2023-02-01T12:52:29-06:00 2022-03-31 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2021-04-01 411724637 CUYUNA REGIONAL MEDICAL CENTER CUYU 2185467000 320 EAST MAIN STREET CROSBY MN 56441 KATIE BERG CFO 2185467000 2023-01-30 1 KATIE BERG 999009999 JULIE BOYER P01278549 2187275025 2023-01-30 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z AMY HART 320 EAST MAIN STREET CROSBY MN 56441 179682328 0 X WWW.CUYUNAMED.ORG X 1992 MN ACCOMMODATING YOU WITH CARE AND COMPASSION BY DEDICATING OURSELVES TO YOU EVERY DAY. 10 7 1251 15 0 0 13387620 3727130 137115392 175411828 230529 67028 425142 476342 151158683 179682328 100000 330198 0 0 71670291 80441033 0 0 0 73004836 93155750 144775127 173926981 6383556 5755347 118817287 120942776 60094518 56476673 58722769 64466103 X ACCOMMODATING YOU WITH CARE AND COMPASSION BY DEDICATING OURSELVES TO YOU EVERY DAY. 0 0 162609224 330198 175391452 AS A COMMUNITY-BASED HOSPITAL AND HEALTH CARE PROVIDER, CRMC'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITY AND PROVIDE QUALITY HEALTH CARE SERVICES FOR ALL CITIZENS, REGARDLESS OF ABILITY TO PAY. EACH YEAR, CRMC GIVES BACK TO THE COMMUNITY THROUGH EDUCATION, HEALTH SERVICES, DONATIONS, AND FREE AND REDUCED COST HEALTH CARE TO ENSURE THAT FINANCIAL ISSUES DO NOT PREVENT PATIENTS FROM SEEKING OR RECEIVING CARE. CRMC MAKES SIGNIFICANT EFFORTS TO ENSURE CHARITY CARE IS GRANTED TO ALL PATIENTS WHO QUALIFY. IN FY22 A TOTAL OF $362,758 IN SERVICES WERE PROVIDED TO LOW-INCOME PATIENTS AT FREE OR REDUCED PRICES AND WAS PROVIDED TO THOSE WHO HAVE EXHAUSTED THIRD PARTY RESOURCES, DO NOT QUALIFY FOR MEDICAID, OR HAVE INSUFFICIENT INCOMES. CRMC ALSO EXPERIENCED A LOSS OF $2,919,303 IN THE UNPAID COSTS OF MEDICAID FOR LOW-INCOME INDIVIDUALS. THE CUYUNA LAKES AREA HAS A HIGH NEED FOR SEVERAL HEALTH CARE SERVICES THAT DO NOT GENERATE SUFFICIENT REVENUE TO COVER THE COST OF PROVIDING THEM. CRMC SUBSIDIZED A TOTAL OF $2,328,143 IN SERVICES IN FY22 TO ENSURE THEIR AVAILABILITY TO OUR COMMUNITY. THE ORGANIZATION ALSO PROVIDES HEALTH-RELATED EDUCATION TO THE COMMUNITY THROUGH EVENTS, CLASSES, LECTURES, AND WELLNESS SCREENINGS COMPLETELY FREE-OF-CHARGE TO THE COMMUNITY. CRMC'S HEALTH AND WELLNESS EVENTS IN 2022 WERE ATTENDED BY 11,859. IN FY22, 4,601 LUNCHES WERE PROVIDED FOR YOUTH IN THE CUYUNA LAKES LUNCH BUNCH FREE SUMMER LUNCH PROGRAM. IN ADDITION, CASH DONATIONS WERE MADE TO THE CUYUNA AND EMILY FOOD BANKS, AND THE CROSBY FARMER'S MARKET AND ITS POWER OF PRODUCE PROGRAM WERE SUPPORTED. CRMC OFFERS YEAR-ROUND COURSES ON FIRST AID, CPR, CHILDBIRTH, AND WEIGHT MANAGEMENT TOGETHER WITH SUPPORT GROUPS ON MENTAL HEALTH, CANCER, AND WEIGHT LOSS. THE VALUE OF CRMC'S COMMUNITY EDUCATION AND SUPPORT IN FY22 TOTALED $497,864. CRMC ALSO SUPPORTS OTHER ORGANIZATIONS AND INITIATIVES THAT SHARE ITS GOAL TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN FY22, THAT INCLUDED $180,198 IN CASH AND IN-KIND DONATIONS TO ORGANIZATIONS FOCUSED ON THE HEALTH, SOCIAL, CULTURAL, AND EDUCATIONAL NEEDS OF THE AREA. IN ADDITION, CRMC STAFF DONATES TIME, MATERIALS, AND LEADERSHIP TO MORE THAN 20 COMMUNITY GROUPS INCLUDING VARIOUS SCHOOLS; CUYUNA LAKES, BRAINERD LAKES AND NISSWA CHAMBERS OF COMMERCE; HALLETT COMMUNITY CENTER; CROSBY-IRONTON, BRAINERD, NISSWA AND PEQUOT LAKES SCHOOLS; NORTHLAND ARBORETUM; AREA CHURCHES; UNITED WAY; KINSHIP PARTNERS; CROSBY, IRONTON, CUYUNA AND DEERWOOD FIRE DEPARTMENTS AND OTHERS. BECAUSE FOOD INSECURITY IS A GREAT NEED FOR THE AREA, CRMC ANNUALLY INVESTS ABOUT $20,000 TOWARDS FREE SUMMER LUNCH AND HOLIDAY BREAK MEALS FOR STUDENTS, HEALTHY FOOD AT COMMUNITY EVENTS, AND STOCKING AREA FOOD SHELVES. CRMC ALSO INVESTS APPROXIMATELY $5 MILLION PER YEAR IN CAPITAL IMPROVEMENTS SUCH AS NEW EQUIPMENT, FACILITIES, AND TECHNOLOGY INFRASTRUCTURE. 162609224 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 112 0 1 1251 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1 MN X KATIE BERG 2185467000 320 EAST MAIN STREET CROSBY MN 56441 DENISE LAUDENBACH DIRECTOR UNTIL 05/18/21 1.00 X 0 0 0 DR PETER MACKAY DIRECTOR UNTIL 09/21/21 1.00 X 0 0 0 KENT FELTZ DIRECTOR 1.00 X 0 0 0 GINNY SAVALOJA DIRECTOR 1.00 X 0 0 0 ANDREA BEDARD DIRECTOR 1.00 X 0 0 0 DR JOSHUA HOROWITZ DIRECTOR/PHYSICIAN 1.00 X 0 0 0 KYLE BAUER CEO UNTIL 4/30/21 40.00 X X 327181 0 15542 AMY HART INTERIM CEO - BEGIN 6/28/21 40.00 X X 324560 0 31297 DR PAIGE HOLMGREN DIRECTOR/PHYSICIAN 1.00 X 0 0 0 JAMIE SKJEVELAND DIRECTOR 1.00 X 0 0 0 JOEL STAEHLING DIRECTOR 1.00 X 0 0 0 WADE LEONARD VICE CHAIR 1.00 X X 0 0 0 BART TAYLOR CHAIR 1.00 X X 0 0 0 KATIE BERG CFO 40.00 X 286709 0 19138 FAWN ATCHISON ANESTHESIOLOGIST 40.00 X 659548 0 30934 KAMRAN DARABI PHYSICIAN UNTIL 10/14/21 40.00 X 600075 0 39414 LEAH KIPPES ANESTHESIOLOGIST 40.00 X 558322 0 47213 AARON HOLLEY PHYSICIAN 40.00 X 490550 0 46788 CHRISTOPHER KACZMARCYK PHYSICIAN 40.00 X 472057 0 18843 3719002 0 249169 105 0 1 0 PREMIER SURGICAL ASSOCIATES PA 318 E MAIN STREET CROSBY MN 56441 PHYSICIAN FEES 11037857 CENTRAL LAKES PHYSICIANS PA 318 E MAIN STREET CROSBY MN 56441 PHYSICIAN FEES 5225092 CENTRAL MN DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 RADIOLOGY SERVICES 2256082 MINNESOTA INTERVENTIONAL SPINE CONSULTAN 23080 CROSS DR DEERWOOD MN 56444 PHYSICIAN FEES 1986681 CROSBY CARDIOVASCULAR SERVICES 318 E MAIN ST CROSBY MN 56441 RADIOLOGY SERVICES 885380 39 3606429 120701 3727130 PATIENT REVENUE 621500 162312532 162312532 PROFESSIONAL SERVICES 621500 8097582 8097582 OTHER OPERATING REVENUE 900099 3150603 3150603 RETAIL PHARMACY 446110 1851111 1830735 20376 175411828 67028 67028 CAFETERIA 722210 476342 476342 476342 179682328 175391452 0 563746 X 330198 330198 914913 914913 64117781 63530738 587043 1805859 1805859 9300531 9300531 4301949 4190525 111424 80499 13409 67090 137489 137489 4139 4139 32045270 31089019 956251 464771 464771 3263882 2821976 441906 225932 225932 2433497 2290714 142783 403641 337420 66221 1380824 1380824 6890365 3418421 3471944 326459 2698 323761 MEDICAL SUPPLIES 16652855 16647522 5333 DRUGS - PROGRAM 11822158 11822158 IMPLICIT PRICE CONCESSI 6009748 6009748 REPAIRS & MAINTENANCE 2770649 2757361 13288 8243572 5550224 2693348 173926981 162609224 11317757 0 24256021 22024328 52860 52902 24784185 26892491 3494341 4078844 2663657 3117361 155147147 95317051 59487598 59830096 2811139 3403773 485367 424696 782119 1118285 118817287 120942776 13206177 16726881 12472 11257 46875869 39738535 60094518 56476673 X 58722769 64466103 58722769 64466103 118817287 120942776 X 5755347 -12013 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4139 4139 0 PART II-B, LINE 1: CUYUNA REGIONAL MEDICAL CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 0 1 X 304340 304340 80558518 38545857 42012661 67782346 54558133 13224213 6501943 2213061 4288882 59830096 DUE TO CUYUNA RANGE HOSPITAL DISTRICT 30087479 DUE TO AFFILIATE 1392639 CRM DUE TO MEDICARE 3737725 MEDICARE ACCELERATED PAYMENTS 4520692 39738535 X 171592449 -24566 -24566 171617015 8065313 8065313 179682328 164591788 2528250 2528250 162063538 11863443 11863443 173926981 PART IV, LINE 2B: THE HOSPITAL IS A CUSTODIAN OF FUNDS FOR RESIDENTS. THE HOSPITAL HOLDS THESE FUNDS FOR PURCHASES MADE BY THE RESIDENTS. PART X, LINE 2: THE CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. NONPROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE CENTER HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: MINNESOTA RADIOLOGY INSTITUTE REVENUE 4,906,341. SLEEP CENTER OF CENTRAL MINNESOTA REVENUE 1,228,841. IMPLICIT PRICE CONCESSIONS -6,009,748. CONTRIBUTION TO CROSBY SENIOR SERVICES -150,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS RELATED TO MINNESOTA RADIOLOGY INSTITUTE 7,515,374. ELIMINATIONS RELATED TO SLEEP CENTER OF CENTRAL MINNESOTA 549,939. PART XII, LINE 2D - OTHER ADJUSTMENTS: MINNESOTA RADIOLOGY INSTITUTE EXPENSES 1,228,166. SLEEP CENTER OF CENTRAL MINNESOTA EXPENSES 1,300,084. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 6,009,748. ELIMINATIONS RELATED TO MINNESOTA RADIOLOGY INSTITUTE 5,153,756. CONTRIBUTION TO CROSBY SENIOR SERVICES 150,000. ELIMINATIONS RELATED TO SLEEP CENTER OF CENTRAL MINNESOTA 549,939. 1 1 X 1 X 175.000000000000 1 X 1 1 0 1 1 3042798 3042798 0.01810 26227259 19346708 6880551 0.04100 29270057 19346708 9923349 0.05910 18 7966 478164 478164 0.00280 4 2393 180198 180198 0.00110 22 10359 658362 658362 0.00390 22 10359 29928419 19346708 10581711 0.06300 1 5370 5370 0.00000 1 1500 14330 14330 0.00010 2 1500 19700 19700 0.00010 1 6009748 0 39250318 42409900 -3159582 X 1 1 1 1 CUYUNA REGIONAL MEDICAL CENTER 320 EAST MAIN STREET CROSBY MN 56441 399552 X X X X N/A CUYUNA REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X SEE PART V, PAGE 8 X 1 20 1 SEE PART V, PAGE 8 0 1 X 175.000000000000 200.000000000000 X X X 1 1 X X X 1 X HTTPS://CUYUNAMED.ORG/PATIENT-INFORMATION/BILLING X HTTPS://CUYUNAMED.ORG/PATIENT-INFORMATION/BILLING X HTTPS://CUYUNAMED.ORG/PATIENT-INFORMATION/BILLING X X X X X X 1 X 0 X X X X 1 X 0 0 CUYUNA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: CRMC UTILIZED INFORMATION FROM RESULTS OF THE 2020-2022 CHNA DEVELOPED BY ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER AS WELL AS THE 2021 CROW WING COUNTY COMMUNITY HEALTH SURVEY. DATA FROM CRMC'S CLINIC AND HOSPITAL PATIENT RECORDS, THE U.S. CENSUS, STATE OF MINNESOTA, AND AREA PUBLIC SCHOOLS WAS ALSO INCLUDED. CUYUNA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER IN BRAINERD, DATA FROM ITS 2020-2022 CHNA WAS UTILIZED. CUYUNA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: CROW WING COUNTY HEALTH DEPARTMENT AND SHERIFF, HALLETT COMMUNITY CENTER, CENTRAL LAKES COLLEGE, LAKES AREA FOOD SHELF, CROSBY-IRONTON SCHOOL DISTRICT, PEQUOT LAKES SCHOOL DISTRICT, UPLIFTED WELLNESS STUDIO, CONSOLIDATED TELECOMMUNICATIONS COMPANY, GREAT RIVER EYE CLINIC, CUYUNA LAKES CHAMBER OF COMMERCE, BRAINERD LAKES AREA CHAMBER OF COMMERCE, NISSWA CHAMBER OF COMMERCE AND SMILES FOR JAKE. CUYUNA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: MENTAL HEALTH - RECRUITED A PSYCHIATRIST TO SERVE THE COMMUNITY. PARTNERED WITH SMILES FOR JAKE SUICIDE PREVENTION COALITION TO PROVIDE COMMUNITY EDUCATION AND EVENTS ON BULLYING, ANXIETY, AND HOPELESSNESS. PROVIDED TRAINING TO CRMC PROVIDERS, LEADERSHIP, AND STAFF. CONTINUED TO PARTNER WITH COMMUNITY ORGANIZATIONS IN PROVIDING EDUCATION TO STAFF AND PROVIDERS. CONTINUE TO OFFER UNLIMITED EAP VISITS FOR STAFF AND THEIR FAMILY MEMBERS. SCREEN ALL CLINIC PATIENTS FOR DEPRESSION AND OFFER ASSISTANCE TO THOSE WITH POSITIVE RESULTS. THROUGH WELLNESS PROGRAM, OFFERED EDUCATION, T-SHIRTS WITH POSITIVE MESSAGES, SOCIAL ACTIVITIES. OFFERED THE PUBLIC THE OPPORTUNITY TO CREATE SMILE BOXES AND PAINT ROCKS WITH POSITIVE MESSAGES AT COMMUNITY EVENTS. PROVIDED 3 GOOD THINGS EDUCATION AND NOTEBOOKS TO NUMEROUS STUDENTS. PARTNERED WITH SMILES FOR JAKE TO COORDINATE A CUYUNA CHRISTMAS, A FREE, POSITIVE HOLIDAY CELEBRATION FOR THE COMMUNITY. SUPPORTED NEW MENTAL HEALTH SUPPORT GROUP FOR THE COMMUNITY BY PROVIDING MEETING SPACE AND PUBLICITY. PHYSICAL ACTIVITY - OFFER WELLBEATS ON-DEMAND FITNESS PROGRAM FOR STAFF. SUPPORT CUYUNA STATE RECREATION AREA TRAIL MAINTENANCE. PROVIDE BIKES FOR STAFF TO RIDE ON BREAKS AND AFTER WORK. ENCOURAGE STAFF TO PARTICIPATE IN GROUP BIKE RIDES, RUNS, AND KICKBALL GAMES. PROVIDED BIKE HELMETS TO AREA STUDENTS. SPONSOR HALLETT CENTER ICE SKATING RINK. PROVIDE ATHLETIC TRAINER FOR CROSBY-IRONTON SCHOOL AND PEQUOT LAKES SCHOOL ATHLETES. SUPPORTED LOCAL COMMUNITY SKATING RINKS, YOUTH HOCKEY ASSOCIATIONS, SPORTS BOOSTERS, BASEBALL TEAMS, AND RANGERETTES DANCE TEAM. INCORPORATE PHYSICAL ACTIVITES INTO COMMUNITY EVENTS, E.G., REINDEER RACES AT CUYUNA CHRISTMAS; BEAN BAG TOSS, GIANT RING TOSS, BEAR BONG, AND VEGGIE/FRUIT WALK; AND HOST BIKE HELMET FITTINGS. NUTRITION- INCLUDE NUTRITION INFORMATION TO CRMC CULINARY MENUS. FINANCIALLY SUPPORT CROSBY, LAKES AREA, AND EMILY FOOD BANKS. OFFERED DIABETES EDUCATION AND SUPPORT GROUPS. OFFER MEDICAL WEIGHT MANAGEMENT PROGRAM AND INTENSIVE BEHAVIORAL THERAPY PROGRAMS FOR OVERWEIGHT INDIVIDUALS. SPONSOR CUYUNA FARMER'S MARKET AND ITS POWER OF PRODUCE PROGRAM ENCOURAGING YOUTH AND SENIORS TO EAT MORE FRUITS AND VEGETABLES. STARTED NEW LIVING WELL: WEIGHT LOSS SERIES CLASS. OFFER MONTHLY VIRTUAL WEIGHT LOSS SUPPORT GROUPS AND SEMINARS. FINANCIALLY SPONSORED FISHING TO END HUNGER FISHING TOURNAMENT BENEFITTING COMMUNITY OUTREACH. HOLD VEGGIE/FRUIT WALK ACTIVITY AT COMMUNITY EVENTS. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE HTTPS://WWW.CUYUNAMED.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE: HTTPS://WWW.CUYUNAMED.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 4 1 - BAXTER CLINIC 13205 ISLE DRIVE BAXTER MN 56425 FREE-STANDING CLINIC 2 - LONGVILLE CLINIC 180 JORDAN LANE LONGVILLE MN 56655 RURAL HEALTH CLINIC 3 - CARE CENTER 320 EAST MAIN CROSBY MN 56441 SKILLED NURSING FACILITY 4 - BREEZY POINT CLINIC 30833 NORTH STAR DRIVE SUITE 1 BREEZY POINT MN 56472 FREE-STANDING CLINIC PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT. PART I, LN 7 COL(F): IMPLICIT PRICE CONCESSIONS THAT WERE SUBTRACTED FROM TOTAL EXPENSE TO OBTAIN THE % OF COMMUNITY BENEFIT TO TOTAL EXPENSE AMOUNTED TO $6,009,748. PART II, COMMUNITY BUILDING ACTIVITIES: CRMC PROMOTED THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH THE FOLLOWING COMMUNITY BUILDING PROJECTS. CRMC FINANCIALLY SUPPORTED THE BRAINERD LAKES AREA ECONOMIC DEVELOPMENT CORPORATION TO HELP FOSTER THE CREATION OF NEW JOBS, ATTRACT NEW INDUSTRY TO THE REGION AND ASSIST AREA BUSINESSES. IT ALSO SUPPORTS THE BRAINERD LAKES, CUYUNA LAKES, PEQUOT LAKES, AND NISSWA CHAMBER OF COMMERCES AND THEIR COMMUNITY EVENTS TO ASSIST IN BUILDING HEALTHY AND SUCCESSFUL BUSINESS COMMUNITIES. HEALTH OF THE COMMUNITY WAS IMPROVED THROUGH NUMEROUS VIRTUAL AND IN-PERSON HEALTH AND WELLNESS EDUCATIONAL CLASSES AND SUPPORT GROUPS. FOOD WAS ALSO PROVIDED TO ECONOMICALLY INSECURE FAMILIES THROUGH THE CUYUNA LAKES LUNCH BUNCH PROGRAM WHERE LUNCHES ARE GIVEN TO YOUTH IN THE SUMMER AND SCHOOL FREE LUNCHES ARE NOT AVAILABLE. FINANCIAL DONATIONS WERE MADE TO THE CUYUNA LAKES, EMILY, AND LAKES AREA FOOD SHELVES AS WELL AS THE OUTREACH PROGRAM. TO ENCOURAGE STUDENTS TO SEEK A HEALTH CARE CAREER, CRMC SUPPORTED BRIDGES ACADEMY CAREER DAY, AN EVENT WHERE AREA HIGH SCHOOL STUDENTS COME TO THE LOCAL COMMUNITY COLLEGE TO HEAR FROM PROFESSIONALS ABOUT THEIR SPECIFIC JOBS. SEVERAL FIELD TRIPS TO THE FACILITIES ARE HOSTED BY THE HOSPITAL'S VARIOUS DEPARTMENTS AND EMERGENCY MEDICAL SERVICES PROVIDED NUMEROUS CPR/FIRST AID TRAINING CLASSES AND DEMONSTRATIONS. CRMC ALSO SUPPORTED CROSBY-IRONTON HIGH SCHOOL'S NEW RANGER MADE PROGRAM WHICH TEACHES STUDENTS MANUFACTURING, DRAFTING, WOODWORKING, METAL WORKS, AND AUTO SKILLS. PART III, LINE 2: REVENUES GENERALLY RELATE TO CONTRACTS WITH PATIENTS IN WHICH THE PERFORMANCE OBLIGATIONS ARE TO PROVIDE HEALTH CARE SERVICES TO THE PATIENTS. REVENUES ARE RECORDED DURING THE PERIOD THE PERFORMANCE OBLIGATIONS TO PROVIDE HEALTH CARE SERVICES ARE SATISFIED. THE CENTER'S PERFORMANCE OBLIGATIONS FOR INPATIENT SERVICES ARE GENERALLY SATISFIED OVER PERIODS THAT AVERAGE APPROXIMATELY THREE DAYS, AND REVENUES ARE RECOGNIZED BASED ON CHARGES INCURRED IN RELATION TO TOTAL EXPECTED CHARGES. PERFORMANCE OBLIGATIONS FOR OUTPATIENT SERVICES ARE GENERALLY SATISFIED OVER A PERIOD OF LESS THAN ONE DAY.REVENUES ARE BASED UPON THE ESTIMATED AMOUNTS THE CENTER EXPECTS TO BE ENTITLED TO RECEIVE FROM PATIENTS, INCLUDING PAYMENTS MADE BY THIRD-PARTY PAYORS ON BEHALF OF PATIENTS. ESTIMATES OF CONTRACTUAL ALLOWANCES UNDER MANAGED CARE AND COMMERCIAL INSURANCE PLANS ARE BASED UPON THE PAYMENT TERMS SPECIFIED IN THE RELATED CONTRACTUAL AGREEMENTS. REVENUES RELATED TO UNINSURED PATIENTS AND UNINSURED COPAYMENTS AND DEDUCTIBLE AMOUNTS FOR PATIENTS WHO HAVE HEALTH CARE COVERAGE MAY HAVE DISCOUNTS APPLIED (UNINSURED DISCOUNTS AND CONTRACTUAL DISCOUNTS). THE CENTER ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY REVENUES AT THE ESTIMATED AMOUNTS THE CENTER EXPECTS TO COLLECT. UNDER THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE (ASU) NO. 2014-09, WHICH WAS ADOPTED APRIL 1, 2019, WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THE CENTER HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE CENTER'S RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE SUBSEQUENT TO THE ADOPTION OF ASU 2014-09, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CENTER DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THANINDIVIDUALLY. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.THE PRIMARY COLLECTIONS RISKS RELATE TO UNINSURED PATIENT ACCOUNTS, INCLUDING PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT THE PATIENT RESPONSIBILITY AMOUNTS (DEDUCTIBLES AND COPAYMENTS) REMAIN OUTSTANDING. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. PART III, LINE 3: AT CUYUNA REGIONAL MEDICAL CENTER IMPLICIT PRICE CONCESSIONS ARE CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY. PART III, LINE 4: SEE FOOTNOTE 1 ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: IT IS OUR GOAL TO PROVIDE AFFORDABLE HEALTHCARE SERVICES TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY AND ASSIST UNINSURED OR UNDERINSURED PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE.WE ALLOW PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE TO PAY WHAT THEY ARE WILLING AND ABLE TO PAY BUT WE DO NOT REQUEST PAYMENT. PATIENT ASSISTANCE IS NOT CONSIDERED TO BE A SUBSTITUTE FOR PERSONAL RESPONSIBILITY. PATIENTS MUST COOPERATE WITH CRMC PROCEDURES FOR OBTAINING FINANCIAL ASSISTANCE. PATIENTS ARE EXPECTED TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR ABILITY TO PAY. INDIVIDUALS WITH THE FINANCIAL MEANS TO PURCHASE HEALTH INSURANCE SHALL BE URGED TO DO SO. THIS ASSURES ACCESS TO HEALTH CARE SERVICES AND PROTECTS THEIR ASSETS.CUYUNA REGIONAL MEDICAL CENTER'S PAYMENT AND COLLECTION POLICY STATES:PURPOSE: CRMC HAS ESTABLISHED A STRONG MISSION OF MEETING THE MEDICAL NEEDS OF THE COMMUNITIES IT SERVES. A SOUND PAYMENT AND COLLECTION POLICY IS A FUNDAMENTAL COMPONENT OF THIS MISSION. CRMC WILL MAINTAIN A POLICY OF COMMUNICATING FINANCIAL RESPONSIBILITY TO OUR PATIENTS WITH THE EXPECTATION OF PAYMENT AT TIME OF SERVICE. CRMC WILL ASSIST PATIENTS IN ALIGNING THEM WITH RESOURCES NEEDED TO FACILITATE THE PROMPT PAYMENT OF ANY PATIENT BALANCE. THE POLICY WILL KEEP IN MIND THE PATIENT'S UNIQUE FINANCIAL SITUATION AND PRESERVE THE DIGNITY OF THOSE INVOLVED.RESPONSIBILITY: CFO, DIRECTOR OF REVENUE CYCLE AND DESIGNATED PERSONNEL ARE RESPONSIBLE FOR THE CREATION, REVISION AND ENFORCEMENT OF THIS POLICY.DEFINITIONS: 1. PATIENT FINANCING OPTIONS: CUYUNA REGIONAL MEDICAL CENTER WILL PROVIDE THE FOLLOWING PAYMENT OPTIONS:A. CASH PAYMENTSI. THE EXPECTATION OF CRMC IS SELF PAY BALANCES WILL BE PAID ON DATE OF SERVICE OR PRIOR TO SERVICE. INQUIRIES INTO PROCEDURE COSTS AND PAYMENT ARRANGEMENTS ARE DIRECTED TO THE DIRECTOR OF REVENUE CYCLE OR REPRESENTATIVE. SELF PAY BALANCES SHOULD BE PAID WITHIN 15 DAYS OF RECEIPT OF FIRST STATEMENT.B. CREDIT CARDSI. CRMC WILL ACCEPT CREDIT CARD PAYMENTS FOR PATIENT'S SELF-PAY PORTION OF BALANCES. MOST MAJOR CREDIT CARDS ARE ACCEPTED.C. MEDICAID ELIGIBILITY & OTHER FUNDING SOURCESI. THE BUSINESS OFFICE OF CRMC WORKS CLOSELY WITH THE STATE MEDICAID ELIGIBILITY PROGRAM TO ENSURE PATIENTS HAVE ACCESS TO AVAILABLE PROGRAMS. NON-INSURED PATIENTS ARE REFERRED TO THE STATE MEDICAID PROGRAM FOR A PROBABILITY OF ELIGIBILITY ASSESSMENT. APPLICATIONS ARE AVAILABLE FROM THE BUSINESS OFFICE. SERVICE ITEMIZATIONS ARE AVAILABLE UPON REQUEST FOR SUBMISSION TO FLEX ACCOUNTS OR HSA'S.D. UNCOMPENSATED CAREI. APPLICATIONS ARE AVAILABLE FROM THE BUSINESS OFFICE. DOCUMENTATION OF INCOME AND MEDICAID ELIGIBILITY MAY BE REQUIRED. FEDERAL POVERTY GUIDELINES MAY BE UTILIZED IN DETERMINING UNCOMPENSATED CARE REDUCTIONS.2. SELF PAY DISCOUNTS: A. CRMC IN COOPERATION WITH THE MN ATTORNEY GENERAL AGREEMENT HAS AGREED TO INITIATE A DISCOUNT EQUAL TO ITS LARGEST COMMERCIAL PAYER TO ANY PATIENT WITHOUT HEALTH INSURANCE. A PAYMENT IN FULL DISCOUNT MAY BE OFFERED TO PATIENTS WITH A SELF-PAY ACCOUNT BALANCE ABOVE $500 WHEN PAID WITHIN THE FIRST BILLING CYCLE. SERVICES EXCLUDED FROM THESE DISCOUNTS MAY INCLUDE: LONG TERM CARE, HOME CARE SPEND DOWNS, ASSISTED LIVING SERVICES, LIFE LINE, AND OTHER CONTRACTED ANCILLARY SERVICES. 3. COLLECTION OF CO-PAYS, DEDUCTIBLES AND CO-INSURANCE:A. COLLECTION OF CO-PAYS, DEDUCTIBLES, AND CO-INSURANCE MAY BE COLLECTED FROM PATIENTS AT THE TIME OF SERVICE OR PRIOR TO SERVICE WHEN THE BENEFIT LEVELS HAVE BEEN VERIFIED. 4. PAYMENT CONTRACTS:A. PATIENTS THAT CANNOT PAY THEIR BALANCE IN FULL MAY ESTABLISH A PAYMENT CONTRACT. CRMC PROMOTES ACHIEVING PATIENT BALANCES AT ZERO WITHIN 6 MONTHS FROM DATE OF SERVICE. IN THE EVENT THAT EXTENDED ARRANGEMENTS NEED TO BE MADE, CONSULTATION WITH THE DIRECTOR OF REVENUE CYCLE OR REPRESENTATIVE WILL BE REQUIRED. CRMC WILL ESTABLISH REASONABLE PAYMENT ARRANGEMENTS BUT NO LESS THAN A MINIMAL PAYMENT OF 4% OF PATIENT'S BALANCE OR $20 PER MONTH WHICHEVER IS GREATER FOR A MAXIMUM PAYMENT CONTRACT OF 24 MONTHS PER ACCOUNT BALANCE. CRMC WILL NOT PROMOTE CONSOLIDATING ACCOUNTS AND WILL WORK WITH PATIENTS TO ENSURE UNDERSTANDING OF ACCOUNTS BALANCES DUE.5. BILLING CONCERNS:A. OUR BUSINESS OFFICE IS OPEN MONDAY THROUGH FRIDAY FROM 7:30 AM UNTIL 4:30 PM TO ANSWER ANY BILLING QUESTIONS. PLEASE HAVE YOUR ACCOUNT NUMBER AVAILABLE WHEN REQUESTING ACCOUNT INFORMATION.6. ESTIMATES:A. PROCEDURE ESTIMATES MAY BE OBTAINED BY CONTACTING THE DIRECTOR OF MANAGED CONTRACTS.POLICY STATEMENT: CUYUNA REGIONAL MEDICAL CENTER'S (CRMC) PAYMENT AND COLLECTION POLICY IS THAT PAYMENT IS DUE WHEN SERVICES ARE RENDERED. HOWEVER, AS A COURTESY, CRMC WILL SUBMIT THIRD PARTY CLAIMS FOR OUR PATIENTS. ANY SELF-PAY PORTION IS DUE AT THE TIME OF SERVICE UNLESS PRIOR ARRANGEMENTS HAVE BEEN MADE WITH THE BUSINESS OFFICE. FOR THE PURPOSES OF THIS POLICY, SELF-PAY PORTION IS DEFINED AS CO-PAYMENTS, DEDUCTIBLES, AND NON COVERED SERVICES (IF KNOWN AT THE TIME OF SERVICE.) SELF-PAY PORTION ALSO REFERS TO AMOUNTS OWED BY INDIVIDUALS WITHOUT INSURANCE. PART VI, LINE 2: NEEDS ASSESSMENT:EVERY THREE YEARS, CUYUNA REGIONAL MEDICAL CENTER CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO SYSTEMATICALLY IDENTIFY, ANALYZE AND PRIORITIZE COMMUNITY HEALTH NEEDS. THE PROCESS IS CONDUCTED IN COLLABORATION WITH MANY COMMUNITY PARTNERS INCLUDING ESSENTIAL HEALTH, THE CROW WING COUNTY HEALTH DEPARTMENT, AND ORGANIZATIONS OR INDIVIDUALS THAT REPRESENT BROAD INTERESTS IN THE COMMUNITY. CRMC UTILIZES EXISTING INFORMATION FROM THE ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER CHNA, CROW WING COUNTY HEALTH RANKINGS, AND MINNESOTA DEPARTMENT OF EDUCATION STUDENT SURVEYS. THE ORGANIZATION ALSO SURVEYS COMMUNITY MEMBERS AT PUBLIC EVENTS AND REVIEWS THE HEALTH STATISTICS OF THE PATIENTS IT SERVES. TO UNDERSTAND THE SOCIAL, ECONOMIC, AND HEALTH STATUS OF AREA RESIDENTS, STATISTICS WERE ALSO COLLECTED FROM STATE, COUNTY, AND LOCAL SOURCES. FOLLOWING ANALYSIS OF ALL DATA SOURCES, CRMC TOGETHER WITH COMMUNITY STAKEHOLDERS IDENTIFIES ITS TOP THREE PRIORITY AREAS TO ADDRESS. CRMC THEN PARTNERS WITH OTHER ORGANIZATIONS TO COORDINATE ACTION PLANS, POOL RESOURCES, AND JOINTLY ADDRESS THE PRIORITIES OF THE ASSESSMENT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:WE PROVIDE A COURTESY PHONE CALL AFTER THE FIRST STATEMENT. AT THAT TIME THE FINANCIAL ASSISTANCE POLICY IS DISCUSSED. WE ALSO HAVE FINANCIAL ADVISORS AVAILABLE DURING NORMAL BUSINESS HOURS IN THE FACILITY. WE ALSO MAIL OUT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION PRIOR TO SENDING A PATIENT TO COLLECTIONS. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE THROUGHOUT OUR FACILITIES AND ONLINE AT: HTTPS://WWW.CUYUNAMED.ORG/PATIENT-INFORMATION/BILLING. PART VI, LINE 4: COMMUNITY INFORMATION:A COMMUNITY-BUILT FACILITY, CUYUNA REGIONAL MEDICAL CENTER SERVES APPROXIMATELY 60,000 PEOPLE IN THE BRAINERD LAKES, AN AREA KNOWN AS MINNESOTA'S VACATION DESTINATION BECAUSE OF ITS BEAUTIFUL LAKES AND WOODLANDS OFFERING A VARIETY OF OUTDOOR RECREATION OPPORTUNITIES. WITH AN AVERAGE DAILY CENSUS OF 15 PATIENTS, CRMC SERVES APPROXIMATELY 1,400 INPATIENTS AND 170,000 OUTPATIENTS ANNUALLY AND HAS OVER 8,000 ER VISITS AND ABOUT 200 BIRTHS. THE MAJORITY OF CRMC'S PATIENTS, 65 PERCENT, RESIDE IN BRAINERD, BAXTER, LONGVIILLE, AITKIN, ONAMIA AND THEIR SURROUNDING AREAS. ANOTHER 35 PERCENT OF ITS PATIENTS LIVE IN THE HOSPITAL DISTRICTS OF BAY LAKE, CROSBY, CUYUNA, DEAN LAKE, DEERFIELD, DEERWOOD, EMILY, FAIRFIELD, FIFTY LAKES, LITTLE PINE, RABBIT LAKE, RIVERTON, TROMMALD, AND WOLFORD. THE MAJORITY OF THE RESIDENTS, 95%, ARE WHITE. ABOUT HALF ARE MALE AND THE OTHER HALF FEMALE. MORE THAN 60% OF THE POPULATION RESIDE IN RURAL AREAS. A TOTAL OF 22% OF RESIDENTS ARE UNDER AGE 18 AND 22% ARE 65 YEARS AND OLDER. THE MEDIAN HOUSEHOLD INCOME IS $53,500. ABOUT 85% OF THE RESIDENTS ARE HIGH SCHOOL GRADUATES AND 71% HAVE SOME COLLEGE EDUCATION. THIRTY PERCENT OF THE CHILDREN LIVE IN SINGLE-PARENT HOUSEHOLDS, 17% OF CHILDREN LIVE IN POVERTY, AND 37% ARE ELIGIBLE FOR FREE OR REDUCED-PRICE LUNCH. PART VI, LINE 5: CRMC ALSO FURTHERS ITS MISSION BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS AND ACTIVITIES THAT FOSTER HEALTH, HEALING, AND WELLNESS. CRMC KNOWS THAT MUCH OF WHAT INFLUENCES HEALTH HAPPENS OUTSIDE OF THE HOSPITAL OR DOCTOR'S OFFICE IN OUR SCHOOLS, WORKPLACES AND NEIGHBORHOODS. JUST AS ITS CARE TEAMS DEVOTE THEMSELVES TO MEETING THE NEEDS OF PATIENTS, CRMC IS DRIVEN TO ADDRESS ITS SPECIFIC COMMUNITY HEALTH NEEDS WITH WELLNESS SCREENINGS, HEALTH EDUCATION CLASSES AND EVENTS, HEALTH FAIRS, AND OTHER COMMUNITY OUTREACH. CRMC PRO-ACTIVELY RECRUITS THE PHYSICIANS AND SPECIALISTS NEEDED TO MEET THE COMMUNITY'S HEALTHCARE NEEDS AND WORKS HARD TO RETAIN ITS MEDICAL STAFF. CRMC STRIVES TO KNOW WHAT KIND OF PHYSICIANS ARE GOING TO BE NEEDED AND THEN PLANS AND ALLOCATES RESOURCES ACCORDINGLY. THE ORGANIZATION ALSO ASSESSES THE DEMOGRAPHICS AND PRACTICE PATTERNS OF CURRENT STAFF TO SHOW POTENTIAL RECRUITING CANDIDATES THAT THERE IS A NEED FOR THEIR SERVICES. CRMC PROVIDED OVER $60,000 IN FINANCIAL ASSISTANCE TO AREA CANCER PATIENTS NEEDING SOME ASSISTANCE DURING TREATMENT. IN ADDITION OUR STAFF ANNUALLY VOLUNTEER APPROXIMATELY 500 HOURS OF THEIR TIME TO HELP OTHERS IN OUR COMMUNITY. CRMC IS GOVERNED BY A NINE-MEMBER, NON-PROFIT BOARD OF DIRECTORS CONSISTING OF FOUR LEADERS WHO LIVE IN AREAS GEOGRAPHICALLY REPRESENTATIVE OF CRMC'S SERVICE AREA, TWO DISTRICT BOARD MEMBERS, TWO MEDICAL STAFF AND THE CEO. THE BOARD'S PRIMARY RESPONSIBILITY IS TO ASSURE THE SERVICES PROVIDED BY CRMC MEET COMMUNITY STANDARDS, PROMOTE PATIENT SAFETY AND ENSURE THE HOSPITAL IS PROVIDING THE HIGHEST QUALITY OF HEALTH CARE SERVICES TO THE COMMUNITIES CRMC SERVES. CRMC ALSO HAS AN 18-MEMBER GOVERNING BOARD ELECTED BY RESIDENTS OF ITS COMMUNITIES. MEMBERS OF THIS GROUP ASSURE THAT PAYMENT ON THE OUTSTANDING DEBT AND OTHER OBLIGATIONS OF CRMC ARE SATISFIED. CRMC INVESTS APPROXIMATELY $5 MILLION PER YEAR IN CAPITAL IMPROVEMENTS TO ENSURE ITS STAFF CAN CONTINUE TO PROVIDE COMPASSIONATE, PATIENT-CENTERED CARE UTILIZING THE MOST ADVANCED TREATMENTS AND TECHNOLOGIES AVAILABLE. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 CROSBY SENIOR SERVICES 2845 N HAMLINE AVE ROSEVILLE MN 55113 204631039 501(C)(3) 150000 0 TO SUPPORT HEARTWOOD SENIOR LIVING COMMUNITY CUYUNA LAKES PICKLEBALL ASSOCIATION PO BOX 264 CROSBY MN 56441 873759460 501(C)(3) 10000 0 PROGRAM SUPPORT CENTRAL LAKES COLLEGE 501 WEST COLLEGE DRIVE BRAINERD MN 56401 411687554 GOVERNMENT 6860 0 PROGRAM SUPPORT 3 0 PART I, LINE 2: CRMC FUNDS PROVIDED TO CROSBY SENIOR SERVICES WERE SET UP AS A LOAN THAT WAS ULTIMATELY FORGIVEN AND RECORDED AS A CONTRIBUTION. GRANTS TO CUYUNA LAKES PICKLEBALL ASSOCIATION AND CENTRAL LAKES COLLEGE WERE FOR TANGIBLE ITEMS. BOTH ORGANIZATIONS SHARED PHOTOS ON OUR SOCIAL MEDIA PLATFORMS. X X 1 0 0 0 0 0 0 0 0 FAWN ATCHISON ANESTHESIOLOGIST 659226 0 0 0 322 0 14500 0 16434 0 690482 0 0 0 KAMRAN DARABI PHYSICIAN UNTIL 10/14/21 599925 0 0 0 150 0 14500 0 24914 0 639489 0 0 0 LEAH KIPPES ANESTHESIOLOGIST 558182 0 0 0 140 0 14500 0 32713 0 605535 0 0 0 AARON HOLLEY PHYSICIAN 490340 0 0 0 210 0 14500 0 32288 0 537338 0 0 0 CHRISTOPHER KACZMARCYK PHYSICIAN 471945 0 0 0 112 0 14500 0 4343 0 490900 0 0 0 AMY HART INTERIM CEO - BEGIN 6/28/21 323958 0 0 0 602 0 14500 0 16797 0 355857 0 0 0 KYLE BAUER CEO UNTIL 4/30/21 163627 0 0 0 163554 0 4992 0 10550 0 342723 0 0 0 KATIE BERG CFO 286569 0 0 0 140 0 14235 0 4903 0 305847 0 0 0 PART I, LINE 4A A SEVERANCE PAYMENT WAS MADE TO THE EXITING CEO IN THE AMOUNT OF $163,462. CARLA CARLSON SISTER-IN-LAW OF ANDREA BEDARD, DIRECTOR 39354 EMPLOYMENT 0 CHRIS CARLSON BROTHER TO ANDREA BEDARD, DIRECTOR 35490 EMPLOYMENT 0 JODI BEDARD DAUGHTER-IN-LAW OF ANDREA BEDARD, DIRECTOR 65774 EMPLOYMENT 0 SHERRY SKJEVELAND WIFE OF JAMIE SKJEVELAND, DIRECTOR 37122 EMPLOYMENT 0 FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CEO WILL REVIEW THE FINAL 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL EMPLOYEES COMPLETE A CONFLICT OF INTEREST FORM. IT'S REVIEWED BY OUR HUMAN RESOURCES, AND ANY CONCERNS ARE BROUGHT TO THE COMPLIANCE OFFICERS AND THE SENIOR LEADERSHIP TEAM. 1. DUTY TO DISCLOSE: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. 2. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS BY MAJORITY VOTE. 3. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: A. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. B. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. C. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. D. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY UNANIMOUS VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. 4. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: A. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. B. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. RECORDS OF PRECEDINGS: THE MINUTES OF THE GOVERNING BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN: 1. THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE GOVERNING BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS. COMPENSATION: 1. A VOTING MEMBER OF THE GOVERNING BOARD WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO VOTING MEMBER OF THE GOVERNING BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. ANNUAL STATEMENTS: EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, 2. HAS READ AND UNDERSTANDS THE POLICY, 3. HAS AGREED TO COMPLY WITH THE POLICY. PERIODIC REVIEWS: TO ENSURE THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH PUBLIC HOSPITAL DISTRICT REQUIREMENTS, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION AND THE RESULT OF ARM'S LENGTH BARGAINING. 2. WHETHER PARTNERSHIPS, JOINT VENTURES AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A A COMMITTEE MADE UP OF INDEPENDENT BOARD MEMBERS REVIEWED COMPENSATION AND MARKET DATA TO DETERMINE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND THE FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 18,294,843. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,294,843. OTHER FEES: PROGRAM SERVICE EXPENSES 1,849,556. MANAGEMENT AND GENERAL EXPENSES 74,250. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,923,806. OTHER FEES FOR SERVICES (NON EMPLOY: PROGRAM SERVICE EXPENSES 10,944,620. MANAGEMENT AND GENERAL EXPENSES 882,001. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,826,621. FORM 990, PART XI, LINE 9: BOOK/TAX DIFFERENCE -12,013. 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