2020-11-15T19:02:26-06:00 2019-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2019-01-01 390908320 AMERY REGIONAL MEDICAL CENTER INC AMER 7152688000 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DEBRA RUDQUIST PRESIDENT 7152688000 2020-11-15 1 MONROE JORDAN GIERL P01413237 6123055000 198.153.9.194 2020-11-15 17:29:07 CS P 763097D6A2B3EA9277A508CC789A2C5E6C07E1F2 763097D6A2B3EA9277A508CC789A2C5E6C07E1F2 2019 2021-01-29 14:40:06Z DEBRA RUDQUIST 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 63227737 0 X WWW.AMERYMEDICALCENTER.ORG X 1954 WI TO PROVIDE ACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE 13 7 500 26 0 0 107300 282579 60760964 62357101 184444 390681 207576 148025 61260284 63178386 35749 42401 0 0 39932985 40651486 0 0 0 20487659 20789982 60456393 61483869 803891 1694517 51714878 53164869 30089212 29387833 21625666 23777036 X AMERY REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDEACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THEHEALTH AND WELLNESS OF ITS COMMUNITY. 0 0 55479136 42401 62357101 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 55479136 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 500 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 1 1 WI X DOUGLAS JOHNSON - CFO 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 X RICK DADO DIRECTOR 1.75 0.25 X 700 0 0 HEIDI ERSPAMER DIRECTOR & VICE CHAIR 1.75 0.25 X 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 800 0 0 STEVEN SCHAFFFER DIRECTOR 1.75 0.25 X 1500 0 0 CHRIS PETERSEN DIRECTOR 1.75 0.25 X 1200 0 0 ORALEE SCHOCK DIRECTOR & SECRETARY 1.75 0.25 X X 1200 0 0 ROSS R BULLARD DIRECTOR & TREASURER 1.00 46.00 X X 0 236514 70370 DYLAN COE MD DIRECTOR 0.25 39.75 X 0 328646 91647 MARTIN E RICHARDS MD DIRECTOR 0.25 39.75 X 0 490399 57228 ANN SEAGREN MD DIRECTOR 0.25 49.75 X 0 233514 72952 THEODORE WEGLEITNER DIRECTOR 0.25 52.75 X 0 548976 116564 MARYANN SCOGLIO CANP DIRECTOR 0.25 64.75 X 0 169933 43446 JASON J LUHRS CFO (JAN-AUG) 0.50 49.50 X 0 231590 53365 SANDRA M REED VP - AMBULATORY CARE 50.00 0.00 X 184600 0 42107 DEBRA RUDQUIST PRESIDENT 53.00 0.00 X 0 329096 61861 PATRICK SURA MD CHIEF MEDICAL OFFICER 0.25 64.75 X 0 457353 56749 DOUGLAS JOHNSON CFO (AUG-DEC) 13.75 41.25 X 0 380795 153262 MARK A TRYGGESTAD DIRECTOR OF PHARMACY 48.00 0.00 X 179668 0 20019 JAMES ERICKSON RN SUPERVISOR 40.00 0.00 X 135508 0 39469 ANTHONY GOULD ANCILLARY SERVICES 40.00 0.00 X 128010 0 38516 ANN SCHILLING HR SR DIRECTOR 40.00 0.00 X 126969 0 38275 BENJAMIN BOGLE PROVIDER-APNP 40.00 0.00 X 130853 0 37663 JOANNE L JACKSON FORMER HR, PR AND MKTG DIR 0.00 45.00 X 160894 0 27544 1054302 3406816 1021037 19 1 1 0 RIVER VALLEY ANESTHESIA INC PO BOX 118 NEW RICHMOND WI 54017 NURSE ANESTHETISTS 993561 TWIN CITIES ORTHOPEDICS PA 5803 NEAL AVE N OAK PARK HEIGHTS MN 55082 PROFESSIONAL SERVICES 849037 SHARED MEDICAL TECHNOLOGY INC 202 W NEWTON ST RICE LAKE WI 54868 PROFESSIONAL SERVICES 383128 HEALOGICS WOUND CARE 28525 NETWORK PLACE CHICAGO IL 60673 WOUND HEALING MANAGEMENT 339205 ABBOT VASCULAR DIVISION PO BOX 91138 CHICAGO IL 60675 PROFESSIONAL SERVICES 221191 12 274285 6186 2108 282579 NET PATIENT SERVICE 621110 61379378 61379378 OTHER OPERATING 900099 686060 686060 FITNESS CENTER 624110 150421 150421 SUBSIDIARY REVENUE 900099 141242 141242 62357101 390681 390681 54711 49351 5360 5360 5360 CAFETERIA AND OTHER 900099 135587 135587 GIFT SHOP 453220 7078 7078 142665 63178386 62357101 0 538706 42401 42401 234507 234507 35801286 32944874 2856412 661021 608281 52740 2358186 2170038 188148 1596486 1469110 127376 16127 16127 3254056 2820353 433703 216118 38654 177464 707015 523629 183386 178734 143779 34955 1006829 756149 250680 100886 47533 53353 22309 11218 11091 788485 788485 3304096 3142650 161446 201221 99532 101689 MEDICAL & DRUG SUPPLIES 7970099 7951342 18757 EQUIP. RENT & REPAIR 1995726 1264592 731134 OTHER EXPENSE 663444 496131 167313 TAXES & ASSESSMENTS 159527 159527 205310 160385 44925 61483869 55479136 6004733 0 23668 15748 8912534 8593132 7412905 7933690 734425 771028 126448 150822 61593553 40105511 23503059 21488042 8125113 10871204 2719280 2680017 157446 661186 51714878 53164869 5581652 5499230 24507560 23438770 0 449833 30089212 29387833 X 21625666 23777036 21625666 23777036 51714878 53164869 X 1694517 681194 -224341 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 24300372 15578685 8721687 3834151 178092 3656059 30296051 23667845 6628206 2179257 680889 1498368 21488042 LONG TERM INVESTMENTS 2680017 C 2680017 LEASE OBILGATION 449833 449833 X PART X, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2019 OR 2018 FOR UNRECOGNIZED TAX BENEFITS. 1 1 X 1 X 1 X 1 1 0 1 1 697878 0 697878 0.01140 9506988 7118154 2388834 0.03890 10204866 7118154 3086712 0.05030 24 1807 290635 2082 288553 0.00470 9 137 32172 32172 0.00050 10 72 149377 6230 143147 0.00230 43 2016 472184 8312 463872 0.00750 43 2016 10677050 7126466 3550584 0.05780 1 1321 1321 0.00000 1 5677 5677 0.00010 1 49 49 0.00000 3 7047 7047 0.00010 0 2301601 1314561 22116989 22116989 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 18 1 1 0 1 X WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX X 1 19 1 WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.AMERYMEDICALCENTER.ORG/MEDICAL_SERVICES/PATIENT_FINANCIAL_SERVI X HTTPS://WWW.AMERYMEDICALCENTER.ORG/MEDICAL_SERVICES/PATIENT_FINANCIAL_SERVI X HTTPS://WWW.AMERYMEDICALCENTER.ORG/MEDICAL_SERVICES/PATIENT_FINANCIAL_SERVI X X X X X X 1 X 0 X X X 1 X 0 0 AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: THE WAYS WE BRING THE MISSION TO LIFE IS TO WORK WITH COMMUNITY PARTNERS TO BETTER UNDERSTAND WHAT CONTRIBUTES TO AND STANDS IN THE WAY OF GOOD HEALTH AND HOW WE CAN WORK TOGETHER TO IMPROVE HEALTH OUTCOMES. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS AN OPPORTUNITY FOR US TO IDENTIFY THE SIGNIFICANT HEALTH NEEDS OF OUR COMMUNITY AND THE MEASURES AND RESOURCES REQUIRED TO ADDRESS THOSE NEEDS. HEALTHPARTNERS WORKED WITH LOCAL HEALTH DEPARTMENTS, LOCAL COALITIONS, THE CENTER FOR COMMUNITY HEALTH (CCH) AND COMMUNITY PARTNERS TO CONDUCT A COMPREHENSIVE CHNA. IN ADDITION, EACH HOSPITAL ENGAGED WITH LOCAL PUBLIC HEALTH PARTNERS AND OTHER LOCAL HEALTH CARE ORGANIZATIONS ON THE CHNA PROCESS THROUGH PARTICIPATION IN TWO LOCAL COLLABORATIVES: THE CENTER FOR COMMUNITY HEALTH EAST METRO CHA (COMMUNITY HEALTH ASSESSMENT)/CHNA COLLABORATIVE AND THE WEST METRO CHNA COLLABORATION. COMMUNITY INPUT: AS PART OF ITS CHNA PROCESS, AMERY AND ITS PARTNERS WORKED COLLABORATIVELY WITH POLK AND BARRON COUNTIES TO ENGAGE COMMUNITY MEMBERS AND HEALTH CARE PROVIDERS IN THE PROCESS TO GATHER INPUT ON WHAT THEIR TOP HEALTH CONCERNS ARE.THE COMMUNITY INPUT IN THIS REPORT INCLUDES:COUNTY PRIORITY DATA: EACH COUNTY IN THE AMERY SERVICE AREA HAS DETERMINED THE TOP HEALTH PRIORITIES FOR ITS COMMUNITY THROUGH A COUNTY-LEVEL COMMUNITY HEALTH ASSESSMENT PROCESS (CHA). BARRON COUNTY COMMUNITY SURVEY DATA: IN 2018, BARRON COUNTY CONDUCTED A COMMUNITY SURVEY ABOUT HEALTH NEEDS AND BARRIERS TO HEALTH FOR ITS COMMUNITY HEALTH ASSESSMENT. A TOTAL OF 815 COMMUNITY MEMBERS PARTICIPATED IN THE SURVEY.POLK COUNTY COMMUNITY SURVEY DATA: IN 2015, POLK COUNTY CONDUCTED A COMMUNITY HEALTH SURVEY ABOUT HEALTH NEEDS AND BARRIERS TO HEALTH FOR ITS 2016 COMMUNITY HEALTH ASSESSMENT. A TOTAL OF 650 SURVEYS WERE COMPLETED BY COUNTY RESIDENTS.PROVIDER SURVEY: IN 2018, HEALTHPARTNERS SURVEYED HEALTH CARE PROVIDERS TO UNDERSTAND THEIR PERCEPTIONS OF LEADING HEALTH NEEDS AND COMMUNITY RESOURCES AVAILABLE TO HELP THEIR PATIENTS. THE SURVEY ALSO ASKED PROVIDERS TO IDENTIFY BARRIERS THEY FACE IN ADDRESSING HEALTH NEEDS AND RESOURCES TO BETTER SERVE THEIR PATIENTS. TWENTY-THREE HEALTH CARE PROVIDERS COMPLETED THE SURVEY, INCLUDING 11 WHO PRACTICE AT AMERY. AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: HEALTHPARTNERS COLLABORATED ACROSS SIX HOSPITALS WITHIN ITS FAMILY OF CARE FOR THE 2018 CHNA: - AMERY HOSPITAL & CLINIC (AMERY, WI) - HUDSON HOSPITAL & CLINIC (HUDSON, WI) - LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (STILLWATER, 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: THE 2018 HEALTHPARTNERS CHNA CONDUCTED RESULTED IN THE FOLLOWING PRIORITIES: PRIORITY 1: ACCESS TO CARE PRIORITY 2: ACCESS TO HEALTH PRIORITY 3: MENTAL HEALTH AND WELL-BEING PRIORITY 4: NUTRITION AND PHYSICAL ACTIVITY PRIORITY 5: SUBSTANCE ABUSEPRIORITIES NOT SELECTED: HEALTHPARTNERS DISCUSSED AND CONSIDERED ADDITIONAL OR ALTERNATIVE PRIORITIES DURING THE PRIORITIZATION PROCESS, INCLUDING: OLDER ADULT HEALTH/AGING, MATERNAL AND CHILD HEALTH, ENVIRONMENTAL HEALTH AND INJURY AND VIOLENCE. THESE NEEDS WERE NOT SELECTED AS TOP FIVE PRIORITIES IN THE CONSENSUS BUILDING PROCESS; HOWEVER, THE THEMES WILL BE CONSIDERED IN THE IMPLEMENTATION FOR THE SELECTED PRIORITY AREAS. A FULL REPORT OF AMERY'S 2018 CHNA AND ANNUAL IMPLEMENTATION PLAN UPDATE IS POSTED ON AMERY'S WEBPAGE AT WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX 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 II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES AT AMERY PRIMARILY INCLUDE ENVIRONMENTAL IMPROVEMENTS AND WORKFORCE DEVELOPMENT. AMERY CONTINUES TO BE A SUSTAINABILITY CHAMPION AND HOSTS AN ANNUAL ELECTRONICS RECYCLING EVENT AND ATTENDS THE ANNUAL CLEANMED CONFERENCE WHICH IS A NATIONAL ENVIRONMENTAL CONFERENCE FOR LEADERS IN HEALTH CARE SUSTAINABILITY. AMERY ALSO HAS REPRESENTATIVES SERVE ON THE WITC MEDICAL ASSISTANT ADVISORY COMMITTEE, WITC ADVISORY COUNCIL, AND WITC HEALTH INFORMATION TECHNOLOGY ADVISORY COMMITTEE. PART III, LINE 3: 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 PAGES 13 & 14 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: IN 2018, A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COLLABORATION WAS CONDUCTED FOR HEALTHPARTNERS AND SIX OF ITS HOSPITALS, INCLUDING REGIONS HOSPITAL, LAKEVIEW HOSPITAL, HUDSON HOSPITAL & CLINIC, WESTFIELDS HOSPITAL & CLINIC, AMERY HOSPITAL & CLINIC, AND PARK NICOLLET METHODIST HOSPITAL) BY THE IMPROVEGROUP TO DETERMINE THE GREATEST HEALTH NEEDS IN THE COMMUNITIES THEY SERVE. THESE HOSPITALS SERVE SIMILAR COMMUNITIES AND HAVE OVERLAPPING STUDY AREAS. THE SYSTEM'S STUDY AREA IS DEFINED AS DAKOTA, HENNEPIN, RAMSEY, SCOTT, AND WASHINGTON COUNTIES IN MINNESOTA AND POLK AND ST. CROIX COUNTIES IN WISCONSIN. AMERY'S SPECIFIC STUDY AREA IS DEFINED AS: BARRON COUNTY POLK COUNTYMETHODOLOGYIN 2018, HEALTHPARTNERS AND AMERY CONTRACTED WITH THE IMPROVE GROUP TO ANALYZE AND REPORT ON THE DATA DESCRIBING THE COMMUNITIES WE SERVE. HEALTHPARTNERS PROVIDED THE IMPROVE GROUP WITH THE DEFINITION OF THE HOSPITAL'S SERVICE AREA, THE INDICATORS TO STUDY FOR THE HEALTH AND DEMOGRAPHIC DATA SUMMARIES AND DATA COLLECTED DURING COMMUNITY CONVERSATIONS. COMMUNITY INPUT WAS COLLECTED IN PARTNERSHIP WITH HEALTHPARTNERS AND PARTNER ORGANIZATIONS THROUGH COMMUNITY CONVERSATIONS AND MULTIPLE SURVEYS. THE IMPROVE GROUP THEN GATHERED SECONDARY DATA FROM PUBLIC SOURCES, ANALYZED COMMUNITY INPUT DATA AND DEVELOPED SUMMARY REPORTS TO GUIDE A PRIORITIZATION PROCESS. PRIORITIZED NEEDSTHE HEALTHPARTNERS CHNA TEAM INCLUDED REPRESENTATIVES FROM EACH HEALTHPARTNERS HOSPITAL AND HEALTHPARTNERS LEADERSHIP. ON SEPTEMBER 14, 2018, THE CHNA TEAM MET TO REVIEW THE DATA AND PRIORITIZE THE COMMUNITY HEALTH NEEDS ACROSS THE SYSTEM. HEALTHPARTNERS COLLECTIVELY PRIORITIZED COMMUNITY HEALTH NEEDS USING A PROCESS INFORMED BY THE HANLON METHOD AND OTHER COMMONLY USED PRIORITIZATION METHODS. EACH HOSPITAL SHARED ITS 4 OR 5 PRIORITY TOPIC AREAS AND RATIONALE FOR EACH TOPIC AREA BASED ON: SIZE: NUMBER OF PERSONS AFFECTED, TAKING INTO ACCOUNT VARIANCE FROM BENCHMARK DATA AND TARGETS; SERIOUSNESS: THE DEGREE TO WHICH THE PROBLEM LEADS TO DEATH, DISABILITY AND IMPAIRMENT OF ONE'S QUALITY OF LIFE (MORTALITY AND MORBIDITY); EQUITY: DEGREE TO WHICH SPECIFIC GROUPS ARE AFFECTED BY THE PROBLEM; VALUE: THE IMPORTANCE OF THE PROBLEM TO THE COMMUNITY; AND CHANGE: WHAT IS THE SAME AND WHAT IS DIFFERENT FROM YOUR PREVIOUS CHNA? HEALTHPARTNERS HOSPITALS WORKED IN A THOROUGH, FACILITATED LARGE AND SMALL GROUP PROCESS TO REACH CONSENSUS ON TOP PRIORITIES. THE CHNA TEAM CONSIDERED THE CRITERIA DESCRIBED ABOVE AS WELL AS COMMUNITY INPUT DATA IN THESE DISCUSSIONS. THE FIVE PRIORITIES ARE OF EQUAL IMPORTANCE AND ARE PRESENTED IN ALPHABETICAL ORDER. THE FIVE PRIORITY AREAS ARE:ACCESS TO CAREACCESS TO CARE REFERS TO HAVING EQUITABLE ACCESS TO APPROPRIATE, CONVENIENT AND AFFORDABLE HEALTH CARE. THIS INCLUDES FACTORS SUCH AS PROXIMITY TO CARE, ACCESS TO PROVIDERS, COST, INSURANCE COVERAGE, MEDICAL TRANSPORTATION, CARE COORDINATION WITHIN THE HEALTH CARE SYSTEM AND CULTURAL SENSITIVITY AND RESPONSIVENESS. ACCESS TO HEALTHACCESS TO HEALTH REFERS TO THE SOCIAL AND ENVIRONMENTAL CONDITIONS THAT DIRECTLY AND INDIRECTLY AFFECT PEOPLE'S HEALTH, SUCH AS HOUSING, INCOME, EMPLOYMENT, EDUCATION AND MORE. THESE FACTORS, ALSO REFERRED TO AS SOCIAL DETERMINANTS OF HEALTH, DISPROPORTIONATELY IMPACT LOW INCOME COMMUNITIES AND COMMUNITIES OF COLOR. MENTAL HEALTH AND WELL-BEINGMENTAL HEALTH AND WELL-BEING REFERS TO THE INTERCONNECTION BETWEEN MENTAL ILLNESS, MENTAL HEALTH, MENTAL WELL-BEING AND THE ASSOCIATED STIGMA. POOR MENTAL HEALTH IS ASSOCIATED WITH POOR QUALITY OF LIFE, HIGHER RATES OF CHRONIC DISEASE AND A SHORTER LIFESPAN.NUTRITION AND PHYSICAL ACTIVITYNUTRITION AND PHYSICAL ACTIVITY REFERS TO EQUITABLE ACCESS TO NUTRITION, PHYSICAL ACTIVITY AND FOOD AND FEEDING CHOICES. POOR NUTRITION AND PHYSICAL INACTIVITY ARE MAJOR CONTRIBUTORS TO OBESITY AND CHRONIC DISEASES SUCH AS DIABETES, HEART DISEASE AND STROKE, WHICH DISPROPORTIONALLY IMPACT LOW INCOME COMMUNITIES AND COMMUNITIES OF COLOR. SUBSTANCE ABUSESUBSTANCE ABUSE AND ADDICTION ARE THE EXCESSIVE USE OF SUBSTANCES INCLUDING ALCOHOL, TOBACCO, PRESCRIPTION DRUGS, OPIOIDS AND OTHER DRUGS IN A MANNER THAT IS HARMFUL TO HEALTH AND WELL-BEING. PRIORITIES NOT SELECTED: HEALTHPARTNERS DISCUSSED AND CONSIDERED ADDITIONAL OR ALTERNATIVE PRIORITIES DURING THE PRIORITIZATION PROCESS, INCLUDING: OLDER ADULT HEALTH/AGING, MATERNAL AND CHILD HEALTH, ENVIRONMENTAL HEALTH AND INJURY AND VIOLENCE. THESE NEEDS WERE NOT SELECTED AS TOP FIVE PRIORITIES IN THE CONSENSUS BUILDING PROCESS; HOWEVER, THE THEMES WILL BE CONSIDERED IN THE IMPLEMENTATION FOR THE SELECTED PRIORITY AREAS. 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 AMERY REGIONAL MEDICAL CENTER FOUNDATION 8170 33RD AVE S BLOOMINGTON MN 554401309 391726539 501(C)(3) 18100 PROGRAM SUPPORT AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW ATLANTA GA 30303 131788491 501(C)(3) 5000 PROGRAM SUPPORT 2 PART I, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) MANAGEMENT STAFF REVIEWS THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH ARMC'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO ARMC'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. 0 1 0 0 0 0 0 0 0 ROSS R BULLARD DIRECTOR & TREASURER 0 194405 0 37530 0 4579 0 37435 0 32935 0 306884 0 0 DYLAN COE MD DIRECTOR 0 169210 0 0 0 159436 0 70917 0 20730 0 420293 0 50770 MARTIN E RICHARDS MD DIRECTOR 0 378478 0 13300 0 98621 0 21000 0 36228 0 547627 0 0 ANN SEAGREN MD DIRECTOR 0 212661 0 0 0 20853 0 41335 0 31617 0 306466 0 0 THEODORE WEGLEITNER DIRECTOR 0 434318 0 108899 0 5759 0 79487 0 37077 0 665540 0 0 MARYANN SCOGLIO CANP DIRECTOR 0 133559 0 0 0 36374 0 13194 0 30252 0 213379 0 0 JASON J LUHRS CFO (JAN-AUG) 0 191700 0 33727 0 6163 0 23722 0 29643 0 284955 0 0 SANDRA M REED VP - AMBULATORY CARE 158243 0 18133 0 8224 0 7458 0 34649 0 226707 0 0 0 DEBRA RUDQUIST PRESIDENT 0 270025 0 49041 0 10030 0 30600 0 31261 0 390957 0 0 PATRICK SURA MD CHIEF MEDICAL OFFICER 0 351644 0 8473 0 97236 0 21000 0 35749 0 514102 0 0 DOUGLAS JOHNSON CFO (AUG-DEC) 0 299890 0 55505 0 25400 0 121094 0 32168 0 534057 0 0 MARK A TRYGGESTAD DIRECTOR OF PHARMACY 169158 0 1973 0 8537 0 6898 0 13121 0 199687 0 0 0 JAMES ERICKSON RN SUPERVISOR 129625 0 714 0 5169 0 5739 0 33730 0 174977 0 0 0 ANTHONY GOULD ANCILLARY SERVICES 119567 0 2301 0 6142 0 5094 0 33422 0 166526 0 0 0 ANN SCHILLING HR SR DIRECTOR 118213 0 7878 0 878 0 5429 0 32846 0 165244 0 0 0 BENJAMIN BOGLE PROVIDER-APNP 121258 0 6000 0 3595 0 4044 0 33619 0 168516 0 0 0 JOANNE L JACKSON FORMER HR, PR AND MKTG DIR 135348 0 8617 0 16929 0 6532 0 21012 0 188438 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 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: TED WEGLEITNER $38,373 990, SCHEDULE J, PART II COLUMN F: 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, GOT FOR THE FOLLOWING DIRECTOR: DYLAN COE, MD $50,770 A VILLAGE OF LUCK WISCONSIN 396006307 2011-04-28 8500000 REFINANCE EXISTING DEBT 0 0 0 B CITY OF AMERY WISCONSIN 396005378 2011-04-13 8500000 REFINANCE EXISTING DEBT 0 0 0 C VILLAGE OF CLEAR LAKE WISCONSIN 396006238 2011-03-29 8500000 REFINANCE EXISTING DEBT 0 0 0 D TOWN OF BLACK BROOK POLK COUNTY WISCONSIN 391169876 2011-05-13 6150000 REFINANCE EXISTING DEBT 0 0 0 A 5811558 8500000 170000 8330000 2007 1 0 1 1 B 5811558 8500000 170000 8330000 2007 1 0 1 1 C 5811558 8500000 170000 8330000 2007 1 0 1 1 D 4169069 6150000 123000 6027000 2007 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 0.00090 0.00090 1 0 0 D 0 1 0 0 0.00090 0.00090 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 D 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 D 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. A TOWN OF LINCOLN POLK COUNTY WISCONSIN 391406159 2011-05-31 6150000 REFINANCE EXISTING DEBT 0 0 0 A 4196069 6150000 123000 1709792 4317208 2007 1 0 1 1 A 0 1 0 0 0.00090 0.00090 1 0 0 A 0 1 0 0 1 0 0 0 0 A 0 FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS 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 NON-PROFIT 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 PHYSICIANS AND DENTISTS, SEVEN OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 125 PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN SERVING MORE THAN 1.2 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 2019 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 IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE 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 2019 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF 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). 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). BENEFIT TO THE COMMUNITY: 1. COMMUNITY HEALTH IMPROVEMENT SERVICES: $ 79,175 - COMMUNITY HEALTH EDUCATION - ARMC HELPS EDUCATE THE LOCAL COMMUNITIES IN REGARDS TO HEALTH ISSUES BY PROVIDING THE FOLLOWING TYPES OF COMMUNITY EDUCATION: CPR/BLS CLASSES, MONTHLY DIABETES SUPPORT GROUP REACHING OVER 100 INDIVIDUALS, MONTHLY BREASTFEEDING SUPPORT GROUP, EXPECTANT PARENTS/PRE-NATAL AND BREASTFEEDING CLASSES REACHING 48 PARENTS, 3 HEALTH FAIRS WITH FOCUS ON HEART HEALTH, STROKE PREVENTION, WOUND HEALING, DIABETES EDUCATION, AND NUTRITION, 13 MENTAL HEALTH FOCUSED COMMUNITY EDUCATION CLASSES WITH A REACH OF OVER 230 INDIVIDUALS. CONTINUING IN 2019, ARMC OFFERED AT LEAST ONE FREE COMMUNITY EDUCATION CLASS EVERY MONTH IN ADDITION TO A MEDICAL NUTRITION THERAPY CLASS TAUGHT BY A REGISTERED DIETITIAN WITH A FOCUS ON DIABETES PREVENTION, OFFERED AT NO COST. BEYOND THE MONTHLY CLASS OFFERINGS, OVER FOUR COMMUNITY-FOCUSED MENTAL HEALTH-RELATED CLASSES WERE TAUGHT BY BEHAVIORAL HEALTH STAFF ON TOPICS SUCH AS: DEMENTIA, SUICIDE PREVENTION, REDUCING MENTAL HEALTH STIGMA, AND MENTAL ILLNESS. ARMC PROVIDES EDUCATION AT OUR SCHOOLS BY HOLDING A 3RD GRADE HEALTH FAIR REACHING 189 STUDENTS FROM AMERY, CLEAR LAKE, CLAYTON, AND TURTLE LAKE. POWERUP, A COMMUNITY-WIDE INITIATIVE TO MAKE IT EASY, FUN AND POPULAR TO EAT BETTER AND MOVE MORE SO YOUTH CAN REACH THEIR FULL POTENTIAL, COMPLETED ITS FOURTH FULL YEAR IN AMERY. OUTREACH AND PROGRAM SUCCESSES INCLUDE: ANNUAL CANDLELIGHT NIGHT ON THE STOWER EVENT DONE IN PARTNERSHIP WITH THE FRIENDS OF THE STOWER SEVEN LAKES STATE TRAIL. THIS FREE EVENT FEATURES TWO MILES OF ILLUMINATED TRAILS WHERE KIDS AND ADULTS OF ALL AGES CAN ENJOY A WALK, SNOWSHOE, CROSS-COUNTRY SKI, OR FAT TIRE BIKING. FREE SNOWSHOES WERE AVAILABLE FOR KIDS AND ADULTS TO TRY ALONG WITH VEGGIE CHILI AND HOT CIDER. OVER 120 WERE IN ATTENDANCE. "VEGGIE FARMER MEET & SEED" EVENT AT LIEN ELEMENTARY DONE IN PARTNERSHIP WITH LIEN ELEMENTARY SCHOOL GARDEN COMMITTEE AND A TEAM OF SIX LOCAL VEGETABLE FARMERS INCLUDED MORNING SESSIONS FOR ALL STUDENTS ON HOW TO PLANT A SEED AND NURTURE A PLANT SO IT GROWS INTO A WHOLESOME AND DELICIOUS VEGETABLE OR BEAUTIFUL FLOWER. STUDENTS ALSO LEARNED ABOUT OUR REGION'S VEGETABLE-GROWING FAMILY FARMS. THESE SEEDLINGS WERE THEN RAISED IN THE SCHOOL HALLWAYS UNTIL READY FOR THE SCHOOL GARDEN. APPROXIMATELY 420 STUDENTS RECEIVED A PACK OF BABY CARROTS TO HELP CELEBRATE. POWERUP AT LIEN ELEMENTARY 4K ORIENTATION FEATURING A SINK OR FLOAT GAME AND OUTREACH MATERIALS. OVER 80 KIDS GUESSED WHETHER DIFFERENT FRUITS AND VEGGIES WOULD SINK OR FLOAT IN A BOWL OF WATER. POWERUP AT THE THIRD GRADE HEALTH FAIR FEATURING A VEGGIE VOTE WHERE APPROXIMATELY 250 STUDENTS TASTE TASTED TWO DIFFERENT VEGETABLES. THIS FUN AND PRESSURE-FREE WAY TO EXPLORE VEGGIES GETS KIDS EXCITED TO TRY! POWERUP SPORTS NUTRITION TALK (FUELING FOR PERFORMANCE, RECOVERY AND INJURY PREVENTION) WITH THE AMERY HIGH SCHOOL GIRLS SOCCER TEAM; APPROXIMATELY 35 STUDENTS. PART III, CONT. POWERUP WEEK IS A TIME TO HAVE FUN, GET INSPIRED, AND POWERUP WITH ACTIVITIES TO HELP KIDS, FAMILIES AND THE ENTIRE COMMUNITY EAT BETTER AND MOVE MORE. THIS SPECIAL WEEK IS A GREAT WAY FOR COMMUNITIES IN THE ST. CROIX VALLEY TO COME TOGETHER AND DO WHAT'S BEST FOR OUR KIDS, SO THEY CAN GROW UP HEALTHY AND STRONG. THIS YEAR, POWERUP WEEK IN AMERY FEATURED: A 2K RUN/WALK WITH 132 PARTICIPANTS, CHOMP'S BIRTHDAY PARTY AT AMERY PUBLIC LIBRARY WITH OVER 40 KIDS AND ADULTS, FAMILY YOGA WITH 22 KIDS AND ADULTS, AND A DANCE PARTY WITH OVER 50 KIDS AND ADULTS. MOBILE TEACHING KITCHEN KNOWN AS THE CHARLIE CART CONTINUED IN A PARTNERSHIP WITH AMERY PUBLIC LIBRARY AND REACHED 80 KIDS. PART OF THE MISSION OF BOTH THE CHARLIE CART PROGRAM AND POWERUP IS TO GIVE KIDS THE POWER TO MAKE HEALTHY CHOICES FOR LIFE THROUGH HANDS-ON EXPERIENCES WITH "BETTER-FOR-YOU" FOODS. POWERUP COOKING CLASSES AT FARM TABLE CONTINUED IN 2019 AND REACHED OVER 150 STUDENTS. COOKING CLASSES GIVE STUDENTS HANDS-ON EXPERIENCES WITH A VARIETY OF ESSENTIAL COOKING SKILLS, HELP THEM LEARN TO READ RECIPES, ADJUST MEASUREMENTS, AND PRACTICE TEAMWORK AND PRACTICE TEAMWORK AND ORGANIZATION. POWERUP, FARM TABLE, AND THE FITNESS CENTER PARTNERED TO HOST 30 POLK COUNTY SPECIAL OLYMPICS ATHLETES IN A TWO-PART CLASS TO HELP THEM PREPARE FOR THEIR UPCOMING BASKETBALL AND SHOW SHOE SEASON. THE GROUP HAD A POWERUP COOKING CLASS AT FARM TABLE AND THEN THEY TOOK A SHORT WALK DOWN THE STREET TO THE FITNESS CENTER WHERE THEY HAD A FITNESS CLASS. LIEN ELEMENTARY SCHOOL CARNIVAL WITH "POWERED UP" FOOD OPTIONS INCLUDING A TACO BAR, FRUIT CUPS, POPCORN, VEGGIE AND DIP CUPS, AND FRESH MADE SMOOTHIES; APPROXIMATELY 200 IN ATTENDANCE. AMERY INTERMEDIATE SCHOOL WALK-A-THON "POWERED UP" THEIR ANNUAL FUNDRAISER FOR THE SECOND YEAR BY COLLECTING DONATIONS (INSTEAD OF SELLING PROCESSED FOODS) AND EARNING THEM BY WALKING/RUNNING AROUND THE TRACK DURING AN ALLOTTED TIME. CLASSROOMS WITHIN EACH GRADE LEVEL THAT HAVE THE MOST LAPS EARN A POWERUP SMOOTHIE PARTY! OPEN GYMS IN THE WINTER MONTHS GIVE KIDS AND FAMILIES A SAFE PLACE TO MOVE THEIR BODIES. IN 2019, OPEN GYMS TOOK PLACE IN AMERY, CLEAR LAKE, AND TURTLE LAKE. TOTAL REACH BETWEEN ALL COMMUNITIES WAS 731 KIDS AND ADULTS. POWERUP FRUIT AND VEGGIE RX CONTINUED THIS YEAR WITH PROVIDERS ASKING CHILDREN AGES 2-17 YEARS OLD ABOUT FRUITS AND VEGGIES, AND THEN "PRESCRIBING" TRYING MORE FRUIT & VEGGIES WHILE ALSO GIVING OUT A $10 VOUCHER FOR PRODUCE AT THE LOCAL GROCERY STORE. AVERAGE REDEMPTION RATE FOR ALL FOUR AMERY HOSPITAL & CLINIC LOCATIONS WAS 51%. THE POWER OF PRODUCE (POP) CLUB WAS NEW THIS SUMMER AND RAN FOR 11 WEEKS AT THE AMERY FARMERS MARKET. EACH WEEK, CHILDREN RECEIVED A $2 TOKEN TO SPEND ON FRESH FRUITS, VEGETABLES, OR FOOD PLANTS. CHILDREN AND FAMILIES WERE ALSO PROVIDED WITH SEASONAL RECIPES, RESOURCES ON HOW TO BUY, USE, AND STORE VEGETABLES, AND A FRUIT OR VEGGIE-INSPIRED ACTIVITY. IN 11 WEEKS, THERE WERE 85 YOUTH THAT PARTICIPATED. OF THE 168 TOKENS FOR $2 THAT WERE DISTRIBUTED, 137 WERE REDEEMED (81.5% REDEMPTION RATE). FAMILY AND YOUTH FEEDBACK FOR THE PROGRAM WAS OVERWHELMINGLY POSITIVE AND HAD KIDS EXCITED TO PICK OUT THEIR OWN PRODUCE. SOME FAMILIES REPORTED AN INCREASED INTEREST IN THEIR CHILD CONSUMING FRUITS AND VEGETABLES BECAUSE OF THIS. - COMMUNITY-BASED CLINICAL SERVICES - $ 342 BEHAVIORAL HEALTH SCREENED 9TH GRADE TEENS FOR DEPRESSION, SUICIDAL THOUGHTS AND STRESSORS AT THE AMERY HIGH SCHOOL. - HEALTH CARE SUPPORT SERVICES - $ 189,700 SOCIAL WORKER, HEALTH BENEFIT COUNSELORS, AND PATIENT FINANCIAL SERVICES REPRESENTATIVES PROVIDE HEALTH CARE SUPPORT SERVICES TO INDIVIDUALS ON A ONE-ON-ONE BASIS. THESE STAFF MEMBERS HELP EDUCATE AND ASSIST INDIVIDUALS WITH ADVANCE DIRECTIVE SUPPORT, INFORMATION AND REFERRAL SERVICES, ENROLLMENT ASSISTANCE IN GOVERNMENT PROGRAMS, FINDING OTHER SOURCES OF PAYMENT, AND ACCESSING SERVICES BEYOND MEDICAL CARE. ARMC SPENT $66,136 IN STAFF TIME TO ASSIST PATIENTS IN ENROLLING IN PUBLIC MEDICAL PROGRAMS, FREE DRUG PROGRAMS, AND REFER INDIVIDUALS TO COMMUNITY SERVICES/PUBLIC HEALTH ASSISTANCE. ARMC'S PATIENT EMERGENCY FUND, SUPPORTED BY EMPLOYEES AND STAFF, DONATED OVER $665 TO HELP 27 INDIVIDUALS IN NEED RECEIVE CARE AT ARMC. FUNDS PROVIDED TO INDIVIDUALS WERE FOR EMERGENT NEEDS RELATED TO THEIR HEALTH INCLUDING EMERGENCY MEDICATIONS AND GAS CARDS. ARMC OPERATES A VAN TRANSPORTATION SERVICE FOR ITS RURAL PATIENT POPULATION. PATIENTS WHO ARE UNABLE TO ARRANGE THEIR OWN TRANSPORTATION TO ARMC FOR CARE AND TREATMENT MAY SCHEDULE A TRANSPORT. PERSONS WHO USE THE SERVICE ARE ASKED TO PAY $2.00 PER RIDE. OVER 1,100 PATIENTS USED THIS SERVICE IN 2019, WITH REVENUE OF $2,082 AND OPERATING COST OF $68,633. - SOCIAL & ENVIRONMENTAL IMPROVEMENT ACTIVITIES - $38,918 DUE THE HEALTH PROFESSIONAL SHORTAGE AREA IN THE ARMC SERVICE AREA, NUMEROUS RESOURCES WERE INVESTED IN PHYSICIAN AND ADVANCED PRACTICE PROVIDER RECRUITMENT, TOTALING AT LEAST $33,200. ARMC WELCOMED ONE DOCTOR OF OSTEOPATHIC MEDICINE, ONE ADULT NURSE PRACTITIONER, AND ONE FAMILY NURSE PRACTITIONER. IN 2019, OVER 825 MEDICAL STUDENTS APPLIED AND OVER 24 WERE INTERVIEWED FOR THE NEWLY INITIATED WESTERN WISCONSIN RURAL RESIDENCY PROGRAM AT ARMC. TWO STUDENTS WERE CHOSEN AND WERE EXPECTED TO START JUNE 10, 2020. ARMC CONTINUES TO PARTNER WITH THE CITY OF AMERY TO OFFER 18 GARDENING PLOTS AT THE COMMUNITY GARDEN LOCATED ON ARMC GROUNDS. 2. HEALTH PROFESSIONAL EDUCATION: $32,712 STUDENTS IN NURSING, PHYSICAL THERAPY, PHARMACY, OCCUPATIONAL THERAPY, RADIOLOGIC TECHNOLOGY, MEDICAL RECORDS, MEDICAL ASSISTANT, LAB TECHNICIAN, NURSE PRACTITIONERS, AND MEDICAL ADMINISTRATIVE ASSISTANTS STUDY AT ARMC. ARMC ALSO HAS AN AGREEMENT WITH THE UNIVERSITY OF MINNESOTA-DULUTH FOR FIRST YEAR AND SECOND YEAR MEDICAL STUDENT ROTATIONS. IN ADDITION, ARMC ACTIVELY COLLABORATES WITH THE WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) TO HELP EDUCATE AND TRAIN NURSES. IN 2019, ARMC PROVIDED CLINICAL TRAINING FOR: 111 NURSES, 3 CERTIFIED REGISTERED NURSE ANESTHETIST STUDENTS, 5 MEDICAL STUDENTS, 1 LAB TECHNICIAN STUDENT, 1 OCCUPATIONAL THERAPIST STUDENT, 3 OCCUPATIONAL THERAPIST ASSISTANT STUDENTS, 5 PHYSICAL THERAPY STUDENTS, 2 PHYSICAL THERAPY ASSISTANTS, 1 PARAMEDIC STUDENT, 4 PHARMACY STUDENTS, 1 RADIOLOGY STUDENT, 2 SOCIAL WORK STUDENTS, 1 PSYCHIATRIST, AND 1 FITNESS CENTER ASSISTANT. EACH YEAR, ARMC AND THE FOUNDATION PROVIDE SEVEN $1,000 SCHOLARSHIPS TO LOCAL HIGH SCHOOL SENIORS PURSUING A CAREER IN A HEALTH-RELATED FIELD. ARMC'S SHARE OF THE COST WAS $3,500. 3. SUBSIDIZED HEALTH SERVICES: NONE 4. FINANCIAL CONTRIBUTIONS: $ 143,147 - CASH DONATIONS - ARMC HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS TOTALING $13, 980. - IN-KIND DONATIONS - IN-KIND SERVICES DONATED INCLUDED STAFF HOURS SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK SUCH AS: VALLEY BEHAVIORAL HEALTH STEERING COMMITTEE, NORTHWESTERN WISCONSIN HEALTHCARE COALITION, MENTAL HEALTH TASK FORCE OF POLK COUNTY, AND THE POLK COUNTY NUTRITION & PHYSICAL ACTIVITY WORKGROUP. ARMC ATHLETIC TRAINERS ARE IN BOTH AMERY AND LUCK SCHOOL DISTRICTS, PROVIDING OVER 2,000 HOURS OF ATHLETIC TRAINING AND SUPPORT FOR A MINIMAL FEE TOTALING $6,230, WITH THE BENEFIT OF DONATED SERVICES TOTALING $43,932. ARMC HOSTED THREE BLOOD DRIVES IN 2019 COLLECTING OVER 65 UNITS OF BLOOD FROM OVER 60 INDIVIDUALS IN SUPPORT OF THE AMERICAN RED CROSS. ARMC PROVIDES MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS WITH A HEALTH FOCUS SUCH AS THE AMERICAN RED CROSS, BABY & ME, PRENATAL & BREASTFEEDING SUPPORT, DAVITA KIDNEY SMART, AND WITC NURSING PROGRAM TOTALING $5,000. IN ORDER TO HELP COMBAT POVERTY, ARMC PROVIDES AMERY AREA FOOD SHELF WITH FREE RENT, HEAT AND SHELVING FOR FOOD ITEMS. IN 2019, OVER $74,829 WAS PROVIDED TO SUPPORT THIS LOCAL PROGRAM. PART III, CONT. 5. COMMUNITY BUILDING ACTIVITIES: $7,047 - ENVIRONMENTAL IMPROVEMENTS - ARMC HAD REPRESENTATIVES ATTEND THE ANNUAL CLEANMED CONFERENCE WHICH IS A NATIONAL ENVIRONMENTAL CONFERENCE FOR LEADERS IN HEALTH CARE SUSTAINABILITY. ARMC CONTINUES TO BE A SUSTAINABILITY CHAMPION AND HOSTS AN ANNUAL ELECTRONICS RECYCLING EVENT. - WORKFORCE DEVELOPMENT - ARMC HAS REPRESENTATIVES SERVE ON THE WITC MEDICAL ASSISTANT ADVISORY COMMITTEE, WITC ADVISORY COUNCIL, AND WITC HEALTH INFORMATION TECHNOLOGY ADVISORY COMMITTEE. 6. COMMUNITY BENEFIT OPERATIONS: $16,023 A COMMUNITY HEALTH SPECIALIST HAS TIME ALLOTTED TO THE TRAINING, MANAGEMENT, AND REPORTING OF COMMUNITY BENEFITS TO BEST CAPTURE ARMC'S COMMITMENT TO COMMUNITY HEALTH IMPROVEMENT. 7. ORGANIZATION AWARDS AND ACHIEVEMENTS 2019 PRACTICE GREENHEALTH AWARDS: EMERALD AWARD GREENING THE OR RECOGNITION CIRCLES OF EXCELLENCE (TOP 10): WATER 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 HEALTH OR BY GROUP HEALTH PLAN, INC. (GHI), ALL OF WHICH ARE RELATED ORGANIZATIONS, OR BY AMERY. GHI, REGIONS, LAKEVIEW HEALTH 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 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 CEO. THE 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 ANERY 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 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 -224,341. 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 8171 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 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 HPI - RAMSEY 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 , PHARMACY 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) 509(A)(3) TYPE III HUTCHINSON HEALTH 0 AMERY REGIONAL MEDICAL CENTER PHARMACY LLC 265 GRIFFIN STREET E AMERY WI 54001 391979705 PHARMACEUTICAL WI AMERY REGIONAL MEDICAL CENTER RELATED -36941 -30168 0 1 0.50000 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 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES L 197530 FAIR VALUE AMERY REGIONAL MEDICAL CENTER FOUNDATION C 265113 FAIR VALUE