2021-11-15T13:37:45-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 311667875 RIDGEVIEW MEDICAL CENTER RIDG 9524422191 500 SOUTH MAPLE STREET WACONIA MN 553871791 AARON BLOOMQUIST CFO 9524422191 2021-11-15 1 AARON BLOOMQUIST 999009999 DARRYN MCGARVEY P00958683 6123764500 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MICHAEL PHELPS 500 SOUTH MAPLE STREET WACONIA MN 553871791 366873816 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1999 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 9 9 2207 182 85860 307570 3346986 6767914 244697905 220617381 3218117 13573017 27726501 26847687 278989509 267805999 2007945 7319 0 0 150383064 149423135 0 0 80330 125180014 125746941 277571023 275177395 1418486 -7371396 298754086 309577235 128582803 147760526 170171283 161816709 X RIDGEVIEW MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF PEOPLE IT SERVES WITH A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. 0 0 212770862 7319 220617381 RIDGEVIEW MEDICAL CENTER ENHANCED AND PROVIDED QUALITY HEALTHCARE SERVICES FOR THE COMMUNITY OF WACONIA AND SURROUNDING AREAS. THE HOSPITAL PROVIDED CHARITY CARE AND OTHER UNCOMPENSATED CARE IN THE AMOUNT OF $847,671 DURING 2020. THE UNPAID COST FOR SERVICES PROVIDED TO MEDICAID AND MEDICARE PATIENTS WAS $1,304,552 AND $14,844,326 IN 2020. UNREIMBURSED COSTS ASSOCIATED WITH THE TRAINING OF HEALTHCARE PROFESSIONALS SUCH AS HIGH SCHOOL STUDENTS SHADOWING FOR INTERNSHIPS FOR PHARMACY, IMAGING, DIETARY, AND MORE TOTALED $243,997. IN 2020 THE HOSPITAL SPENT $11,893,574 ON OTHER UNCOMPENSATED COMMUNITY SERVICES INCLUDING TAXES AND FEES. THE HOSPITAL SERVED 5,781 INPATIENTS, 28,463 EMERGENCY CARE VISITS, 45,993 HOME HEALTH VISITS, 4,951 SURGERIES, 1,208 BIRTHS, 16,831 AMBULANCE RUNS, AND 184,932 OUTPATIENT VISITS IN 2020. RIDGEVIEW MEDICAL CENTER SERVES MORE THAN 300,000 PEOPLE, OPERATES ONE HOSPITAL, ONE FREE-STANDING EMERGENCY AND URGENT CARE FACILITY CENTER AND SEVEN MULTI-SPECIALTY CLINIC LOCATIONS. 212770862 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 55 0 1 2207 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X AARON BLOOMQUIST 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 THERESA DALEN BOARD MEMBER & CHAIR 2.00 X X 6000 0 0 WAYNE HUBIN BOARD MEMBER 2.00 0.40 X 5000 0 0 BRIAN MARK BOARD MEMBER & VICE CHAIR 2.00 X X 5000 0 0 KATHERINE ROEHL SECRETARY 2.00 X X 5000 0 0 JULIE OSTERBERG BOARD MEMBER 2.00 X 5000 0 0 VAN COLSON BOARD MEMBER & TREASURER 2.00 X X 5000 0 0 DAVID KIRSCH BOARD MEMBER 2.00 X 6250 0 0 MIKE SCHULER BOARD MEMBER 2.00 X 4167 0 0 MICHAEL PHELPS PRESIDENT/CEO 41.00 9.00 X 561195 0 64748 GORDON GABLENZ CIO & TREASURER 30.50 19.50 X 764988 0 83372 KEN GILLES CIO 50.00 X 244702 0 77455 BENJAMIN NIELSEN COO 44.00 6.00 X 320292 0 15401 ELAINE ARION VICE PRESIDENT & CNO 50.00 X 247983 0 47036 SARAH URTEL VICE PRESIDENT 50.00 X 219518 0 52341 PAMELA WILLIAMS VICE PRESIDENT 1.00 50.00 X 150868 0 46261 AARON BLOOMQUIST CFO 30.50 19.50 X 67505 0 27892 HEATHER REIGHARD BOARD MEMBER 2.00 X 4167 0 0 PAUL HAM VICE PRESIDENT 50.00 X 219700 0 43202 MATTHEW HEROLD VICE PRESIDENT MEDICAL AFFAIRS 50.00 X 31151 0 0 DOUGLAS STASEK EXEC DIRECTOR 2.50 47.50 X 216612 0 62603 GREGORY MARCHETTI CRNA 50.00 X 191815 0 63791 GREGORY ERICKSON CRNA 50.00 X 187246 0 67718 SARAH HASTINGS EXEC DIRECTOR 49.00 1.00 X 202449 0 52824 CHRISTOPHER STEFFEN EXEC DIRECTOR 2.00 X 205947 0 39768 3877555 0 744412 13 0 1 0 EMPAC 500 S MAPLE STREET WACONIA MN 55387 ED PHYSICIAN SERVICES 9350506 KNUTSON CONSTRUCTION SERVICES INC 7515 WAYZATA BLVD MINNEAPOLIS MN 55426 CONSTRUCTION 4069965 MAYO COLLABORATIVE SERVICE INC PO BOX 9146 MINNEAPOLIS MN 55480 MEDICAL SERVICES 2457581 CHILDRENS HOSPITAL & CLINIC OF MN 2525 CHICAGO AVENUE S MINNEAPOLIS MN 55404 MEDICAL SERVICES 1370557 CHANGE HEALTHCARE PO BOX 98347 CHICAGO IL 60693 IT SERVICES 1203190 46 2492727 4275187 6767914 NET PATIENT REVENUE 621610 220617381 220617381 220617381 1121513 1121513 6119092 3589815 2529277 2529277 2529277 106963086 94511582 12451504 12451504 12451504 4864960 966420 3898540 3898540 MISCELLANEOUS 621610 20191387 85860 20105527 CAFETERIA REVENUE 722210 596179 596179 PHARMACY SERVICES 621610 66536 66536 -434232 -434232 20419870 267805999 220617381 85860 40334844 X 7319 7319 3331189 3331189 126541396 102113696 24427700 3641954 2589807 1052147 7784609 3976942 3807667 8123987 5847024 2276963 470417 470417 186853 186853 519365 519365 40492478 32256481 8235997 89432 81358 8074 6129325 2818403 3230592 80330 3427615 261505 3166110 12131471 9928720 2202751 371956 331908 40048 98071 85083 12988 3679128 3679128 13616770 7962793 5653977 966683 157570 809113 MEDICAL SUPPLIES 33203379 33203379 BAD DEBT EXPENSE 3138281 3138281 MINNESOTA CARE TAX 2399606 2399606 LOSS ON REFINANCING 2014976 2014976 2811135 1412494 1398641 275177395 212770862 62326203 80330 3978229 3260333 63362072 65816835 41336364 45543763 4076396 4080553 4465159 4447002 305197159 185774704 119173414 119422455 19523426 22891047 8911089 9615605 33927937 34499642 298754086 309577235 24425478 41039888 760095 82706682 81909615 21450643 24050928 128582803 147760526 X 163251508 153981835 6919775 7834874 170171283 161816709 298754086 309577235 X -7371396 -4110994 3127816 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3435 3435 0 PART II-B, LINE 1: RIDGEVIEW MEDICAL CENTER PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE USED FOR LOBBYING EXPENSES. 8362607 8362607 107944828 55634734 52310094 15777946 9195124 6582822 148840821 120944846 27895975 24270957 24270957 119422455 INVESTMENT IN RIDGEVIEW INSURANCE 691067 F INVESTMENT IN FOUNDATION 22199980 F 22891047 SELF INSURANCE RESERVES 1546268 DEFERRED COMPENSATION PLAN 17939305 STEP LEASE ASSET 393381 DUE FROM AFFILIATES 14620688 34499642 DEFERRED COMPENSATION 7618877 THIRD PARTY PAYABLE 2465596 WORKERS COMPENSATION 1501369 ASSET RETIREMENT OBLIGATION 12224 BRIDGE LOAN FROM RIDGEVIEW FOUNDATION 139783 DUE TO CARDIOLOGY JOINT VENTURE 9552147 STEP LEASE LIABILITY 2760932 24050928 X 278809540 28242134 28242134 250567406 519365 16719228 17238593 267805999 289794588 20289815 20289815 269504773 519365 5153257 5672622 275177395 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. THE HOSPITAL IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISTICTION. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT IN UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 3,589,815. HOME MEDICAL EQUIPMENT COST OF GOODS SOLD 948,298. GIFT SHOP EXPENSES 18,122. REVENUES OF ENTITIES NOT INCLUDED IN THIS FORM 990 23,685,899. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 602,148. REALIZED GAINS ON INVESTMENTS 12,451,504. BAD DEBT EXPENSES 3,138,281. RESTRICTED CONTRIBUTIONS RECIEVED 527,295. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 3,589,815. HOME MEDICAL EQUIPMENT COST OF GOODS SOLD 948,298. EXPENSES OF ENTITIES NOT INCLUDED IN THIS FORM 990 15,733,580. GIFT SHOP EXPENSE 18,122. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSES 3,138,281. DISTRIBUTION EXPENSE CAPITAL CONTRIBUTIONS 2,014,976. 1 1 X 1 X 1 X 1 1 1 0 1 1 847748 0 847748 0.00310 3467042 2162175 1304867 0.00480 4314790 2162175 2152615 0.00790 17 3652 4473662 975994 3497668 0.01300 3 148 243994 0 243994 0.00090 2 9 33601 11346 22255 0.00010 0 0 0 0 1 18 42000 0 42000 0.00020 23 3827 4793257 987340 3805917 0.01420 23 3827 9108047 3149515 5958532 0.02210 1 5237086 211918 32711367 44957321 -12245954 X 1 1 1 WACONIA BUILDING INVESTMENTS PHYSICIAN PROFESSIONAL BUILDING 0.35000 0.00000 0.65000 1 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 WWW.RIDGEVIEWMEDICAL.ORG 00055 X X X RIDGEVIEW MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ X 1 19 1 WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 5: RIDGEVIEW PARTNERED WITH CARVER COUNTY PUBLIC HEALTH TO COMPLETE THE PRIMARY DATA COLLECTION FOR THE 2019 CHNA. THIS INCLUDED PRIMARY RESEARCH, DATA ANALYSIS, VALIDATION AND PRIORITIZATION, AND ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS WITH COMMUNITY INPUT. THE COMMUNITY INPUT INCLUDED SURVEYS FROM RESIDENTS OF CARVER COUNTY PLUS ACROSS THE SIX OTHER COUNTIES IN RIDGEVIEW'S SERVICE AREA. THIS PRIMARY DATA WAS SUPPLEMENTED WITH SECONDARY DATA* COLLECTED FROM THE FOLLOWING SOURCES (BUT NOT LIMITED TO): RIDGEVIEW'S ELECTRONIC MEDICAL RECORD AND FINANCIAL SYSTEMS, US CENSUS BUREAU, COUNTY HEALTH RANKINGS, MINNESOTA HOSPITAL ASSOCIATION. RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 6A: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH RIDGEVIEW SIBLEY MEDICAL CENTER AND RIDGEVIEW LE SUEUR MEDICAL CENTER. RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 6B: CARVER COUNTY PUBLIC HEALTH RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 11: RIDGEVIEW MEDICAL CENTER CONTINUES TO DEVELOP BROAD COMMUNITY STRATEGIES THAT FOCUS ON FOUR HEALTH ISSUES THAT WERE IDENTIFIED AND PRIORITIZED IN THE CHNA AND IMPLEMENTATION PLAN: 1) PREVENTION, CLINICAL CARE, AND DISEASE MANAGEMENT (PREVENTATIVE SCREENINGS, ACCESS TO CARE - RURAL SERVICE AREA), 2) AGING AND AGING-RELATED CONCERNS (SENIOR SERVICES, TRANSPORTATION), 3) MENTAL AND BEHAVIORAL HEALTH (EMERGENCY SERVICES, ADULT BEHAVIORAL HEALTH). RIDGEVIEW WILL CONTINUE TO OFFER CARE AND SERVICES TO ADDRESS THESE PRIORITY HEALTH ISSUES. THE INFORMATION FROM THE CHNA WILL FURTHER INFORM ORGANIZATIONAL LEADERSHIP IN DECISION-MAKING PROCESSES TO EXPAND, REFINE, AND DIRECT SERVICES, COMMUNICATION, COLLABORATION, EDUCATION AND OUTREACH ACTIVITIES. ADDRESSING THE PRIORITY HEALTH ISSUES INVOLVES MANY FACTORS OUTSIDE THE CLINICAL SETTING, RIDGEVIEW WILL CONTINUE TO WORK TO ENHANCE THE IMPACT OF BROADER COMMUNITY HEALTH EFFORTS TO ADDRESS THESE ISSUES. BY FACILITATING SYSTEM-WIDE AND CROSS-COMMUNITY COMMUNICATION AND COLLABORATION, EXISTING EFFORTS WILL RESULT IN IMPROVED SUCCESS AND IMPACT. WHILE EMPHASIS IS PLACED ON THE THREE HEALTH ISSUES DETAILED IN THE CHNA REPORT DOCUMENT, RIDGEVIEW AS A COMMUNITY HEALTH PROVIDER, WILL CONTINUE TO FOCUS RESOURCES ON OTHER LONG-STANDING INITIATIVES AND SERVICES THAT HELP IMPROVE OVERALL HEALTH. RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT WWW.RIDGEVIEWMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/. 10 1 - CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 GENERAL MEDICAL CLINIC 2 - SAME DAY SURGERY 3000 HUNDERTMARK ROAD CHASKA MN 55318 GENERAL MEDICAL & SURGICAL CLINIC 3 - SPECIALTY CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 SEE PART VI FOR DETAILS 4 - HOME HEALTH HOSPICE 500 SOUTH MAPLE STREET STE 1 WACONIA MN 55387 HOME HEALTH & HOSPICE 5 - REHAB SPECIALTIES 560 SOUTH MAPLE STREET WACONIA MN 55387 REHABILITATION SERVICES 6 - HOME MEDICAL EQUIPMENT 500 SOUTH MAPLE STREET STE 2 WACONIA MN 55387 MEDICAL EQUIPMENT SUPPLIER 7 - RIDGEVIEW SLEEP CENTER 560 SOUTH MAPLE STREET STE 103 WACONIA MN 55387 SLEEP DISORDER SERVICES 8 - PEDIATRIC REHAB 490 SOUTH MAPLE STREET STE 125 WACONIA MN 55387 PEDIATRIC SERVICES 9 - RIDGEVIEW RESEARCH 3000 HUNDERTMARK ROAD STE 8 CHASKA MN 55318 RESEARCH FACILITY 10 - WESTERN OBGYN 560 SOUTH MAPLE STREET WACONIA MN 55387 OBESTRIC AND GYNECOLOGY SERVICES PART I, LINE 3C: TO QUALIFY FOR FINANCIAL ASSISTANCE, THE FOLLOWING CONDITIONS MUST BE MET:(A) THE MEDICAL CARE PROVIDED BY RIDGEVIEW MEDICAL CENTER IS MEDICALLY NECESSARY;(B) THE INDIVIDUAL SUBMITS A COMPLETED APPLICATION;C) THE INDIVIDUAL COOPERATES WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE, IF NECESSARY (INCLUDING SSI, DISABILITY, MEDICARE AND MEDICAID); AND(D) THE INDIVIDUAL'S FAMILY INCOME IS LESS THAN 250% OF FEDERAL POVERTY GUIDELINES ("FPG"). FREE CARE IS OFFERED FOR FEDERAL ADJUSTED GROSS INCOME UP TO 200% OF FPG. 75% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 200% AND 225% FPG. 56% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 225% AND 250% OF FPG. IN ADDITION, PATIENTS SEEKING FINANCIAL ASSISTANCE MAY BE ASKED FIRST TO APLY FOR OTHER EXTERNAL PROGRAMS (SUCH AS MEDICAID OR INSURANCE THROUGH THE PUBLIC MARKETPLACE).RIDGEVIEW MAY RELY ON EXTERNAL SOURCES TO DETERMINE ELIGIBILITY WHEN:(A) THE PATIENT IS HOMELESS;(B) THE PATIENT IS ELIGIBLE FOR OTHER UNFUNDED STATE OR LOCAL ASSISTANCE PROGRAMS;C) THE PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH;(D) THE PATIENT IS ELIGIBLE FOR STATE-FUNDED PRESCRIPTION MEDICATION;(E)THE PATIENT'S VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING; OR (F) THE PATIENT RECEIVEDS FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL FOR FURTHER TREATMENT.RIDGEVIEW MEDICAL CENTER ALSO USES RELAYHEALTH CLEARANCE, AN ELIGIBILITY VENDOR, TO HELP IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE COSTING METHODOLOGY USED BY RIDGEVIEW TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON RMC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,237,086. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS CALCULATED BY RIDGEVIEW AS FOLLOWS: PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF THE INVOICE OR CLAIM SUBMITTED. PATIENT ACCOUNTS THAT ARE MORE THAN 90 DAYS PAST DUE ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE ORGANIZATION. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE. PART III, LINE 3: RIDGEVIEW ESTIMATES THAT APPROXIMATELY 25% OF ITS TOTAL COST OF CHARITY CARE IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE BUT DID NOT COMPLETE AN APPLICATION AND WERE ULTIMATELY INCLUDED IN BAD DEBT EXPENSE REPORTED IN PART III, LINE 2. PART III, LINE 4: THE NOTE OF RIDGEVIEW'S 2020 FINANCIAL STATEMENTS THAT INCLUDES THE EXPLANATION OF BAD DEBT EXPENSE IS THE "PATIENT RECEIVABLES, NET NOTE INCLUDED ON PAGE 10. PART III, LINE 8: RIDGEVIEW USES THE 2020 FILED MEDICARE COST REPORT TO CALCULATE THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6. APPLIED AGAINST ACTUAL RECEIPTS RIDGEVIEW EXPERIENCED COSTS NOT COVERED BY MEDICARE IN THE AMOUNT OF $14,844,326 IN 2020. THIS IS A DIRECT BENEFIT TO THE MEDICARE POPULATION IN OUR COMMUNITY. PART III, LINE 9B: RIDGEVIEW'S CHARITY PROGRAM ALLOWS FOR ACCOUNTS IN BAD DEBT STATUS TO COMPLETE A CHARITY CARE APPLICATION. IF APPROVED, THE ACCOUNT WILL BE RETURNED FROM BAD DEBT AND APPLIED TO OUR CHARITY CARE PROGRAM. ALL PATIENTS ARE ADVISED OF OUR CHARITY CARE PROGRAM THROUGH OUR MONTHLY BILLING PROCESS. RIDGEVIEW MEDICAL CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING PATIENT ACCOUNT BALANCES. PART VI, LINE 2: RIDGEVIEW MEDICAL CENTER ASSESSES THE CURRENT HEALTH STATUS, HEALTH OUTCOMES, AND UNMET NEEDS IN THE 46+ COMMUNITIES IT SERVES THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS. COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND PUBLIC REPORTING ENSURES THAT RIDGEVIEW HEALTH IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH COMMUNITY HEALTH PRIORITIES. RIDGEVIEW WILL CONTINUE TO USE A CHNA AND OTHER INTERNAL AND EXTERNAL INFORMATION (INCLUDING DISCHARGE, QUALITY MEASURES, PREDICTIVE, AND POPULATION DATA) TO AID STRATEGIC PLANNING PROCESSES AND ALIGN ORGANIZATIONAL SERVICES/RESOURCES ACCORDINGLY. PART VI, LINE 3: AT THE TIME OF SCHEDULING, PRE-REGISTRATION, REGISTRATION, OR DISCHARGE (WHICHEVER IS APPLICABLE), THE PATIENT WILL BE ASKED FO INSURANCE COVERAGE, AND THE PATIENT WILL BE INFORMED OF ANY CO-PAYMENTS THAT WILL BE EXPECTED AT THE TIME OF PAYMENT. IF THE PATIENT WISHES TO APPLY FOR COMMUNITY CARE, HE OR SHE WILL BE GIVEN OR MAILED AN APPLICATION; THE APPLICATION IS ALSO AVAILABLE FOR DOWNLOAD FROM THE RMC WEBSITE. A PATIENT MAY NOT QUALIFY FOR COMMUNITY CARE UNTIL HE OR SHE HAS COMPLETED THE APPLICATION. AFTER COMPLETING THE COMMUNITY CARE APPLICATION (INCLUDING SUPPORTING DOCUMENTATION), THE ACCOUNT REPRESENTATIVE WILL ASSESS THE APPLICATION AND DETERMINE WHETHER THE PATIENT QUALIFIES FOR COMMUNITY CARE OR ANY OTHER GOVERNMENTAL HEALTH CARE COVERAGE. IF THE PATIENT IS LIKELY TO QUALIFY FOR OTHER GOVERNMENTAL HEALTH CARE COVERAGE, THE ACCOOUNT REPRESENTATIVE WILL DETERMINE APPROPRIATE COVERAGE AND REFER THE PATIENT AS APPROPRIATE. IF AN UNINSURED PATIENT IS UNLIKELY TO QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE, OR DENIED HOSPITAL PRESUMPTIVE ELIGIBILITY, AND THE PATIENT DOES NOT QUALIFY FOR COMMUNITY CARE, APPROPRIATE PAYMENT ARRANGEMENTS MUST BE MADE WITH THE ACCOUNT REPRESENTATIVE BASED UPON RMC'S UNINSURED PAYMENT POLICY. SHOULD THE PATIENT SUBSEQUENTLY QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE OR ANY OTHER HEALTH INSURANCE, ANY PAYMENTS RECEIVED WILL BE REFUNDED LESS ANY CO-PAYMENTS DUE. PART VI, LINE 4: RIDGEVIEW SERVES A POPULATION OF APPROXIMATELY 300,000 PEOPLE, PRIMARILY FROM ITS FIVE-COUNTY SERVICE AREA OF CARVER, NORTHERN SIBLEY, SOUTHERN WRIGHT, WESTERN HENNEPIN, AND EASTERN MCLEOD.AS OF THE 2010 CENSUS, THE SERVICE AREA POPULATION DISTRIBUTION BY AGE COHORT WAS 10% ARE 65+, 28% ARE 45-64, 35% ARE 18-44, AND 27% ARE 0-17. ACCORDING TO CARVER COUNTY DATA (PRIMARY SERVICE AREA), FAMILY HOUSEHOLDS MAKE UP 42% OF THE SERVICE AREA, 90% OF THE TOTAL POPULATION ARE OF CAUCASIAN DESCENT, 4% ARE OF HISPANIC DESCENT, AND 3% ARE OF ASIAN DESCENT. CARVER COUNTY MEDIAN HOUSEHOLD INCOME IS $82,710 AND 5% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PART VI, LINE 5: RIDGEVIEW MEDICAL CENTER'S PHYSICIANS, AND MEDICAL AND SUPPORT STAFF, PROVIDE SERVICES AND IN-KIND CONTRIBUTIONS TO THE COMMUNITIES IT SERVES IN A FIVE-COUNTY AREA. EXAMPLES OF RIDGEVIEW'S COMMUNITY BENEFIT CONTRIBUTIONS INCLUDE UNDERFUNDING OF MEDICARE, MEDICAID AND CHARITY CARE, FREE LACTATION CONSULTATIONS TO NEW MOTHERS, JOB SHADOWS FOR HIGH SCHOOL AND COLLEGE STUDENTS, INTERNSHIP OPPORTUNITIES FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS (BOTH CLINICAL AND NON-CLINICAL), AND DISCOUNTS TO THE UNINSURED. RIDGEVIEW ALSO PROVIDES IN-KIND AND FINANCIAL DONATIONS TO OTHER NON-PROFITS' COMMUNITY HEALTH INITIATIVES (INCLUDING WESTONKA WECAB TRANSPORTATION SERVICE, PAY IT FORWARD FUND, AND COMMUNITY HEALTH AND WELLNESS EVENTS). PART VI, LINE 6: RIDGEVIEW MEDICAL CENTER IS A 129-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE: RIDGEVIEW CLINICS PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA. SIBLEY MEDICAL CENTER (DBA: RIDGEVIEW SIBLEY MEDICAL CENTER) IS A CRITICAL ACCESS HOSPITAL PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY MEDICAL CENTER ALSO HAS CLINICAL LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON AND WINTHROP.MINNESOTA VALLEY HEALTH CENTER (DBA: RIDGEVIEW LE SUEUR MEDICAL CENTER) OPERATES A 15-BED ACCUTE CARE HOSPITAL, A 55-BED NURSING HOME, AND A 37-UNIT HUD APARTMENT BUILDING FOR THE ELDERLY.CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST.MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST. WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS. RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS. RIDGEVIEW COMMUNITY NETWORK OPERATES AN ACCOUNTABLE CARE ORGANIZATION. RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW FOUNDATION OPERATES FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER. PART VI, LINE 7, REPORTS FILED WITH STATES MN PART V, SECTION D, LINE 3 RIDGEVIEW'S SPECIALTY CLINICS INCLUDE ENDOCRINOLOGY, PEDIATRIC INTEGRATIVE MEDICINE, DERMATOLOGY, PODIATRY, PULMONOLOGY, RHEUMATOLOGY, OTOLARYNGOLOGY, GASTROENTEROLOGY, AND BARIATRIC. X X X X X X 0 1 0 0 0 1 1 0 0 GORDON GABLENZ CIO & TREASURER 290231 0 56602 0 418155 0 22910 0 60462 0 848360 0 0 0 MICHAEL PHELPS PRESIDENT/CEO 466890 0 91332 0 2973 0 25176 0 39572 0 625943 0 0 0 BENJAMIN NIELSEN COO 259023 0 37452 0 23817 0 14647 0 754 0 335693 0 0 0 KEN GILLES CIO 183223 0 36535 0 24944 0 21451 0 56004 0 322157 0 0 0 ELAINE ARION VICE PRESIDENT & CNO 192561 0 32604 0 22818 0 21075 0 25961 0 295019 0 0 0 DOUGLAS STASEK EXEC DIRECTOR 159515 0 36018 0 21079 0 20370 0 42233 0 279215 0 0 0 SARAH URTEL VICE PRESIDENT 170291 0 30751 0 18476 0 21683 0 30658 0 271859 0 0 0 PAUL HAM VICE PRESIDENT 181220 0 19663 0 18817 0 23744 0 19458 0 262902 0 0 0 GREGORY MARCHETTI CRNA 187605 0 2280 0 1930 0 19826 0 43965 0 255606 0 0 0 SARAH HASTINGS EXEC DIRECTOR 157191 0 28089 0 17169 0 23634 0 29190 0 255273 0 0 0 GREGORY ERICKSON CRNA 182887 0 2429 0 1930 0 17284 0 50434 0 254964 0 0 0 CHRISTOPHER STEFFEN EXEC DIRECTOR 159871 0 28501 0 17575 0 11613 0 28155 0 245715 0 0 0 PAMELA WILLIAMS VICE PRESIDENT 117164 0 17538 0 16166 0 15155 0 31106 0 197129 0 0 0 PART I, LINE 4B ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2020, $0 WAS CONTRIBUTED TO THE PLAN, $73,774 ACCRUED WITHIN THE PLAN, AND $170,041 WAS PAID OUT OF THE PLAN. MICHEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2020, $0 WAS CONTRIBUTED TO THE PLAN, $24,880 WAS ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2020, $414,540 WAS CONTRIBUTED TO THE PLAN, $37,525 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. PART I, LINE 6 THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2019 AND PAID IN 2020. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIR, THE VICE CHAIR, THE SECRETARY, AND THE TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE FULL AUTHORITY OF THE BOARD EXCEPT AS OTHERWISE LIMITED BY LAW, BY THE BOARD, OR BY THE BYLAWS. THE EXECUTIVE COMMITTEE TRANSACTS THE BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD. THE EXECUTIVE COMMITTEE CONDUCTS AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND REPORTS THE FINDINGS AND RECOMMENDED COMPENSATION AND BENEFITS TO THE BOARD OF DIRECTORS. AFTER RECEIVING THE EXECUTIVE COMMITTEE'S REPORT, THE ENTIRE BOARD THEN SETS THE COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AS THE BOARD DEEMS APPROPRIATE. THE EXECUTIVE COMMITTEE ESTABLISHES A PROCESS FOR STRATEGIC PLANNING THAT ALSO ENCOMPASSES BOARD RETREATS. FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S HEALTH CARE (DBA: CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA) IS A MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE MAYOR OF WACONIA SERVES AS AN EX-OFFICIO NON-VOTING MEMBER OF THE BOARD. CERTAIN RIGHTS, LIKE AUTHORITY OVER CAPITAL EXPENDITURES, ARE RESERVED BY THE CITY OF WACONIA. AS A CORPORATE MEMBER OF RIDGEVIEW MEDICAL CENTER, CHILDREN'S HOSPITAL AND CLINICS HAS THE RIGHT TO APPROVE ANY AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS TO THE EXTENT SUCH AMENDMENT WOULD MATERIALLY ADVERSELY AFFECT THE RIGHTS OR OBLIGATIONS OF CHILDREN'S AS A MEMBER OF RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWED THE FORM 990 AND PROVIDED A COPY OF THE FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION. THE BOARD USES COMPARABILITY DATA FROM A COMPENSATION SURVEY AND VOTES ON HIS COMPENSATION. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2020. THE CEO DETERMINES THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES. HIS DUE DILIGENCE PROCEDURES INCLUDE REVIEWING COMPENSATION SURVEYS AND PRESENTING HIS CONCLUSIONS TO THE BOARD OF DIRECTORS FOR APPROVAL. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2020. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW MEDICAL CENTER HOLDS A PUBLIC MEETING ANNUALLY, AT WHICH THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PRESENTED. OTHERWISE THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES AND OTHER MISCELLANEOUS SERVICES: PROGRAM SERVICE EXPENSES 32,256,481. MANAGEMENT AND GENERAL EXPENSES 8,235,997. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,492,478. FORM 990, PART XI, LINE 9: INVESTMENT IN FOUNDATION 3,127,816. RIDGEVIEW REAL ESTATE LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 LAND LESSOR MN 49992 4166 RIDGEVIEW MEDICAL CENTER RIDGEVIEW REAL ESTATE II LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 LAND LESSOR MN 0 0 RIDGEVIEW MEDICAL CENTER RIDGEVIEW COMMUNITY NETWORK LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 ACCOUNTABLE CARE ORGANIZATION MN 587201 400881 RIDGEVIEW MEDICAL CENTER RIDGEVIEW FOUNDATION 500 SOUTH MAPLE STREET WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 1 RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 1 RIDGEVIEW INSURANCE CO 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 1 SIBLEY MEDICAL CENTER 601 W CHANDLER ST ARLINGTON MN 55307 411801967 CRITICAL ACCESS HOSPITAL MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 1 MINNESOTA VALLEY HEALTH CENTER 621 S 4TH STREET LE SUEUR MN 56058 410837659 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 1 MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC 500 S MAPLE ST WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN RIDGEVIEW MEDICAL CENTER RELATED 231583 7622669 0 1 0.50000 CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD CHASKA MN 55318 450975783 SURGERY SERVICES MN RIDGEVIEW MEDICAL CENTER RELATED 2362667 4149345 0 1 0.51000 EXECUTIVE HEALTH MANAGEMENT SERVICES 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN RIDGEVIEW MEDICAL CENTER C 1.00000 1 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN 0 0 1 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 SIBLEY MEDICAL CENTER O 6442264 FAIR MARKET VALUE RIDGEVIEW LE SUEUR MEDICAL CENTER O 6302094 FAIR MARKET VALUE RIDGEVIEW FOUNDATION O 389982 FAIR MARKET VALUE RIDGEVIEW FOUNDATION M 867602 FAIR MARKET VALUE RIDGEVIEW FOUNDATION C 1383257 FAIR MARKET VALUE RIDGEVIEW CLINICS P 19288816 FAIR MARKET VALUE MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC O 920522 FAIR MARKET VALUE MINNEAPOLIS HEART INSTITITUE AT RIDGEIEW HEART CENTER LLC J 725506 FAIR MARKET VALUE CHASKA PLAZA SURGERY CENTER D 2504417 FAIR MARKET VALUE CHASKA PLAZA SURGERY CENTER Q 972283 FAIR MARKET VALUE SIBLEY MEDICAL CENTER P 796865 FAIR MARKET VALUE LE SUEUR MECIAL CENTER P 311332 FAIR MARKET VALUE