2022-02-07T11:25:13-06:00 2021-03-31 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2020-04-01 411724637 CUYUNA REGIONAL MEDICAL CENTER CUYU 2185467000 320 EAST MAIN STREET CROSBY MN 56441 KATIE BERG CFO 2185467000 2022-02-03 1 KATIE BERG 999009999 JULIE BOYER P01278549 2187275025 2022-02-03 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z AMY HART 320 EAST MAIN STREET CROSBY MN 56441 151158683 0 X WWW.CUYUNAMED.ORG X 1992 MN ACCOMMODATING YOU WITH CARE AND COMPASSION BY DEDICATING OURSELVES TO YOU EVERY DAY. 9 7 1187 65 0 0 67818 13387620 138007713 137115392 492598 230529 868198 425142 139436327 151158683 100000 100000 0 0 68267290 71670291 0 0 0 68765130 73004836 137132420 144775127 2303907 6383556 117156569 118817287 65117236 60094518 52039333 58722769 X ACCOMMODATING YOU WITH CARE AND COMPASSION BY DEDICATING OURSELVES TO YOU EVERY DAY. 0 0 134493645 100000 137115392 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 FY21 A TOTAL OF $422,415 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 $2,141,175 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 $976,825 IN SERVICES IN FY21 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 EVENT ATTRACTED NEARLY 10,000 PARTICIPANTS. IN FY21, 4,142 LUNCHES WERE PROVIDED FOR YOUTH IN THE CUYUNA LAKES 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, BREASTFEEDING, AND DIABETES PREVENTION TOGETHER WITH SUPPORT GROUPS ON MEMORY LOSS, BRAIN INJURY AND STROKE, CANCER, AND WEIGHT LOSS. THE VALUE OF CRMC'S COMMUNITY EDUCATION AND SUPPORT IN FY21 TOTALED $1,152,587. CRMC ALSO SUPPORTS OTHER ORGANIZATIONS AND INITIATIVES THAT SHARE ITS GOAL TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN FY21, THAT INCLUDED $69,397 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 $3 MILLION PER YEAR IN CAPITAL IMPROVEMENTS SUCH AS NEW EQUIPMENT, FACILITIES, AND TECHNOLOGY INFRASTRUCTURE. 134493645 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 1 114 0 1 1187 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 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 1.00 X 0 0 0 DR PETER MACKAY DIRECTOR 1.00 X 0 0 0 KENT FELTZ DIRECTOR 1.00 X 0 0 0 WADE LEONARD 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 40.00 X 36140 0 2568 RICHARD SCHILLER CHAIR UNTIL 8/1/20 1.00 X X 0 0 0 BART TAYLOR CHAIR 1.00 X X 0 0 0 KEVIN EGAN VICE CHAIR UNTIL 8/1/20 1.00 X X 0 0 0 KYLE BAUER CEO 40.00 X X 396386 0 44543 AMY HART COO 40.00 X 271460 0 38965 KATIE BERG CFO 40.00 X 215101 0 14696 KAMRAN DARABI PHYSICIAN 40.00 X 766011 0 39249 FAWN ATCHISON ANESTHESIOLOGIST 40.00 X 640067 0 29564 RAJESH BHARGAVA HOSPITALIST 40.00 X 616784 0 41382 LEAH KIPPES ANESTHESIOLOGIST 40.00 X 581803 0 44999 AARON HOLLEY PHYSICIAN 40.00 X 560201 0 43787 4083953 0 299753 87 0 1 0 PREMIER SURGICAL ASSOCIATES PA 318 E MAIN STREET CROSBY MN 56441 PHYSICIAN FEES 8508208 CENTRAL LAKES PHYSICIANS PA 318 E MAIN STREET CROSBY MN 56441 PHYSICIAN FEES 4209493 CENTRAL MN DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 RADIOLOGY SERVICES 1756852 MINNESOTA INTERVENTIONAL SPINE CONSULTAN 23080 CROSS DR DEERWOOD MN 56444 PHYSICIAN FEES 1501202 RJ MECHANICAL PO BOX 373 MORA MN 55051 BUILDING CONTRACTOR 1281034 53 480183 12907437 13387620 PATIENT REVENUE 621500 127617066 127617066 PROFESSIONAL SERVICES 621500 6630143 6630143 OTHER OPERATING REVENUE 900099 1456751 1456751 RETAIL PHARMACY 446110 1411432 1411432 137115392 230529 230529 CAFETERIA 722210 425142 425142 425142 151158683 137115392 0 655671 X 100000 100000 980337 980337 56407904 55870713 537191 2109470 2109470 8278343 8278343 3894237 3533065 361172 100899 8375 92524 94932 94932 3617 3617 23812424 23175455 636969 503352 503352 2907041 2507446 399595 294226 294226 2120984 1990253 130731 225729 177138 48591 1707827 1707827 6341611 3486076 2855535 320168 2602 317566 MEDICAL SUPPLIES 11667219 11655683 11536 DRUGS - PROGRAM 9838999 9838999 IMPLICIT PRICE CONCESSI 4306626 4306626 REPAIRS & MAINTENANCE 2315216 2308604 6612 6443966 4347219 2096747 144775127 134493645 10281482 0 13041204 24256021 52776 52860 22708865 24784185 10303500 0 3276983 3494341 2794856 2663657 147975016 88487418 61158121 59487598 3106825 2811139 485367 713439 782119 117156569 118817287 10649421 13206177 21373 12472 14400000 0 40046442 46875869 65117236 60094518 X 52039333 58722769 52039333 58722769 117156569 118817287 X 6383556 299880 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3617 3617 0 PART II-B, LINE 1: CUYUNA REGIONAL MEDICAL CENTER PAY 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 79526951 34705227 44821724 64550602 51723726 12826876 3593123 2058465 1534658 59487598 DUE TO CUYUNA RANGE HOSPITAL DISTRICT 34598644 DUE TO AFFILIATE 412654 MEDICARE ACCELERATED PAYMENTS 11864571 46875869 X 147320130 -1115125 -1115125 148435255 2723428 2723428 151158683 140399101 2156625 2156625 138242476 6532651 6532651 144775127 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 1,888,320. SLEEP CENTER OF CENTRAL MINNESOTA REVENUE 1,403,181. IMPLICIT PRICE CONCESSIONS -4,306,626. CONTRIBUTION TO CROSBY SENIOR SERVICES -100,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS RELATED TO MINNESOTA RADIOLOGY INSTITUTE 2,723,428. PART XII, LINE 2D - OTHER ADJUSTMENTS: MINNESOTA RADIOLOGY INSTITUTE EXPENSES 943,810. SLEEP CENTER OF CENTRAL MINNESOTA EXPENSES 1,212,815. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 4,306,626. ELIMINATIONS RELATED TO MINNESOTA RADIOLOGY INSTITUTE 2,126,025. CONTRIBUTION TO CROSBY SENIOR SERVICES 100,000. 1 1 X 1 X 175.000000000000 1 X 1 1 0 1 1 2429782 2429782 0.01730 21624663 17037337 4587326 0.03270 24054445 17037337 7017108 0.05000 14 16233 1065867 1065867 0.00760 4 2496 69397 69397 0.00050 18 18729 1135264 1135264 0.00810 18 18729 25189709 17037337 8152372 0.05810 1 5807 5807 0.00000 1 5807 5807 0.00000 1 4306626 0 35596806 37553391 -1956585 X 1 1 1 1 CUYUNA REGIONAL MEDICAL CENTER 320 EAST MAIN STREET CROSBY MN 56441 394840 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 X HTTPS://CUYUNAMED.ORG/PATIENT-INFORMATION X HTTPS://CUYUNAMED.ORG/PATIENT-INFORMATION 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 USED DATA COLLECTED FROM A COMMUNITY HEALTH SURVEY CONDUCTED AT ITS ANNUAL WOMEN'S WELLNESS EVENT AND ALSO USED INPUT FROM DISCUSSION AT A COMMUNITY KEY STAKEHOLDERS' FOCUS GROUP. INFORMATION FROM RESULTS OF THE 2020-2022 AND 2017-2019 CHNAS DEVELOPED BY ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER AS WELL AS THE 2017 CROW WING COUNTY COMMUNITY HEALTH SURVEY WAS ALSO UTILIZED. DATA FROM CRMC'S CLINIC 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 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 AND SOCIAL WORKER TO SERVE THE COMMUNITY. PARTNERED WITH SMILES FOR JAKE SUICIDE PREVENTION COALITION TO PROVIDE COMMUNITY EDUCATION AND EVENTS ON BULLYING, ANXIETY, AND HOPELESSNESS. PROVIDED FIRST AID TRAINING TO CRMC LEADERSHIP AND SOME STAFF AND PROVIDERS. CONTINUED TO PARTNER WITH COMMUNITY ORGANIZATIONS IN PROVIDING MAKE IT OKAY EDUCATION TO STAFF AND PROVIDERS. DURING COVID, OFFERED UNLIMITED EAP VISITS FOR STAFF AND THEIR FAMILY MEMBERS. SCREENED ALL CLINIC PATIENTS FOR DEPRESSION AND OFFERED 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. OFFERED BURNOUT AND RESILIENCE IN NURSING EDUCATION TO NURSING STAFF. PROVIDED 3 GOOD THINGS EDUCATION AND NOTEBOOKS TO NUMEROUS STUDENTS. PHYSICAL ACTIVITY - OFFERED WELLBEATS ON-DEMAND FITNESS PROGRAM FOR STAFF. SUPPORTED CUYUNA STATE RECREATION AREA TRAIL MAINTENANCE. ADDED NUTRITION INFORMATION TO CRMC CULINARY MENUS. FINANCIALLY SUPPORTED CROSBY AND EMILY FOOD BANKS. PROVIDED BIKES FOR STAFF TO RIDE ON BREAKS AND AFTER WORK. PROVIDED BIKE HELMETS TO AREA STUDENTS. SPONSORED HALLETT CENTER ICE SKATING RINK. PROVIDED ATHLETIC TRAINER FOR CROSBY-IRONTON SCHOOL ATHLETES. SUPPORTED LOCAL COMMUNITY SKATING RINKS AND YOUTH HOCKEY ASSOCIATIONS. NUTRITION- OFFERED DIABETES EDUCATION AND SUPPORT GROUPS. HELD INTENSIVE BEHAVIORAL THERAPY PROGRAMS FOR OVERWEIGHT INDIVIDUALS. SPONSORED FARMER'S MARKET AND ITS POWER OF PRODUCE PROGRAM ENCOURAGING YOUTH AND SENIORS TO EAT MORE FRUITS AND VEGETABLES. STARTED NEW MEDICAL WEIGHT MANAGEMENT PROGRAM. OFFERED MONTHLY VIRTUAL WEIGHT LOSS SUPPORT GROUPS AND SEMINARS. FINANCIALLY SPONSORED FISHING TO END HUNGER FISHING TOURNAMENT BENEFITTING COMMUNITY OUTREACH. PRIORITIES NOT SELECTED:MANY OF THE OTHER HEALTH ISSUES WERE NOT SELECTED BECAUSE EFFORTS IN THESE THREE AREAS WOULD ALSO IMPACT THOSE ISSUES. FOR EXAMPLE, IN ADDRESSING MENTAL HEALTH ISSUES, CRMC WILL ALSO TACKLE SUBSTANCE ABUSE, DEPRESSION, ANXIETY, PANIC ATTACKS, AND STRESS. IF CRMC IS SUCCESSFUL IN IMPROVING NUTRITION AND INCREASING ACTIVITY, IT WILL REDUCE THE OBESITY AND OVERWEIGHT RATES, ADDRESS THE LACK OF NUTRITIOUS FOODS, REDUCE DIABETES, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. BY ENCOURAGING INDIVIDUALS TO BE MORE ACTIVE, OVERWEIGHT RATES WILL BE REDUCED TOGETHER WITH STRESS AND DEPRESSION. OTHER ISSUES WERE NOT CHOSEN BECAUSE THEY CONSISTENTLY RANKED AS A LOWER PRIORITY IN THE SURVEYS AND STATISTICS. 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 $4,306,626. 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, 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 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 WHEN SCHOOL FREE LUNCHES ARE NOT AVAILABLE. 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. 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 9 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:AS A HOSPITAL, CUYUNA REGIONAL MEDICAL CENTER (CRMC) IS CONSTANTLY ASSESSING THE HEALTH OF THE COMMUNITY. CRMC HOSTS MULTIPLE COMMUNITY INITIATIVES THROUGH REGULAR MONTHLY MEETINGS, EVENTS AND FOCUSED SOCIAL GATHERINGS. THESE ACTIVITIES ALLOW US TO GET INVOLVED WITH MEMBERS OF THE COMMUNITY TO GET ONGOING FEEDBACK FROM THEM SO THAT WE CONTINUE TO ADDRESS THE HEALTH CARE NEEDS THAT ARE RELEVANT TO OUR COMMUNITY MEMBERS. FOR ADDITIONAL INFORMATION ABOUT CRMC'S WELLNESS PROGRAM, PLEASE VISIT OUR WEBSITE: HTTPS://WWW.CUYUNAMED.ORG/WELLNESS. 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. 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: PROMOTION OF COMMUNITY HEALTH:DURING THE COVID PANDEMIC, CRMC PROVIDED 11,000 COVID TESTS TO CLINIC AND HOSPITAL PATIENTS AND ANOTHER 5,060 COVID TESTS TO NURSING HOME RESIDENTS. CRMC PURCHASED AN ICE FISHING HOUSE AND TENT FOR $25,000 SO STAFF COULD PROVIDE COVID VACCINATIONS AT OUTDOOR CLINICS IN THE WINTER MONTHS. A TOTAL OF 5,755 FREE COVID VACCINES WERE GIVEN TO COMMUNITY INDIVIDUALS AT 23 CLINICS. A NURSE EDUCATION LINE WAS ALSO OFFERED 24/7 TO ANSWER INDIVIDUAL'S QUESTIONS. COVID EDUCATION WAS PROVIDED THROUGH PROVIDER'S VIDEOS AND MEDIA APPEARANCES AND ALSO THROUGH WEBSITE AND SOCIAL MEDIA POSTINGS. IN ADDITION, CRMC DEDICATED 117 HOURS WORKING WITH CROW WING COUNTY PUBLIC HEALTH STAFF ON A COORDINATED PLAN TO TEST AND VACCINATE COMMUNITY MEMBERS AND ANOTHER 156 HOURS TO WORKING WITH THE COALITION TO ENSURE ALL ORGANIZATIONS HAD THE PROPER SUPPLIES AND EQUIPMENT. 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 $12,225 IN FINANCIAL ASSISTANCE TO AREA CANCER PATIENTS NEEDING SOME ASSISTANCE DURING TREATMENT. IN ADDITION, OUR STAFF VOLUNTEERED 530 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 $3 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 0 CROSBY SENIOR SERVICES 2845 N HAMLINE AVE ROSEVILLE MN 55113 204631039 501(C)(3) 100000 0 0 0 TO SUPPORT HEARTWOOD SENIOR LIVING COMMUNITY 1 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. X X 0 0 0 0 0 0 0 0 0 KAMRAN DARABI PHYSICIAN 765831 0 0 0 180 0 9712 0 29537 0 805260 0 0 0 FAWN ATCHISON ANESTHESIOLOGIST 639887 0 0 0 180 0 14250 0 15314 0 669631 0 0 0 RAJESH BHARGAVA HOSPITALIST 615992 0 0 0 792 0 14250 0 27132 0 658166 0 0 0 LEAH KIPPES ANESTHESIOLOGIST 581683 0 0 0 120 0 14250 0 30749 0 626802 0 0 0 AARON HOLLEY PHYSICIAN 560021 0 0 0 180 0 14250 0 29537 0 603988 0 0 0 KYLE BAUER CEO 396206 0 0 0 180 0 14250 0 30293 0 440929 0 0 0 AMY HART COO 270944 0 0 0 516 0 13926 0 25039 0 310425 0 0 0 KATIE BERG CFO 214982 0 0 0 119 0 10694 0 4002 0 229797 0 0 0 CARLA CARLSON SISTER-IN-LAW OF ANDREA BEDARD, DIRECTOR 34485 EMPLOYMENT 0 CHRIS CARLSON BROTHER TO ANDREA BEDARD, DIRECTOR 31283 EMPLOYMENT 0 JODI BEDARD DAUGHTER-IN-LAW OF ANDREA BEDARD, DIRECTOR 59185 EMPLOYMENT 0 FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND INTERIM 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 14,606,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,606,200. OTHER FEES: PROGRAM SERVICE EXPENSES 954,370. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 954,370. OTHER FEES FOR SERVICES (NON EMPLOYEE): PROGRAM SERVICE EXPENSES 7,614,885. MANAGEMENT AND GENERAL EXPENSES 636,969. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,251,854. FORM 990, PART XI, LINE 9: BOOK/TAX DIFFERENCE 299,880. 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