$0	$0	$0
JERRY MCCAULEY
DIRECTOR	1.50	Yes (X)	$0	$0	$0
BRUCE ROESLER
CEO	40.00		$320,750	$0	$41,987	Yes (X)
ELIZABETH MOORE
CFO	40.00		$77,721	$0	$13,704	Yes (X)	1.00
JEFFERY LONGBRAKE
INTERIM CFO (THRU AUG)	40.00		$190,590	$0	$0	Yes (X)
THOMAS BECK
ORTHOPEDIC SURGEON	40.00		$574,009	$0	$28,915			Yes (X)
BRYAN MCCARVEL
CRNA	40.00		$392,230	$0	$10,774			Yes (X)
ANDREW WRIGHT
FAMILY DOCTOR	40.00		$374,563	$0	$45,042			Yes (X)
ANDREW HARRIS
ER MD DOCTOR	40.00		$345,736	$0	$51,176			Yes (X)
SHAWN O' BRIEN
EMERGENCY PHYSICIAN	40.00		$344,689	$0	$46,588			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,112,284	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$307,096	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	9	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
RURAL PHYSICIANS GROUP
5575 DTC PKWY STE 225	GREENWOOD VILLAGE	CO	80111	HOSPITALIST PROVIDER	$843,588
PSYCHIATRIC MEDICAL CARE LLC
4322 HARDING PIKE 417	NASHVILLE	TN	37205	PSYCHIATRIC SERVICES	$553,221
MERITER KEALTH ENTERPRISES DBA MERITER L
36 SOUTH BROOKS STREET	MADISON	WI	53715	LABORATORY TESTING SERVICES	$460,565
MEDICAL SOLUTIONS LLC
PO BOX 310737	DES MOINES	IA	503310737	CONTRACTED LABOR-NURSING	$226,654
HURON CONSULTING SERVICES LLC
550 W VAN BUREN STREET	CHICAGO	IL	60607	MT EXPANSE SOFTWARE CONSULTING	$217,055

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	7	CntrctRcvdGreaterThan100KCnt
Related Organizations	$105,810	RelatedOrganizationsAmt
Government Grants	$5,381,807	GovernmentGrantsAmt
Total Contributions	$5,487,617	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
PATIENT SERVICE REVENUE	621990	$64,086,811	$64,085,820	$991
PHARMACY 340B REVENUE	446110	$910,413	$910,413
MEALS	722320	$127,895			$127,895
CONTRACTED THERAPY	621990	$124,861			$124,861

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$54,003	TotalRevenueColumnAmt
Exclusion	$54,003	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$65,303,983	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$411,534	TotalRevenueColumnAmt
Exclusion	$411,534	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$444,700	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$29,163	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$415,537	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$415,537	TotalRevenueColumnAmt
Exclusion	$415,537	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$7,137,294	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$6,549,909	SecuritiesAmt
Other	$42,701	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$587,385	SecuritiesAmt
Other	-$42,701	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$544,684	TotalRevenueColumnAmt
Exclusion	$544,684	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$72,163,355	TotalRevenueColumnAmt
Related Or Exempt Func Income	$64,996,233	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$991	UnrelatedBusinessRevenueAmt
Exclusion	$1,678,514	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$964,838	TotalAmt
Management And General	$964,838	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$28,162,824	TotalAmt
Program Services	$23,493,995	ProgramServicesAmt
Management And General	$4,577,555	ManagementAndGeneralAmt
Fundraising	$91,274	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$908,683	TotalAmt
Program Services	$694,572	ProgramServicesAmt
Management And General	$211,164	ManagementAndGeneralAmt
Fundraising	$2,947	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$4,348,463	TotalAmt
Program Services	$3,278,050	ProgramServicesAmt
Management And General	$1,056,506	ManagementAndGeneralAmt
Fundraising	$13,907	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,844,442	TotalAmt
Program Services	$1,374,741	ProgramServicesAmt
Management And General	$463,869	ManagementAndGeneralAmt
Fundraising	$5,832	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$126,370	TotalAmt
Management And General	$126,370	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$42,155	TotalAmt
Management And General	$42,155	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$7,678,967	TotalAmt
Program Services	$6,055,915	ProgramServicesAmt
Management And General	$1,621,813	ManagementAndGeneralAmt
Fundraising	$1,239	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$149,374	TotalAmt
Program Services	$573	ProgramServicesAmt
Management And General	$148,801	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$334,811	TotalAmt
Program Services	$179,090	ProgramServicesAmt
Management And General	$153,920	ManagementAndGeneralAmt
Fundraising	$1,801	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$678,607	TotalAmt
Management And General	$678,607	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$906,579	TotalAmt
Program Services	$902,919	ProgramServicesAmt
Management And General	$3,660	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$37,278	TotalAmt
Program Services	$36,066	ProgramServicesAmt
Management And General	$1,212	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$205,342	TotalAmt
Program Services	$122,881	ProgramServicesAmt
Management And General	$82,156	ManagementAndGeneralAmt
Fundraising	$305	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,138,380	TotalAmt
Program Services	$2,700,809	ProgramServicesAmt
Management And General	$437,571	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$135,833	TotalAmt
Program Services	$60,635	ProgramServicesAmt
Management And General	$75,198	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
SUPPLIES	$7,930,280	$7,532,187	$398,093
BAD DEBT EXPENSE	$2,931,034	$2,931,034
EQUIPMENT RENTAL & MAIN	$954,482	$948,209	$6,273
STATE HOSPITAL ASSESSME	$281,447		$281,447

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$276,902	TotalAmt
Program Services	$251,988	ProgramServicesAmt
Management And General	$24,914	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$62,037,091	TotalAmt
Program Services	$50,563,664	ProgramServicesAmt
Management And General	$11,356,122	ManagementAndGeneralAmt
Fundraising	$117,305	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,585	BOYAmt
EOY	$1,488	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$24,898,639	BOYAmt
EOY	$29,933,448	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$11,080,824	BOYAmt
EOY	$11,024,020	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$2,021,007	BOYAmt
EOY	$2,104,042	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$233,678	BOYAmt
EOY	$353,883	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$70,262,678	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$44,163,632	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$25,626,258	BOYAmt
EOY	$26,099,046	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$17,125,183	BOYAmt
EOY	$18,163,195	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$639,851	BOYAmt
EOY	$319,926	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$2,438,263	BOYAmt
EOY	$2,296,129	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$84,065,288	BOYAmt
EOY	$90,295,177	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$7,164,200	BOYAmt
EOY	$6,049,745	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$65,988	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$16,611	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$5,919,001	BOYAmt
EOY	$2,900,361	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$13,165,800	BOYAmt
EOY	$8,950,106	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$70,264,315	BOYAmt
EOY	$81,178,059	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$635,173	BOYAmt
EOY	$167,012	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$70,899,488	BOYAmt
EOY	$81,345,071	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$84,065,288	BOYAmt
EOY	$90,295,177	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$10,126,264	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$145,679	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$173,640	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

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)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$6,821	OtherActivitiesAmt
Total Lobbying Expenditures	$6,821	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	THE RICHLAND HOSPITAL, INC. (THE "HOSPITAL") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAD NOTIFIED THE HOSPITAL THAT APPROXIMATELY $2,483 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE HOSPITAL PAYS MEMBERSHIP FEES TO RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN SECURING GRANT FUNDING FOR NEW OR EXISTING HEALTHCARE PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, RWHC ALSO DOES PROVIDE ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON BEHALF OF THE MEMBER ORGANIZATIONS. IT WAS DETERMINED THAT APPROXIMATELY $2,594 OF THE FEES PAID BY THE HOSPITAL IN 2021 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. THE HOSPITAL IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) IN WHICH $1,744 OF THEIR MEMBERSHIP DUES IS DEVOTED TO LOBBYING AND ADVOCATION AT A NATIONAL LEVEL.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$76,264	BeginningYearBalanceAmt
Investment Earnings Or Losses	$377	InvestmentEarningsOrLossesAmt
End Year Balance	$76,641	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$75,098	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,166	InvestmentEarningsOrLossesAmt
End Year Balance	$76,264	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$72,416	BeginningYearBalanceAmt
Investment Earnings Or Losses	$2,682	InvestmentEarningsOrLossesAmt
End Year Balance	$75,098	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$71,496	BeginningYearBalanceAmt
Investment Earnings Or Losses	$920	InvestmentEarningsOrLossesAmt
End Year Balance	$72,416	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$71,787	BeginningYearBalanceAmt
Investment Earnings Or Losses	$709	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	-$1,000	GrantsOrScholarshipsAmt
End Year Balance	$71,496	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.78000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.22000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,153,752	OtherCostOrOtherBasisAmt
Book Value	$2,153,752	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$45,438,099	OtherCostOrOtherBasisAmt
Depreciation	$29,245,436	DepreciationAmt
Book Value	$16,192,663	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$609,073	OtherCostOrOtherBasisAmt
Depreciation	$609,073	DepreciationAmt
Book Value	$0	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$20,526,736	OtherCostOrOtherBasisAmt
Depreciation	$14,309,123	DepreciationAmt
Book Value	$6,217,613	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,535,018	OtherCostOrOtherBasisAmt
Book Value	$1,535,018	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$26,099,046	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
DEFERRED COMPENSATION PLAN LIABILITY	$596,091
OTHER DEFERRED GRANTS	$1,531,046
AMOUNTS PAYABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS	$773,224

Field	Value	IRS element (for citing)
Total Liability	$2,900,361	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$69,375,108	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$145,679	NetUnrealizedGainsInvstAmt
Other Revenue	$138,925	OtherRevenueAmt
Revenue Not Reported	$284,604	RevenueNotReportedAmt
Revenue Subtotal	$69,090,504	RevenueSubtotalAmt
Other Revenues Not Included	$3,072,851	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$3,072,851	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$72,163,355	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$59,099,590	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$29,163	OtherExpensesIncludedAmt
Expenses Not Reported	$29,163	ExpensesNotReportedAmt
Expenses Subtotal	$59,070,427	ExpensesSubtotalAmt
Other Expenses Not Included	$2,966,664	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$2,966,664	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$62,037,091	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, LINE 4:	THE ENDOWMENT FUNDS MAINTAINED BY THE RICHLAND HOSPITAL, INC. HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED IN PERPETUITY, THE INCOME OF WHICH IS EXPENDABLE TO SUPPORT SCHOLARSHIP PROGRAMS OF THE HOSPITAL.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 29,163. CHANGE IN NET ASSETS OF UNCONSOLIDATED AFFILIATES 109,762.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	OTHER EXPENSES NET AGAINST REVENUE ON FINANCIAL STATEMENTS 35,630. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 2,931,034. INVESTMENT INCOME RECORDED TO UNRESTRICTED NET ASSETS 377. CONTRIBUTIONS FROM FOUNDATION 105,810.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 29,163.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	OTHER EXPENSES NET AGAINST REVENUE ON FINANCIAL STATEMENTS 35,630. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 2,931,034.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$216,793	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$216,793	NetCommunityBenefitExpnsAmt
Total Expense	0.00350	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,324,652	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,170,435	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,154,217	NetCommunityBenefitExpnsAmt
Total Expense	0.06700	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,541,445	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,170,435	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,371,010	NetCommunityBenefitExpnsAmt
Total Expense	0.07050	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,033	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,033	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,682,914	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,722,975	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$959,939	NetCommunityBenefitExpnsAmt
Total Expense	0.01550	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$752	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$752	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,688,699	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,722,975	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$965,724	NetCommunityBenefitExpnsAmt
Total Expense	0.01560	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,230,144	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,893,410	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,336,734	NetCommunityBenefitExpnsAmt
Total Expense	0.08610	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,066,933	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,066,933	NetCommunityBenefitExpnsAmt
Total Expense	0.01720	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,066,933	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,066,933	NetCommunityBenefitExpnsAmt
Total Expense	0.01720	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$1,251,950	BadDebtExpenseAmt
Bad Debt Expense Attributable	$625,975	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$23,044,195	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$22,830,826	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$213,369	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	THE RICHLAND HOSPITAL INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	333 EAST SECOND STREET	AddressLine1Txt
City	RICHLAND CENTER	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53581	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.RICHLANDHOSPITAL.COM	WebsiteAddressTxt
State License	1045	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	THE RICHLAND HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	19	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, SECTION C, LINE 7D	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V, SECTION C, LINE 7D	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	150.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	SEE PART V, SECTION C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE PART V, SECTION C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	SEE PART V, SECTION C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr Prvt	Yes (X)	LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
THE RICHLAND HOSPITAL, INC.	PART V, SECTION B, LINE 5: IN 2019, RICHLAND COUNTY PUBLIC HEALTH'S LOCAL HEALTH OFFICER, RICHLAND COUNTY UW EXTENSION FAMILY LIVING AGENT, AND THE RICHLAND HOSPITAL'S DIRECTOR OF MARKETING PARTNERED TO CONDUCT A COMBINED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPROVEMENT PLAN. AS A RESULT, A HEALTH ASSESSMENT AND WELLNESS COMMISSION (HAWC) MADE UP OF KEY STAKEHOLDERS IN THE COMMUNITY WAS ESTABLISHED TO CREATE AND OVERSEE THE PROCESS OF ASSESSING OUR COMMUNITY'S HEALTH AND WELLNESS NEEDS.MEMBERS OF THIS COMMISSION INCLUDED: 1. CHRIS DREA, RICHLAND HOSPITAL, DIRECTOR OF MARKETING2. MARCIA CARLSON, RICHLAND HOSPITAL, REGISTERED DIETITIAN AND CERTIFIED DIABETES EDUCATOR3. CHELSEA WUNNICKE, UW EXTENSION, RICHLAND COUNTY FAMILY LIVING AGENT4. ROSE KOHOUT, RICHLAND COUNTY HEALTH AND HUMAN SERVICES, PUBLIC HEALTH, COUNTY OFFICER5. CINDY CHICKER, RICHLAND HOSPITAL, ASSISTANT ADMINISTRATOR6. SHAWN TJOSSEM, RICHLAND SCHOOL DISTRICT, SCHOOL PSYCHOLOGIST7. JARRED BURKE, RICHLAND SCHOOL DISTRICT, DISTRICT ADMINISTRATOR8. BETSY ROESLER, RICHLAND COUNTY PUBLIC HEALTH, HEALTH AND WELLNESS COORDINATOR AND PREVENTION SPECIALIST9. MEGAN RYAN, RICHLAND HOSPITAL, ADMINISTRATIVE ASSISTANT DATA COLLECTION METHODOLOGY:AT EARLY MEETINGS OF THE HAWC'S IT WAS DETERMINED BY CONSENSUS TO COLLECT CHNA DATA IN 3 WAYS. THE COMMISSION ENVISIONED THIS AS A 3-LEGGED STOOL THAT WOULD SUPPORT OUR RECOMMENDATIONS OF THE TOP HEALTH NEEDS.1. SECONDARY DATA - PURPOSE: UNDERSTAND THE HEALTH ENVIRONMENT & DOCUMENTED REALITIES. HAWC MEMBERS CURATED PUBLISHED & PRIVATE HEALTH DATA.2. COMMUNITY SURVEY - PURPOSE: COLLECT OPINIONS THAT CAN STATISTICALLY REPRESENT RICHLAND COUNTY. MAILED TO 2,000 RANDOMLY GENERATED RESIDENCE ADDRESSES IN RICHLAND COUNTY.3. STAKEHOLDER FOCUS GROUPS - PURPOSE: MULTI-SECTOR STAKEHOLDERS REVIEW THE RESULTS OF THE COMMUNITY SURVEY AND PRIORITIZE NEEDS. FOCUS GROUPS WERE BY INVITATION ONLY.
THE RICHLAND HOSPITAL, INC.	PART V, SECTION B, LINE 6B: RICHLAND COUNTY HEALTH AND HUMAN SERVICES
THE RICHLAND HOSPITAL, INC.	PART V, SECTION B, LINE 7D: SCHEDULE H, PART V, LINE 7AHTTPS://WWW.RICHLANDHOSPITAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/SCHEDULE H, PART V, LINE 10AHTTPS://WWW.RICHLANDHOSPITAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/
THE RICHLAND HOSPITAL, INC.	PART V, SECTION B, LINE 11: IN PLANNING TO MEET COMMUNITY NEEDS, THE HOSPITAL WORKS CLOSELY WITH KEY COMMUNITY STAKEHOLDERS TO ASSESS HOW COMMUNITY HEALTH NEED PRIORITIES IDENTIFIED IN THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT ARE BEING ADDRESSED. THE RICHLAND HOSPITAL CREATED AND ADOPTED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) THAT SERVES AS A ROAD MAP FOR THE ORGANIZATION TO MAINTAIN A KEEN EYE ON THOSE PRIORITIES. THE HOSPITAL'S COMMUNITY CONNECTIONS TEAM OVERSEES THE CHIP. INDIVIDUAL MEMBERS SERVE AS PRIORITY CHAMPIONS AND WORK WITH GOAL CHAMPIONS TO ENSURE THAT THE HOSPITAL CONTINUES TO PURSUE IMPROVEMENT IN THESE AREAS. THE THREE PRIORITIES IDENTIFIED IN THE COMMUNITY INCLUDED: 1. MENTAL HEALTH 2. SUBSTANCE ABUSE TREATMENT AND PREVENTION 3. OBESITY TREATMENT AND PREVENTIONIN 2021, COVID-19 AND OUR PRECAUTIONS AROUND THE PANDEMIC CHALLENGED US TO FIND NEW WAYS TO MAKE PROGRESS AROUND ADDRESSING OUR COMMUNITY HEALTH NEEDS; IN-PERSON EVENTS WERE NOT AN OPTION, MANY EVENTS SPONSORED WITHIN THE COMMUNITY CONTINUED TO BE CANCELLED. OUR COMMUNITY CONNECTIONS COMMITTEE IN COOPERATION WITH OUR WELLNESS COMMITTEE FOUND CREATIVE WAYS TO ADDRESS THE THREE TOP COMMUNITY HEALTH NEEDS BY HOSTING VIRTUAL EVENTS SUCH AS A VIRTUAL 5K AND WELLNESS STRATEGIES VIA SOCIAL MEDIA PLATFORMS. DESPITE THESE EFFORTS TO ADDRESS OUR AUDIENCES AND ISSUES IDENTIFIED IN OUR CHIP VIRTUALLY, COVID-19 WAS OUR PREDOMINANT FOCUS FOR 2021
THE RICHLAND HOSPITAL, INC.	PART V, SECTION B, LINE 13H: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE RICHLAND HOSPITAL, INC. CONSIDERS THE FOLLOWING WHEN DETERMINING ELIGIBILITY FOR PROVIDING "FREE OR "DISCOUNTED" CARE TO INDIVIDUALS:- PATIENT IS HOMELESS- PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED- PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE CRIME VICTIMS ACT OR SEXUAL ASSAULT ACT- PATIENT IS DECEASED, AND WITHOUT A SPOUSE, AND NO ESTATE HAS BEEN FILED WITH THE COURT SYSTEM WITHIN 12 MONTHS OF EXPIRATION OR IF IT DETERMINED PATIENT DOES NOT HAVE ASSETS REQUIRING THE FILING OF AN ESTATE- PATIENT RECEIVES A BANKRUPTCY DETERMINATION WITHIN THE SIX MONTHS IMMEDIATELY PRECEDING THE APPLICATION DATE IF APPLICANT IS LOOKING FOR CONSIDERATION ON ANY ACTIVE ACCOUNT NOT DISCHARGED AS A PART OF THE BANKRUPTCY DETERMINATION- PATIENT'S VALID ADDRESS IS CONSIDERED LOW INCOME OR SUBSIDIZED HOUSING AND PATIENT AUTHORIZES THE APPLICABLE HOUSING AUTHORITY TO VALIDATE INCOME LEVEL DIRECTLY TO THE HOSPITAL- ACCOUNTS RETURNED BY COLLECTION AGENCY- ACCOUNTS CLOSED AS A RESULT OF A COURT-ORDER-PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM
THE RICHLAND HOSPITAL, INC.	PART V, SECTION B, LINE 16J: PLAIN LANGUAGE SUMMARY IS INCLUDED IN WRITTEN ACCOUNT COMMUNICATION, PLAIN LANGUAGE SUMMARY IS OFFERED AT REGISTRATION, PLAIN LANGUAGE SUMMARY IS INCLUDED ON STATEMENTS.
PART V, SECTION C, LINES 16A-C:	HTTPS://WWW.RICHLANDHOSPITAL.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - MUSCODA HEALTH CENTER
1075 NORTH WISCONSIN AVENUE	MUSCODA	WI	53573	RURAL HEALTH CLINIC
2 - SPRING GREEN MEDICAL CENTER
150 EAST JEFFERSON STREET	SPRING GREEN	WI	53588	RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	ADDITIONALLY, THE RICHLAND HOSPITAL, INC. MAY REFER TO OR RELY ON EXTERNAL SOURCES AND/OR OTHER PROGRAM ENROLLMENT RESOURCES IN THE CASE OF PATIENTS LACKING DOCUMENTATION THAT SUPPORTS ELIGIBILITY OR INDIVIDUAL CIRCUMSTANCE. AT ITS SOLE DISCRETION, WHEN A PATIENT IS UNABLE TO PROVIDE NECESSARY DOCUMENTATION TO SUPPORT AN ELIGIBILITY DETERMINATION, THE RICHLAND HOSPITAL, INC. MAY PROVIDE FREE OR DISCOUNTED SERVICES UNDER THIS PROGRAM WHEN PATIENT: - IS HOMELESS - IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED - IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM - IS ELIGIBLE FOR ASSISTANCE UNDER THE CRIME VICTIMS ACT OR SEXUAL ASSAULT ACT - IS DECEASED, WITHOUT A SPOUSE, AND NO ESTATE HAS BEEN FILED WITH THE COURT SYSTEM WITHIN 12 MONTHS OF EXPIRATION OR AT THE TIME IT CAN BE DETERMINED PATIENT DOES NOT HAVE ASSETS REQUIRING THE FILING OF AN ESTATE. - RECEIVES A BANKRUPTCY DETERMINATION WITHIN THE SIX MONTHS IMMEDIATELY PRECEDING THE APPLICATION DATE IF APPLICANT IS LOOKING FOR CONSIDERATION ON ANY ACTIVE ACCOUNT NOT DISCHARGED AS A PART OF THE BANKRUPTCY DETERMINATION. - VALID ADDRESS IS CONSIDERED LOW INCOME OR SUBSIDIZED HOUSING AND PATIENT AUTHORIZES THE APPLICABLE HOUSING AUTHORITY TO VALIDATE INCOME LEVEL DIRECTLY TO THE HOSPITAL.
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 DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. 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, INC. AND ARE PRIMARILY UTILIZED FOR EMERGENCY SERVICES. THE EMERGENCY ROOM DEPARTMENT OPERATES 24-HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED PRIMARILY BY BOARD CERTIFIED EMERGENCY ROOM PHYSICIANS. 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, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY.
PART II, COMMUNITY BUILDING ACTIVITIES:	THE RICHLAND HOSPITAL, INC. IS ACCREDITED THROUGH THE JOINT COMMISSION ("TJC"). THE TJC IS AN ORGANIZATION THAT EVALUATES HOSPITAL PERFORMANCE STANDARDS, FOCUSING ON THE QUALITY OF HEALTHCARE. ACCREDITATION THROUGH THE JOINT COMMISSION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY, AS IT REQUIRES RIGOROUS PERFORMANCE STANDARDS. TO EARN AND MAINTAIN ACCREDITATION, THE HOSPITAL IS EVALUATED THROUGH AN UNANNOUNCED SURVEY PROCESS COVERING NEARLY 600 STANDARDS RELATED TO QUALITY PATIENT CARE, SAFETY, INFECTION CONTROL, AND ONGOING PERFORMANCE-IMPROVEMENT ACTIVITIES, AMONG OTHERS. ALL HOSPITALS SURVEYED BY THE JOINT COMMISSION ARE EVALUATED AGAINST THE SAME CRITERIA, REGARDLESS OF SIZE OR LOCATION.THE ACTIVITIES OF THE RICHLAND HOSPITAL, INC. ARE SUPPORTED LOCALLY BY A VOLUNTEER BOARD OF DIRECTORS WHICH OVERSEE THE OPERATIONS OF THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS THAT RESIDE IN RICHLAND CENTER, WI, AND THE SURROUNDING AREA WHICH IS THE HOSPITAL'S PRIMARY PATIENT SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO A MAJORITY OF ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS WHO WISH TO BETTER SERVE THEIR PATIENTS BY PROVIDING CARE AT THE RICHLAND HOSPITAL, INC.ANY SURPLUSES IN OPERATIONS THAT ARE ACHIEVED BY THE HOSPITAL OPERATING IN AN EFFECTIVE MANNER AND CONTROLLING THE COST OF HEALTHCARE ARE PRIMARILY RESERVED FOR FUTURE BUILDING AND CAPITAL PURCHASE NEEDS. THE RICHLAND HOSPITAL, INC. RECOGNIZES THAT IT IS IMPORTANT TO SAVE THESE RESERVES DURING YEARS OF SURPLUS SO THAT IN TIMES OF ECONOMIC DOWNTURN, IF A LARGE CAPITAL ADDITION IS NEEDED, THE HOSPITAL WILL NOT HAVE TO PASS HIGHER COSTS ON TO MEMBERS OF THE COMMUNITY. THE HOSPITAL FURTHER ACHIEVES ITS GOAL OF PROVIDING TRUE COMMUNITY SUPPORT BY PROVIDING CHARITY CARE AS DESCRIBED THROUGHOUT SCHEDULE H AND PROVIDING SERVICES TO MEMBERS OF OTHER PROGRAMS WHICH OFTEN REIMBURSE THE HOSPITAL BELOW THE COST OF PROVIDING THIS CARE SUCH AS CHAMPUS, TRICARE, AND THE WISCONSIN HEALTH INSURANCE RISK SHARING PROGRAM OR "HIRSP" (THE HIRSP PROGRAM REIMBURSES THE HOSPITAL AT RATES SIMILAR TO THE MEDICAID PROGRAM AND IS FOR PATIENTS THAT HAVE PRE-EXISTING ILLNESSES WHICH MAKE IT DIFFICULT TO OBTAIN INSURANCE FROM COMMERCIAL INSURANCE CARRIERS IN THE MARKETPLACE).
PART III, LINE 2:	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, EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE CONSOLIDATED FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
PART III, LINE 3:	MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE 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 HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTS PATIENTS WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.
PART III, LINE 4:	IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8:	THE RICHLAND HOSPITAL, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND, AS SUCH, A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES ONLY A PORTION OF THE TOTAL MEDICARE REVENUE OF THE HOSPITAL. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, RADIOLOGIST SERVICES, AND SURGICAL ANESTHESIA SERVICES AT THE RICHLAND HOSPITAL, INC. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND, AS SUCH, THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE RICHLAND HOSPITAL, INC. PROVIDES TO THE COMMUNITIES IT SERVES. THE COSTING METHOD USED ABOVE FOR IRS FORM 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 REVENUE (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 III, LINE 9B:	AT THE TIME OF PATIENT PRESENTATION, THE RICHLAND HOSPITAL, INC. WILL GATHER DEMOGRAPHIC AND INSURANCE INFORMATION THAT SUPPORTS THE TIMELY GENERATION AND RELEASE OF INSURANCE CLAIM FORMS AND /OR SELF-PAY STATEMENTS FOR SERVICES RENDERED. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, THE RICHLAND HOSPITAL, INC. MAY TAKE ANY AND ALL LEGAL ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS (ECA'S), TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED. THE RICHLAND HOSPITAL, INC. WILL NOT ENGAGE IN ECA'S, EITHER DIRECTLY OR BY ANY DEBT COLLECTIONS AGENCY OR OTHER PARTY TO WHICH THE HOSPITAL HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL^) IS ELIGIBLE FOR ASSISTANCE UNDER THE COMMUNITY CARE PROGRAM, FINANCIAL ASSISTANCE POLICY. AT THE POINT A RESPONSIBLE INDIVIDUAL REQUESTS A COMMUNITY CARE PROGRAM APPLICATION, THE ABOVE PROCEDURE WILL CEASE, AND THE FOLLOWING PROCEDURE WILL TAKE EFFECT.UPON REQUEST, A COMMUNITY CARE PROGRAM APPLICATION WILL BE SENT/GIVEN TO THE RESPONSIBLE INDIVIDUAL ALONG WITH A COVER LETTER DETAILING DOCUMENTATION REQUIRED TO PROCESS THE APPLICATION.APPLICATION MUST BE RETURNED WITHIN 30 DAYS FROM THE DATE THE RESPONSIBLE INDIVIDUAL IS GIVEN OR MAILED THE APPLICATION.IF INCOMPLETE OR INSUFFICIENT DOCUMENTATION IS RECEIVED, RESPONSIBLE INDIVIDUAL WILL BE NOTIFIED IN WRITING OF THE MISSING OR INCOMPLETE DOCUMENTATION. RESPONSIBLE INDIVIDUAL WILL HAVE 30 DAYS FROM THE DATE OF THE NOTIFICATION TO PROVIDE THE MISSING INFORMATION OR DOCUMENTATION. FAILURE TO SUBMIT A COMPLETED APPLICATION OR SUBSEQUENTLY REQUESTED DOCUMENTATION WITHIN 30 DAYS MAY RESULT IN THE APPLICATION BEING DENIED, THE ACCOUNT BEING REFERRED TO AN EXTERNAL COLLECTION AGENCY AND ECA'S MAY COMMENCE. IF A COMMUNITY CARE PROGRAM APPLICATION IS RECEIVED AFTER AN ACCOUNT HAS BEEN REFERRED TO AN EXTERNAL COLLECTION AGENCY, BUT PRIOR TO 240 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT, THE EXTERNAL COLLECTION AGENCY WILL BE INSTRUCTED TO DISCONTINUE COLLECTION ACTIVITY UNTIL THE COMMUNITY CARE PROGRAM APPLICATION HAS BEEN PROCESSED. IF THE APPLICATION IS APPROVED FOR A FULL OR PARTIAL DISCOUNT, THE EXTERNAL COLLECTION AGENCY WILL BE NOTIFIED AND INSTRUCTED TO REMOVE OR REVERSE ANY ECAS THAT MAY HAVE BEEN TAKEN AND THE ACCOUNT WILL BE REFERRED BACK TO THE RICHLAND HOSPITAL, INC.RESPONSIBLE INDIVIDUALS APPROVED FOR A PARTIAL DISCOUNT WILL BE NOTIFIED IN WRITING OF THEIR APPROVAL FOR A PARTIAL DISCOUNT AND AN UPDATED STATEMENT REFLECTING THE NEW DISCOUNTED AMOUNT DUE WILL BE INCLUDED. RESPONSIBLE INDIVIDUALS DETERMINED TO BE INELIGIBLE FOR A COMMUNITY CARE PROGRAM DISCOUNT WILL BE NOTIFIED IN WRITING OF THEIR INELIGIBILITY. THE NOTIFICATION TO RESPONSIBLE INDIVIDUALS DETERMINED TO BE INELIGIBLE FOR A COMMUNITY CARE PROGRAM DISCOUNT OR ELIGIBLE FOR A PARTIAL DISCOUNT WILL INCLUDE A PAYMENT PLAN AGREEMENT. RESPONSIBLE INDIVIDUAL WILL BE PROVIDED 30 DAYS TO COMPLETE AND RETURN THE PAYMENT PLAN AGREEMENT. FAILURE TO RETURN A COMPLETED PAYMENT PLAN AGREEMENT WITHIN 30 DAYS COULD RESULT IN THE ACCOUNT BEING REFERRED TO AN EXTERNAL COLLECTION AGENCY AND ECAS MAY COMMENCE. HOSPITAL AND EXTERNAL COLLECTION AGENCIES MAY ALSO TAKE ANY AND ALL LEGAL ACTIONS INCLUDING BUT NOT LIMITED TO TELEPHONE CALLS, EMAILS, TEXTS, MAILING NOTICES AND SKIP TRACING TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED
PART VI, LINE 2:	IN ADDITION TO THE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2019, THE RICHLAND HOSPITAL, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES BY LOOKING AT LOCAL AND SURROUNDING COMMUNITY DEMOGRAPHICS TO DETERMINE THE SERVICES THAT ARE MOST NECESSARY IN ORDER TO FULFILL ITS MISSION. THE HOSPITAL ACTIVELY SEEKS INPUT FROM MEMBERS OF THE MEDICAL STAFF REGARDING EXISTING SERVICES, POTENTIAL NEED FOR EXPANDED SERVICES, AND THE POTENTIAL NEED FOR NEW SERVICE LINES NOT OFFERED LOCALLY. THE HOSPITAL MONITORS THE LOSS OF SPECIALTY PROVIDERS IN THE AREA AND, COLLABORATIVELY WORKING WITH OUR RURAL HEALTH CLINICS (RICHLAND HOSPITAL CLINIC, SPRING GREEN MEDICAL CENTER, AND MUSCODA HEALTH CENTER), PARTICIPATES IN A DETERMINATION OF WHETHER AND HOW THIS NEW NEED CAN BEST BE MET. A RECENT EXAMPLE WAS THE IMPENDING LOSS OF A GENERAL SURGEON DUE TO RETIREMENT. THE HOSPITAL ALSO REVIEWS HOSPITAL STATISTICS OF PATIENT VISITS TO DETERMINE WHAT TYPES OF SERVICES OFFERED BY THE HOSPITAL ARE BEING UTILIZED.
PART VI, LINE 3:	CONSISTENT WITH THE MISSION OF THE RICHLAND HOSPITAL, INC., HEALTH-RELATED SERVICES ARE PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL IS COMMITTED TO PROVIDING FREE OR DISCOUNTED CARE TO QUALIFIED INDIVIDUALS THAT ARE IN NEED OF MEDICALLY NECESSARY TREATMENT EVEN IF THAT PERSON IS UNINSURED, UNDERINSURED, INELIGIBLE FOR OTHER GOVERNMENT PROGRAMS, OR UNABLE TO PAY BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. WHEN AN UNINSURED OR UNDERINSURED PATIENT REQUESTS FINANCIAL ASSISTANCE AND HAS AN ADJUSTED GROSS INCOME THAT IS AT OR BELOW 150% OF THE FEDERAL POVERTY LEVEL, THEY ARE ELIGIBLE FOR A 100% DISCOUNT ON ANY PATIENT BALANCE. WHEN AN UNINSURED PATIENT'S ADJUSTED GROSS INCOME IS 151 TO 300% OF THE FEDERAL POVERTY LEVEL, THEY ARE PROVIDED CARE AT THE AMOUNT GENERALLY BILLED OR LESS. FOR UNDERINSURED PATIENTS WITH AN ADJUSTED GROSS INCOME OF 151 TO 300%, THE AMOUNT PATIENT IS CHARGED AND RESPONSIBLE FOR PAYING (CO-INSURANCE, DEDUCTIBLES, ETC.) AFTER APPLYING DEDUCTIONS, DISCOUNTS AND PAYMENTS APPLIED BY THE THIRD PARTY PAYER WILL NOT BE GREATER THAN THE AGB. TO BE ELIGIBLE UNDER THIS PROGRAM, PATIENTS MUST COOPERATE WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE AND IF NECESSARY, INCLUDING APPLICATION OR ACTIONS NEEDED TO SECURE COVERAGE BY MEDICARE, MEDICAID, AND THE MARKETPLACE. PATIENTS WILL BE REQUIRED TO PROVIDE NECESSARY INFORMATION AND DOCUMENTATION WHEN APPLYING FOR A PROGRAM DISCOUNT, OR FOR OTHER PRIVATE OR PUBLIC PAYMENT PROGRAMS. THE FACILITY'S FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS WITH THE APPLICATION PROCESS. APPLICATIONS AND ALL SUPPORTING DOCUMENTATION IS REVIEWED BY THE FACILITY'S FINANCIAL COUNSELOR FOR ELIGIBILITY AND APPROVED BY THE PATIENT ACCOUNTING SUPERVISOR. FREE RADIOLOGY, LABORATORY, AND OTHER DIAGNOSTIC ANCILLARY SERVICES ARE ALSO PROVIDED TO PATIENTS WHO ARE REFERRED TO THE HOSPITAL BY THE RICHLAND CENTER FREE CLINIC. THE HOSPITAL ALSO OFFERS A 20% PROMPT PAY DISCOUNT FOR UNINSURED PATIENTS.THE RICHLAND HOSPITAL, INC. COMMUNICATES THE AVAILABILITY AND TERMS OF THE PROGRAM TO ALL PATIENTS, THROUGH MEANS WHICH INCLUDE, BUT ARE NOT LIMITED TO:1. POSTED SIGNS WITHIN WAITING ROOMS, EMERGENCY ROOMS, AND PATIENT ACCOUNTING AREAS.2. COMMUNITY CARE PROGRAM APPLICATION AND PLAIN LANGUAGE SUMMARY OFFERED TO INDIVIDUALS AT TIME OF REGISTRATION AND DISCHARGE FROM AN INPATIENT ADMISSION. THE COMMUNITY CARE PROGRAM POLICY, COMMUNITY CARE PROGRAM APPLICATION AND THE PLACEMENT FOR COLLECTION POLICY ARE AVAILABLE UPON REQUEST. SPANISH VERSIONS WILL ALSO BE AVAILABLE UPON REQUEST.3. PLAIN LANGUAGE SUMMARY, COMMUNITY CARE PROGRAM POLICY, COMMUNITY CARE PROGRAM APPLICATION AND PLACEMENT FOR COLLECTIONS POLICY INCLUDING SPANISH VERSIONS CAN BE OBTAINED BY:A. REQUESTING IN PERSON AT THE RICHLAND HOSPITAL, INC., RICHLAND HOSPITAL CLINIC, SPRING GREEN MEDICAL CENTER AND MUSCODA HEALTH CENTERB. CONTACTING THE RICHLAND HOSPITAL, INC. PATIENT ACCOUNTING DEPARTMENT AT 608-647-6321.C. ACCESSING THE RICHLAND HOSPITAL, INC. WEBSITE D. SUBMITTING A WRITTEN REQUEST TO THE RICHLAND HOSPITAL, INC.4. PLAIN LANGUAGE SUMMARY PROVIDED WITH WRITTEN CORRESPONDENCE.5. CONSPICUOUS MESSAGE ON PATIENT STATEMENTS.6. PLAIN LANGUAGE SUMMARY AVAILABLE AT THE LOCAL AGING AND DISABILITY RESOURCE CENTER AND AT THE RICHLAND COMMUNITY FREE CLINIC.7. DESIGNATED STAFF KNOWLEDGEABLE ON THE PROGRAM WILL BE AVAILABLE TO ANSWER PATIENT QUESTIONS AND/OR REFER PATIENTS TO THE PROGRAM.REGISTRATION CLERKS AT THE HOSPITAL, THE HOSPITAL CLINIC AND AT THE TWO HOSPITAL OWNED CLINICS, ARE TRAINED TO INQUIRE WITH PATIENTS UPON REGISTRATION IF THEY WOULD LIKE INFORMATION ON THIS PROGRAM. DURING THE COLLECTION PROCESS, THE RICHLAND HOSPITAL PROVIDES INFORMATION AND INCLUDES COMMUNITY CARE PROGRAM MATERIALS WITH CORRESPONDENCE. SOCIAL SERVICES AND BUSINESS OFFICE STAFF AT THE HOSPITAL ARE ALSO AVAILABLE TO PROVIDE INFORMATION TO PATIENTS ON OTHER GOVERNMENT PROGRAMS SUCH AS THE MEDICAID PROGRAM OR TO REFER PATIENTS TO PERSONNEL AT RICHLAND COUNTY OR OTHER STATE OF WISCONSIN OR COUNTY AGENCIES THAT MAY PROVIDE ACCESS TO CARE.
PART VI, LINE 4:	THE RICHLAND HOSPITAL, INC. IS LOCATED IN RICHLAND CENTER, WISCONSIN, WHICH IS A COMMUNITY OF APPROXIMATELY 5,000 PEOPLE AND IS LOCATED 50 MINUTES FROM MADISON, WISCONSIN. THE 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 SPECIALTY SERVICES, WHICH INCLUDE: AUDIOLOGY, CARDIOLOGY, ORTHOPEDICS, CHEMOTHERAPY, CLINICAL SERVICES, AMONG OTHERS. CARE IS OFFERED TO PATIENTS REGARDLESS OF PAY SOURCE AND REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COMMUNITIES SERVED BY THE RICHLAND HOSPITAL ARE DEFINED BY THE FOLLOWING ZIP CODES: 53506 - AVOCA53556 - LONE ROCK53518 - BLUE RIVER53573 - MUSCODA53581 - RICHLAND CENTER53588 - SPRING GREENTHEY ARE GEOGRAPHICALLY CONTIGUOUS COMMUNITIES. ACCORDING TO 2018 DATA PUBLISHED BY INTELLIMED, THE RICHLAND HOSPITAL, INC. HAD AN OVERALL INPATIENT MARKET SHARE OF 40.7 PERCENT AND OUTPATIENT MARKET SHARE OF 35.02 PERCENT IN THESE ZIP CODES. NO OTHER HEALTHCARE PROVIDER PROVIDING THE SAME SERVICES HAD A MARKET SHARE AS HIGH AS OR HIGHER THAN THE RICHLAND HOSPITAL, INC. (INTELLIMED COMBINES STATEWIDE HEALTHCARE DATA FROM WISCONSIN HOSPITAL ASSOCIATION IN A WEB-BASED SUPPORT ENGINE THAT ALLOWS US TO ANALYZE OUR MARKET.)SOCIO-DEMOGRAPHIC PROFILE OF THE MARKET AREA SERVED BY THE RICHLAND HOSPITAL, INC. SERVES PERSONS WHO ARE REPRESENTATIVE OF THE POPULATION OF THE MARKET AREA. A HIGHER PERCENTAGE OF THE POPULATION SERVED IS ELDERLY; THIS IS DUE TO THE FACT THAT PERSONS 65 YEARS OF AGE AND OLDER ARE HOSPITALIZED AT NEARLY THREE TIMES THE OVERALL RATE. SOME THINGS TO NOTE RELATED TO PLANNING FOR MEETING COMMUNITY HEALTH NEEDS INCLUDES THE FOLLOWING:- THE OVERALL POPULATION OF THE MARKET AREA IS PROJECTED TO REMAIN VERY STABLE, WITH NEGLIGIBLE GROWTH OR DECLINE PROJECTED OVER THE NEXT FIVE YEARS.- THE RESIDENTS OF THE MARKET AREA ARE AGING SIGNIFICANTLY. THERE IS A PROJECTED 29.2% GROWTH IN THE POPULATION AGED 75 TO 79 AND A PROJECTED 14.0% GROWTH IN THE POPULATION AGED 80-84. THERE IS A CORRESPONDING 20.6% PROJECTED DECLINE IN THE 25 TO 29 YEAR OLD POPULATION, 15.2 PERCENT DECLINE IN THE 55-59 YEAR OLD POPULATION AND 12.6 PERCENT DECLINE IN 20 TO 24 YEAR OLD POPULATION. PERSONS IN THE 0 TO 14 AGE GROUP ARE ALSO PROJECTED TO DECREASE BY 3.5%.DURING 2019, MEDICARE AND MEDICARE ADVANTAGE PLAN BENEFICIARIES ACCOUNTED FOR OVER 56 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE AT THE RICHLAND HOSPITAL, INC. AND MEDICAID BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 13 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE. MEDICARE AND MEDICAID BENEFICIARIES MADE UP THE LARGEST PORTION OF PATIENTS THAT ARE SERVED BY THE RICHLAND HOSPITAL, INC. OVER THE PREVIOUS FEW YEARS.
PART VI, LINE 5:	THE RICHLAND HOSPITAL, INC. IS ACCREDITED THROUGH THE JOINT COMMISSION ("TJC"). THE TJC IS AN ORGANIZATION THAT EVALUATES HOSPITAL PERFORMANCE STANDARDS, FOCUSING ON THE QUALITY OF HEALTHCARE. ACCREDITATION THROUGH THE JOINT COMMISSION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY, AS IT REQUIRES RIGOROUS PERFORMANCE STANDARDS. TO EARN AND MAINTAIN ACCREDITATION, THE HOSPITAL IS EVALUATED THROUGH AN UNANNOUNCED SURVEY PROCESS COVERING NEARLY 600 STANDARDS RELATED TO QUALITY PATIENT CARE, SAFETY, INFECTION CONTROL, AND ONGOING PERFORMANCE-IMPROVEMENT ACTIVITIES, AMONG OTHERS. ALL HOSPITALS SURVEYED BY THE JOINT COMMISSION ARE EVALUATED AGAINST THE SAME CRITERIA, REGARDLESS OF SIZE OR LOCATION.THE ACTIVITIES OF THE RICHLAND HOSPITAL, INC. ARE SUPPORTED LOCALLY BY A VOLUNTEER BOARD OF DIRECTORS WHICH OVERSEE THE OPERATIONS OF THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS THAT RESIDE IN RICHLAND CENTER, WI, AND THE SURROUNDING AREA WHICH IS THE HOSPITAL'S PRIMARY PATIENT SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO A MAJORITY OF ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS WHO WISH TO BETTER SERVE THEIR PATIENTS BY PROVIDING CARE AT THE RICHLAND HOSPITAL, INC.ANY SURPLUSES IN OPERATIONS THAT ARE ACHIEVED BY THE HOSPITAL OPERATING IN AN EFFECTIVE MANNER AND CONTROLLING THE COST OF HEALTHCARE ARE PRIMARILY RESERVED FOR FUTURE BUILDING AND CAPITAL PURCHASE NEEDS. THE RICHLAND HOSPITAL, INC. RECOGNIZES THAT IT IS IMPORTANT TO SAVE THESE RESERVES DURING YEARS OF SURPLUS SO THAT IN TIMES OF ECONOMIC DOWNTURN, IF A LARGE CAPITAL ADDITION IS NEEDED, THE HOSPITAL WILL NOT HAVE TO PASS HIGHER COSTS ON TO MEMBERS OF THE COMMUNITY. THE HOSPITAL FURTHER ACHIEVES ITS GOAL OF PROVIDING TRUE COMMUNITY SUPPORT BY PROVIDING CHARITY CARE AS DESCRIBED THROUGHOUT SCHEDULE H AND PROVIDING SERVICES TO MEMBERS OF OTHER PROGRAMS WHICH OFTEN REIMBURSE THE HOSPITAL BELOW THE COST OF PROVIDING THIS CARE SUCH AS CHAMPUS, TRICARE, AND THE WISCONSIN HEALTH INSURANCE RISK SHARING PROGRAM OR "HIRSP" (THE HIRSP PROGRAM REIMBURSES THE HOSPITAL AT RATES SIMILAR TO THE MEDICAID PROGRAM AND IS FOR PATIENTS THAT HAVE PRE-EXISTING ILLNESSES WHICH MAKE IT DIFFICULT TO OBTAIN INSURANCE FROM COMMERCIAL INSURANCE CARRIERS IN THE MARKETPLACE).
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
THOMAS BECK
ORTHOPEDIC SURGEON	$445,056	$0	$125,100	$0	$3,853	$0	$11,600	$0	$17,315	$0	$602,924	$0	$0	$0
ANDREW WRIGHT
FAMILY DOCTOR	$278,186	$0	$93,057	$0	$3,320	$0	$11,600	$0	$33,442	$0	$419,605	$0	$0	$0
BRYAN MCCARVEL
CRNA	$385,310	$0	$5,000	$0	$1,920	$0	$0	$0	$10,774	$0	$403,004	$0	$0	$0
ANDREW HARRIS
ER MD DOCTOR	$341,883	$0	$0	$0	$3,853	$0	$11,600	$0	$39,576	$0	$396,912	$0	$0	$0
SHAWN O' BRIEN
EMERGENCY PHYSICIAN	$329,726	$0	$12,500	$0	$2,463	$0	$7,126	$0	$39,462	$0	$391,277	$0	$0	$0
BRUCE ROESLER
CEO	$288,533	$0	$28,500	$0	$3,717	$0	$11,600	$0	$30,387	$0	$362,737	$0	$0	$0
CHRISTINE RICHARDS MD
CHIEF OF STAFF	$204,303	$0	$95,935	$0	$2,757	$0	$11,600	$0	$17,144	$0	$331,739	$0	$0	$0
KAY BALINK MD
DIRECTOR (& EMPLOYEE)	$147,703	$0	$39,075	$0	$2,223	$0	$7,821	$0	$32,345	$0	$229,167	$0	$0	$0
JEFFERY LONGBRAKE
INTERIM CFO (THRU AUG)	$190,590	$0	$0	$0	$0	$0	$0	$0	$0	$0	$190,590	$0	$0	$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11B	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, AND KEY EMPLOYEES 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 15	THE BOARD OF DIRECTORS HAS AN ESTABLISHED PROCESS TO ANNUALLY REVIEW THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND TO DEFINE APPROPRIATE MARKET AND PERFORMANCE-BASED ADJUSTMENTS. COMPARATIVE DATA IS OBTAINED FROM EITHER THE WISCONSIN HOSPITAL ASSOCIATION EXECUTIVE COMPENSATION SURVEY OR OTHER REPUTABLE THIRD-PARTY HEALTHCARE DATA SOURCES TO USE IN THE ESTABLISHMENT OF A MARKET FOR THIS KEY POSITION. THE PERSONNEL COMMITTEE OF THE BOARD OF DIRECTORS FULFILLS THIS ROLE. THE BOARD OF DIRECTORS HAS DELEGATED THE AUTHORITY AND RESPONSIBILITY FOR THE ONGOING MAINTENANCE OF OTHER KEY EMPLOYEES AND THE OVERALL ORGANIZATIONAL COMPENSATION MODEL TO THE CHIEF EXECUTIVE OFFICER AND HUMAN RESOURCE DIRECTOR. COMPARATIVE 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 VII, SECTION A	CHRISTINE RICHARDS IS ON THE BOARD OF DIRECTORS AS A VOTING MEMBER, SHE IS ALSO CONSIDERED A FULL TIME EMPLOYEE AS CHIEF OF STAFF. THEIR COMPENSATION REPORTED IN PART VII, SECTION A REFLECTS THEIR ROLE AS CHIEF OF STAFF. $11,700 IS TOWARDS HER ROLE THAT DOES INCLUDE CERTAIN BOARD DUTIES. KAY BALINK IS ALSO ON THE BOARD OF DIRECTORS. THE COMPENSATION REPORTED REFLECTS ONLY HER ROLE AS AN EMPLOYEE AND SHE RECEIVES NO COMPENSATION FOR HER TIME DEVOTED TO THE BOARD OF DIRECTORS.
FORM 990, PART IX, LINE 11G	OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,116,763. MANAGEMENT AND GENERAL EXPENSES 1,621,813. FUNDRAISING EXPENSES 1,239. TOTAL EXPENSES 2,739,815. MEDICAL IMAGING PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,782,265. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,782,265. CLINICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 93,550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,550. LABORATORY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 544,310. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 544,310. SURGICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 117,940. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,940. HOSPITALIST PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 845,692. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 845,692. BEHAVIORAL HEALTH PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 555,395. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 555,395.
FORM 990, PART XI, LINE 9:	NET CHANGE IN RESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS 109,762. NET CHANGE IN UNRESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS -468,538. INCREASE IN EQUITY OF UNCONSOLIDATED AFFILIATE 532,416.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd
RICHLAND HOSPITAL FOUNDATION INC
333 EAST SECOND STREET	RICHLAND CENTER	WI	53581	391567249	FOUNDATION	WI	501(C)(3)	LINE 7	N/A	0
PARTNERS OF RICHLAND HOSPITAL INC
333 EAST SECOND STREET	RICHLAND CENTER	WI	53581	391693458	AUXILIARY	WI	501(C)(3)	LINE 10	N/A	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	RICHLAND HOSPITAL FOUNDATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Transaction Type	C	TransactionTypeTxt
Involved	$105,810	InvolvedAmt
Method Of Amount Determination	CASH	MethodOfAmountDeterminationTxt