2020-05-13T11:17:05-05:00 2019-06-30 420714325 RSM US LLP 801 NICOLLET MALL WEST TOWER STE 1100 MINNEAPOLIS MN 554022526 990 2018-07-01 410695596 ST CLOUD HOSPITAL STCL 3202512700 1406 SIXTH AVENUE NORTH ST CLOUD MN 563031901 MICHAEL A BLAIR CFO/TREASURER 3202512700 2020-05-08 1 KACIE MCEWEN P01599614 6123324300 2020-05-08 174.219.32.236 2020-05-08 14:20:39 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 2018 2021-01-29 14:40:06Z CRAIG BROMAN 1406 SIXTH AVENUE NORTH ST CLOUD MN 563031901 999795896 0 X WWW.CENTRACARE.COM X 1962 MN WE'RE HERE FOR YOUR WHOLE LIFE - TO LISTEN THEN SERVE, TO GUIDE AND HEAL BECAUSE HEALTH MEANS EVERYTHING. 19 13 6869 1535 38812 0 3489416 8498542 903118738 943131084 34815359 37920481 8853529 2285920 950277042 991836027 2353906 2072589 0 0 466258313 480122535 0 0 0 369215611 391517809 837827830 873712933 112449212 118123094 1256961524 1385541956 500844664 599501059 756116860 786040897 X WE'RE HERE FOR YOUR WHOLE LIFE - TO LISTEN THEN SERVE, TO GUIDE AND HEAL BECAUSE HEALTH MEANS EVERYTHING. 0 0 794122269 2040919 907196178 CENTRACARE HEALTH IS PRIMARILY ENGAGED IN SUPPORTING AND DIRECTING HEALTHCARE DELIVERY THROUGH ITS AFFILIATED ENTITIES. CENTRACARE OPERATES AS THE PARENT CORPORATION TO THE SAINT CLOUD HOSPITAL WHICH STRIVES TO IMPROVE THE QUALITY AND EXPAND THE CLINICAL SCOPE OF, ENHANCE ACCESS TO, AND ASSURE AFFORDABILITY OF, HEALTH SERVICES FOR RESIDENTS IN THE ST. CLOUD AREA AND CENTRAL MINNESOTA. THESE AIMS ARE SUPPORTED BY CENTRACARE'S COMMITMENT TO ADVANCE MEDICAL EDUCATION, TRAINING AND RESEARCH. AS A HIGH QUALITY REGIONAL MEDICAL CENTER, ST CLOUD HOSPITAL PROVIDES A BROAD RANGE OF ACUTE INPATIENT SERVICES. WITH 489 LICENSED INPATIENT BEDS, ST CLOUD HOSPITAL CARED FOR 28,174 INPATIENT ADMISSIONS WITH 120,924 ASSOCIATED PATIENT DAYS DURING FISCAL 2019. INPATIENT SERVICES INCLUDE MEDICAL AND SURGICAL CARE, BIRTHING SERVICES, CHILDREN'S SERVICES INCLUDING NEONATAL INTENSIVE CARE AND PEDIATRIC INTENSIVE CARE, BEHAVIORAL HEALTH CARE SERVICES FOR ADULTS AND ADOLESCENTS, ALONG WITH SPECIALIZED CARE IN CARDIOLOGY, NEUROSCIENCES, NEUROSURGERY, ORTHOPEDICS AND REHABILITATION SERVICES. 6253996 31670 35896094 AS PART OF THE ST CLOUD HOSPITAL, ST BENEDICTS SENIOR COMMUNITY PROVIDES RESIDENTIAL HEALTH CARE SERVICES INCLUDING INDEPENDENT LIVING, ASSISTED LIVING AND SHORT AND LONG TERM SKILLED NURSING SERVICES. IN FISCAL 2019 THERE WERE 198 SKILLED STAFFED BEDS AND RESIDENT DAYS OF 57,268. SHORT STAY SKILLED SERVICES INCLUDE AN EXTENSIVE REHABILITATIVE CARE PROGRAM WITH THE GOAL OF ENABLING RESIDENTS TO RETURN TO THEIR HOMES. IN FISCAL 2019 THERE WERE 383 HOUSING UNITS AND TENANT DAYS OF 121,340. ASSISTED LIVING AND INDEPENDENT LIVING COMMUNITIES ARE DESIGNATED AS HOUSING WITH SERVICES. HOMECARE SERVICES ARE PROVIDED TO THESE TENANTS ON A BASE RATE PLUS POINTS SYSTEM. 0 0 0 AS A HIGH QUALITY REGIONAL MEDICAL CENTER, ST CLOUD HOSPITAL PROVIDES A BROAD RANGE OF OUTPATIENT SERVICES. OUTPATIENT ENCOUNTERS DURING FISCAL YEAR 2019 WERE 307,431 AND INCLUDED EMERGENCY ROOM SERVICES, BEHAVIORAL HEALTH CARE, CANCER TREATMENT, DIALYSIS, IMAGING PROCEDURES, DIAGNOSTIC HEART PROCEDURES, REHABILITATION THERAPY, SAME DAY SURGERY AND OTHER AMBULATORY CARE SERVICES. 800376265 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 461 0 1 6869 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 19 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X MICHAEL BLAIR 3202512700 1406 SIXTH AVENUE NORTH ST CLOUD MN 563031901 CRAIG J BROMAN PRESIDENT 37.00 3.00 X X 1380622 0 36391 MERRYN JOLKOVSKY MD DIRECTOR, PAST CHIEF OF STAFF 2.00 0.00 X X 0 306111 41409 TODD SEVERNACK MD DIRECTOR, CHIEF OF STAFF 2.00 0.00 X X 0 552107 36835 TIMOTHY WENSMAN DIRECTOR, CHAIR 2.00 0.00 X X 0 0 0 FATHER THOMAS KNOBLACH DIRECTOR, VICE CHAIR 2.00 0.00 X X 0 0 0 RYAN DANIEL DIRECTOR 2.00 0.00 X 0 0 0 EILEEN DAUER MD DIRECTOR 2.00 0.00 X 0 0 0 LISA FOSS DIRECTOR 2.00 0.00 X 0 0 0 RENEE FRAUENDIENST DIRECTOR 2.00 0.00 X 0 0 0 MELINDA GAU DIRECTOR 2.00 0.00 X 0 0 0 WILLIE JETT DIRECTOR 2.00 0.00 X 0 0 0 RICHARD JOLKOVSKY MD DIRECTOR 2.00 0.00 X 0 589578 20625 ROBERT KOVELL DIRECTOR 2.00 0.00 X 0 0 0 EDWARD B MARTIN-CHAFFEE MD DIRECTOR 2.00 38.00 X 0 679775 42735 ALBERT MERCURI MD DIRECTOR 2.00 0.00 X 0 441815 34494 JENNIFER MROZEK DIRECTOR (UNTIL 7/1/18) 2.00 0.00 X 0 0 0 JAMES RUDOLPH DIRECTOR 2.00 0.00 X 0 0 0 JAMES SCHLENNER DIRECTOR (UNTIL 7/1/18) 2.00 0.00 X 0 0 0 PATRICIA SNIEZERK OSB DIRECTOR 2.00 0.00 X 0 0 0 ROBERT THUERINGER DIRECTOR 2.00 0.00 X 0 0 0 COLLEEN QUINLIVAN OSB DIRECTOR 2.00 0.00 X 0 0 0 GREGORY R KLUGHERZ TREASURER/CFO 11.00 29.00 X 756425 0 33266 PAUL R HARRIS ESQ SECRETARY 10.00 30.00 X 0 573539 309499 SUSAN R KRATSKE VICE PRESIDENT 40.00 0.00 X 250782 0 145393 HANI S ALKHATIB MD PHYSICIAN 40.00 0.00 X 0 1255731 47396 DAHLIA H ELKADI MB BCH PHYSICIAN 40.00 0.00 X 0 771983 36439 DONALD J JURGENS MD PHYSICIAN 40.00 0.00 X 0 910755 36439 CHRISTOPHER B MILLER MD PHYSICIAN 40.00 0.00 X 0 796560 32999 HILARY I UFEARO MD PHYSICIAN 40.00 0.00 X 0 1023919 41685 2387829 7901873 895605 449 0 1 0 CROTHALL HEALTHCARE INC 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING/LAUNDRY SERVICES 3538048 AEGIS THERAPIES PO BOX 936653 ATLANTA GA 311936653 CONTRACT REHAB SERVICES 1790890 HAYES LOCUMS 6700 N ANDREWS AVENUE SUITE 600 FORT LAUDERDALE FL 33309 PHYSICIAN LOCUMS 1586671 HAMMEL GREEN AND ABRAHAMSON 420 NORTH 5TH STREET MINNEAPOLIS MN 55401 ENGINEERING-DESIGN/ARCHITECT SERVICES 1547317 AIR HEALTHCARE SOLUTIONS 400 SELBY AVENUE SUITE D ST PAUL MN 55102 BEHAVIORAL HEALTHCARE SOLUTIONS FOR EMPL 1449913 80 4270326 4089341 138875 138000 8498542 PATIENT/RESIDENT SERVICES 621110 922233362 922233362 FOOD SALES 621110 5198723 5198723 DEPT EXP REIMBURSEMENT 621110 3064589 3064589 OTHER MISC REVENUE 621110 796580 796580 11837830 11799018 38812 943131084 37801694 37801694 3601160 3601160 0 132975 14188 118787 118787 118787 6495201 4344521 2150680 2150680 PURCHASE DISCOUNTS 541200 135240 135240 135240 991836027 943092272 38812 40206401 1970226 1970226 102363 102363 1484733 1484733 369875944 340640092 29235852 16731556 15402651 1328905 66372572 60923955 5448617 25657730 23540698 2117032 281321 258109 23212 13138 12054 1084 25569 25569 1358270 1358270 71015121 65155630 5859491 375676 344679 30997 1767418 1621588 145830 6723922 6169128 554794 9626856 8832540 794316 1327740 1218188 109552 10245880 9400488 845392 52462531 48133823 4328708 2224115 2040602 183513 DRUGS/MEDICAL SUPPLIES 149805860 149805860 MEDICAID/MN CARE 16177731 16177731 BAD DEBT 14047527 14047527 54039134 34578333 19460801 873712933 800376265 73336668 0 39222358 9886897 13420128 0 135141293 165345129 12364835 15713105 4430559 4843566 1093867483 569939988 523349008 523927495 434383155 461529866 77878097 135202481 16772091 69093417 1256961524 1385541956 89421383 112676509 354001667 416595542 57421614 70229008 500844664 599501059 X 756116860 786040897 756116860 786040897 1256961524 1385541956 X 118123094 -26585938 -61613119 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 1 25569 1 0 0 25569 0 PART II-B, LINE 1: ST. CLOUD HOSPITAL AND ST. BENEDICTS SENIOR COMMUNITY PAID $25,569 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 17172374 17172374 675249654 280585678 394663976 392731498 289335050 103396448 8713957 19260 8694697 523927495 FUNDS HELD BY TRUSTEE, WORKER'S COMP & FUTURE BUILDING 135202481 F 135202481 OTHER LONG TERM LIABILITIES 70229008 70229008 X PART X, LINE 2: CENTRACARE, THE CORPORATION, THE CLINIC, CCH - MELROSE, CCH - LONG PRAIRIE, CCH - SAUK CENTRE AND THE FOUNDATION HAVE BEEN DETERMINED TO QUALIFY AS TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CCH - MONTICELLO, CCH - PAYNESVILLE AND CARRIS HEALTH, AS DISREGARDED LIMITED LIABILITY COMPANIES (LLCS) UNDER INTERNAL REVENUE SERVICE REGULATIONS, ACHIEVE TAX-EXEMPT TREATMENT BASED ON THE EXEMPT STATUS OF THEIR PARENT, CENTRACARE HEALTH SYSTEM. AT JUNE 30, 2019 AND 2018, THERE WERE NO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 1527005 1527005 0.00180 142657781 106380880 36276901 0.04220 144184786 106380880 37803906 0.04400 1804287 500 1803787 0.00210 4722039 2322460 2399579 0.00280 249339 249339 0.00030 2103648 2103648 0.00240 8879313 2322960 6556353 0.00760 153064099 108703840 44360259 0.05160 600 24003 24003 0.00000 300 30141 30141 0.00000 600 7099 7099 0.00000 1500 61243 61243 0.00000 1 14047527 301944790 281142855 20801935 X 1 1 1 1 SAINT CLOUD HOSPITAL 1406 6TH AVENUE NORTH ST CLOUD MN 563031901 WWW.CENTRACARE.COM/LOCATIONS/CENTRACAR 395453 X X X X REHAB, PSYCH, HOME HEALTH, HOSPICE, AND RENAL DIALYSIS ST CLOUD HOSPITAL 1 0 0 1 X X X X X X 15 1 1 0 1 X SEE SECTION C SUPPLEMENTAL INFORMATION FOR PART V, SECTION B X X 1 15 1 SEE SECTION C SUPPLEMENTAL INFORMATION FOR PART V, SECTION B 0 1 X 175.000000000000 250.000000000000 X X 1 1 X X X 1 X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X X X X X X X 1 0 X X X X X 1 X 0 0 ST. CLOUD HOSPITAL PART V, SECTION B, LINE 3J: CENTRACARE HEALTH'S (CCH) CHNA PRIMARY NEEDS WERE IDENTIFIED USING THE CENTER FOR DISEASE CONTROL'S COMMUNITY HEALTH STATUS INDICATORS (CHSI). THE PROCESS ALSO CONSIDERED SECONDARY DATA FROM THE DARTMOUTH ATLAS, ROBERT WOOD JOHNSON, MINNESOTA DEPARTMENT OF HEALTH, US CENSUS BUREAU, MINNESOTA HOSPITAL ASSOCIATION, AND PUBLIC HEALTH DEPARTMENTS FROM APPROPRIATE COUNTIES AND ADDITIONAL FEDERAL AND STATE ENTITIES. THE CHNA WAS INFORMED BY A COLLABORATIVE AND ONGOING COMMUNITY HEALTH SURVEY JOINTLY FUNDED AND MANAGED WITH A NUMBER OF AREA COUNTIES WHO WERE JOINTLY CONDUCTING COMMUNITY SURVEYS TO INFORM THEIR COMMUNITY HEALTH ASSESSMENTS IN SUPPORT OF DEVELOPMENT OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS. ST. CLOUD HOSPITAL PART V, SECTION B, LINE 5: DATA WAS OBTAINED FROM LOCAL COUNTY PUBLIC HEALTH DEPARTMENTS, INCLUDING THEIR MOST RECENT HEALTH ASSESSMENTS AND COMMUNITY REPORTS. IN ADDITION, HEALTH-RELATED INFORMATION WAS COLLECTED FROM AREA NONPROFIT ORGANIZATIONS THAT REGULARLY CONDUCT ASSESSMENTS AND EVALUATIONS OF THE SERVICES THEY PROVIDE AND THEIR TARGETED DEMOGRAPHICS. USEFUL MATERIAL WAS GATHERED FROM THE LOCAL UNITED WAY, CATHOLIC CHARITIES, THE CENTRAL MINNESOTA COUNCIL ON AGING, AND THE TRI-COUNTY ACTION PROGRAM (TRI-CAP). THESE ORGANIZATIONS SUPPORT A BROAD RANGE OF CONSTITUENTS WITH DIVERSE HEALTH-RELATED NEEDS; THEY REPRESENT DEMOGRAPHICS THAT ARE STATISTICALLY MORE LIKELY TO ENCOUNTER HEALTH-RELATED BARRIERS. CCH ALSO CONDUCTED A SERIES OF FOCUS GROUPS THAT INFORMED ITS CHNA. SPECIFICALLY, THE FOCUS GROUPS REPRESENTED POPULATIONS OF COLOR, RECENT IMMIGRANT POPULATIONS, CULTURAL MINORITIES, THOSE WHO WERE AUDIBLY CHALLENGED AND OTHERS WHO WERE DEEMED TO BE UNDER-REPRESENTED OR UNDER-SERVED. ST. CLOUD HOSPITAL PART V, SECTION B, LINE 6A: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE BEGINNING OF ITS FISCAL 2016. THOSE FACILITIES INCLUDED ST. CLOUD HOSPITAL, CENTRACARE HEALTH - MELROSE, CENTRACARE HEALTH - LONG PRAIRIE, CENTRACARE HEALTH - SAUK CENTRE, CENTRACARE HEALTH - MONTICELLO AND CENTRACARE HEALTH - PAYNESVILLE.EACH HOSPITAL PREPARED INDIVIDUAL ACTION PLANS TO THE CHNA BASED ON SPECIFIC INPUT FROM THOSE COMMUNITIES. ST. CLOUD HOSPITAL PART V, SECTION B, LINE 7D: IN ADDITION TO MAKING ITS CHNA AVAILABLE TO THE PUBLIC ON ITS WEB SITE AND AT ITS BUSINESS OFFICE, CCH HAS SHARED COPIES OF THE CHNA WITH COUNTY PUBLIC HEALTH OFFICIALS AND, INTERNALLY, WITH INDIVIDUALS WORKING ON QUALITY IMPROVEMENT AND COMMUNITY HEALTH INITIATIVES. CCH HAS ALSO PUBLISHED CONTACT INFORMATION FOR ITS DIRECTOR OF COMMUNITY & GOVERNMENT RELATIONS TO RESPOND TO QUESTIONS OR CONCERNS ABOUT THE CHNA. THE DIRECTOR HAS ALSO PRESENTED RESULTS OF THE CHNA TO COMMUNITY GROUPS AND TO REPRESENTATIVES OF LOCAL FUNDING GROUPS. ST. CLOUD HOSPITAL PART V, SECTION B, LINE 11: THE NEEDS IDENTIFIED BY THE CHNA ARE CURRENTLY IN ORGANIZATIONAL WORK PLANS AND ARE UNDER IMPLEMENTATION. TO PRIORITIZE IDENTIFIED NEEDS, CHNA ADVISORY TASK FORCE MEMBERS DEVISED A SET OF CRITERIA. THE CRITERIA USED WERE: COMMUNITY IMPACT, POTENTIAL FOR CHANGE, ECONOMIC FEASIBILITY, COMMUNITY ASSETS, AND VALUE AND MISSION. THE PRIORITIZATION PROCESS IDENTIFIED PROCESS IDENTIFIED THE FOLLOWING SIX, BROAD COMMUNITY HEALTH ISSUES: 1 - ADULT OBESITY2 - ADULT DIABETES3 - OLDER ADULT PREVENTABLE HOSPITALIZATIONS4 - STROKE DEATHS5 - CORONARY HEART DISEASE DEATHS6 - CANCER DEATHSST. CLOUD HOSPITAL WILL MAINTAIN ITS ENGAGEMENTS WITH THE CHNA ADVISORY TASK FORCE TO ENSURE EFFECTIVE COLLABORATION AND COMMUNICATION WITH THE OTHER CENTRACARE HOSPITALS. THE CHNA ADVISORY TASK FORCE WILL CONTINUE TO MEET DURING THE THREE-YEAR PERIOD IN WHICH THE IMPLEMENTATION STRATEGY WILL UNFOLD. DURING THIS TIME THE GROUP WILL:- IDENTIFY WHAT OTHER COMMUNITY ORGANIZATION ARE DOING IN REGARD TO HEALTH PRIORITY AREAS;- DEVELOP SPECIFIC GOALS AND METRICS TO MONITOR AND MEASURE PROGRESS AND OUTCOMES;- COMMUNICATE SHORT-TERM AND LONG-TERM RESULTS OF ACTION PLANS WITHIN THE COMMUNITY.BASED ON THE FINDINGS AND PRIORITIES ESTABLISHED BY THE CHNA, AND AFTER HAVING REVIEWED THE COMMUNITY BENEFITS ACTIVITIES THAT CURRENTLY EXIST, ST. CLOUD HOSPITAL WILL CONTINUE TO SUPPORT THE SYSTEM-WIDE INITIATIVES OUTLINED BELOW AND WILL PARTICIPATE IN LOCALIZED ADAPTATIONS (AS DESCRIBED IN THE ACTION STEPS) OF THESE PROGRAMS WITH REGARD TO THE SPECIFIC NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. TO SEE THE SPECIFIC ACTION PLAN FOR EACH OF THE SIX PRIORITY HEALTH AREAS SEE THE FULL IMPLEMENTATION STRATEGY FOR FISCAL YEAR 2016 - 2018 LOCATED ON THE WEBSITE AT WWW.CENTRACARE.COM/DOCUMENTS/ABOUT/2016-CENTRACARE-CHNA-AND-IMPELMENTATION-STRATEGIES.PDF.PER GUIDANCE FROM THE IRS, REGULATION 1.501(R)-3(C), THE CHNA FOR CCH ELECTED NOT TO DIRECTLY ADDRESS SEVERAL DETERMINANTS OF HEALTH THAT IT IDENTIFIED IN ITS PROCESS WHICH WERE NOT WITHIN THE ORGANIZATION'S CAPABILITIES OR CORE COMPETENCIES. EXAMPLES OF ISSUES NOT SPECIFICALLY ADDRESSED IN THE CHNA ACTION PLANS INCLUDE HIGH SCHOOL GRADUATION RATES, AFFORDABLE HOUSING OR SUPPORTED HOUSING. CCH DID SUPPORT AN EFFORT OF THE CITY OF ST. CLOUD TO CONDUCT A HOUSING ASSESSMENT AS A RESULT OF THE CHNA PROCESS AND IS ALREADY THE LARGEST AREA PROVIDER OF SUPPORTED HOUSING DUE TO ITS EXTENSIVE CHEMICAL DEPENDENCY PROGRAMS AND SENIOR HOUSING PROGRAMS. ST. CLOUD HOSPITAL PART V, SECTION B, LINE 13H: A NON-CITIZEN CAN BE DENIED CARE IF THEY CAME TO THE US SPECIFICALLY TO RECEIVE FREE CARE. PRESUMPTIVE ELIGIBILITY - IF PATIENTS FAIL TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT FINANCIAL ASSISTANCE ELIGIBILITY, CENTRACARE HEALTH MAY REFER TO OR RELY ON EXTERNAL SOURCES AND/OR OTHER PROGRAM ENROLLMENT RESOURCES TO DETERMINE ELIGIBILITY WHEN:(A) PATIENT IS HOMELESS(B) PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS(C) PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM(D) PATIENT IS ELIGIBLE FOR A STATE-FUNDED PRESCRIPTION MEDICATION PROGRAM(E) PATIENT'S VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING(F) PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO HOSPITAL FOR FURTHER TREATMENT ST. CLOUD HOSPITAL PART V, SECTION B, LINE 16J: PATIENTS WHO ARE AT A SELF PAY STATUS RECEIVE FINANCIAL ASSISTANCE INFORMATION EITHER VIA A TELEPHONE CALL OR ON BILLING STATEMENTS. ST. CLOUD HOSPITAL PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY CARE INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST A PATIENT. ST. CLOUD HOSPITAL: PART V, SECTION B, LINES 7A AND 10A: THE HOSPITAL'S CHNA AND STRATEGY AND IMPLEMENTATION PLAN CAN BE FOUND ON ITS WEBSITE AT WWW.CENTRACARE.COM/DOCUMENTS/ABOUT/2016-CENTRACARE-CHNA-AND-IMPELMENTATION-STRATEGIES.PDF. 27 1 - SAINT BENEDICT'S SENIOR COMMUNITY 1810 MINNESOTA BLVD ST CLOUD MN 56304 SKILLED NURSING FACILITY 2 - COBORN CANCER CENTER 1900 CENTRACARE CIRCLE ST CLOUD MN 56303 OUTPATIENT CANCER 3 - MIDMINNESOTA FAMILY MEDICINE CENTER 1520 WHITNEY COURT SUITE 200 ST CLOUD MN 56303 CLINIC SERVICES 4 - BEHAVIORAL HEALTH CLINIC 1900 CENTRACARE CIRCLE ST CLOUD MN 56303 OUTPATIENT CLINIC 5 - RECOVERY PLUS 713 ANDERSON AVE ST CLOUD MN 56303 OUTPATIENT SERVICES 6 - DIAGNOSTIC CENTER 1900 CENTRACARE CIRCLE ST CLOUD MN 56303 OUTPATIENT RADIOLOGY 7 - ST CLOUD SLEEP CENTER 1586 COUNTY RD 134 ST CLOUD MN 56303 OUTPATIENT SERVICES 8 - ST CLOUD PHYSICAL THERAPY 12800 ROLLING ROCK RIDGE RD BECKER MN 55308 PHYSICAL THERAPY 9 - SARTELL PSYCHOLOGY 166 19TH ST S SARTELL MN 56377 BEHAVIORAL HEALTH 10 - PASSAGE HOME 121 PARK AVE SO ST CLOUD MN 56301 SUBSTANCE ABUSE 11 - JOURNEY HOME 1485 10TH AVE NE SAUK RAPIDS MN 56379 SUBSTANCE ABUSE 12 - CLARA'S HOUSE 1564 COUNTY ROAD 134 ST CLOUD MN 56303 ADOLESCENT MENTAL HEALTH 13 - ST CLOUD HOSPITAL WOUND CARE CENTER 2035 15TH ST NORTH SUITE 130 ST CLOUD MN 56303 WOUND CARE 14 - ST CLOUD HOSPITAL PHYSICAL THERAPY - ALBA 320 3RD AVE ALBANY MN 56307 PHYSICAL THERAPY 15 - RECOVERY PLUS RESIDENTIAL - ADOLESCENT 1572 CO RD 134 ST CLOUD MN 563030346 BEHAVIORAL HEALTH 16 - RECOVERY PLUS WOMEN'S OUTPATIENT SERVICES 1428 2ND ST N SAUK RAPIDS MN 563792533 BEHAVIORAL HEALTH 17 - DIALYSIS - LITCHFIELD 520 HWY 12 E SUITE 6 LITCHFIELD MN 55355 DIALYSIS 18 - DIALYSIS - STAPLES 403 PRAIRIE AVE NE STAPLES MN 56479 DIALYSIS 19 - DIALYSIS - BRAINERD 2024 6TH STREET BRAINERD MN 56401 DIALYSIS 20 - DIALYSIS - ALEXANDRIA 111 17TH AVE E ALEXANDRIA MN 56308 DIALYSIS 21 - DIALYSIS - PRINCETON 112 S RUM RIVER DR SUITE 10 PRINCETON MN 55371 DIALYSIS 22 - DIALYSIS - BIG LAKE 16830 198TH AVE NW BIG LAKE MN 55309 DIALYSIS 23 - DIALYSIS - LITTLE FALLS 808 3RD ST SSE LITTLE FALLS MN 56345 DIALYSIS 24 - DIALYSIS - CAMBRIDGE 520 11TH AVE SW SOUTH BLD CAMBRIDGE MN 55008 DIALYSIS 25 - DIALYSIS - OLIVIA 600 EAST PARK AVE SUITE 1 OLIVIA MN 56277 DIALYSIS 26 - CENTRACARE PLAZA REHAB 1900 CENTRACARE CIRCLE ST CLOUD MN 56303 PHYSICIAL, OCCUPATIONAL, SPEECH THERAPY 27 - CENTRACARE SOUTHWAY REHAB 1301 33RD ST S ST CLOUD MN 56301 PHYSICIAL, OCCUPATIONAL, SPEECH THERAPY PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. 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 $ 14,047,527. PART II, COMMUNITY BUILDING ACTIVITIES: THE ACTIVITIES INCLUDED IN COMMUNITY BUILDING ACTIVITIES INCLUDE COMMUNITY SUPPORT WHICH CONSISTS OF SEVERAL ST. CLOUD HOSPITAL DIRECTORS PARTICIPATING IN A VARIETY OF COMMITTEES SUCH AS THE BOARD OF BIG BROTHERS/BIG SISTERS, REHAB BOARD ETC. UNDER COMMUNITY HEALTH IMPROVEMENTS ADVOCACY, EMPLOYEES PARTICIPATED WITH CREATE COMMUNITY, WHICH IS A COLLABORATION TO BUILD INCLUSION AMONGST DIVERSE POPULATION AND SEVERAL COUNTY TASK FORCES TO ADVOCATE FOR MENTAL AND CHEMICAL HEALTH. FINALLY UNDER WORKFORCE DEVELOPMENT, AN EMPLOYEE IS A BOARD MEMBER OF THE STEARNS BENTON WORKFORCE COUNCIL AND STUDENTS WERE GIVEN TOURS OF THE HOSPITAL AND ATTENDED PRESENTATIONS ON CAREERS IN HEALTHCARE. PART III, LINE 2: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PART III, LINE 4: THE FOLLOWING IS FROM THE "ACCOUNTS RECEIVABLE" PARAGRAPH INCLUDED IN NOTE 2 OF THE ORGANIZATION'S AUDITED FINANCIALS."CENTRACARE REPORTS PATIENT AND RESIDENT SERVICE REVENUE AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH CENTRACARE EXPECTS TO BE ENTITLED TO IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS AND THIRD-PARTY PAYORS (INCLUDING MEDICARE, MEDICAID, BLUE CROSS AND OTHER THIRD-PARTY PAYORS). CERTAIN REIMBURSEMENT ARRANGEMENTS INCLUDE VARIABLE CONSIDERATION FOR AMOUNTS SUBJECT TO RETROACTIVE AUDIT AND ADJUSTMENT. DIFFERENCES BETWEEN AMOUNTS ORIGINALLY RECORDED AND FINALLY SETTLED ARE INCLUDED IN OPERATIONS IN THE YEAR IN WHICH THE DIFFERENCES ARE KNOWN. REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED." PART III, LINE 8: THE AMOUNT ON LINE 7 OF PART III WAS DETERMINED BY UTILIZING THE MEDICARE COST REPORT. UTILIZING KEY SECTIONS OF THAT REPORT, PRIMARILY THE D SERIES AND E SERIES, ALONG WITH KEY SECTIONS FROM THE HOME HEALTH, HOSPICE AND DIALYSIS SECTIONS. PART III, LINE 9B: THE COLLECTION POLICIES AT ST. CLOUD HOSPITAL REQUIRE COLLECTION STAFF TO OFFER CHARITY TO PATIENTS WHO INDICATE THAT PAYMENT MAY BE AN ISSUE. IF A PATIENT DOES QUALIFY FOR FULL CHARITY, ALL OTHER COLLECTION EFFORTS MUST CEASE. IF A PATIENT QUALIFIES FOR PARTIAL CHARITY, COLLECTION EFFORTS WILL CONTINUE ON THE BALANCE OF THE ACCOUNT. THESE PROVISIONS APPLY TO BOTH HOSPITAL EMPLOYED COLLECTION STAFF AND COLLECTION AGENCY STAFF. NO PATIENTS, WHETHER THEY QUALIFY FOR CHARITY OR NOT, ARE REPORTED TO CREDIT REPORTING AGENCIES. PART VI, LINE 2: ST. CLOUD HOSPITAL FOUNDATION HAS IN PLACE A COMMUNITY COLLABORATION COMMITTEE WHICH HAS A MEMBERSHIP OF OVER 30 MEMBERS. THIS COMMITTEE IS MADE UP OF COMMUNITY LEADERS FROM BOTH THE HEALTHCARE AND BUSINESS WORLD. THESE MEMBERS MEET MONTHLY TO ADDRESS COMMUNITY HEALTH ISSUES (SEE PROMOTION OF COMMUNITY HEALTH FOR MORE DETAIL). THESE IDENTIFIED HEALTH NEEDS ARE THEN COMMUNICATED TO ST. CLOUD HOSPITAL. PART VI, LINE 3: INPATIENTS WHO ARE SELF PAY ARE IDENTIFIED, AND A REPRESENTATIVE OF THE ORGANIZATION'S BILLING DEPARTMENT EXPLAINS THE CHARITY CARE POLICY TO PATIENTS. THEY ALSO EXPLAIN THE SELF PAY DISCOUNT AND SCREENS THE PATIENT FOR ELIGIBILITY FOR ANY STATE OR FEDERAL PROGRAMS. THEY ALSO ASSIST THE PATIENT WITH ANY PAPERWORK REQUIRED TO APPLY FOR SUCH PROGRAMS. OUTPATIENTS WHO ARE SELF PAY RECEIVE AN AUTOMATIC SELF PAY DISCOUNT. IF THE PATIENT DOES NOT REMIT PAYMENT, COLLECTION STAFF ATTEMPT TO REACH THE PATIENT BY PHONE. PATIENTS ARE TOLD ABOUT THE CHARITY PROGRAM. FOR BOTH INPATIENTS AND OUTPATIENTS, ALL STATEMENTS CONTAIN A LETTER REGARDING THE AVAILABILITY OF CHARITY CARE. ALSO ALL PRECOLLECTION LETTERS HAVE THIS SAME LANGUAGE INDICATING THE AVAILABILITY AND PROCESS OF OBTAINING CHARITY CARE. PART VI, LINE 4: ST. CLOUD HOSPITAL'S IMMEDIATE SERVICE AREA CONSISTS OF STEARNS, BENTON AND SHERBURNE COUNTIES. COLLECTIVELY THEIR ESTIMATED POPULATION IN 2019 IS 305,531 AND IS PROJECTED TO GROW BY 3.9% IN 2024. THE PROJECTED POPULATION GROWTH BY AGE BRACKET FOR 2019 TO 2024 IS 0-24, 0.8%; 25-44, 4.4%; 45-64, -0.4% AND 65+ 18.5%. THE OTHER NINE COUNTIES LOCATED IN THE SERVICE AREA ARE CROW WING, DOUGLAS, KANDIYOHI, MEEKER, MILLE LACS, MORRISON, POPE, TODD AND WRIGHT. COLLECTIVELY THEIR POPULATION IN 2019 WAS 403,658 AND IS PROJECTED TO GROW BY 2.9% BY 2024. THAT 9-COUNTY PROJECTED POPULATION GROWTH TO 2024 BY AGE BRACKET ARE AS FOLLOWS: 0-24, 3.9%; 25-44, 8.6%; 45-64, -3.4% AND 65+ 14.3%. THE PROJECTED 2024 ETHNICITY BREAKDOWN FOR THE ENTIRE 12-COUNTY AREA IS AS FOLLOWS: WHITE 88.9%, BLACK 3.4%, ASIAN & PACIFIC ISLANDER 1.4%, HISPANIC 3.9% AND OTHER 2.4%. THE DEMOGRAPHIC INFORMATION IS UPDATED EVERY 2 YEARS BY THE ORGANIZATION. PART VI, LINE 5: THE COMMUNITY COLLABORATION COMMITTEE (CCC), A STANDING COMMITTEE OF CENTRACARE HEALTH FOUNDATION, HAS A MEMBERSHIP OF OVER 15 PERSONS REPRESENTING HEALTHCARE AND COMMUNITY NEEDS ACROSS CENTRAL MINNESOTA. THE CCC MEETS QUARTERLY TO DISCUSS WAYS TO ADDRESS TYPICAL HEALTH ISSUES THROUGH AWARENESS BUILDING, EDUCATION AND ADVOCACY. THERE ARE SEVERAL COMMUNITY HEALTHY OUTREACH INITIATIVES THAT THE FOUNDATION IS INVOLVED WITH, THESE INITIATES INCLUDE:- GREATER ST. CLOUD DEVELOPMENT CORPORATION, WELLBEING 5 SURVEY A WORKPLACE ASSESSMENT TO ENGAGE 20,000 CENTRAL MINNESOTA EMPLOYEES IN THEIR OWN HEALTH AND WELLBEING.- FEELING GOOD MN ADVANCING HEALTH IN OUR COMMUNITIES BY BUILDING ON THE SUCCESS OF EXISTING HEALTH IMPROVEMENT PROGRAMS AND BRINGING EVERYONE TOGETHER TO COLLABORATE IN A WAY THAT WILL STRENGTHEN COMMUNITIES THROUGH POLICY, SYSTEMS, ENVIRONMENT (PSE) WORK:- BLEND CHILDHOOD OBESITY COALITION OF CENTRAL MINNESOTA - GOAL IS TO REDUCE THE INCIDENCE OF CHILDHOOD OBESITY.- CRAVE THE CHANGE - WORKING TO BUILD HEALTHY, TOBACCO-FREE COMMUNITIES FOR THE NEXT GENERATION- PROJECT BRAINSAFE - A COMMUNITY COLLABORATIVE AROUND THE PREVENTION AND TREATMENT OF CONCUSSIONS AND TRAUMATIC BRAIN INJURIES.-IHI INTEGRATED BEHAVIORAL HEALTH PROJECT - IMPROVING ACCESS AND CARE DELIVERY FOR OUR PATIENTS WITH BEHAVIORAL HEALTH NEEDS. PART VI, LINE 6: THE ORGANIZATION IS PART OF CENTRACARE HEALTH SYSTEM (CCHS) WHICH PROVIDES A BROAD RANGE OF HEALTH CARE SERVICES TO THE PATIENTS OF CENTRAL MINNESOTA. CCHS IS DEDICATED TO IMPROVING THE HEALTH OF PEOPLE LIVING AND WORKING IN THE COMMUNITIES IT SERVES. TO ACCOMPLISH ITS GOALS IT WORKS ACTIVELY WITH ITS AFFILIATE HEALTH CARE ORGANIZATIONS. CCHS CONTINUES TO FOCUS ON PROVIDING THE BEST CARE POSSIBLE AND IN REINVESTING INTO THE COMMUNITY. CCHS ALSO PROMOTES WELLNESS BY SPONSORING PROGRAMS AND EVENTS IN LOCAL COMMUNITIES THAT FOCUS ON HEALTHY EATING AND EXERCISE, AND BY CONDUCTING SCREENINGS FOR CONDITIONS SUCH AS HIGH BLOOD PRESSURE. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 501(C)(3) 1913226 TO SUPPORT THE CENTRACARE FOUNDATION ORDER OF SAINT BENEDICT INC 104 CHAPEL LANE ST ST JOSEPH MN 56374 410693973 501(C)(3) 50000 TO PAY FOR HEALTHCARE COSTS HELPS INTERNATIONAL 16610 DALLAS PKWY SUITE 2025 ADDISON TX 75248 751966419 501(C)(3) 7000 GUATEMALA MISSION TRIPS. 3 0 HOME DELIVERED MEALS 204 102363 BOOK COST TO PROVIDE MEALS TO THE NEEDY. PART I, LINE 2: CENTRACARE HEALTH SYSTEM, INCLUDING ST. CLOUD HOSPITAL, HAS THE FOLLOWING POLICY REGARDING CHARITABLE CONTRIBUTIONS: CONTRIBUTIONS MUST BE IN KEEPING WITH THE MISSION OF CENTRACARE HEALTH, WHICH IS TO WORK TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. CONTRIBUTIONS WILL BE MADE TO ORGANIZATIONS RATHER THAN TO INDIVIDUALS WITHIN THE CENTRAL MINNESOTA REGION. CENTRACARE'S CHARITABLE FUNDS MAY NOT BE USED TO SUPPORT ANY ORGANIZATION OR EVENT THAT WOULD RESULT IN BENEFITS OF ANY KIND TO AN EMPLOYEE OF THE HEALTH SYSTEM OR A MEMBER OF THE VARIOUS BOARDS OF DIRECTORS, EITHER DIRECTLY OR INDIRECTLY. ONE EXCEPTION EXISTS TO THE GUIDELINE REGARDING BENEFIT TO EMPLOYEES: WE WILL SUPPORT, VIA SCHOLARSHIPS AND THE PURCHASE OF SUPPLIES, THE MEDICAL MISSION WORK OF OUR STAFF AND PHYSICIANS. THE CENTRACARE HEALTH CONTRIBUTIONS COMMITTEE IS MADE UP OF : ONE REPRESENTATIVE FROM CENTRACARE HEALTH FOUNDATION; ONE REPRESENTATIVE FROM ST. CLOUD HOSPITAL HUMAN RESOURCES/DIVERSITY COMMITTEE; THE DIRECTOR OF CENTRACARE HEALTH'S COMMUNICATION DEPARTMENT AND THE COMMUNICATIONS/MARKETING FOR ST. BENEDICT'S SENIOR COMMUNITY; THE DIRECTOR OF CENTRACARE HEALTH'S MARKETING DEPARTMENT; THE DIRECTOR OF ST. CLOUD HOSPITAL VOLUNTEER SERVICES; AND ST. CLOUD HOSPITAL'S DIRECTOR OF MISSION & SPIRITUAL CARE. THE COMMITTEE MEETS MONTHLY TO ENSURE A STREAMLINED, COORDINATED PROCESS OF REVIEWING REQUESTS AND DETERMINING FUNDING. THE COMMITTEE MAINTAINS A DATABASE TO TRACK ALL CONTRIBUTIONS. OTHER CENTRACARE ENTITIES, INCLUDING CENTRACARE HEALTH - LONG PRAIRIE, MELROSE, MONTICELLO, PAYNESVILLE AND SAUK CENTRE, MAY DEVELOP A BUDGET FOR APPROVAL AND IMPLEMENT THEIR OWN CONTRIBUTIONS DECISIONS WITHIN THE GUIDELINES OF THIS DOCUMENT. CONTRIBUTIONS MAY NOT EXCEED THE STATED BUDGET AND NO MULTI-YEAR COMMITMENTS TO ORGANIZATIONS MAY BE MADE WITHOUT APPROVAL FORM THE CENTRACARE HEALTH EXECUTIVE COUNCIL. INDIVIDUALS AND DEPARTMENTS FROM THROUGHOUT ST. CLOUD HOSPITAL AND CENTRACARE CLINIC SHOULD FORWARD ALL OUTSIDE FUNDING REQUESTS TO A MEMBER OF THE COMMITTEE FOR THE FULL GROUP'S CONSIDERATION. THOSE REQUESTING FUNDS SHOULD BE ASKED TO SUBMIT REQUESTS IN WRITING. X X X X X X 0 1 0 0 0 0 1 0 0 CRAIG J BROMAN PRESIDENT 843549 0 165926 0 371147 0 20625 0 16564 0 1417811 0 93908 0 MERRYN JOLKOVSKY MD DIRECTOR, PAST CHIEF OF STAFF 0 281657 0 14628 0 9826 0 19350 0 24888 0 350349 0 0 TODD SEVERNACK MD DIRECTOR, CHIEF OF STAFF 0 519511 0 29024 0 3572 0 20625 0 17531 0 590263 0 0 RICHARD JOLKOVSKY MD DIRECTOR 0 498747 0 84212 0 6619 0 20625 0 2828 0 613031 0 0 EDWARD B MARTIN-CHAFFEE MD DIRECTOR 0 639916 0 11533 0 28326 0 20625 0 24758 0 725158 0 0 ALBERT MERCURI MD DIRECTOR 0 408715 0 23274 0 9826 0 15734 0 22161 0 479710 0 0 GREGORY R KLUGHERZ TREASURER/CFO 622849 0 113782 0 19794 0 16500 0 17607 0 790532 0 0 0 PAUL R HARRIS ESQ SECRETARY 0 390662 0 85223 0 97654 0 105471 0 204905 0 883915 0 66403 SUSAN R KRATSKE VICE PRESIDENT 203972 0 40567 0 6243 0 44613 0 101657 0 397052 0 0 0 HANI S ALKHATIB MD PHYSICIAN 0 1226994 0 16533 0 12204 0 20625 0 29508 0 1305864 0 0 DAHLIA H ELKADI MB BCH PHYSICIAN 0 727064 0 16533 0 28386 0 20625 0 18551 0 811159 0 0 DONALD J JURGENS MD PHYSICIAN 0 871415 0 11533 0 27807 0 20625 0 17960 0 949340 0 0 CHRISTOPHER B MILLER MD PHYSICIAN 0 531396 0 235169 0 29995 0 11939 0 23655 0 832154 0 0 HILARY I UFEARO MD PHYSICIAN 0 973729 0 21949 0 28241 0 20625 0 23455 0 1067999 0 0 PART I, LINE 4B THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED NON-QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO FORM 990, THE AMOUNTS LISTED IN PART VII AND SCHEDULE J, PART II, COLUMN C, REFLECT TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON FORM 990 - ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF AND WHEN IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: CRAIG J BROMAN - PAID $152,547; ACCRUED $0 PAUL R HARRIS - PAID $66,403; ACCRUED $88,628 GREGORY R KLUGHERZ - PAID $0; ACCRUED $0 SUSAN KRATZKE - PAID $0; ACCRUED $39,360 PART I, LINE 6 THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: STEWARDSHIP, THROUGH A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR SAINT CLOUD HOSPITAL AND/OR CENTRACARE HEALTH SYSTEM AS WELL THROUGH ACHIEVING METRICS FOR AN IDENTIFIED COST REDUCTION PROGRAM; QUALITY, THROUGH ACHIEVING SAINT CLOUD HOSPITAL AND SYSTEM QUALITY METRICS; PATIENT EXPERIENCE, THROUGH ACHIEVEMENT OF PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; AND PEOPLE/EMPLOYEES, THROUGH ACHIEVEMENT OF SPECIFIED EMPLOYMENT SATISFACTION GOALS AND HIRING AND/OR RETENTION GOALS. THE INCENTIVE COMPENSATION PAID OUT IS NOT A PORTION OR PERCENTAGE OF ACTUAL NET EARNINGS OF ANY CENTRACARE HEALTH SYSTEM AFFILIATE, HOWEVER NET EARNINGS GOALS ARE REQUIRED TO BE MET BEFORE THE INCENTIVE COMPENSATION IS PAID. X ULTRASOUND MACHINES 2 138000 TRADE IN VALUE RECEI 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 MERRYN JOLKOVSKY & RICHARD JOLKOVSKY - FAMILY RELATIONSHIP (MARRIED) FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATE MEMBERS OF ST. CLOUD HOSPITAL ARE TWO REPRESENTATIVES OF THE SISTERS OF THE ORDER OF SAINT BENEDICT, TWO REPRESENTATIVES OF THE DIOCESE OF ST. CLOUD, AND FOUR OTHER CORPORATE MEMBERS APPOINTED BY THE FOUR REPRESENTATIVES. THE CORPORATE MEMBERS SERVE AS REPRESENTATIVES OF THE LOCAL CATHOLIC CHURCH OF SAINT CLOUD. FORM 990, PART VI, SECTION A, LINE 7A THE CENTRACARE HEALTH (CCH) BOARD APPOINTS THE ST. CLOUD HOSPITAL (SCH) BOARD BASED ON RECOMMENDATION OF THE SCH JOINT NOMINATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO APPOINTING THE ST. CLOUD HOSPITAL BOARD, THE MEMBERS APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION, APPROVE DISSOLUTION OF THE HOSPITAL, AND SUPPORT AND ASSESS THE HOSPITAL'S ROMAN CATHOLIC IDENTITY AND MISSIONS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS HAS DELEGATED THE APPROVAL AUTHORITY OF THE FORM 990 TO THE AUDIT COMMITTEE. ANNUALLY, AT THE AUDIT COMMITTEE MEETING, PRIOR TO FILING WITH THE IRS, THE AUDIT COMMITTEE REVIEWS AND APPROVES FORM 990. A COPY OF FORM 990 IS THEN PROVIDED FOR THE FULL BOARD TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE TWICE A YEAR. ALL STAFF SIGN CONFLICTS OF INTEREST FORMS ON AN ANNUAL BASIS. THE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AS WELL AS THE CORPORATE COMPLIANCE GROUP (A COMPLIANCE COMMITTEE WHICH INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRES ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD. THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTERESTS RELATED TO BOARD AND STAFF AND TO ALERT AFFECTED PARTIES WHEN A CONFLICT ARISES. WHEN AN ACTUAL CONFLICT ARISES, THE AFFECTED PARTY IS ASKED TO RECUSE HIM/HER SELF FROM THE DECISION MAKING PROCESS. THE CORPORATE COMPLIANCE OFFICER ATTENDS BOARD MEETINGS AND SPECIFIED BOARD COMMITTEE MEETINGS WHERE CONFLICT ISSUES MAY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION AND BENEFITS OF THE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS DONE IN MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. CLOUD HOSPITAL TO PERFORM SERVICES. LINE 15B: THE COMPENSATION AND BENEFITS OF THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE ALSO PAID BY A RELATED ORGANIZATION AND SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS DONE IN MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. CLOUD HOSPITAL TO PERFORM THESE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES RELEASE AN ANNUAL REPORT TO THE COMMUNITY IN WHICH FINANCIAL RESULTS ARE REPORTED TO AND DISCUSSED WITH THE PUBLIC. THIS REPORT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE. FORM 990, PART XI, LINE 9: ADJUSTMENTS TO FUNDED STATUS OF PENSION PLAN -13,544,146. NET EQUITY TRANSFERS TO AFFILIATED ORGANIZATIONS -48,068,973. CENTRACARE HEALTH SYSTEM 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411813221 HEALTHCARE HOLDING COMPANY MN 501(C)(3) LINE 3 N/A 0 CENTRACARE HEALTH-MELROSE 11 NORTH 5TH AVE WEST MELROSE MN 56352 411865315 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH-LONG PRAIRIE 50 CENTRACARE DRIVE LONG PRAIRIE MN 56347 411924645 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH-SAUK CENTRE 425 ELM STREET NORTH SAUK CENTRE MN 56378 452438973 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 411806657 MULTI-SPECIALTY MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 FUNDRAISING MN 501(C)(3) LINE 7 CENTRACARE HEALTH SYSTEM 0 CUSHMAN ALBERT RICE TRUST 1100 WEST ST GERMAIN STREET ST CLOUD MN 56303 416019335 SUPPORT FOR RICE MEMORIAL HOSPITAL MN 501(C)(3) LINE 12A, I RICE MEMORIAL HOSPITAL 0 RICE HEALTH FOUNDATION 301 BECKER AVE SW WILLMAR MN 56303 411611555 SUPPORT FOR RICE MEMORIAL HOSPITAL MN 501(C)(3) LINE 12A, I RICE MEMORIAL HOSPITAL 0 MONTICELLO CANCER CENTER 1001 HART BLVD STE 50 MONTICELLO MN 55362 261909519 RADIATION & ONCOLOGY SERVICES MN N/A MONTICELLO SURGERY CENTER 1013 HART BLVD MONTICELLO MN 55362 813593057 AMBULATORY SURGERY CENTER MN N/A BENSON MEDICAL LLC 1228 ATLANTIC AVENUE BENSON MN 56215 203149203 HEALTHCARE MN N/A CENTRACARE HOLDINGS INC 1406 6TH AVE N ST CLOUD MN 56303 472688595 INVESTMENTS/PHARMACY MN N/A C 0 AFFILIATED COMMUNITY MEDICAL CENTERS PA 301 BECKER AVE SW WILLMAR MN 56201 823166379 HEALTH CARE SYSTEM MN N/A C 0 AFFILIATED COMMUNITY HEALTH NETWORK INC 101 WILLMAR AVE SW WILLMAR MN 56201 410850702 HEALTH NETWORK MN N/A C 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1