2019-11-15T09:12:54-06:00 2018-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2018-01-01 390808498 THE RICHLAND HOSPITAL INC RICH 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 BRUCE ROESLER CHIEF EXECUTIVE OFFICER 6086476321 2019-11-11 1 PAUL M TRACZEK CPA P01368830 7158323407 2019-11-11 137.26.200.211 2019-11-11 11:18:15 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2F3CDBAF1037015F68690DD19EBC2430D808C728 2018 2020-03-31 21:24:44Z BRUCE ROESLER 333 EAST SECOND STREET RICHLAND CENTER WI 53581 53142832 0 X WWW.RICHLANDHOSPITAL.COM X 1937 WI THE RICHLAND HOSPITAL, INC. IS DEDICATED TO CARING, EDUCATING, AND HEALING. 10 9 362 145 4247 -11548 274914 45741 42506335 42063889 1625531 587578 -273487 -304705 44133293 42392503 26042 58496 0 0 22753517 23767378 0 0 136011 17996267 16739737 40775826 40565611 3357467 1826892 66813200 69069702 3993772 4864419 62819428 64205283 X THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S FIRST CHOICE FOR BETTER HEATH. 0 0 32578672 58496 39815516 THE RICHLAND HOSPITAL, INC. (THE HOSPITAL) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN RICHLAND CENTER, WI. PATIENTS SERVED BY THE HOSPITAL IN 2018 INCLUDED 3,315 ADULTS AND PEDIATRICS INPATIENT DAYS, 503 SWING BED PATIENT DAYS, 242 NEWBORN PATIENT DAYS, 41,996 TOTAL OUTPATIENT VISITS, AND 6,144 EMERGENCY ROOM VISITS. AS A PART OF THE HOSPITAL'S MISSION AND IN KEEPING WITH ITS STATUS AS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, THE HOSPITAL HAS ESTABLISHED A COMMUNITY (CHARITY) CARE POLICY THAT SETS FORWARD THE CRITERIA BY WHICH A PATIENT MAY QUALIFY TO RECEIVE CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. IN THE CURRENT YEAR, THE TOTAL HEALTHCARE SERVICES PROVIDED TO PATIENTS UNDER THE COMMUNITY CARE POLICY HAS BEEN MEASURED IN BOTH TOTAL CHARGES AND AT THE ESTIMATED COST OF PROVIDING CARE TO PATIENTS UNDER THE COMMUNITY CARE POLICY. BOTH FIGURES ARE REPORTED AND AVAILABLE BY REFERRING TO SCHEDULE H. IN ADDITION, THE HOSPITAL IS A PROVIDER UNDER THE WISCONSIN MEDICAID PROGRAM. UNDER THIS PROGRAM, THE HOSPITAL IS LEGALLY BOUND TO ACCEPT THE AMOUNT DETERMINED BY THE STATE OF WISCONSIN AS PAYMENT IN FULL FOR EACH PATIENT'S CHARGES EVEN THOUGH REIMBURSEMENT IS LESS THAN THE COST TO PROVIDE THE CARE; THEREFORE, SERVICE TO PATIENTS UNDER THIS PROGRAM SHOULD ALSO BE CONSIDERED PART OF THE ORGANIZATION'S BENEFIT PROVIDED TO THE COMMUNITY. (FOR ADDITIONAL INFORMATION ON THE HOSPITAL'S CHARITY CARE PROGRAM AND PRACTICES AND COST OF PARTICIPATION IN THE WISCONSIN MEDICAID PROGRAM, PLEASE REFER TO SCHEDULE H OF THE FORM 990.) THE HOSPITAL ALSO ENGAGES IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES THAT WOULD NOT OTHERWISE, WITHOUT THE EFFORTS AND SPECIALIZED KNOWLEDGE OF THE LOCAL HOSPITAL, BE PROVIDED FOR THE BENEFIT OF THE RESIDENTS OF RICHLAND CENTER, WISCONSIN AND THE SURROUNDING COMMUNITIES. IN 2018, THE HOSPITAL HOSTED HEALTH FAIRS, PARTICIPATED IN LOCAL WELLNESS EVENTS, CONDUCTED EDUCATIONAL SEMINARS, AND PROVIDED INFORMATIONAL PACKETS FOR MEMBERS OF OUR COMMUNITY. OUR TARGET AUDIENCE INCLUDED COMMUNITY MEMBERS OF ALL AGES AND ETHNICITY, MALES, FEMALES, AFFLUENT, AND UNDERSERVED.THE HOSPITAL SUPPORTED SOUTHWEST PARTNERS, A COMMUNITY GROUP COMMITTED TO CREATING OPPORTUNITIES TO ENJOY THE BEAUTIFUL OUTDOORS, SUPPORTING GREAT SCHOOLS, SUPPORTING STRONG BUSINESSES, AND BRINGING INDIVIDUALS TOGETHER. PROJECTS THAT THEY ARE WORKING ON THAT SUPPORT IMPROVED MENTAL HEALTH AND WELLBEING, A DEFINED UNMET NEED FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), FALL UNDER TWO SUBGROUPS. 1. CAREER EDUCATION COOPERATIVE - TO CREATE A REGIONAL SCHOOL-TO-CAREER PATHWAY THAT PREPARES STUDENTS FOR LIVING WAGE CAREER OPPORTUNITIES, EDUCATIONAL GROWTH AND GOOD CITIZENSHIP. IN 2017, THE PROGRAM WAS SUPPORTED WITH RESOURCES THAT INCLUDED STAFF TIME AND TALENT. 2. PINE RIVER TRAILS PROJECTS RICHLAND HOSPITAL EMPLOYEES SERVE AS VOICES ON GROUPS THAT HAVE A FOCUS ON INCREASING PHYSICAL ACTIVITY AND POSITIVELY INFLUENCING HEALTH.A. CANOE AND KAYAKING THE PINE B. BIKING RICHLAND COUNTY C. SNOWSHOE AND CROSS COUNTRY SKI D. SAFE WAYS TO SCHOOLE. COMMUNITY PROSPERITY ALLIANCE WORKS TO SUSTAIN AND IMPROVE THE QUALITY OF LIFE WITH A MISSION TO CREATE A CULTURE OF OPPORTUNITY, OPTIMISM, AND PROSPERITY IN SOUTHWEST WISCONSIN. IN ADDITION, THE HOSPITAL HAS STARTED COMMUNITY AND ECONOMIC DEVELOPMENT CONVERSATIONS AND WORK ACROSS RICHLAND, VERNON, IOWA, AND GRANT COUNTIES. THROUGH STAFF ACTIVITIES AND OTHER EFFORTS, THE HOSPITAL SUPPORTS THE RICHLAND COUNTY CHILDREN AND FAMILY ADVISORY COUNCIL (RCCFAC) WHO HAS ASSUMED THE RESPONSIBILITY TO ADDRESS THE 2016 CHNA PRIORITY: SUBSTANCE ABUSE TREATMENT AND PREVENTION. 1. A MEMBER OF THE RICHLAND HOSPITAL TEAM ACCOMPANIED RICHLAND COUNTY YOUTH TO A WISCONSIN YOUTH SUMMIT WHERE THE KIDS LEARNED HOW TO BEGIN TO CHANGE CULTURE AND ATTITUDES ABOUT SUBSTANCE USE. 2. RCCFAC CREATED 5 PILLARS TO ADDRESS SPECIFIC AREAS OF THE PRIORITY INCLUDING PREVENTION, LAW ENFORCEMENT, WORKPLACE, HARM REDUCTION, AND TREATMENT.3. RCCFAC PLANS TO HAVE RECOVERY HOUSES IN RICHLAND CENTER FOR MEN AND WOMEN THAT ARE PROACTIVE IN ASSISTING INDIVIDUALS IN THE TRANSITION FROM TREATMENT TO BECOMING RESPONSIBLE, PRODUCTIVE, SELF-SUFFICIENT MEMBERS OF SOCIETY. THE HOSPITAL JOINED SOUTHWEST WISCONSIN COMMUNITY ACTION BY SIGNING THE COMMUNITY COALITION PARTNERSHIP AGREEMENT ON MENTAL HEALTH. THE SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM, WORKING WITH A MULTI-SECTOR NETWORK OF COMMUNITY PARTNERS, HAS BEEN AWARDED FUNDING THROUGH THE ADVANCING A HEALTHIER WISCONSIN (AHW) ENDOWMENT AT THE MEDICAL COLLEGE OF WISCONSIN (MCW). THIS PROJECT WILL FOCUS ON COMMUNITY BASED BEHAVIORAL HEALTH IN IOWA, GRANT, GREEN LAFAYETTE AND RICHLAND COUNTIES AND WILL COLLABORATE WITH SEVERAL LOCAL COMMUNITY PARTNERS INCLUDING ALL SEVEN REGION HOSPITALS, ALL FIVE HEALTH DEPARTMENTS, MANY OTHER SOCIAL SERVICE, HEALTH CARE AND OTHER AGENCIES AND IN PARTNERSHIP WITH THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE. THE FIRST YEAR IS FOCUSED ON DEVELOPING IMPLEMENTATION PLANS WITH THE ULTIMATE OUTCOME OF A STATEWIDE IMPROVEMENT IN BEHAVIORAL HEALTH, IMPROVED PHYSICAL HEALTH AMONG THOSE WITH BEHAVIORAL HEALTH CONDITIONS, AND IMPROVED PREVENTION AND HEALTHCARE RESOURCES.THE BEHAVIORAL HEALTH PROBLEMS IN SOUTHWESTERN WISCONSIN SHOW UP IN MANY LOCATIONS INCLUDING EMERGENCY ROOMS, COUNTY JAILS, SCHOOLS, BUSINESSES, FOOD PANTRIES, CLINICS, ETC. AND HAVE A DETRIMENTAL EFFECT ON MANY LIVES. IN PARTICULAR IN THE SOUTHWESTERN COUNTIES OF WISCONSIN THERE IS A SIGNIFICANT PROBLEM IN THE LACK OF ALL TYPES OF MENTAL HEALTH PROVIDERS. ADDITIONALLY, THE HOSPITAL, RCCFAC, AND SWCAP BEGAN WORKING TO BRING A NAMI (NATIONAL ALLIANCE ON MENTAL ILLNESS) SUPPORT GROUP TO RICHLAND COUNTY. THE HOSPITAL HOSTED ONE LADIES HEALTH FAIR EVENT, A HEART HEALTH EVENT, AND A TODDLER WELLNESS EVENT IN RICHLAND CENTER. IN ADDITION, THE HOSPITAL HOSTED ONE LADIES NIGHT OUT IN MUSCODA. THE HOSPITAL CONTINUES TO SERVE AS THE LOCATION FOR SMART RECOVERY. THIS IS A FREE SUPPORT GROUP HELPING PEOPLE LEARN SELF-EMPOWERING TOOLS AND PROVIDING SUPPORT FOR EACH OTHER IN RECOVERY. THE GOAL OF SMART RECOVERY IS FOR YOU TO ACHIEVE A HEALTHY, POSITIVE, AND BALANCED LIFESTYLE SO YOU CAN CONQUER NEW CHALLENGES WHEN YOU FEEL CONFIDENT YOUR ADDICTIVE BEHAVIOR IS BEHIND YOU. EACH OF THE EVENTS WAS FREE TO ATTEND AND OPEN TO THE PUBLIC. ITEMS DONATED INCLUDED: STAFF TIME, MATERIALS, SPACE, GIVEAWAYS, AND/OR EQUIPMENT. ADDITIONALLY, THE HOSPITAL PARTICIPATED IN OTHER FREE EVENTS OPEN TO THE PUBLIC AND CONDUCTED SCREENINGS AND PROVIDED FREE HEALTH AND WELLNESS INFORMATION. THOSE EVENTS INCLUDE: RICHLAND COUNTY GARDEN EXPO, RICHLAND COUNTY FOOD PANTRY, RICHLAND COUNTY FAIR, SENIOR FEST, GREATER RICHLAND CANCER ELIMINATION WALK, RICHLAND ROCKS, AND WESTON HEALTH FAIR. THE HOSPITAL SAW AN AVERAGE OF 250 PEOPLE AT EACH OF THESE EVENTS. RICHLAND CENTER, WI IS PROUD TO BE THE HOME OF RICHLAND ROCKS! DESIGNED TO GET FAMILIES OUTSIDE AND MOVING, RICHLAND ROCKS HAD A TREMENDOUS 2017 THAT SAW MANY COMMUNITY MEMBERS EXPLORING OUR TOWN. INDIVIDUALS AND FAMILIES SEARCH FOR PAINTED ROCKS HIDDEN AROUND TOWN, ENCOURAGED TO KEEP THEM, OR HIDE THEM FOR OTHERS. THE HOSPITAL'S RESPIRATORY REHAB TEAM PROVIDED FOUR FREEDOM FROM SMOKING SESSIONS TO THE PUBLIC THAT, WERE PARTIALLY REIMBURSED BY AN AREA CHARITY, GREATER RICHLAND AREA CANCER ELIMINATION. IN RESPONSE TO REQUESTS TO LOCAL EMPLOYERS, THE HOSPITAL PROVIDED STAFF TIME, EDUCATIONAL MATERIALS, AND GIVEAWAYS AT NO CHARGE FOR EMPLOYEE HEALTH FAIRS FOR WISCONSIN MAXIMUM SECURITY PRISON IN BOSCOBEL, WI; RIVERDALE SCHOOL DISTRICT IN MUSCODA, WI; AND UW RICHLAND STUDENT WELCOME. AN AVERAGE OF 80 PEOPLE WERE HELPED BY HOSPITAL REPRESENTATIVES AT EACH EVENT. THE HOSPITAL PROVIDED SIX FREE BREASTFEEDING SUPPORT GROUPS, 12 FREE NEWBORN EDUCATION AND LABOR SUPPORT CLASSES, AND FREE E-CLASS OPTIONS FOR NEW AND EXPECTING PARENTS. THE HOSPITAL HOSTED 10 DIABETES SUPPORT GROUP MEETINGS. EDUCATIONAL MATERIALS WERE PROVIDED FREE OF CHARGE. HEALTHCARE PROFESSIONALS SPOKE TO THE PUBLIC AT COMMUNITY EVENTS THAT WERE FREE AND OPEN TO THE PUBLIC AND THEY PROVIDED INDIVIDUAL COUNSELING AS WELL TO HELP PEOPLE UNDERSTAND THE SERVICES AVAILABLE LOCALLY. SEE CONTINUATION LATER IN SCHEDULE O FOR REMAINING STATEMENT ON THE PROGRAM SERVICE ACCOMPLISHMENTS. 1523157 0 1669916 THE RICHLAND HOSPITAL, INC. ALSO OPERATES TWO RURAL HEALTH CLINICS LOCATED IN SPRING GREEN AND MUSCODA, WI. DURING 2018 THESE TWO CLINICS PROVIDED OVER 7,500 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. 34101829 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 46 0 362 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 WI X JEFF LONGBRAKE 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 DOROTHY BEHLING DIRECTOR 1.50 X 0 0 0 JENNY MYSZKOWSKI MD DIRECTOR 1.50 X 0 0 0 JERRY GANDER DIRECTOR 1.50 X 0 0 0 JERRY MCCAULEY DIRECTOR 1.50 X 0 0 0 TRACI PETERSON DIRECTOR 1.50 X 0 0 0 DAVID MAY MD CHIEF OF STAFF 2.00 X 11700 0 0 MARILYN RINEHART SECRETARY 2.00 X X 0 0 0 JOHN ANNEAR TREASURER 2.00 X X 0 0 0 JOHN POOLE VICE-CHAIR 2.00 X X 0 0 0 ROBERT NUGENT CHAIR 3.00 X X 0 0 0 KAREN TRAYNOR CFO 40.00 X 196653 0 13287 BRUCE ROESLER CEO 40.00 X 272332 0 44005 ANDREW HARRIS MD DOCTOR 41.00 X 360666 0 52385 BRIAN O'NEILL CRNA ANESTHETIST 44.00 X 305814 0 51469 BRYAN MCCARVEL ANESTHESIA DIRECTOR 40.00 X 360555 0 52840 JOSEPH SPENNETTA MD DOCTOR 34.00 X 322672 0 20433 MUHAMMAD KHAN MD ER PHYSICIAN 42.00 X 337645 0 49912 2168037 0 284331 24 0 1 0 RICHLAND MEDICAL CENTER LTD 301 EAST SECOND STREET RICHLAND CENTER WI 53581 PHYSICIANS/CLINIC MGMT SERVICES 1111265 RURAL PHYSICIANS GROUP-PANNU PLLC 10624 SEASTERN AVE HENDERSON NV 89052 HOSPITALIST-PHYSICIAN SERVICE 771947 RURAL WISCONSIN HEALTH COOPERATIVE 880 INDEPENDENCE LANE SAUK CITY WI 53583 LEGAL, CLINICAL & ADMIN RESOURCES 330433 PSYCHIATRIC MEDICAL CARE LLC 4322 HARDING PIKE 417 NASHVILLE TN 37205 PHYSICIAN-STAFF SERVICES 329298 MERITER LABORATORIES 36 SOUTH BROOKS ST MADISON WI 53715 LAB SERVICES 178408 6 15950 29791 45741 PATIENT SERVICE REVENUE 621990 41489679 41485432 4247 CONTRACTED THERAPY 621990 246563 246563 MEALS 722320 191621 191621 136026 136026 42063889 413065 413065 683391 988096 -304705 -304705 -304705 9911746 25000 9723207 39026 188539 -14026 174513 174513 42392503 41485432 4247 857083 X 58496 58496 537978 537978 17064794 14937857 2034249 92688 575714 503958 68629 3127 4413437 3863351 526114 23972 1175455 1000758 168487 6210 261397 261397 63870 63870 5421609 4471776 941833 8000 137808 700 137108 212800 99146 111955 1699 347877 347877 526177 467246 58931 53215 41751 11434 30 92594 69352 22957 285 1755487 1590228 165259 83097 83097 SUPPLIES 5991718 5211212 780506 EQUIPMENT RENTAL & MAIN 772109 766019 6090 BAD DEBT EXPENSE 601883 601883 DIETARY EXPENSE 250782 250782 167314 167314 40565611 34101829 6327771 136011 1085 1085 16563111 18490978 8341965 9668556 1621793 1682666 126191 166245 59772852 37119240 23761418 22653612 13501748 13679012 1030076 720105 1865813 2007443 66813200 69069702 3704108 4610325 88664 46649 201000 207445 3993772 4864419 X 62257030 63706359 502398 438924 60000 60000 62819428 64205283 66813200 69069702 X 1826892 -650484 209447 X 0 0 0 X 0 0 0 0 0 0 0 0 1 9618 9618 0 PART II-B, LINE 1: 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 $2,363 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 $3,058 OF THE FEES PAID BY THE HOSPITAL IN 2018 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 $4,197 OF THEIR MEMBERSHIP DUES IS DEVOTED TO LOBBYING AND ADVOCATION AT A NATIONAL LEVEL. 71496 920 72416 71787 709 -1000 71496 71880 907 -1000 71787 71176 704 71880 70473 703 71176 0.00000 0.82850 0.17150 0 0 941726 941726 42156604 24736556 17420048 609073 607507 1566 14423371 11298058 3125313 1642078 477119 1164959 22653612 DEFERRED COMPENSATION PLAN LIABILITY 207445 207445 42799669 1068468 1068468 41731201 661302 661302 42392503 40893328 988096 988096 39905232 660379 660379 40565611 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 988,096. NET ASSETS RELEASED FROM RESTRICTION 6,068. CHANGE IN NET ASSETS OF UNCONSOLIDATED AFFILIATES 74,304. PART XI, LINE 4B - OTHER ADJUSTMENTS: SCHOLARSHIP & GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENT 58,496. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 601,883. INVESTMENT INCOME RECORDED TO UNRESTRICTED NET ASSETS 923. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 988,096. PART XII, LINE 4B - OTHER ADJUSTMENTS: SCHOLARSHIP & GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENT 58,496. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 601,883. 1 1 X 1 X 1 X 1 1 1 0 1 1 514695 514695 0.01270 6227140 2625486 3601654 0.08880 6741835 2625486 4116349 0.10150 115497 27091 88406 0.00220 25657 25657 0.00060 5538708 3041870 2496838 0.06160 4933 4933 0.00010 5602 5602 0.00010 5690397 3068961 2621436 0.06460 12432232 5694447 6737785 0.16610 1909 1909 0.00000 3897 3897 0.00010 5806 5806 0.00010 0 290329 145165 16220239 16376399 -156160 X 0 1 1 THE RICHLAND HOSPITAL INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 WWW.RICHLANDHOSPITAL.COM 1045 X X X X THE RICHLAND HOSPITAL INC 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X HTTP://WWW.RICHLANDHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X SEE PART V, SECTION C, LINE 7D X 1 16 1 HTTP://WWW.RICHLANDHOSPITAL.COM/WP-CONTENT/UPLOADS/2016/12/RH-CHIP-2017-19- 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X SEE SCHEDULE O X SEE SCHEDULE O X X X X X X 1 X 0 X X X X 1 X 0 0 THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 5: IN 2016, 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. MARIANNE STANEK, RICHLAND COUNTY HEALTH AND HUMAN SERVICES - PUBLIC HEALTH, COUNTY HEALTH OFFICER3. CHELSEA WUNNICKE, UW EXTENSION, RICHLAND COUNTY FAMILY LIVING AGENT4. DR. DAVID MAY, RICHLAND HOSPITAL, MEDICAL STAFF, CHIEF OF STAFF5. 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, RICHLAND F.I.T. (FITNESS IN TOTAL) HEALTH AND WELLNESS COORDINATORDATA 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 7AHTTP://WWW.RICHLANDHOSPITAL.COM/WP-CONTENT/UPLOADS/2017/11/2016-CHNA_11.08.2016_WEB.PDFSCHEDULE H, PART V, LINE 7BHTTP://WWW.CO.RICHLAND.WI.US/DEPARTMENTS/HHS/PUBLICHEALTH/PDFS/RICHLAND%20COUNTY%20HEALTH%20NEEDS%20ASSESSMENT%20CHNA%202016.PDF; HTTP://RICHLAND.UWEX.EDU/2016/11/28/2016-RICHLAND-AREA-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-IS-NOW-AVAILABLE/ 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 2016 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 INCLUDED:1. MENTAL HEALTH2. SUBSTANCE ABUSE TREATMENT AND PREVENTION3. OVERWEIGHT / OBESITY TREATMENT AND PREVENTION1. TO ADDRESS MENTAL HEALTH NEEDS, RICHLAND HOSPITAL HAS MADE GROWING THE SENIOR LIFE SOLUTIONS PROGRAM A GOAL UNDER THE MENTAL HEALTH PRIORITY. IN 2017, THE PROGRAM CONTINUED TO GROW WITH THE PLAN TO ADD A SECOND TRACK IN 2018. ADDITIONALLY, RICHLAND HOSPITAL JOINED THE SOUTHWEST WISCONSIN COMMUNITY ACTION PROGRAM'S MENTAL HEALTH COALITION. THE AGING OF THE POPULATION IS SIGNIFICANT BECAUSE PERSONS IN THE AGE CATEGORIES THAT ARE GROWING FACE MORE CHALLENGES RELATED TO HEALTHCARE THAN YOUNGER POPULATIONS. IN THE OLDER POPULATION GROUPS, PERSONS VISIT PRIMARY CARE PHYSICIANS MORE FREQUENTLY AND HAVE HIGHER INCIDENT RATES OF HEART DISEASE, CANCER, AND RELATED ILLNESSES. THE ONSET OF CHRONIC DISEASES ARE HIGHER IN THIS AGE CATEGORY, E.G., ONSET OF DIABETES, COPD, OR HEART PROBLEMS, AND MUST BE MANAGED WITH ASSISTANCE FROM THE HEALTHCARE PROVIDERS FOR THE REMAINDER OF THE PERSON'S LIFE. IMPORTANT TO NOTE IS THAT AS A PERSON AGES, TRAVEL BECOMES MORE CHALLENGING, SO THE ABILITY TO GET AS MUCH OF THEIR HEALTHCARE NEEDS MET LOCALLY GROWS IN IMPORTANCE. HAVING VISITING SPECIALISTS, FOR EXAMPLE, ELIMINATES THE NEED FOR A TRIP TO A MAJOR MEDICAL CENTER FOR MANY. IN ADDITION, IT ENSURES THAT PERSONS GET THE CARE THAT THEY NEED. AN EXAMPLE OF A RECENT SERVICE ADDITION IS THE ADDITION OF SENIOR LIFE SOLUTIONS WHICH HAS BEEN WELL RECEIVED BY PATIENTS AND PHYSICIANS ALIKE. THE HOSPITAL CONTINUES TO MORE FULLY DEVELOP THE ELECTRONIC HEALTH RECORD SYSTEM (EHR) WITH ONE OF THE MAIN GOALS BEING IMPROVED ACCESS TO STRONG CLINICAL DOCUMENTATION INCLUDING PATIENT MEDICAL HISTORIES AS A MEANS TO SUPPORT A MORE EFFICIENT AND EFFECTIVE PATIENT EXPERIENCE. TRAINING OUR COMMUNITY MEMBERS TO USE AND ACCESS THEIR PERSONAL HEALTH INFORMATION THROUGH THE EHR PORTAL IS ANOTHER EXAMPLE OF THE HOSPITAL'S WORK TO IMPROVE OUR PATIENT'S HEALTH STATUS THROUGH ACCESS AND INFORMATION. IN TURN, THE ELECTRONIC HEALTH RECORD SYSTEM PROVIDES FOR A MORE COMPLETE MEDICAL HISTORY SHOULD THAT PATIENT REQUIRE TREATMENT AT OTHER HEALTHCARE FACILITIES. IN RESPONSE TO INCREASED PATIENT DEMANDS FOR ACCESS TO PRIMARY AMBULATORY CLINIC CARE, THE HOSPITAL COMPLETED CONSTRUCTION OF A REPLACEMENT CLINIC FACILITY IN MUSCODA, WISCONSIN IN 2012 AS A MEANS TO BETTER SERVE THE NEEDS OF THE PATIENTS IN MUSCODA AND THE SURROUNDING RURAL COMMUNITIES. 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. 2 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 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 -PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED -PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM -PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE CRIME VICTIMS ACT OR SEXUAL ASSAULT ACT -PATIENT 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. -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. 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, THE INTENSIVE CARE INPATIENT UNIT, AND THE OPERATION OF TWO RURAL HEALTH CLINICS. 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. 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 HEALTHCARE 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. 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. (RH) REGULARLY SERVES AS THE AREA'S RESOURCE FOR HEALTH AND WELLNESS INFORMATION. IT ENGAGES IN PROVIDING A VARIETY OF COMMUNITY BUILDING ACTIVITIES THAT WOULD OTHERWISE NOT BE PROVIDED WITHOUT THE EFFORTS AND SPECIALIZED KNOWLEDGE OF THOSE WORKING AT THE LOCAL COMMUNITY HOSPITAL. IN 2018, THE RICHLAND HOSPITAL PARTICIPATED IN THE FOLLOWING COMMUNITY BUILDING ACTIVITIES.1. RICHLAND HOSPITAL IS SUPPORTED RICHLAND FITNESS IN TOTAL (FIT). RICHLAND FIT PARTICIPATES IN THE HEALTHY WISCONSIN LEADERSHIP INSTITUTE (HWLI). WITH THE SUPPORT OF THE COALITION PARTNERS, RICHLAND FIT APPLIED AND WAS ACCEPTED FOR THE HWLI IN AN EFFORT TO MOVE TOWARDS A SUSTAINABLE MODEL TO CONTINUE ITS WORK. AFTER THE TWO YEAR PROCESS, RICHLAND FIT APPLIED AND WAS ACCEPTED AS PART OF THE HWLI COACH PROGRAM TO WORK FURTHER OBESITY PREVENTION AND TREATMENT NEEDS IN THE COMMUNITY MOVE 2016.2. RICHLAND HOSPITAL DIETITIANS SUPPORTED RICHLAND FITNESS IN TOTAL (FIT) WITH THEIR POINT OF PURCHASE PROGRAM. THIS REPRESENTED ONE OF SEVERAL FIT STRATEGIES ONGOING IN THE COUNTY SINCE 2012 WHEN A UW PARTNERSHIP PROGRAM GRANT WAS AWARDED. THE IDEA WAS TO PARTNER WITH FOOD SELLERS AND SERVERS TO CREATE AN ENVIRONMENT WHERE MAKING THE HEALTHY CHOICE WAS AN EASIER OPTION.3. THE RICHLAND HOSPITAL, IN PARTNERSHIP WITH METASTAR, INC. CONTINUED SUPPORT OF THE DIABETES PREVENTION AND SUPPORT PROGRAM PROVIDING 12 COMMUNITY WORKSHOPS IN 6 COMMUNITIES THROUGHOUT THE COUNTY. 79 RESIDENTS ATTENDED AT LEAST 3 SESSIONS (50%) OF THE PROGRAM.4. RICHLAND HOSPITAL ATHLETIC TRAINERS SUPPORTED EXISTING SUMMER FITNESS PROGRAMS AT RICHLAND CENTER HIGH SCHOOL AND RIVERDALE HIGH SCHOOL. THESE PROGRAMS WERE OFFERED FOR A CLASS CREDIT AND WERE AVAILABLE TO ALL STUDENTS.5. RICHLAND HOSPITAL AND RICHLAND COUNTY BREASTFEEDING TASK FORCE CONDUCTED 1:1 INTERVIEWS TO GATHER DATA FROM LOCAL EMPLOYERS REGARDING BREASTFEEDING POLICIES AT THE WORKPLACE.6. RH PARTNERED WITH LOCAL LAW ENFORCEMENT TO HOST AN ACTIVE SHOOTER DRILL.7. RICHLAND HOSPITAL EMPLOYEES AND COMMUNITY MEMBERS ATTENDED THE HEALTHY WISCONSIN LEADERSHIP INSTITUTE8. RICHLAND HOSPITAL PROVIDED CPR CLASSES FOR LOCAL BUSINESSES WHO NEED THE CERTIFICATION TO DO BUSINESS LIKE DENTAL OFFICES, SCHOOLS, AND OTHERS.9. RICHLAND HOSPITAL SUPPORTED THE LOCAL ECONOMIC DEVELOPMENT GROUP CALLED COMMUNITY PROSPERITY ALLIANCE WITH TIME AND RESOURCES.10. RICHLAND HOSPITAL SUPPORTED LOCAL CHAMBER OF COMMERCE GROUPS IN MUSCODA, SPRING GREEN, AND RICHLAND CENTER.11. RICHLAND HOSPITAL SUPPORTED LOCAL LIONS CLUBS ORGANIZATION.12. RICHLAND HOSPITAL SUPPORTED RICHLAND CENTER MOVIE THEATER.13. RICHLAND HOSPITAL, UW EXTENSION, RICHLAND SCHOOL DISTRICT, ITHACA SCHOOL DISTRICT, RICHLAND COUNTY HEALTH AND HUMAN SERVICES, AND PAUQUETTE CENTER JOINED TOGETHER TO CREATE THE RICHLAND MENTAL HEALTH COALITION.14. RICHLAND HOSPITAL PARTNERED WITH SUSAN SPRINGER JUDD FROM THE SUICIDE PREVENTION COALITION OF IOWA COUNTY TO PROVIDE 2 QPR TRAINING (QUESTION. PERSUADE. REFER.) SESSIONS AND A COMMUNITY TALK "COPING WITH SUICIDE THROUGH THE HOLIDAYS" FOR ANYONE IN THE COMMUNITY. 15. RICHLAND HOSPITAL PARTICIPATED IN THE SOUTHWEST WISCONSIN MENTAL HEALTH SUMMIT.16. RICHLAND HOSPITAL SUPPORTED RICHLAND MIDDLE SCHOOL'S TRAVEL DRUG FREE CAMPAIGN.17. RICHLAND HOSPITAL STAFF ARE MEMBERS OF THE RICHLAND COUNTY CHILDREN AND FAMILY ADVISORY COUNCIL (RCCFAC). RICHLAND COUNTY HEALTH AND HUMAN SERVICES AS THE FISCAL AGENT, RCCFAC RECEIVED TWO WI DHS STATE TARGETED RESPONSE GRANTS TO ADDRESS THE OPIOID CRISIS. PRESCRIPTION DRUG LOCK BOXES, DRUG DEACTIVATION KITS AND TWO NEW PERMANENT DRUG DROP BOXES WERE DISTRIBUTED. NARCAN TRAINING SESSIONS WERE HELD, A MEDIA CAMPAIGN WAS PROVIDED AND THE COMMUNITY HAD FOUR DRUG TAKE BACK DAYS.18. RICHLAND HOSPITAL PROMOTED DRUG TAKE BACK DAYS IN RICHLAND CENTER, MUSCODA, SPRING GREEN, AND RICHLAND COUNTY.19. RCCFAC, RICHLAND SCHOOL DISTRICT, AND RICHLAND HOSPITAL SPONSORED THE MOVIE "STRAIGHT FORWARD". ONE HUNDRED TWENTY FIVE PEOPLE ATTENDED THE MOVIE AND VIEWED THE "HIDDEN IN PLAIN SIGHT" DISPLAY. A PANEL DISCUSSION FOLLOWED THE MOVIE. RICHLAND MEDICAL CENTER PHYSICIAN, DOCTOR ANDREW WRIGHT AND RICHLAND CENTER HIGH SCHOOL STUDENTS SERVED AS PANEL MEMBERS. RX DRUG LOCK BOXES, PWHLM YARD SIGNS AND DRUG DEACTIVATION KITS WERE DISTRIBUTED.20. RCCFAC HOSTED COMMUNITY EDUCATION CALLED "RECOVERY REDISCOVERED." A VISUAL COLLECTION OF LOCAL SUBSTANCE ABUSE DATA WAS SHARED. DR. DAVID MAY FROM THE RICHLAND MEDICAL CENTER WAS THE FEATURED SPEAKER WHO PROVIDED INFORMATION ON CURRENT ADDICTION MEDICINE PRACTICES. KIMBERLY HILL PROVIDED A PROGRESS UPDATE ON THE SOBER HOUSING PROJECT IN RICHLAND COUNTY.21. RICHLAND HOSPITAL SUPPORTED POST PROM PARTIES AT SCHOOL DISTRICTS IN THEIR AREA.22. RCCFAC AND RICHLAND HOSPITAL SPONSORED DRUG INFORMATION TRAINING FOR EDUCATORS AND OTHER PROFESSIONALS (DITEP) PROVIDED BY THE ALLIANCE FOR WI YOUTH. SEVERAL SCHOOL DISTRICT ADMINISTRATORS, FACULTY AND STAFF ATTENDED THIS TRAINING.23. RICHLAND HOSPITAL PROVIDED JOB SHADOW OPPORTUNITIES FOR STUDENTS PURSUING PROFESSIONS SUCH AS PRIMARY MEDICINE, SURGICAL MEDICINE, NURSING, MEDICAL NUTRITION, PHYSICAL THERAPY, NURSE PRACTITIONER, ANESTHESIA, LAB, AND HEALTH INFORMATION MANAGEMENT.24. RICHLAND HOSPITAL HOSTED A HEALTHCARE PROVIDERS AND DOMESTIC VIOLENCE PROFESSIONALS TRAINING PRESENTATION.25. RICHLAND HOSPITAL PARTICIPATED AT SEVERAL LOCAL HEALTH AND WELLNESS FAIRS AND COVES SPORTING EVENTS AT LOCAL SCHOOLS. 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 VI, LINE 2: IN ADDITION TO THE REFERRING TO THE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2016, 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, WORKING COLLABORATIVELY WITH RICHLAND MEDICAL CENTER, CAREFULLY 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., 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, 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 2018, MEDICARE AND MEDICARE ADVANTAGE PLAN BENEFICIARIES ACCOUNTED FOR OVER 52 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE AT THE RICHLAND HOSPITAL, INC. AND MEDICAID BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 14 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 1 SCHOLARSHIPS FOR HEALTHCARE EDUCATION 24 31791 PART I, LINE 2: THE RICHLAND HOSPITAL, INC. FOLLOWS A STANDARD PROCEDURE ON ISSUANCE OF SCHOLARSHIP FUNDS WHICH IS DETERMINED BY THE BOARD OF DIRECTORS AND MANAGEMENT OF THE RICHLAND HOSPITAL, INC. AND THE RICHLAND HOSPITAL FOUNDATION, INC. THESE SEPARATE ORGANIZATIONS HAVE ESTABLISHED CRITERIA FOR REVIEW OF APPLICATIONS FOR PROSPECTIVE SCHOLARSHIP RECIPIENTS TO ENSURE THAT SCHOLARSHIPS ARE BEING GRANTED FOR HEALTH EDUCATION RELATED PURPOSES AND TO A QUALIFIED STUDENT STUDYING AT AN ACCREDITED TECHNICAL COLLEGE, COLLEGE, OR UNIVERSITY. (A LARGE PORTION OF THE FUNDING FOR SCHOLARSHIPS IS ALSO GOVERNED BY DONOR AGREEMENTS AS NOTED IN SCHEDULE D TO THE FORM 990 RELATED TO ENDOWMENT FUNDS.) X 1 0 X X X X 0 0 0 0 0 0 0 0 0 KAREN TRAYNOR CFO 194520 0 0 0 2133 0 7801 0 5486 0 209940 0 0 0 BRUCE ROESLER CEO 244934 0 23755 0 3643 0 10790 0 33215 0 316337 0 0 0 ANDREW HARRIS MD DOCTOR 357991 0 0 0 2675 0 9122 0 43263 0 413051 0 0 0 BRIAN O'NEILL CRNA ANESTHETIST 235996 0 0 0 69818 0 11000 0 40469 0 357283 0 0 0 BRYAN MCCARVEL ANESTHESIA DIRECTOR 264748 0 0 0 95807 0 11000 0 41840 0 413395 0 0 0 JOSEPH SPENNETTA MD DOCTOR 317408 0 3000 0 2264 0 1667 0 18766 0 343105 0 0 0 MUHAMMAD KHAN MD ER PHYSICIAN 334205 0 0 0 3440 0 11000 0 38912 0 387557 0 0 0 PART I, LINE 1A HEALTH CLUB DUES GROSS UPS, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. 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 IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,582,852. MANAGEMENT AND GENERAL EXPENSES 941,833. FUNDRAISING EXPENSES 8,000. TOTAL EXPENSES 2,532,685. MEDICAL IMAGING PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,415,380. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,415,380. CLINICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 569,009. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 569,009. LABORATORY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 251,330. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 251,330. SURGICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 653,205. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 653,205. FORM 990, PART XI, LINE 9: NET CHANGE IN RESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS -58,329. NET CHANGE IN UNRESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS 193,472. INCREASE IN EQUITY OF UNCONSOLIDATED AFFILIATE 74,304. FORM 990, PART XII, LINE 2C: SELECTION OF INDEPENDENT ACCOUNTANT THE FINANCE COMMITTEE OF THE RICHLAND HOSPITAL, INC., WHICH IS A SUB-COMMITTEE TO THE HOSPITAL'S BOARD OF DIRECTORS, REVIEWS THE ANNUAL AUDIT PROCESS WITH THE INDEPENDENT ACCOUNTANTS. BOARD MEMBERS ARE ALSO GIVEN THE NAMES AND CONTACT INFORMATION OF THE INDEPENDENT ACCOUNTANTS AT THE ANNUAL FINANCE COMMITTEE'S REVIEW MEETING OF THE AUDITED FINANCIAL STATEMENTS SO THAT THEY MAY INQUIRE, IF NEEDED, WITH THE ACCOUNTANTS THROUGHOUT THE YEAR. A BOARD MEMBER IS ALSO SELECTED ANNUALLY FOR REVIEW AND INQUIRY BY THE INDEPENDENT ACCOUNTANTS FOR SEPARATE AND PRIVATE INTERVIEW AS A PART OF THE AUDIT PROCESS. THESE FUNCTIONS ALLOW A GREATER AMOUNT OF OVERSIGHT BY THE BOARD INTO THE ANNUAL AUDIT PROCESS. THERE HAS BEEN NO CHANGE TO THESE PROCEDURES DURING THE PAST YEAR. RICHLAND HOSPITAL FOUNDATION INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391567249 FOUNDATION WI 501(C)(3) LINE 7 THE RICHLAND HOSPITAL INC 1 PARTNERS OF RICHLAND HOSPITAL INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391693458 AUXILIARY WI 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 RICHLAND HOSPITAL FOUNDATION S 136879 CASH