2022-11-10T16:43:11-06:00 2021-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2021-01-01 390908320 AMERY REGIONAL MEDICAL CENTER INC AMER 7152688000 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DEBRA RUDQUIST PRESIDENT 7152688000 2022-11-10 1 DEBRA RUDQUIST 999009999 MONROE J GIERL P01413237 6123055000 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DEBRA A RUDQUIST 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 71258980 0 X WWW.AMERYMEDICALCENTER.ORG X 1954 WI TO PROVIDE ACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE 13 7 485 18 0 0 5090592 998823 59133527 69154036 625543 773650 206727 318130 65056389 71244639 8519 7885 0 0 41505581 44909968 0 0 0 20349108 22601594 61863208 67519447 3193181 3725192 67160715 71776941 39681628 40570544 27479087 31206397 X AMERY REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDEACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THEHEALTH AND WELLNESS OF ITS COMMUNITY. 0 0 58209879 7885 69154036 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 58209879 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0 0 485 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DOUGLAS E JOHNSON - CFO 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 X RICK DADO DIRECTOR & SECRETARY 1.75 0.25 X X 1200 0 0 CHUCK WILLIAMSON DIRECTOR 1.75 0.25 X 1200 0 0 JAMES A LEADHOLM JR DIRECTOR & CHAIR 1.75 0.25 X X 1200 0 0 MARGO ROSEN DIRECTOR 1.75 0.25 X 1200 0 0 JANE JOHNSON DIRECTOR 1.75 0.25 X 0 0 0 CHRIS PETERSEN DIRECTOR 1.75 0.25 X 1200 0 0 ORALEE SCHOCK DIRECTOR & VICE CHAIR 1.75 0.25 X X 1200 0 0 ROSS R BULLARD DIRECTOR & TREASURER 2.00 48.00 X X 0 270690 78271 DYLAN COE MD DIRECTOR 0.25 29.25 X 0 132165 61598 MARTIN E RICHARDS MD DIRECTOR 0.25 39.75 X 0 465331 50279 ANN R SEAGREN MD DIRECTOR 0.25 39.75 X 0 263351 76348 THEODORE T WEGLEITNER DIRECTOR 0.25 52.75 X 0 381403 38782 MARYANN SCOGLIO CANP DIRECTOR 0.25 54.75 X 0 161063 42265 BRIAN H RANK MD DIRECTOR 0.25 64.75 X 0 1103277 295296 RONDA D DAVIS MD DIRECTOR 0.25 44.75 X 0 275767 49726 SANDRA M REED VP - PATIENT CARE SERVICES 55.00 0.00 X 208026 0 31251 DEBRA A RUDQUIST PRESIDENT 53.00 0.00 X 0 340466 59348 PATRICK D SURA MD CHIEF MEDICAL OFFICER 0.25 59.75 X 0 391228 50226 DOUGLAS E JOHNSON CFO 13.75 41.25 X 0 410661 233539 MARK A TRYGGESTAD DIRECTOR OF PHARMACY 42.00 0.00 X 164957 0 19740 ANTHONY R GOULD DIRECTOR -ANCILLARY SERVICES 50.00 0.00 X 145623 0 42355 JOLLEEN M NICHOLS PROVIDER-APNP 50.00 0.00 X 136509 0 16302 ANN M SCHILLING HR SR DIRECTOR 40.00 0.00 X 136885 0 41224 JAMES G ERICKSON RN HOUSE SUPERVISOR 40.00 0.00 X 137636 0 41809 JASON J LUHRS FORMER CFO 0.00 50.00 X 0 255205 53578 936836 4450607 1281937 22 1 1 0 KRAUS-ANDERSON CONSTRUCTION CO 501 S 8TH ST MINNEAPOLIS MN 55404 CONSTRUCTION 1475452 RIVER VALLEY ANESTHESIA INC PO BOX 118 NEW RICHMOND WI 54017 NURSE ANESTHETISTS 934518 INFINITE HEALTH COLLABORATIVE 4200 DALBERG DR STE 300 GOLDEN VALLEY MN 55422 PROFESSIONAL SERVICES 864646 HEALOGICS WOUND CARE 28525 NETWORK PLACE CHICAGO IL 60673 WOUND HEALING MANAGEMENT 397256 ASSOCIATED EYE CARE 1719 TOWER DR STE 10 STILLWATER MN 55082 PROFESSIONAL SERVICES 204948 14 137331 861492 998823 NET PATIENT SERVICE 621110 68418582 68418582 OTHER OPERATING 641110 709824 709824 FITNESS CENTER 624110 25630 25630 69154036 773650 773650 195405 14341 181064 181064 181064 CAFETERIA AND OTHER 445200 73692 73692 OTHER 621110 44493 44493 GIFT SHOP 453220 18881 18881 137066 71244639 69154036 0 1091780 7885 7885 246377 246377 38450071 33558473 4891598 707743 617704 90039 4039982 3553206 486776 1465795 1279317 186478 2470 2470 4435045 3823368 611677 57977 24935 33042 679598 422181 257417 117075 61805 55270 1057379 729197 328182 19272 9981 9291 4175 1815 2360 666614 666614 3413619 3039009 374610 184037 63344 120693 MEDICAL & DRUG SUPPLIES 8920839 8891722 29117 EQUIP. RENT & REPAIR 2103803 775648 1328155 OTHER EXPENSE 771693 519552 252141 TAXES & ASSESSMENTS 120306 120306 47692 43817 3875 67519447 58209879 9309568 0 6274 21728322 24591162 5741748 6940177 8377868 907073 1255029 175514 116879 62450641 43492482 19492609 18958159 11932369 12778877 2630802 2403195 484735 416864 67160715 71776941 16088308 18710459 861492 600538 22336378 20862531 395450 397016 39681628 40570544 X 27479087 31206397 27479087 31206397 67160715 71776941 X 3725192 139449 -137331 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 0 PART II-B, LINE 1: AMERY REGIONAL MEDICAL CENTER, INC. PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 983722 983722 24719692 17849941 6869751 5997221 1133686 4863535 28691305 24508855 4182450 2058701 2058701 18958159 LEASE OBILGATION 397016 397016 X PART X, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. JUDGMENT IS REQUIRED IN DETERMINING HP'S EFFECTIVE TAX RATE AND IN EVALUATING ITS TAX POSITION. HP ESTABLISHES ACCRUALS FOR UNCERTAIN TAX POSITIONS WHEN, DESPITE THE BELIEF THAT HP'S TAX RETURN POSITIONS ARE FULLY SUPPORTABLE, HP BELIEVES THAT ITS POSITION MAY NOT BE FULLY SUSTAINED, PRIMARILY GIVEN THE RISKS ASSOCIATED WITH TAX LITIGATION OR DISPUTES. THE UNCERTAIN TAX POSITION ACCRUALS ARE ADJUSTED IN LIGHT OF CHANGING FACTS AND CIRCUMSTANCES, SUCH AS THE PROGRESS OF TAX AUDITS, CASE LAW, AND EMERGING LEGISLATION. HP'S EFFECTIVE TAX RATE INCLUDES THE IMPACT OF CHANGES TO THE ACCRUALS FOR UNCERTAIN TAX POSITIONS. HP CLASSIFIES INTEREST AND PENALTIES ON TAX-RELATED MATTERS AS INCOME AND OTHER TAX EXPENSE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2021 OR 2020 FOR UNRECOGNIZED TAX BENEFITS. 1 1 X 1 X 1 X 1 1 0 0 279576 0 279576 0.00410 9840271 7620302 2219969 0.03290 10119847 7620302 2499545 0.03700 13 678 112337 0 112337 0.00170 7 17 278964 0 278964 0.00410 2 2630389 0 2630389 0.03900 6 135581 4970 130611 0.00190 28 695 3157271 4970 3152301 0.04670 28 695 13277118 7625272 5651846 0.08370 1 2742 0 0.00000 1 3805 0 0.00000 4 7416 0 0.00000 1 944 0 0.00000 7 14907 0 0.00000 1 829228 23131249 23131249 X 1 1 1 1 AMERY REGIONAL MEDICAL CENTER 265 GRIFFIN STREET EAST AMERY WI 54001 WWW.AMERYMEDICALCENTER.ORG CAH CERT LICENSE 1010 X X X X AMERY REGIONAL MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY X 1 19 1 HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE NOTES X SEE NOTES X SEE NOTES X X X X X X 1 X 0 X X X X 1 X 0 0 AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: TO COMPREHENSIVELY UNDERSTAND AND DESCRIBE THE NEEDS OF THE COMMUNITIES HEALTHPARTNERS SERVES, WE SYSTEMATICALLY IDENTIFIED A LIST OF PUBLICLY AVAILABLE DATA SOURCES AND A LIST OF INTERNALLY AVAILABLE HEALTHPARTNERS DATA SOURCES. WITH THE CHNA WORKGROUP THAT HAD EXPERTISE FROM PUBLIC HEALTH, HEALTHCARE AND EPIDEMIOLOGY, WE CAREFULLY REVIEWED THE LIST TO IDENTIFY OPPORTUNITIES WITH A SPECIFIC LENS TOWARDS INCLUDING MEMBERS WITH UNIQUE INSIGHT INTO NEEDS OF OUR UNDERSERVED COMMUNITIES WHERE HEALTH AND OTHER DISPARITIES EXIST. TO FURTHER ROUND OUT UNDERSTANDING, WE SOUGHT ADDITIONAL DATA SOURCES TOGETHER WITH OUR COMMUNITY PARTNERS. WHERE OPPORTUNITIES STILL REMAIN FOR BETTER UNDERSTANDING DUE TO LACK OF CURRENTLY AVAILABLE DATA, WE HAVE NOTED IN THE REPORT. FOR EXAMPLE, WE IDENTIFIED SPECIFIC GAPS IN DATA AVAILABLE TO UNDERSTAND THE COVID-19 PANDEMIC CONTEXT AND THE INFLUENCE OF STRUCTURAL RACISM ON THE NEEDS AREAS. THUS, WE SPECIFICALLY DESIGNED OUR QUALITATIVE COMMUNITY CONVERSATIONS AND OUR QUANTITATIVE HEALTHPARTNERS PROVIDER SURVEYS TO FILL THESE GAPS. HEALTHPARTNERS PROVIDER SURVEYS: SELECT HEALTHPARTNERS STAFF WHO PROVIDE DIRECT CARE FOR OUR PATIENTS WERE INVITED BY HOSPITAL LEADERS AND THE CHNA EXPERT PANEL MEMBERS TO COMPLETE A BRIEF WEB SURVEY ABOUT THE NEEDS OF THE PATIENTS THEY SERVE. THE SURVEY WAS DEVELOPED BY AN EXPERT SURVEY METHODOLOGIST WITH INPUT FROM THE CHNA WORKGROUP. OVERALL, 444 PROVIDERS INCLUDING DOCTORS, CARE COORDINATORS, PHARMACISTS, PHYSICAL OR OCCUPATIONAL THERAPISTS, DIETITIANS, NURSES, AND SOCIAL WORKERS COMPLETED SURVEYS ACROSS ALL HEALTHPARTNERS HOSPITALS. DESCRIPTIVE STATISTICS AND A THEMATIC ANALYSIS WERE COMPLETED AND INCLUDED IN THE NEEDS AREA SUMMARIES BELOW.COMMUNITY CONVERSATIONS: A TOTAL OF 41 COMMUNITY CONVERSATIONS WERE HELD OR ATTENDED BY HEALTHPARTNERS WORKGROUP MEMBERS. RESULTS WERE SUMMARIZED AND KEY THEMES AND QUOTES WERE ADDED TO THE NEEDS AREA SUMMARIES THROUGHOUT. ADDITIONAL DETAILS ABOUT THE COMMUNITY CONVERSATIONS CAN BE FOUND IN THE APPENDIX OF THE AMERY'S 2021CHNA AT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: HEALTHPARTNERS COLLABORATED ACROSS EIGHT HOSPITALS WITHIN ITS FAMILY OF CARE FOR THE 2021 CHNA: AMERY HOSPITAL & CLINIC (AMERY, WI) HUDSON HOSPITAL & CLINIC (HUDSON, WI) HUTCHINSON HEALTH (HUTCHINSON, MN) LAKEVIEW HOSPITAL (STILLWATER, MN) OLIVIA HOSPITAL AND CLINIC (OLIVIA, MN) PARK NICOLLET HEALTH SERVICES INCLUDING PARK NICOLLET METHODIST HOSPITAL (ST. LOUIS PARK, MN) REGIONS HOSPITAL (ST. PAUL, MN) WESTFIELDS HOSPITAL & CLINIC (NEW RICHMOND, WI) AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: IN 2021, SEVERAL TACTICS WERE IMPLEMENTED TO HELP ADDRESS THE NEEDS IDENTIFIED IN OUR CHNA AND DESCRIBED IN OUR IMPLEMENTATION PLAN. HIGHLIGHTS OF THE 2021 ACTIVITIES AND RESULTS ARE INCLUDED BELOW.ACCESS TO CARE GOAL: IMPROVE ACCESS TO CARE THAT IS APPROPRIATE, AFFORDABLE, AND CONVENIENT. -CONTINUED TO INCREASE WEBSITE ACCESS TO PATIENT AND COMMUNITY ACCESS TO HEALTH INFORMATION AND APPOINTMENT SCHEDULING. -IMPROVED GEOGRAPHIC ACCESS OF CARE FOR PATIENTS THROUGH COORDINATION OF APPOINTMENT SCHEDULING BETWEEN FIVE SITES IN THE ST. CROIX VALLEY AREA. -SIGNIFICANTLY INCREASED TELEMEDICINE FOR PRIMARY, SPECIALTY AND BEHAVIORAL HEALTH SERVICES IN A VERY SHORT TIME FRAME TO INCREASE ACCESS DURING PANDEMIC RESTRICTIONS. ACCESS TO HEALTH GOAL: STRENGTHEN EXISTING AND EXPLORE NEW COMMUNITY PARTNERSHIPS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH, PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT, AND PROMOTE SUSTAINABLE OPERATIONS TO POSITIVELY IMPACT THE COMMUNITY.- DUE TO COVID-19 PANDEMIC, NEW PARTNERSHIPS WERE ESTABLISHED, AND EXISTING PARTNERSHIPS WERE STRENGTHENED TO MEET SHIFTING AND EMERGING COMMUNITY NEEDS. - UPDATED COMMUNITY RESOURCE LIST TO INCLUDE NEW RESOURCES AND SUPPORT DURING COVID PANDEMIC; AVAILABLE TO PATIENTS, STAFF AND COMMUNITY MEMBERS. - CONTINUED TO SERVE ON CORE LEADERSHIP TEAM FOR SUPERSHELF FOOD SHELF TRANSFORMATIONS AND MAKE ADAPTATIONS IN DELIVERY METHODS FOR COVID-19. - DISTRIBUTED BOOKS TO CHILDREN IN CLINICS THROUGH REACH OUT AND READ. LITTLE MOMENTS COUNT OFFERED VIRTUAL TRAINING AND RESOURCES TO CONTINUE MOMENTUM OF COLLABORATION TO PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT. - INCREASED RECYCLING AND PURCHASES OF SUSTAINABLY PRODUCED AND LOCAL FOODS AND BEVERAGES. - REDUCED WASTE TO LANDFILLS, MEAT PURCHASES, SINGLE USE PLASTIC BOTTLES, ELECTRICITY, NATURAL GAS AND WATER USE AND TOTAL GREENHOUSE EMISSIONS. INCREASED USE OF ENVIRONMENTALLY PREFERRED AND RECYCLED PAPER AND OFFICE SUPPLIES. MENTAL HEALTH AND WELL-BEING GOAL: REDUCE THE STIGMA SURROUNDING MENTAL ILLNESS, INCREASE ACCESS TO EDUCATION AND RESOURCES AROUND MENTAL HEALTH AND WELL-BEING AND IMPROVE ACCESS TO MENTAL HEALTH SERVICES.IN 2021, THE REACH OF THE MAKE IT OK CAMPAIGN EXPANDED THROUGH TRAINING LOCAL AMBASSADORS, PROMOTION, AND PARTNERSHIPS WITH LOCAL AGENCIES AND PUBLIC HEALTH. DESPITE THE CHALLENGE OF COVID-19, MAKE IT OK MADE PROGRESS IN REDUCING THE STIGMA OF MENTAL ILLNESS WITH THE FOLLOWING IMPACT: - RECEIVED 81,349 WEBSITE VISITS WITH 62,780 UNIQUE VISITORS IN 2021. THE MAKE IT OK TOOLS AND RESOURCES WERE DOWNLOADED MORE THAN 500 TIMES BY PEOPLE IN 250 US CITIES AND 25 MINNESOTA COUNTIES. - HELD 11 AMBASSADOR TRAININGS BOTH IN PERSON AND VIRTUALLY, MOBILIZING AN ADDITIONAL 200 AMBASSADORS. - REACHED MORE THAN 2,000 PEOPLE THROUGH COMMUNITY PRESENTATIONS, EVENTS AND TABLING. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. -MORE THAN 500 AMBASSADORS ARE NOW TRAINED IN THE ST. CROIX VALLEY AREA. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. -OFFERED BEATING THE BLUES AND RESILIENCY RESOURCES AT NO CHARGE TO MEMBERS, PATIENTS AND EMPLOYEES. MENTAL HEALTH RESOURCES PROMOTED AS KEY PART OF EMPLOYEE WELL-BEING PROGRAM. HOSPITAL CONVENES AND PARTICIPATES IN MULTIPLE COLLABORATIVES FOCUSING ON MENTAL HEALTH. - INCREASED VALLEY-WIDE USE OF BEHAVIORAL HEALTH TELEHEALTH (BHTV) PROGRAM FOR PATIENTS ACCESSING EMERGENCY DEPARTMENT CARE DURING A MENTAL HEALTH CRISIS.NUTRITION AND PHYSICAL ACTIVITY GOALS: PROMOTE AND SUPPORT PHYSICAL ACTIVITY AND NUTRITION AND SUPPORT AND ENCOURAGE HEALTHY FOOD AND PHYSICAL ACTIVITY ENVIRONMENT CHANGE. POWERUP: SINCE 2015, THE HOSPITAL HAS SUPPORTED POWERUP, A COMMUNITYWIDE HEALTH INITIATIVE THAT INSPIRES AND ENGAGES THE ENTIRE COMMUNITY TO PROMOTE BETTER EATING AND PHYSICAL ACTIVITIES SO YOUTH CAN REACH THEIR FULL POTENTIAL. OUR WORK WITH HUNDREDS OF PARTNERS ACROSS THE REGION HAS RESULTED IN A HIGH LEVEL OF COMMUNITY AND SCHOOL ENGAGEMENT, STRONGER SCHOOL WELLNESS POLICIES AND PRACTICES; MORE FREE AND LOW-COST OPTIONS FOR PHYSICAL ACTIVITY INCLUDING OPEN GYMS; PARTNERSHIPS WITH STATE AND LOCAL PARKS; TRANSFORMED FOOD PANTRIES, CAFETERIAS AND CONCESSIONS; AND COMMUNITY MOMENTUM TO CREATE CHANGE. SUBSTANCE USE GOAL: REDUCED OPIOID PRESCRIPTIONS, DOSES, AND PATIENTS MEETING CHRONIC OPIOID USE CRITERIA. THROUGH COLLABORATIVE EFFORTS WITH PHARMACY, PRESCRIBERS AND PAIN CLINICS, ACHIEVED SIGNIFICANT REDUCTION IN OPIOID PRESCRIBING IN OUR CARE SYSTEM AND COMMUNITY. VALLEY-WIDE, SINCE 2016, THERE HAS BEEN A 68% AND 52% REDUCTION IN OPIOIDS PRESCRIBED AT DISCHARGE IN HOSPITALS AND EMERGENCY DEPARTMENTS, RESPECTIVELY. PART V, SECTION B, LINE 3E AMERY ADDRESSES THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY THROUGH OUR CHNA. SCHEDULE H, PART V, LINE 20A AMERY DOES NOT PERFORM ANY ECAS (EXTRAORDINARY COLLECTION ACTIONS), THEREFORE WE WOULD NOT GIVE A PATIENT A WRITTEN NOTICE OF DOING SO. 6 1 - ARMC REHAB SERVICES 220 N KELLER AVENUE AMERY WI 54001 REHABILITATION 2 - LUCK MEDICAL CLINIC 137 FIRST AVENUE LUCK WI 54853 RURAL HEALTH CLINIC 3 - TURTLE LAKE MEDICAL CLINIC 550 MARTIN AVENUE TURTLE LAKE WI 54889 RURAL HEALTH CLINIC 4 - CLEAR LAKE CLINIC 357 THIRD AVENUE CLEAR LAKE WI 54005 RURAL HEALTH CLINIC 5 - LUCK PT & FITNESS 2547 STATE ROAD 35 SUITE 5 LUCK WI 54853 PHYSICAL THERAPY 6 - AMERY REGIONAL MEDICAL CENTER WEST 230 DERONDA STREET AMERY WI 54001 10 BED INPATIENT DPU OF AMERY PART I, LINE 7: AMERY REGIONAL MEDICAL CENTER (AMERY) USES THE COST-TO-CHARGE RATIO METHOD WHEN CALCULATING THE AMOUNTS REPORTED ON PART I. LINE 7. THE COST-TO-CHARGE RATIO WAS DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE-COST-TO-CHARGE, FROM THE SCHEDULE H INSTRUCTIONS PART III, LINE 2: AMERY USES THE COST TO CHARGE METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. AMERY BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. AMERY IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN ITS SERVICE AREA THAT ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH AMERY ALSO INCLUDES AS A COMMUNITY BENEFIT. PART III, LINE 4: SEE THE ORGANIZATION'S FOOTNOTES 1.O AND 1.Q, ON PAGE 25 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENT. PART III, LINE 8: AMERYS MEDICARE COST IS DERIVED BASED ON THE RATIO OF MEDICARE FFS CHARGES TO TOTAL CHARGES MULTIPLIED BY TOTAL EXPENSES (LESS CHARITY CARE & BAD DEBT). NONE OF THE MEDICARE FFS LOSS REPORTED ON SCHEDULE H, PART III, LINE 7 IS TREATED AS COMMUNITY BENEFIT ON SCHEDULE H, PART I, LINE 7A. PART III, LINE 9B: COLLECTIONS PRACTICESAMERY'S DEBT COLLECTION POLICY CONTAINS PROVISIONS ON COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE. AMERY WILL NOT REFER ANY ACCOUNT TO A THIRD PARTY DEBT COLLECTION AGENCY UNLESS IT HAS CONFIRMED THAT:- THERE IS REASONABLE BASIS TO BELIEVE THAT THE PATIENT OWES THE DEBT.- ALL KNOWN THIRD-PARTY PAYERS HAVE BEEN PROPERLY BILLED, AND THE PATIENT IS RESPONSIBLE FOR THE REMAINING DEBT.- IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT, THE PATIENT HAS BEEN OFFERED A REASONABLE PAYMENT PLAN. AMERY WILL NOT REFER PATIENTS TO DEBT COLLECTION AGENCIES WHO ARE PERFORMING AS SPECIFIED IN THEIR PAYMENT PLANS.- THE PATIENT HAS BEEN GIVEN AN OPPORTUNITY TO SUBMIT A CHARITY CARE (FINANCIAL ASSISTANCE) APPLICATION. IF THE PATIENT HAS SUBMITTED AN APPLICATION FOR CHARITY CARE, ALL COLLECTION ACTIVITY WILL BE SUSPENDED UNTIL THE APPLICATION HAS BEEN PROCESSED. PART VI, LINE 2: TO COMPREHENSIVELY UNDERSTAND AND DESCRIBE THE NEEDS OF THE COMMUNITIES HEALTHPARTNERS SERVES, WE SYSTEMATICALLY IDENTIFIED A LIST OF PUBLICLY AVAILABLE DATA SOURCES AND A LIST OF INTERNALLY AVAILABLE HEALTHPARTNERS DATA SOURCES. WITH THE CHNA WORKGROUP THAT HAD EXPERTISE FROM PUBLIC HEALTH, HEALTHCARE AND EPIDEMIOLOGY, WE CAREFULLY REVIEWED THE LIST TO IDENTIFY OPPORTUNITIES WITH A SPECIFIC LENS TOWARDS INCLUDING MEMBERS WITH UNIQUE INSIGHT INTO NEEDS OF OUR UNDERSERVED COMMUNITIES WHERE HEALTH AND OTHER DISPARITIES EXIST. TO FURTHER ROUND OUT UNDERSTANDING, WE SOUGHT ADDITIONAL DATA SOURCES TOGETHER WITH OUR COMMUNITY PARTNERS. WHERE OPPORTUNITIES STILL REMAIN FOR BETTER UNDERSTANDING DUE TO LACK OF CURRENTLY AVAILABLE DATA, WE HAVE NOTED IN THE REPORT. FOR EXAMPLE, WE IDENTIFIED SPECIFIC GAPS IN DATA AVAILABLE TO UNDERSTAND THE COVID-19 PANDEMIC CONTEXT AND THE INFLUENCE OF STRUCTURAL RACISM ON THE NEEDS AREAS. THUS, WE SPECIFICALLY DESIGNED OUR QUALITATIVE COMMUNITY CONVERSATIONS AND OUR QUANTITATIVE HEALTHPARTNERS PROVIDER SURVEYS TO FILL THESE GAPS. HEALTHPARTNERS PROVIDER SURVEYS: SELECT HEALTHPARTNERS STAFF WHO PROVIDE DIRECT CARE FOR OUR PATIENTS WERE INVITED BY HOSPITAL LEADERS AND THE CHNA EXPERT PANEL MEMBERS TO COMPLETE A BRIEF WEB SURVEY ABOUT THE NEEDS OF THE PATIENTS THEY SERVE. THE SURVEY WAS DEVELOPED BY AN EXPERT SURVEY METHODOLOGIST WITH INPUT FROM THE CHNA WORKGROUP. OVERALL, 444 PROVIDERS INCLUDING DOCTORS, CARE COORDINATORS, PHARMACISTS, PHYSICAL OR OCCUPATIONAL THERAPISTS, DIETITIANS, NURSES, AND SOCIAL WORKERS COMPLETED SURVEYS ACROSS ALL HEALTHPARTNERS HOSPITALS. DESCRIPTIVE STATISTICS AND A THEMATIC ANALYSIS WERE COMPLETED AND INCLUDED IN THE NEEDS AREA SUMMARIES BELOW.COMMUNITY CONVERSATIONS: A TOTAL OF 41 COMMUNITY CONVERSATIONS WERE HELD OR ATTENDED BY HEALTHPARTNERS WORKGROUP MEMBERS. RESULTS WERE SUMMARIZED AND KEY THEMES AND QUOTES WERE ADDED TO THE NEEDS AREA SUMMARIES THROUGHOUT. ADDITIONAL DETAILS ABOUT THE COMMUNITY CONVERSATIONS CAN BE FOUND IN THE APPENDIX OF THE AMERY'S 2021CHNA AT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY PART VI, LINE 3: AMERY'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS WHO ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE ARE REFERRED TO AMERY'S HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH AMERY AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON AMERY'S INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION. PART VI, LINE 4: THE AMERY REGIONAL MEDICAL CENTER (AMERY) SERVICE AREA INCLUDED 15 DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES THREE RURAL HEALTH CLINICS IN LUCK, TURTLE LAKE, AND CLEAR LAKE, WHICH ARE ALL MEDICALLY UNDERSERVED AREAS. THE AMERY COMMUNITY IS ALSO CONSIDERED A MENTAL HEALTH MEDICALLY UNDERSERVED AREA. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS FROM OUTSIDE AMERY'S NORMAL SERVICE AREA. PART VI, LINE 5: TEN OF AMERY'S THIRTEEN BOARD MEMBERS LIVE IN AMERY'S SERVICE AREA. AMERY HAS AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, AND OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN AMERY'S COMMUNITY. PART VI, LINE 6: HEALTHPARTNERS AND AMERY HAVE HAD A LONG-STANDING RELATIONSHIP, WITH HEALTHPARTNERS EMPLOYING AND SOURCING PHYSICIANS AND MID-LEVEL PRACTITIONERS TO AMERY FOR AMERY'S PRIMARY CARE CLINICS. IN 2014, AMERY BECAME PART OF THE HEALTHPARTNERS FAMILY OF MISSION-DRIVEN NON-PROFIT ORGANIZATIONS. AS PART OF HEALTHPARTNERS, AMERY USES HEALTHPARTNERS' INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM, PARTICIPATES IN COORDINATED CHNA PROCESSES AND IMPLEMENTATION STRATEGIES, AND ACCESSES CENTRALIZED SUPPORT SERVICES IN FINANCE, LEGAL, IS&T, AND QUALITY. THE FOUR HEALTHPARTNERS HOSPITALS IN THE ST. CROIX VALLEY - STILLWATER MN AND HUDSON, NEW RICHMOND, AND AMERY WI - WORK TOGETHER TO ESTABLISH ACCESSIBLE AND COORDINATED SPECIALTY SERVICES FOR VALLEY RESIDENTS. EXAMPLES OF THESE SERVICES INCLUDE RADIATION THERAPY ON THE NEW RICHMOND CAMPUS, BREAST DIAGNOSTICS ON THE STILLWATER CAMPUS, AND GERIATRIC BEHAVIORAL HEALTH SERVICES ON THE ARMC CAMPUS. HEALTHPARTNERS INCLUDES INSURANCE AND HMO (HEALTH MAINTENANCE ORGANIZATION) ENTITIES THAT PROVIDE CARE COORDINATION, DISEASE MANAGEMENT, ON-LINE CARE OF BASIC CONDITIONS, A 24-HOUR/7-DAY PER WEEK NURSE LINE, AND OTHER SERVICES THAT ENHANCE CARE OF MEMBERS, PATIENTS AND THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 1 1 0 0 BRIAN H RANK MD DIRECTOR 0 613808 0 135000 0 354469 0 247121 0 48175 0 1398573 0 252464 DOUGLAS E JOHNSON CFO 0 334804 0 49000 0 26857 0 198123 0 35416 0 644200 0 0 MARTIN E RICHARDS MD DIRECTOR 0 384613 0 10000 0 70718 0 9971 0 40308 0 515610 0 0 PATRICK D SURA MD CHIEF MEDICAL OFFICER 0 341028 0 7000 0 43200 0 10992 0 39234 0 441454 0 0 THEODORE T WEGLEITNER DIRECTOR 0 227505 0 91000 0 62898 0 11233 0 27549 0 420185 0 46259 DEBRA A RUDQUIST PRESIDENT 0 285521 0 43000 0 11945 0 25300 0 34048 0 399814 0 0 ROSS R BULLARD DIRECTOR & TREASURER 0 227675 0 38000 0 5015 0 41795 0 36476 0 348961 0 0 ANN R SEAGREN MD DIRECTOR 0 199092 0 0 0 64259 0 39755 0 36593 0 339699 0 0 RONDA D DAVIS MD DIRECTOR 0 161507 0 0 0 114260 0 13549 0 36177 0 325493 0 0 JASON J LUHRS FORMER CFO 0 227159 0 23000 0 5046 0 16797 0 36781 0 308783 0 0 SANDRA M REED VP - PATIENT CARE SERVICES 179306 0 0 0 28720 0 8106 0 23145 0 239277 0 0 0 MARYANN SCOGLIO CANP DIRECTOR 0 123583 0 0 0 37480 0 10082 0 32183 0 203328 0 0 DYLAN COE MD DIRECTOR 0 118389 0 10000 0 3776 0 46187 0 15411 0 193763 0 0 ANTHONY R GOULD DIRECTOR -ANCILLARY SERVICES 128407 0 0 0 17216 0 5802 0 36553 0 187978 0 0 0 MARK A TRYGGESTAD DIRECTOR OF PHARMACY 153318 0 0 0 11639 0 6556 0 13184 0 184697 0 0 0 JAMES G ERICKSON RN HOUSE SUPERVISOR 121878 0 1250 0 14508 0 5844 0 35965 0 179445 0 0 0 ANN M SCHILLING HR SR DIRECTOR 124804 0 0 0 12081 0 5696 0 35528 0 178109 0 0 0 JOLLEEN M NICHOLS PROVIDER-APNP 123622 0 750 0 12137 0 4915 0 11387 0 152811 0 0 0 PART I, LINE 3 AMERY'S PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS) OR BY GROUP HEALTH PLAN, INC. (GHI), BOTH OF WHICH ARE RELATED ORGANIZATIONS, OR BY AMERY. GHI, REGIONS, AND AMERY HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF AMERY'S PRESIDENT AND OTHER OFFICERS. PART I, LINE 6 AMERY REGIONAL MEDICAL CENTER (AMERY) OFFICERS, DIRECTORS AND HIGHEST COMPENSATED EMPLOYEES ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS),GROUP HEALTH PLAN, INC. (GHI), OR LAKEVIEW HOSPITAL, RELATED ORGANIZATIONS, OR BY AMERY. COMPENSATION REPORTED IN FORM 990, PART VIII INCLUDES ANY COMPENSATION DERIVED FROM REGIONS, GHI, LAKEVIEW OR AMERY'S MANAGEMENT INCENTIVE PROGRAMS, WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGRAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G. VICE PRESIDENT, DIRECTOR, MANAGER, OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE, BUT ARE NOT LIMITED TO, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, HEALTH EQUITY, HEALTHCARE AFFORDABILITY MEASURES, HEALTH CARE AND CARE DELIVERY MARKET SHARE, STRATEGIC CAPABILITIES, HOSPITAL AND CLINIC QUALITY MEASURES, FINANCIAL PERFORMANCE (OPERATING INCOME), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A OPERATING MARGIN THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT. FORM 990, SCH. J, PART II - PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS: THEODORE T. WEGLEITNER $ 46,259 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. A CITY OF AMERY WISCONSIN 396005378 2021-05-02 5000000 REFINANCE EXISTING DEBT 0 0 0 B TOWN OF BLACK BROOK POLK COUNTY WISCONSIN 391169876 2021-05-02 8500000 REFINANCE EXISTING DEBT 0 0 0 C TOWN OF LINCOLN POLK COUNTY WISCONSIN 391406159 2021-05-02 8500000 REFINANCE EXISTING DEBT 0 0 0 A 258516 5000000 19425 4980575 2021 1 0 1 1 B 439477 8500000 33024 8466976 2021 1 0 1 1 C 439477 8500000 33024 8466976 2021 1 0 1 1 A 0 1 0 0 0.00090 0.00090 1 0 0 B 0 1 0 0 0.00090 0.00090 1 0 0 C 0 1 0 0 0.00080 0.00080 1 0 0 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 C 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 FORM 990, SCHEDULE K, PART IV, LINE 2A THRU 2C REBATE CALCULATION IS NOT DUE BUT EVERY 5 YEARS. THERE IS NO REBATE CALCULATION DUE FOR ANY BONDS LISTED IN SCHEDULE K, PART I. FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER (ARMC), A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS ("HEALTHPARTNERS"). FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED HEALTH CARE ORGANIZATION, PROVIDING HEALTH CARE SERVICES AND HEALTH PLAN FINANCING AND ADMINISTRATION, AND IS THE LARGEST CONSUMER-GOVERNED NONPROFIT HEALTH CARE ORGANIZATION IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTH CARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS, INC. (HPI) IS A MINNESOTA NONPROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4) AND IS THE PARENT ENTITY OF HEALTHPARTNERS ORGANIZATIONS REFERRED TO COLLECTIVELY AS "HEALTHPARTNERS". HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS. HEALTHPARTNERS PROVIDES A FULL RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.8 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,800 EMPLOYED PHYSICIANS AND DENTISTS, EIGHT OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 129 PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN SERVING MORE THAN 1.32 MILLION PATIENTS. HEALTHPARTNERS HEALTH PLANS CONTRACT WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS TO SERVE PLAN MEMBERS. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUNDRAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. HEALTHPARTNERS COLLABORATES WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2021 ARE TOTAL COST OF CARE MEASUREMENTS (A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN HEALTHPARTNERS, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, LAKEVIEW HEALTH, RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF ARMC. GHI IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) A WISCONSIN NON-STOCK CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). CHARITY CARE: CHARITY CARE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY; PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER; AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES, OR SPECIAL FINANCIAL HARDSHIP, WARRANT SPECIAL CONSIDERATION. WITH ALL HEALTH CARE ENTITIES COMBATING A WORLDWIDE PANDEMIC, 2021 WAS YET ANOTHER UNPRECEDENTED YEAR. ALTHOUGH HOSPITAL VOLUMES RECOVERED TO NEAR PRE-PANDEMIC LEVELS, CHARITY CARE APPLICATIONS WERE STILL DOWN FROM PRE-PANDEMIC LEVELS. IN-PERSON COMMUNITY SUPPORT WAS LIMITED, AS WAS PARTICIPATION IN ALMOST EVERY COMMUNITY PROGRAM. WHILE THE NEED FOR COMMUNITY SUPPORT WAS GREATER THAN EVER IN MANY CASES, HOSPITALS TURNED THEIR FOCUS TO PEOPLE'S IMMEDIATE CONCERNS AND LOOKED FOR NEW APPROACHES TO SERVING NEEDS. ARMC PROVIDED $279,576 IN FREE OR DISCOUNTED CARE TO LOW INCOME AND UNINSURED PATIENTS IN 2021. GOVERNMENT-SPONSORED MEANS-TESTED HEALTH CARE: ARMC PROVIDED INPATIENT AND OUTPATIENT CARE, INCLUDING EMERGENCY DEPARTMENT SERVICES TO MEDICAID PATIENTS. PAYMENTS RECEIVED FOR THESE SERVICES WERE BELOW THE COST OF CARE PROVIDED. THE EXPENSE TO COVER UNREIMBURSED MEDICAID COSTS FOR PATIENTS TOTALED $2,219,969. COMMUNITY BENEFIT SERVICES: 1. COMMUNITY HEALTH IMPROVEMENT SERVICES: $ 112,337 ARMC IS COMMITTED TO COMMUNITY HEALTH IMPROVEMENT SERVICES, WHICH INCLUDE A RANGE OF ACTIVITIES CARRIED OUT TO IMPROVE COMMUNITY HEALTH BEYOND PATIENT CARE. BELOW ARE HIGHLIGHTS OF SUCH ACTIVITIES THAT FALL WITHIN THE CATEGORIES OF COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, HEALTH CARE SUPPORT SERVICES AND SOCIAL AND ENVIRONMENTAL IMPROVEMENT. EACH YEAR, ARMC HELPS EDUCATE THE LOCAL COMMUNITIES ABOUT HEALTH TOPICS BY PROVIDING THEM A VARIETY OF COMMUNITY EDUCATION. WHILE THE COVID-19 PANDEMIC AND SUBSEQUENT PAUSE OF NEARLY ALL IN-PERSON ACTIVITIES, CLASSES AND EVENTS CONTINUED IN 2021, WE CONTINUED TO ADAPT AND SERVE OUR COMMUNITIES IN DIGITAL/VIRTUAL FORMATS. OVER 50 VIRTUAL CLASSES, EVENTS, AND PODCASTS WERE CARRIED OUT ON A VARIETY OF TOPICS INCLUDING: STRESS RELIEF, BUILDING RESILIENCE IN CHILDREN, SUICIDE PREVENTION, DEMENTIA, HIGH BLOOD PRESSURE, AND HOW TO SUPPORT LOVED ONES IN RECOVERY. IN TOTAL, THESE HAVE BEEN ACCESSED OVER 3500 TIMES. PART III, CONT. MAKE IT OK IS A COMMUNITY CAMPAIGN TO HELP END THE STIGMA OF MENTAL ILLNESSES. DESPITE THE MANY CHALLENGES FACED DURING COVID 19 RESTRICTIONS, MAKE IT OK REACHED THOUSANDS THROUGH VIRTUAL AND IN-PERSON EVENTS, TRAININGS, PRESENTATIONS, MESSAGING EFFORTS, AND OUR NETWORK OF AMBASSADORS AND COMMUNITY PARTNERS. OUR HOSPITAL'S 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), IDENTIFIED MENTAL HEALTH AND WELL-BEING AS THE NUMBER ONE COMMUNITY HEALTH PRIORITY, REAFFIRMING THE IMPORTANCE OF MAKE IT OK AND FOCUSING THE EFFORT. REDUCING STIGMA AND CREATING CARING COMMUNITIES ARE KEY STRATEGIES THAT PRIORITY. MAKE IT OK UPDATED CONTENT AND MATERIALS FOR TRAINING, WEBSITE AND ONLINE TOOLKITS. 2021 MAKE IT OK IMPACT INCLUDED MORE THAN: - 270 NEW MAKE IT OK AMBASSADORS TRAINED THROUGH 17 TRAINING SESSIONS - 630 PARTICIPANTS IN 32 VIRTUAL MAKE IT OK PRESENTATIONS - 1500 ENGAGED IN MAKE IT OK THROUGH SEVEN OUTDOOR COMMUNITY EVENTS THE POWERUP INITIATIVE CONTINUES TO FOCUS PROGRAMS, CLASSES AND RESOURCES TO INSPIRE KIDS AND FAMILIES TO EAT BETTER, MOVE MORE AND FEEL GOOD. POWERUP PROVIDES NUMEROUS PROGRAMS, CLASSES AND RESOURCES TO THE COMMUNITY INCLUDING SCHOOL CHALLENGE, A COMPREHENSIVE WEBSITE (POWERUP4KIDS.ORG), COOKING CLASSES, PRINT RESOURCES ON NUTRITION AND PHYSICAL ACTIVITY AND COMMUNITY PARTNERSHIPS TO CREATE HEALTHY COMMUNITIES. WITH A STRONG COMMITMENT TO HEALTH EQUITY, POWER UP RESOURCES FOCUS ON BEING INCLUSIVE, DIVERSE AND WELCOMING FOR ALL KIDS, FAMILIES, AND COMMUNITY. WITH A FOCUS ON VIRTUAL TOOLS TO INCREASE ACCESS, POWERUP DEVELOPED TWO NEW LIVE VIRTUAL COOKING CLASSES AND TWO NEW KIDS COOKING CLASS VIDEOS WITH A LOCAL COOKING SCHOOL PARTNER. IN ADDITION, TWO NEW FAMILY MAGAZINES WERE DEVELOPED WITH A FOCUS ON FAMILY PHYSICAL ACTIVITY AND MINDFULNESS. 2021 POWERUP IMPACT INCLUDED MORE THAN: - 78,000 REACHED VIRTUALLY, THROUGH CLASSES, EVENTS, WEBSITE, AND E-NEWSLETTERS - 41,000 WITH THE POWERUP PRESS FAMILY NEWSLETTERS DISTRIBUTED TO FAMILIES, SCHOOLS AND COMMUNITY - 8,000 STUDENTS PARTICIPATED IN THE POWERUP SCHOOL CHALLENGE ACROSS 24 ELEMENTARY SCHOOLS THROUGHOUT THE ST. CROIX VALLEY - 4,100 PEOPLE ENGAGED THROUGH 20 OUTDOOR EVENTS ARMC IS COMMITTED TO PROVIDING SEVERAL HEALTH CARE SUPPORT SERVICES, INTENDED TO INCREASE ACCESS AND QUALITY OF CARE IN HEALTH SERVICES TO INDIVIDUALS, ESPECIALLY PERSONS LIVING IN POVERTY AND THOSE IN OTHER VULNERABLE POPULATIONS. THESE SUPPORT SERVICES INCLUDE: PATIENT EMERGENCY FUND, SOCIAL WORKERS PROVIDING SUPPORT ABOVE AND BEYOND STANDARD OF PRACTICE, AND ADVANCE CARE DIRECTIVES ASSISTANCE. ARMC SERVICE AREA IS CONSIDERED A MENTAL HEALTH PROVIDER SHORTAGE AREA. RESOURCES ARE ALLOCATED TO PROVIDER RECRUITMENT AND IN 2021 THE HOSPITAL WELCOMED TWO MENTAL HEALTH PROVIDERS. ARMC CONTINUES TO HOST, MAINTAIN AND SUPPORT THE COMMUNITY GARDEN OF 18 BEDS ALONGSIDE LOCAL COMMUNITY PARTNERS. 2. HEALTH PROFESSIONS EDUCATION: $ 278,964 IN 2021, ARMC PROVIDED TRAINING FOR STUDENTS IN THE FOLLOWING FIELDS: NURSING (9), CERTIFIED REGISTERED NURSE ANESTHETIST (3), RADIOLOGY (1), PHLEBOTOMY (1), PHYSICAL THERAPY (2), PHYSICAL THERAPY ASSISTANT (1), MEDICAL ASSISTANT (2), SOCIAL WORK (1), RESIDENT PHYSICIANS (4). ARMC ALSO SUPPORTS SCHOLARSHIPS TO LOCAL HIGH SCHOOL SENIORS PURSUING A CAREER IN A HEALTH-RELATED FIELD. 3. SUBSIDIZED HEALTH SERVICES: $2,630,390 ARMC IS COMMITTED TO PROVIDING NEEDED SERVICES, EVEN AT A FINANCIAL LOSS. IN 2021, SUBSIDIZED HEALTH SERVICES INCLUDED: AMERY, CLEAR LAKE AND LUCK CLINICS, EMERGENCY & TRAUMA, LABOR & DELIVERY, BEHAVIORAL HEALTH, AND ONCOLOGY. 4. CASH AND IN-KIND CONTRIBUTIONS: $ 130,611 ARMC HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS AND SPONSORSHIPS. IN-KIND DONATIONS INCLUDE STAFF HOURS SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK SUCH AS: KINSHIP OF POLK COUNTY, REGIONAL TRAUMA ADVISORY COUNCIL, AND WISCONSIN HEALTHCARE ENGINEERING ASSOCIATION. TO HELP COMBAT POVERTY, ARMC PROVIDES AMERY AREA FOOD SHELF WITH FREE RENT, HEAT AND SPACE, A BENEFIT OF OVER $74,000. 5. COMMUNITY BUILDING ACTIVITIES: $ 14,907 IN 2021, COVID-19 CONTINUED TO AFFECT OUR ENTIRE COMMUNITY, INCLUDING OUR EMPLOYEES AND THEIR FAMILIES. RESPONDING TO THE PANDEMIC TO SERVE AND SAFEGUARD PATIENTS AND COMMUNITY MEMBERS WAS A PRIORITY, ESPECIALLY REGARDING VACCINE ROLLOUT. MORE THAN 61,000 COVID-19 VACCINATIONS AND BOOSTERS HAVE BEEN ADMINISTERED TO PEOPLE IN OUR ST. CROIX VALLEY COMMUNITIES IN 2021. IN ADDITION, CLEAR AND EFFECTIVE PUBLIC HEALTH MESSAGING RELATED TO THE VACCINE ROLLOUT, SURGES, VARIANTS, RESEARCH, EQUITY, DRIVE-UP SITES, MONOCLONAL ANTIBODIES, MANDATES, AND CAPACITY HAVE BEEN CENTRAL TO OUR RESPONSE AND BUILDING COMMUNITY TRUST AND AWARENESS. ARMC PROVIDES LEADERSHIP AND PARTICIPATES IN SEVERAL STRATEGIC COMMUNITY COLLABORATIONS AND INITIATIVES, INCLUDING: POLK COUNTY ECONOMIC DEVELOPMENT CORP, POLK COUNTY PUBLIC HEALTH, POLK UNITED, AMERY ECONOMIC DEVELOPMENT CORP, MENTAL HEALTH TASK FORCE, NORTHWEST WISCONSIN HEALTHCARE EMERGENCY READINESS, POLK COUNTY VACCINE TASKFORCE, AND POLK COUNTY I-TEAM. THE MEDICATION TAKE BACK PROGRAM COLLECTS UNUSED PRESCRIPTION MEDICATIONS IN A SECURE MANNER TO PREVENT ACCIDENTAL POISONING OR MISUSE AND PREVENT MEDICATIONS FROM ENTERING THE WATER AND DRINKING WATER. 6. COMMUNITY BENEFIT OPERATIONS: $ 19,028 STAFF TIME IS ALLOCATED TO THE TRAINING, MANAGEMENT, AND REPORTING OF COMMUNITY BENEFITS TO BEST CAPTURE THE HOSPITAL'S COMMITMENT TO COMMUNITY HEALTH IMPROVEMENT. HEALTHPARTNERS AND ARMC CONTRACTED WITH THE CENTER FOR EVALUATION AND SURVEY RESEARCH (CESR), PART OF HEALTHPARTNERS INSTITUTE, TO COMPLETE THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IS COMPRISED OF MULTIPLE DATA SOURCES, MANY EXISTING FOR OTHER PRIMARY PURPOSES, WHILE OTHERS WERE COLLECTED SPECIFICALLY FOR THIS PURPOSE. TYPES OF DATA CESR GATHERED INCLUDE HEALTHPARTNERS ADMINISTRATIVE DATA, HEALTHPARTNERS PATIENT AND MEMBER-REPORTED DATA COLLECTED PRIMARILY FOR EVALUATION OF HEALTHPARTNERS COMMUNITY INITIATIVES OR OPERATIONAL PURPOSES, AND PUBLICLY AVAILABLE DATA DESCRIBING BOTH DEMOGRAPHIC CHARACTERISTICS AND HEALTH AND WELL-BEING OUTCOMES. PART III, CONT. 7. ORGANIZATION AWARDS AND ACHIEVEMENTS DESPITE 2021 BEING FOCUSED ON COVID, WE ARE VERY PROUD THAT OUR HOSPITAL CONTINUED ITS NATIONAL AWARD-WINNING TRADITIONS OF EXCEPTIONAL CARE AND PERFORMANCE IN ALL AREAS. HERE ARE A FEW OF THE HIGHLIGHTS FROM 2021: - STATE RECOGNITION FROM THE WISCONSIN SUSTAINABLE BUSINESS COUNCIL - DESIGNATED AS NATIONAL TREE CAMPUS HEALTH CARE FACILITIES BY THE ARBOR DAY FOUNDATION FOR A SECOND YEAR. - GREEN PROFESSIONAL AWARD FROM THE WISCONSIN SUSTAINABLE BUSINESS COUNCIL. - COMPREHENSIVE HEAL RATE AWARD FROM HEALOGICS, GIVEN TO THE WOUND CARE CENTER IN THE MIDWEST WITH THE GREATEST IMPACT AND IMPROVEMENT IN THEIR COMPREHENSIVE HEAL RATE FROM ONE QUARTER TO THE NEXT. - TREE CAMPUS HEALTHCARE FACILITY BY THE ARBOR DAY FOUNDATION. FORM 990, PART VI, SECTION A, LINE 6 RH WISCONSIN, INC. IS THE CLASS A MEMBER AND GHI IS THE CLASS B MEMBER OF ARMC. FORM 990, PART VI, SECTION A, LINE 7A ARMC'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN 13 PERSONS APPOINTED AS FOLLOWS: - 7 COMMUNITY REPRESENTATIVES APPOINTED BY THE CLASS A MEMBER (RH-WISCONSIN), FROM RECOMMENDATIONS BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. - 3 REPRESENTATIVES APPOINTED BY THE CLASS B MEMBER (GHI). - 3 HEALTH CARE PROVIDERS NOMINATED BY THE PHYSICIAN GROUP STAFFING ARMC'S PRIMARY CARE CLINIC AND APPOINTED BY THE CLASS B MEMBER (GHI). - THE PRESIDENT AND CHIEF MEDICAL OFFICER OF ARMC SIT IN EX-OFFICIO CAPACITIES, WITHOUT THE RIGHT TO VOTE. FORM 990, PART VI, SECTION A, LINE 7B THE CLASS A AND CLASS B MEMBERS (RH WISCONSIN, INC. AND GHI RESPECTIVELY) BOTH MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS IMPACTING MEMBERSHIP - RESIGNATION OF A MEMBER - DISSOLUTION - ANY CHANGE IN THE FUNDAMENTAL NATURE OR PURPOSE - MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION - DISPOSITION OF SUBSTANTIALLY ALL ASSETS. ONLY THE CLASS A MEMBER MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS NOT IMPACTING MEMBERSHIP - ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS - ESTABLISHMENT OF NEW ENTITIES OR SIGNIFICANT RELATIONSHIPS WITH OTHER ENTITIES - UNBUDGETED EXPENDITURES IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - GUARANTEEING THE DEBT OF ANY OTHER PERSON OR ENTITY - A LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - TRANSFER OF ASSETS TO ANOTHER ENTITY - APPOINTMENT OF THE PRESIDENT AND THE BOARD CHAIR. FORM 990, PART VI, SECTION B, LINE 11B ARMC'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF ARMC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF ARMC, GHI'S INTERNAL LEGAL DEPARTMENT AND ARMC'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF ARMC. ARMC MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE AMERY BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEES ("COVERED PERSONS") BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, COVERED PERSONS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND ASKED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. THE LEGAL DEPARTMENT OF HEALTHPARTNERS REVIEWS THE QUESTIONNAIRE RESPONSES AND DEVELOPS A REPORT DETAILING ANY POTENTIALLY MATERIAL CONFLICTS FOR THE PRESIDENT AND CHAIR OF THE BOARD. A VERBAL SUMMARY IS ALSO GIVEN TO THE FULL BOARD OR APPROPRIATE COMMITTEE ENDING WITH A REMINDER TO COVERED PERSONS OF THE POLICY'S MANDATE THAT EACH PERSON IS OBLIGATED TO DISCLOSE ANY NEW POTENTIAL CONFLICTS AS THEY MAY ARISE THROUGHOUT THE YEAR. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 AMERY'S PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS), LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC (LAKEVIEW) OR BY GROUP HEALTH PLAN, INC. (GHI), ALL OF WHICH ARE RELATED ORGANIZATIONS, OR BY AMERY. GHI, REGIONS, LAKEVIEW AND AMERY HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF AMERY'S PRESIDENT AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE GHI BOARD OF DIRECTORS (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE EXECUTIVE COMMITTEE OF REGIONS, THE COMPENSATION COMMITTEE OF GHI,THE COMPENSATION COMMITTEE OF LAKEVIEW, OR THE AMERY EXECUTIVE COMMITTEE (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEES MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH AMERY'S BOARD OF DIRECTORS INPUT, THE ST CROIX VALLEY EXECUTIVE LEADER CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH AMERY'S BOARD APPROVAL, DETERMINES THE COMPENSATION OF THE ARMC PRESIDENT. AMERY'S BOARD HAS DELEGATED TO THE PRESIDENT THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL ARMC-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE AMERY EXECUTIVE COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2. FORM 990, PART VI, SECTION C, LINE 18 AMERY'S 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM AMERY OR HEALTHPARTNERS, INC. FORM 990, PART VI, SECTION C, LINE 19 AMERY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 990, PART VII, SEC A, LN 1A, COL (B) - RELATED ORGANIZATION AVERAGE HOURS DIRECTORS AND OFFICERS OF ARMC ARE EMPLOYED AND COMPENSATED BY GHI, INC., REGIONS HOSPITAL, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION OR ARMC. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. FORM 990, PART XI, LINE 9: CONTRIBUTION FROM AMERY HOSPITAL FOUNDATION -137,331. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 0 HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 0 RH WISCONSIN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE I HPI - RAMSEY 0 HEALTHPARTNERS INSTITUTE 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411670163 HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 412011453 TRANSITIONAL CARE SERVICES, STEP DOWN FROM INPATIENT HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410956618 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411888902 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY 0 RHSC INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411891928 HEALTHCARE STAFFING AND INTENSE REHAB SERVICES MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC 0 PHYSICIANS NECK & BACK CLINICS 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 270684883 SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC 0 HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390804125 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN INC 0 HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391279567 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC 0 LAKEVIEW HEALTH FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411386635 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) LAKEVIEW HEALTH 0 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410811697 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) LAKEVIEW HEALTH 0 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 830379473 CLINIC STAFF AND FACILITIES MN 501(C)(3) 509(A)(3) TYPE I LAKEVIEW HEALTH 0 LAKEVIEW HEALTH 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 300221189 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 0 WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390808442 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN INC 0 WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391770913 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) WESTFIELDS HOSPITAL INC 0 RAMSEY INTEGRATED HEALTH SERVICES 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411503090 HOME CARE AND HOSPICE MN 501(C)(3) 509(A)(2) HPI - RAMSEY 0 PARK NICOLLET HEALTH SERVICES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 363465840 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) HEALTHPARTNERS INC 0 PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 237346465 SUPPORT TO RELATED ENTITIES AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410132080 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET HEALTH CARE PRODUCTS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 010638901 DURABLE MEDICAL EQUIPMENT AND OTHER HEALTH CARE RETAIL SALES MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET CLINIC 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410834920 CLINIC SERVICES MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PNMC HOLDINGS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411741792 HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391726539 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) AMERY REGIONAL MEDICAL CENTER INC 1 HUTCHINSON HEALTH 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 841715908 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 HUTCHINSON HEALTH FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 363317820 PROVIDE SUPPORT TO HOSPITAL MN 501(C)(3) 170(B)(1) (A)(VI) HUTCHINSON HEALTH 0 HEALTHPARTNERS RC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 844261122 HOSPITAL MN 501(C)(3) 170(B)(1)(A)(III) PARK NICOLLET HEALTH SERVICES 0 OLIVIA HOSPITAL & CLINIC FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411839619 PROVIDE SUPPORT TO HOSPITAL MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS RC 0 HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411629390 THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC C 0 HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 522365151 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683568 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683523 MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC C 0 DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 451297583 PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411236798 MEDICAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC C 0 PARK NICOLLET ENTERPRISES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411656735 REAL ESTATE FOR RELATED ORGANIZATIONS MN PARK NICOLLET HEALTH SERVICES C 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES L 333320 FAIR VALUE AMERY REGIONAL MEDICAL CENTER FOUNDATION INC C 137331 FAIR VALUE