2019-05-15T14:05:32-05:00 2018-06-30 420714325 RSM US LLP 801 NICOLLET MALL WEST TOWER STE 1100 MINNEAPOLIS MN 554022526 990 2017-07-01 411924645 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE CENT 3207322141 20 SE NINTH STREET LONG PRAIRIE MN 563031900 CRAIG BROMAN CHIEF OPERATING OFFICER 3207322141 2019-05-10 1 TODD JACKSON P00092672 6123324300 66.98.98.9 2019-05-10 14:19:30 CD P C0F43978DBA0C0105C9EC865D2B1B55C6AA9D490 B56786F7D21A8F39D00ED83C272556B8DDCB8C36 2017 2019-02-21 02:37:17Z CENTRACARE HEALTH - LONG PRAIRIE DR KENNETH D HOLMEN 20 SE NINTH STREET LONG PRAIRIE MN 563031900 37601901 0 X WWW.CENTRACARE.COM X 1999 MN CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 5 0 339 50 0 2094 218547 298257 31097020 34733987 559147 958900 630898 1337188 32505612 37328332 77074 79128 0 0 18347104 20419652 0 0 0 11632703 17312768 30056881 37811548 2448731 -483216 74944386 59961772 55228511 40539302 19715875 19422470 X CENTRACARE HEALTH WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 0 0 20715014 4738 21959391 CCH - LONG PRAIRIE IS PART OF A LARGER INTEGRATED HEALTH CARE DELIVERY SYSTEM KNOWN AS CENTRACARE HEALTH, A SYSTEM RECOGNIZED FOR BEING A LEADER IN PROVIDING HIGH-QUALITY, COMPREHENSIVE CARE THROUGHOUT THE REGION. CCH - LONG PRAIRIE IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE SERVICES IN THE AREAS OF MEDICAL, SURGICAL, DIAGNOSTIC, AND OBSTETRICS ALONG WITH OTHER SERVICES OF 24 HOUR EMERGENCY ROOM, IMAGING, LABORATORY, REHABILITATION, AND CHEMOTHERAPY TO THE COMMUNITY OF LONG PRAIRIE AND THE SURROUNDING AREA. THERE WERE 622 ADMISSIONS, 2,718 INPATIENT DAYS, AND 32,231 OUTPATIENT VISITS DURING FISCAL YEAR 2018. 5345824 74390 CCH - LONG PRAIRIE OPERATES THE LONG PRAIRIE CLINIC WHICH IS CONVENIENTLY CONNECTED TO THE LONG PRAIRIE HOSPITAL FOR THE HEALTH CARE NEEDS OF THE COMMUNITY. LONG PRAIRIE CLINIC PROVIDES HEALTH CARE THROUGH A MIXTURE OF PHYSICIANS AND MIDLEVEL PROVIDERS. THERE WERE 20,636 CLINIC VISITS DURING FISCAL YEAR 2018. ALSO 496 SURGEON CLINIC VISITS, AND 236 OPTHALMOLOGIST CLINIC VISITS DURING FISCAL YEAR 2018CCH - LONG PRAIRIE ALSO OPERATES THE EAGLE VALLEY CLINIC IN EAGLE BEND, MN WHICH PROVIDES HEALTH CARE FOR BOTH THE CLARISSA AND EAGLE BEND COMMUNITIES AND SURROUNDING AREAS. THE EAGLE VALLEY CLINIC PROVIDES HEALTH CARE THROUGH THE USE OF MIDLEVEL PROVIDERS WITH OVERSIGHT OF THE PHYSICIANS FROM THE LONG PRAIRIE CLINIC. THERE WERE 1,097 CLINIC VISITS DURING FISCAL YEAR 2018. 4897368 5775224 THE CCH - LONG PRAIRIE CARE CENTER IS AN ATTACHED 70 BED SKILLED NURSING FACILITY THAT PROVIDES QUALITY, COMPASSIONATE CARE WITH AN EMPHASIS ON ENHANCING EACH RESIDENT'S PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL WELL-BEING. THERE WERE 22,578 RESIDENT DAYS DURING FISCAL YEAR 2018. 1542869 228664 CCH - LONG PRAIRIE BUILT AN ASSISTED LIVING BUILDING AND OPENED IT FOR SERVICES IN MID AUGUST 2017. THE BUILDING CONSISTS OF 24 ASSISTED LIVING APARTMENTS AND 16 MEMORY CARE APARTMENTS. THERE WERE 3,385 ASSISTED LIVING OCCUPIED UNIT DAYS AND 1,612 MEMORY CARE OCCUPIED UNIT DAYS FOR FISCAL YEAR 2018. THERE WERE 3,844 ASSISTED LIVING TENANT DAYS AND 1,612 MEMORY CARE TENANT DAYS FOR FISCAL YEAR 2018. 1542869 228664 32501075 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 42 0 1 339 1 1 1 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X LARRY KNUTSON 3207327240 20 SOUTHEAST NINTH STREET LONG PRAIRIE MN 56347 KENNETH D HOLMEN MD CEO 1.00 39.00 X X 0 1588645 33551 CRAIG J BROMAN CHIEF OPERATING OFFICER 1.00 39.00 X X 0 1142484 36506 DAVID J TILSTRA MD CPE VICE PRESIDENT 1.00 39.00 X X 0 621862 125447 PAUL R HARRIS ESQ CORPORATE SECRETARY 2.00 38.00 X X 0 548527 110529 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 1.00 39.00 X X 0 841851 32906 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 39.50 0.50 X 0 266314 58159 WINN H GREGORY MD PHYSICIAN 40.00 0.00 X 0 449754 42631 PAUL E VAN GORP MD PHYSICIAN 40.00 0.00 X 0 233169 37021 RENE ELDIDY MD PHYSICIAN 40.00 0.00 X 0 321116 42164 DEBORAH P RASMUSSEN MD PHYSICIAN 40.00 0.00 X 0 278704 37360 HARRISON H HANSON MD PHYSICIAN 40.00 0.00 X 0 318036 30851 0 6610462 587125 12 0 1 0 WHITESELL MEDICAL STAFFING 1630 ANDERSON AVE SUITE 100 BUFFALO MN 55303 PHYSICIAN SERVICES 519992 CENTRAL MN DIAGNOSTIC INC 150 10TH ST NW MILACA MN 56353 MRI/CT SERVICES 513662 WEST CENTRAL ANESTHESIA PC 520 COUNTRY OAK DRIVE SAUK CENTRE MN 56370 CRNA SERVICES 405732 MA MORTENSON COMPANY 700 MEADOW LN N 400 GOLDEN VALLEY MN 55422 CONSTRUCTION SERVICES 319403 JOHNSON CONTROLS INC 402 GREAT OAK DRIVE BLDG B WAITE PARK MN 56387 BUILDING EFFICIENCY 290593 13 4466 227954 65837 298257 PATIENT AND RESIDENT SERVICE REVE 621110 34241283 34241283 OTHER PROGRAM REVENUE 621110 492704 492704 34733987 964366 964366 513273 0 513273 513273 513273 5466 -5466 -5466 -5466 1023527 268103 755424 755424 OTHER MISC REVENUE 621110 68491 68491 68491 37328332 34733987 0 2296088 X 75459 75459 3669 3669 15632453 13086329 2546124 3296134 2759279 536855 584819 489567 95252 906246 758642 147604 33471 28019 5452 26027 21788 4239 1292 1292 5576 5576 4835047 4047542 787505 60941 51015 9926 102609 85897 16712 804548 673508 131040 58960 49357 9603 1096782 918144 178638 2976837 2491987 484850 143435 120073 23362 MEDICAL SUPPLIES 3316350 3316350 BAD DEBT 780906 780906 MEDICAID/MN CARE 668905 668905 MEDICAL EQUIPMENT RENTA 390159 390159 2010923 1683188 327735 37811548 32501075 5310473 0 3147485 2879374 4814055 5626171 327806 385306 84477 34999 61509113 13433331 41687045 48075782 13650389 2420087 428850 452053 10804279 88000 74944386 59961772 2420581 2698406 9185 6488 2090355 50708390 37834408 55228511 40539302 X 19659180 19359196 56695 63274 19715875 19422470 74944386 59961772 X -483216 -403666 593477 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1292 1292 0 PART II-B, LINE 1: CENTRACARE - LONG PRAIRIE PAID $1,292 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 0 0 297762 297762 46528190 6133237 40394953 2263664 873203 1390461 12419497 6426891 5992606 48075782 ASSET RETIREMENT OBLIGATION 602497 BOND PREMIUM 32695597 CAPITAL LEASES 20735 DUE TO AFFILIATES 4515579 37834408 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, 2018 AND 2017, THERE WERE NO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 266081 266081 0.00720 10113770 8111115 2002655 0.05410 10379851 8111115 2268736 0.06130 2850 2850 0.00010 2850 2850 0.00010 10382701 8111115 2271586 0.06140 1 780906 10232068 10225685 6383 X 1 1 1 1 CENTRACARE HEALTH - LONG PRAIRIE 20 NINTH STRET SOUTHEAST LONG PRAIRIE MN 56347 WWW.RICEHOSPITAL.COM/ X X X X RURAL HEALTH CLINIC, NURSING HOME CENTRACARE HEALTH - LONG PRAIRIE 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 1 15 1 WWW.CENTRACARE.COM/APP/FILES/PUBLIC/8124/CHNA-ACTION-PLAN-LONG-PRAIRIE.PDF 0 1 X 175.000000000000 250.000000000000 X X 1 1 X X X X 1 X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X X X X X X X 1 X X 1 X X X X X X X 1 X 0 0 CENTRACARE HEALTH - LONG PRAIRIE 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.LACK OF CURRENT PUBLIC HEALTH DATA WAS A SIGNIFICANT INFORMATION GAP IN THE CHNA AS THE SURVEY COULD NOT BE COMPLETED IN TIME TO INCLUDE ITS DATA IN THE CCH CHNA. CCH HAS COMMITTED TO A CONTINUING EFFORT WITH PUBLIC HEALTH OFFICIALS TO JOINTLY DEVELOP PRIORITIES WITH THE COUNTIES AS A PART OF ITS ACTION PLANS. CENTRACARE HEALTH - LONG PRAIRIE 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. CENTRACARE HEALTH - LONG PRAIRIE 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. CENTRACARE HEALTH - LONG PRAIRIE 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 ADAPTIONS (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 HTTP://WWW.CENTRACARE.COM/APP/FILES/PUBLIC/5221/COMMUNITY-HEALTH-NEEDS-ASSESSMENT---CENTRACARE-HEALTH-SYSTEM.PDFPER 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. CENTRACARE HEALTH - LONG PRAIRIE 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-INCOM OR SUBSIDIZED HOUSING(F) PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO HOSPITAL FOR FURTHER TREATMENT CENTRACARE HEALTH - LONG PRAIRIE 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. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 18E: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE GARNISHMENTS & LAWSUITS AS WELL. ALL LEGAL ACTIONS ARE REVIEWED & APPROVED BY CCH MANAMGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 19E: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE GARNISHMENTS & LAWSUITS AS WELL. ALL LEGAL ACTIONS ARE REVIEWED & APPROVED BY CCH MANAMGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST THE PATIENT. CENTRACARE HEALTH - LONG PRAIRIE: PART V, SECTION B, LINE 7A: THE HOSPTIAL'S CHNA CAN BE FOUND ON IT'S WEBSITE AT WWW.CENTRACARE.COM/APP/FILES/PUBLIC/205/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-LONG-PRAIRIE.PDF. 4 1 - LONG PRAIRIE CARE CENTER 20 NINTH STREET SE LONG PRAIRIE MN 56347 NURSING HOME 2 - LONG PRAIRIE CLINIC 20 NINTH STREET SE LONG PRAIRIE MN 56347 CLINIC 3 - EAGLE VALLEY CLINIC 815 HWY 71 SOUTH EAGLE BEND MN 56446 CLINIC 4 - LONG PRAIRIE MEADOW PLACE 220 CENTRACARE DRIVE LONG PRAIRIE MN 56347 ASSISTED LIVING PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE ORGANIZATIONS TOTAL EXPENSES WERE REDUCED BY THEIR NON-OPERATING REVENUE, MEDICAID SURCHARGE AND MN CARE TAX. THE NET TOTAL EXPENSES WERE THEN DIVIDED BY GROSS CHARGES TO DETERMINE THE COST TO CHARGE RATIO. 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 $ 780,906. 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."PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FORUNCOLLECTIBLE ACCOUNTS. THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS, CONSIDERING HISTORICAL NET COLLECTION, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CENTRACARE FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY CENTRACARE." PART III, LINE 8: THE HOSPITAL PROVIDES AN EXCELLENT LEVEL OF CARE TO THE PEOPLE IN THE COMMUNITY. THE AMOUNT ON LINE 6 OF PART III WAS DETERMINED BY UTILIZING THE MEDICARE COST REPORT UTILIZING KEY SECTION OF THAT REPORT, PRIMARILY THE D SERIES AND E SERIES. PART III, LINE 9B: THE COLLECTION POLICIES AT THE ORGANIZATION 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: THE ORGANIZATIONS' STRATEGIC PLANNING ASSESSES THE NEEDS OF THE COMMUNITY AND PATIENTS THROUGH PATIENT SATISFACTION SURVEYS, COMMENT CARDS, COMMUNITY ASSESSMENTS AND A DIVERSE OPERATING COMMITTEE THAT REPRESENTS THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS AND RECOMMENDATIONS FOR HEALTH CARE SERVICES. 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: LONG PRAIRIE IS LOCATED IN TODD COUNTY, MINNESOTA. THE ESTIMATED 2018 POPULATION SHOWS 6,721 RESIDENTS WITH AN ESTIMATED SLIGHT INCREASE TO 6,724 BY 2023. THIS AREA HAS SEEN DECLINES IN ITS POPULATION. THE PROJECTED GROWTH BY AGE BRACKET FROM 2018 TO 2023 IS AS FOLLOWS: 0-17: 2.1%, 18-44: 2.1%, 45-64: -9.2%, 65+: 6.1%. THE ESTIMATED 2018 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 77.6%, AFRICAN AMERICAN: .6%, ASIAN: 1.3%, HISPANIC: 18.8%, OTHER: 1.8%. PART VI, LINE 5: THE ORGANIZATION HAS A COMMUNITY BASED OPERATING COMMITTEE THAT MEETS ON A MONTHLY BASIS TO REVIEW VARIOUS ASPECTS OF THE FACILITY AND PROVIDE INPUT ON THOSE ASPECTS FROM A COMMUNITY PERSPECTIVE. THE ORGANIZATION PARTICIPATES IN THE COMMUNITY BLOOD DRIVES BY PROVIDING FOOD AND SUPPLIES FOR BOTH THE WORKERS AND BLOOD DONORS. THE FACILITY ALSO SPONSORS A HEALTH FAIR ON AN ANNUAL BASIS FOR THE LOCAL AND SURROUNDING COMMUNITIES. 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 0 1 0 0 0 0 1 0 0 KENNETH D HOLMEN MD CEO 0 1095784 0 273662 0 219199 0 16195 0 23317 0 1628157 0 185139 CRAIG J BROMAN CHIEF OPERATING OFFICER 0 786856 0 171344 0 184284 0 20250 0 22651 0 1185385 0 140722 DAVID J TILSTRA MD CPE VICE PRESIDENT 0 411991 0 108773 0 101098 0 98536 0 31872 0 752270 0 66768 PAUL R HARRIS ESQ CORPORATE SECRETARY 0 385014 0 89704 0 73809 0 83771 0 31592 0 663890 0 58526 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 0 595405 0 120905 0 125541 0 16200 0 22684 0 880735 0 105613 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 0 209955 0 31830 0 24529 0 34808 0 24735 0 325857 0 24266 WINN H GREGORY MD PHYSICIAN 0 448535 0 0 0 1219 0 20911 0 25756 0 496421 0 0 PAUL E VAN GORP MD PHYSICIAN 0 196005 0 36829 0 335 0 16186 0 20887 0 270242 0 0 RENE ELDIDY MD PHYSICIAN 0 262392 0 57536 0 1188 0 18604 0 25733 0 365453 0 0 DEBORAH P RASMUSSEN MD PHYSICIAN 0 226904 0 51169 0 631 0 16526 0 21830 0 317060 0 0 HARRISON H HANSON MD PHYSICIAN 0 282127 0 480 0 35429 0 3840 0 27708 0 349584 0 0 PART I, LINE 3 THE COMPENSATION PAID TO THE PRESIDENT AND VICE-PRESIDENTS (NON-MEDICAL PROVIDERS) IS DETERMINED BY CENTRACARE HEALTH SYSTEM, A RELATED ORGANIZATION. CENTRACARE HEALTH SYSTEM USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE 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: KENNETH D. HOLMEN, MD - PAID $199,538; ACCRUED $0 CRAIG J BROMAN - PAID $140,722; ACCRUED $0 DAVID TILSTRA, MD, CPE - PAID $66,768; ACCRUED $78,286 PAUL R HARRIS - PAID $58,526; ACCRUED $67,163 GREGORY R KLUGHERZ - PAID $105,613; ACCRUED $0 DANIEL J SWENSON - PAID $24,266; ACCRUED $21,064 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. FORM 990, PART VI, SECTION A, LINE 6 CENTRACARE HEALTH SYSTEM, A MINNESOTA NONPROFIT ASSOCIATION, IS THE SOLE MEMBER OF CENTRACARE HEALTH SYSTEM - LONG PRAIRIE. FORM 990, PART VI, SECTION A, LINE 7A ALL BOARD MEMBERS ARE APPOINTED BY CENTRACARE HEALTH SYSTEM, THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS ARE RESERVED FOR ACTION BY CENTRACARE HEALTH SYSTEM, THE SOLE MEMBER: 1. ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. 2. APPOINTMENT OF DIRECTORS AND OFFICERS. 3. APPROVAL OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY DEBTS TO BE INCURRED. 4. APPROVAL OF ALL STRATEGIC PLANS. 5. DETERMINATION OF THE DISSOLUTION OF OR THE DISCONTINUATION OF THE BUSINESS OF THE CORPORATION. 6. APPROVAL OF ANY TRANSACTION WHICH MAY AFFECT THE CORPORATION'S STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXATION. FORM 990, PART VI, SECTION B, LINE 11B ANNUALLY, AT THE BOARD OF DIRECTORS' MEETING, PRIOR TO FILING WITH THE IRS, THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW THE FORM 990 WITH STAFF TO ASK QUESTIONS AND SEEK CLARIFICATIONS AND TO APPROVE THE FINAL DOCUMENT. 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 PRESIDENT 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 MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. COULD HOSPITAL TO PERFORM SERVICES. FORM 990, PART VI, QUESTION 15B: THE COMPENSATION AND BENEFITS OF THE VICE 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 COMPLETED 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 DO 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 IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 2,740,419. MANAGEMENT AND GENERAL EXPENSES 533,186. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,273,605. CONTRACTED/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,307,123. MANAGEMENT AND GENERAL EXPENSES 254,319. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,561,442. FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS TO AFFILIATED ORGANIZATIONS -1,421,693. CAPITAL CONTRIBUTION 2,015,170. CENTRACARE HEALTH SYSTEM 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411813221 INTEGRATED HEALTH SYSTEM MN 501(C)(3) LINE 3 N/A 0 ST CLOUD HOSPITAL 1406 6TH AVE N ST CLOUD MN 56303 410695596 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRACARE HEALTH-MELROSE 11 NORTH 5TH AVE WEST MELROSE MN 56352 411865315 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 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 1 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1406 6TH AVE N ST CLOUD MN 56303 411708142 EMERGENCY PHYSICIANS MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 411806657 MULTI-SPECIALTY MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 FUNDRAISING MN 501(C)(3) LINE 7 CENTRACARE HEALTH SYSTEM 1 CUSHMAN ALBERT RICE TRUST 1100 WEST ST GERMAIN STREET ST CLOUD MN 56303 416019335 SUPPORT FOR RICE MEMORIAL HOSPITAL MN 501(C)(3) N/A 1 RICE HEALTH FOUNDATION 301 BECKER AVE SW WILLMAR MN 56303 411611555 SUPPORT FOR RICE MEMORIAL HOSPITAL MN 501(C)(3) LINE 7 N/A 1 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 HOLDING COMPANY/PHARMACY MN N/A C 0 AFFILIATED COMMUNITY MEDICAL CENTERS PA 301 BECKER AVE SW WILLMAR MN 56201 410850702 HEALTH CARE SYSTEM MN N/A C 0 AFFILIATED COMMUNITY HEALTH NETWORK INC 101 WILLMAR AVE SW WILLMAR MN 56201 HEALTH NETWORK MN N/A C 0 0 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 1 1 1 CENTRACARE HEALTH - SAUK CENTRE O 78610 ACTUAL AMOUNT