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 411813221 CENTRACARE HEALTH SYSTEM CENT 3202512700 1406 6TH AVENUE NORTH ST CLOUD MN 56303 GREGORY R KLUGHERZ VICE PRESIDENT/CFO 3202512700 2019-05-13 1 TODD JACKSON P00092672 6123324300 66.98.98.9 2019-05-13 17:15:59 CD P C0F43978DBA0C0105C9EC865D2B1B55C6AA9D490 B56786F7D21A8F39D00ED83C272556B8DDCB8C36 2017 2019-02-21 02:37:17Z KENNETH D HOLMEN MD 1406 6TH AVENUE NORTH ST CLOUD MN 56303 316156326 0 X WWW.CENTRACARE.COM X 1995 MN CENTRACARE HEALTH WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 17 13 2987 1560 3781119 64586 1214113 1867541 206045833 292511337 2091866 4234522 4887876 8858624 214239688 307472024 20477 344074 0 0 113617042 161364843 0 0 0 105772114 142537613 219409633 304246530 -5169945 3225494 243270436 431777761 139293816 280015582 103976620 151762179 X THE MISSION OF CENTRACARE HEALTH SYSTEM (CCHS) IS TO OPERATE AN INTEGRATED MULTI-ORGANIZATIONAL HEALTH CARE SYSTEM DESIGNED TO PROVIDE ACCESS TO QUALITY HEALTH CARE SERVICES AT AN AFFORDABLE PRICE. 1 0 131730448 60761 127552106 CENTRACARE HEALTH SYSTEM (CCHS) IS AN INTEGRATED HEALTH SYSTEM, COMPRISED OF FIVE CRITICAL ACCESS HOSPITALS, ONE ACUTE CARE HOSPITAL, A MULTI-SPECIALTY CLINIC, SURGICAL CENTER, RETAIL PHARMACY NETWORK, NURSING HOME AND A FOUNDATION. CCHS SERVES ITS PATIENTS IN 4 MAIN AREAS:MONTICELLO HOSPITAL IS CONSIDERED A DISREGARDED ENTITY FOR PURPOSES OF 990 REPORTING, THUS IT IS INCLUDED WITH THIS 990 FILING. MONTICELLO HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL AND ALSO OPERATES A 10 BED ACUTE GERIATRIC PSYCHIATRIC UNIT. IN FISCAL YEAR 2018, THEY HAD 6,322 PATIENT DAYS, 35,472 OUTPATIENT VISITS AND 12,757 EMERGENCY ROOM VISITS' WHICH GENERATED $127,552,106 OF PROGRAM REVENUE AND $131,730,448 OF PROGRAM EXPENSES. 59491150 256596 68647293 AS OF JANUARY 1, 2018 CARRIS HEALTH, LLC IS CONSIDERED A DISREGARDED ENTITY OF CCHS FOR PURPOSES OF 990 REPORTING, THUS THE SHORT PERIOD OF 1/1/18 - 6/30/18 IS INCLUDED WITH THIS 990 FILING. CARRIS HEALTH, LLC INCLUDES THE SUBSIDIARY CARRIS HEALTH - RICE MEMORIAL HOSPITAL, WHICH HAS 136 LICENSED BEDS. DURING THE PERIOD JANUARY 1 - JUNE 30, 2018 RICE MEMORIAL HOPSITAL CARED FOR 1,835 INPATIENT ADMISSIONS WITH 5,941 ASSOCIATED PATIENT DAYS. INPATIENT SERVICES INCLUDE MEDICAL AND SURGICAL CARE, BIRTHING SERVICES, PEDIATRIC SERVICES, BEHAVIORAL HEALTH CARE SERVICES, AND REHABILITATION SERVICES. OUTPATIENT ENCOUNTERS DURING FISCAL YEAR 2018 WERE 41,149 AND INCLUDED EMERGENCY ROOM SERVICES, DIALYSIS, IMAGING, RESPIRATORY THERAPY, A REHABILITATION CENTER, SAME DAY SURGERY AND OTHER AMBULATORY CARE SERVICES. CARRIS HEALTH - RICE MEMORIAL HOSPITAL JOINED CENTRACARE JANUARY OF 2018 IN CREATING AN INNOVATIVE CARE DELIVERY MODEL THAT WOULD BENEFIT COMMUNITIES IN CENTRAL, SOUTHWEST AND WEST CENTRAL MINNESOTA TO PROVIDE CARE CLOSER TO HOME. CARRIS HEALTH ALSO OFFERS A CERTIFIED SKILLED NURSING FACILITY LOCATED IN WILLMAR, MN, THE FACILITY HAS 78 LICENSED BEDS AND HAS REALIZED 8,469 RESIDENT DAYS IN THE LONG-TERM CARE PORTION OF THE FACILITY AND 4,365 RESIDENT DAYS IN THE SHORT-TERM THERAPY SUITES AREA DURING JANUARY THROUGH JUNE 2018. CARRIS HEALTH ALSO OFFERS A BRAND NEW (MAY 2018) ACCREDITED AMBULATORY SURGICAL CENTER LOCATED IN WILLMAR, MN. THE CARRIS HEALTH SURGICAL CENTER WILLMAR IS UTILIZED BY 30+ PHYSICIANS AND IN ITS FIRST MONTH OF OPERATIONS COMPLETED 645 OUTPATIENT (SAME DAY) PROCEDURES. CARRIS HEALTH ALSO OFFERS A DURABLE MEDICAL EQUIPMENT PROVIDER, RICE HOME MEDICAL. RICE HOME MEDICAL IS A LEADING RETAIL PROVIDER OF MEDICAL EQUIPMENT AND SUPPLIES THROUGHOUT WESTERN MINNESOTA. RICE HOME MEDICAL WAS FOUNDED IN 1988 AND IS HEADQUARTERED IN WILLMAR, MN. RICE HOME MEDICAL OFFERS MEDICAL EQUIPMENT AND SUPPLIES FOR RESPIRATORY, MOBILITY, COMPLEX MOBILITY, WOMEN'S HEALTH, INDEPENDENT LIVING, HOME MODIFICATIONS AND OTHER HEALTHCARE RELATED EQUIPMENT AND SERVICES. RICE HOME MEDICAL HAS LOCATIONS IN WILLMAR, ALEXANDRIA, REDWOOD AND MADISON, MN. EACH YEAR IT SERVES MORE THAN 20,000 PATIENTS. 34520912 26717 39920694 CENTRACARE HEALTH - PAYNESVILLE HOSPITAL IS CONSIDERED A DISREGARDED ENTITY FOR PURPOSES OF 990 REPORTING, THUS IT IS INCLUDED WITH THIS 990 FILING. CENTRACARE HEALTH - PAYNESVILLE HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL. IN FISCAL YEAR 2018 THEY HAD 2,498 PATIENT DAYS, 41,458 OUTPATIENT VISITS AND 3,768 EMERGENCY ROOM VISITS. IN FISCAL YEAR 2018, PAYNESVILLE GENERATED $39,920,694 OF PROGRAM REVENUE AND $34,520,912 OF PROGRAM EXPENSE. 36151573 0 56391244 CENTRACARE LABORATORY SERVICES ALL HOSPITALS UNDER ITS UMBRELLA AS WELL AS CENTRACARE CLINIC. IT ALSO PERFORMS TESTS FOR VARIOUS FACILITIES IN THE REGION. CENTRACARE LABORATORY PERFORMED 2,215,255 TESTS IN FISCAL YEAR 2018. IN FISCAL YEAR 2018 CENTRACARE LABORATORY GENERATED $45,300,905 IN PROGRAM REVENUE AND INCURRED $26,816,500 OF EXPENSES. CENTRACARE SURGICAL CENTER PROVIDES ELECTIVE SURGERY PROCEDURES TO PATIENTS IN THE CENTRAL MN REGION. IN FY 2018, THE CENTER PERFORMED 5,434 SURGERIES AND GENERATED $11,090,339 OF PROGRAM REVENUE AND $9,335,073 OF PROGRAM EXPENSE. 36151573 0 56391244 261894083 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 308 0 1 2987 1 1 1 0 0 0 0 0 0 0 0 0 X 17 13 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 MN X GREGORY R KLUGHERZ 3202512700 1406 SIXTH AVENUE NORTH ST CLOUD MN 56303 KENNETH D HOLMEN MD PRESIDENT/CEO 21.00 19.00 X X 1588645 0 33551 MIKE BENUSA DIRECTOR, CHAIR 2.00 X X 0 0 0 STEVE LARAWAY DIRECTOR, VICE CHAIR 2.00 X X 0 0 0 CHRISTIAN SCHMIDT MD DIRECTOR & SURGEON 2.00 38.00 X 0 758602 45661 ROBERT STOCKER MD DIRECTOR & OB/GYN 2.00 38.00 X 0 571016 20850 CHRISTOPHER COBORN DIRECTOR 2.00 X 0 0 0 DENISE ROSIN DIRECTOR 2.00 X 0 0 0 TERESA BOHNEN DIRECTOR 2.00 X 0 0 0 JOSEPH UPHUS DIRECTOR 2.00 X 0 0 0 DAVID ANFINSON DIRECTOR 2.00 X 0 0 0 TIM HEBL MD DIRECTOR 2.00 X 0 0 0 DONALD JURGENS MD DIRECTOR/PHYSICIAN 2.00 38.00 X 0 851518 44661 DONALD KETTLER JCL DIRECTOR 2.00 X 0 0 0 SHARON RUGGIERO MD DIRECTOR/PHYSICIAN 2.00 38.00 X 0 270005 29686 RICHARD WEHLSER MD DIRECTOR/PHYSICIAN 2.00 38.00 X 0 0 0 TIM WENSMAN DIRECTOR 2.00 X 0 0 0 JEFF GAU DIRECTOR 2.00 X 0 0 0 GREGORY R KLUGHERZ TREASURER/CFO 25.00 15.00 X 841851 0 32906 PAUL R HARRIS ESQ CORPORATE SECRETARY 25.00 15.00 X 548527 0 110529 AMY M PORWOLL VICE PRESIDENT 20.00 20.00 X 565952 0 94229 DUANE A RASUMUSSON VICE PRESIDENT 20.00 20.00 X 559220 0 38827 THOMAS SCHRUP MD VICE PRESIDENT 20.00 20.00 X 430118 0 76093 KURT OTTO MD VICE PRESIDENT 20.00 20.00 X 355398 0 81237 JOY PLAMANN VICE PRESIDENT 20.00 20.00 X 288822 0 82921 KELLY MACKEN-MARBLE VICE PRESIDENT 20.00 20.00 X 433421 0 72202 NELSON L ADAMSON MD PHYSICIAN 40.00 0.00 X 0 572511 48132 LAWRENCE G STRATE MD PHYSICIAN 40.00 0.00 X 0 404201 38763 RANDALL J ZIMMERMAN MD PHYSICIAN 40.00 0.00 X 0 425088 45728 KURT A HABBEN MD PHYSICIAN 40.00 0.00 X 0 368852 43383 TIMOTHY L MALLING MD PHYSICIAN 40.00 0.00 X 0 417887 42140 5611954 4639680 981499 142 0 1 0 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 PHYSICIAN SERVICES 7284431 MAYO MEDICAL LABORATORIES PO BOX 4100 ROCHESTER MN 559034100 LABORATORY SERVICES 3851041 NORTH MEMORIAL 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 MEDICAL PROFESSIONAL SERVICES 3398834 METRO ANESTHESIA CONSULTANT 9855 AETNA AVE NE MONTICELLO MN 55362 ANESTHESIA SERVICES 3116592 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1200 6TH AVE N ST CLOUD MN 56303 EMERGENY COVERAGE 2076494 52 21932 581313 1264296 1867541 PATIENT & SERVICE REVENUE 621110 236872327 236872327 HEALTH INSURANCE PREMIUM CREDIT 621110 31716723 31716723 SHARED/LEGAL SYSTEM REVENUE 621110 23917547 23917547 CORPORATE REVENUE 621110 4740 4740 292511337 4138081 4138081 10337719 8380072 1957647 1957647 1957647 96441 0 96441 96441 96441 1617067 304230 1312837 1312837 ALL OTHER REVENUE 900099 5438021 3781119 1656902 REVENUE FROM JOINT VENTURES 900099 150119 150119 5588140 307472024 292511337 3781119 9312027 X 263096 263096 80978 80978 5301026 4437626 863400 90958369 76143596 14814773 9480201 7936121 1544080 44213720 37012445 7201275 11411527 9552883 1858644 968700 810924 157776 195446 163613 31833 86788 86788 52049 52049 62568328 52377560 10190768 692757 579925 112832 2097468 1755845 341623 2802659 2346178 456481 334601 280103 54498 1813885 1518450 295435 4700595 3934989 765606 14040286 11753485 2286801 1832408 1533956 298452 DRUGS/MEDICAL SUPPLIES 36076938 36076938 BAD DEBT 4233313 4233313 MEDICAID SURCHARGE/MN C 3741324 3741324 MINOR EQUIPMENT 431596 361300 70296 5868472 4912647 955825 304246530 261894083 42352447 0 15371703 17182374 18336626 0 3034698 79128689 3128411 6661489 7183185 8532848 351289634 130686565 138670030 220603069 33112025 62073005 2447239 10347142 21986519 27249145 243270436 431777761 44230431 82134870 13865 65375867 61766795 15015541 65495756 14671977 70604296 139293816 280015582 X 103976620 132866179 15297527 3598473 103976620 151762179 243270436 431777761 X 3225494 -1257243 45817308 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 86788 86788 0 PART II-B, LINE 1: CENTRACARE HEALTH SYSTEM PAID $86,788 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 16002176 16002176 252342079 82468922 169873157 246551 24327 222224 73855786 48167468 25688318 8843042 25848 8817194 220603069 FUNDS HELD BY TRUSTEE UNDER BOND INDENTURES 10520967 C FUNDS HELD BY BOARD FOR FUTURE PROPERTY & EQUIP REPLACEMENT/EXPANSION 36590370 C INVESTMENT IN JOINT VENTURES 1720289 C INVESTMENT IN MUTUAL SERVICE CORP 957280 C INVESTMENT IN OTHER 12284099 C 62073005 OTHER ASSETS 3764524 DUE FROM AFFILIATES 23484621 27249145 PENSION ACCRUAL 158255 ASSET RETIREMENT OBLIGATION 1539564 DUE TO AFFILIATES 68906477 70604296 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 479505 0 479505 0.00430 31462379 27227176 4235203 0.03790 31941884 27227176 4714708 0.04220 1595 1595 0.00000 217007 217007 0.00190 218602 218602 0.00190 32160486 27227176 4933310 0.04410 1 3164114 54631519 55485400 -853881 X 1 1 3 1 CENTRACARE HEALTH - MONTICELLO 1013 HART BLVD MONTICELLO MN 55362 WWW.CENTRACARE.COM/LOCATIONS/MONTICELL X X X X DISTINCT PART REHAB 2 CENTRACARE HEALTH - PAYNESVILLE 200 WEST FIRST STREET PAYNESVILLE MN 56362 WWW.CENTRACARE.COM/LOCATIONS/PAYNESVIL X X X X 3 RICE MEMORIAL HOSPITAL 301 BECKER AVE SW WILLMAR MN 56201 WWW.RICEHOSPITAL.COM/ X X X CENTRACARE HEALTH - MONTICELLO 1 0 0 1 X 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 SEE SECTION C SUPPLEMENTAL INFORMATION FOR PART V, SECTION B 0 1 X 175.000000000000 250.000000000000 X X 1 1 X 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 X X 1 X X X X X 1 X 0 0 CENTRACARE HEALTH - PAYNESVILLE 2 0 0 1 X 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 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 X X 1 X X X X X 1 X 0 0 RICE MEMORIAL HOSPITAL 3 0 1 0 0 1 X 175.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X WWW.RICEHOSPITAL.COM/BILLING-INSURANCE/DOCUMENTS-AND-RESOURCES/ X WWW.RICEHOSPITAL.COM/BILLING-INSURANCE/DOCUMENTS-AND-RESOURCES/ X WWW.RICEHOSPITAL.COM/BILLING-INSURANCE/DOCUMENTS-AND-RESOURCES/ X X X X X X 1 X X 1 X X X X X X 1 X 0 0 CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 3J: CCH'S 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 - PAYNESVILLE PART V, SECTION B, LINE 3J: CCH'S 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 - MONTICELLO 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 - PAYNESVILLE 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 - MONTICELLO 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 - PAYNESVILLE 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 - PAYNESVILLE 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. RICE MEMORIAL HOSPITAL PART V, SECTION B, LINE 2: RICE MEMORIAL HOSPITAL WAS ACQUIRED BY CENTRACARE HEALTH AS OF JANUARY 1, 2018. PRIOR TO THE ACQUISITION RICE MEMORIAL HOSPITAL WAS A GOVERNMENTAL HOSPITAL. CENTRACARE HEALTH - MONTICELLO 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 DEATHSCENTRACARE HEALTH 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 - PAYNESVILLE 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 DEATHSCENTRACARE HEALTH 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 - MONTICELLO PART V, SECTION B, LINE 13H: A NON-CITIZEN CAN BE DENIED CARE IF THEY CAME TO THE US SPECIFICALLY TO RECEIVE FREE CARE. FOR ALL HOSPITALS OF CENTRACARE WITH FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUALS WILL NOT BE CHARGED MORE FOR EMERGENT AND MEDICALLY NECESSARY CARE, USING THE LOOK BACK METHOD OF (AVERAGE GENERALLY BILLED) AGB AS DESCRIBED IN THE 501R REGULATIONS THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WITH INSURANCE COVERING EMERGENCY AND MEDICALLY NECESSARY CARE. CENTRACARE HEALTH - PAYNESVILLE 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 RICE MEMORIAL 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-INCOM OR SUBSIDIZED HOUSING(F) PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO HOSPITAL FOR FURTHER TREATMENT CENTRACARE HEALTH - MONTICELLO 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 - PAYNESVILLE 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 - MONTICELLO 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 MANAGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - PAYNESVILLE 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 MANAGEMENT PRIOR TO INITIATING. RICE MEMORIAL HOSPITAL 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 CARRIS HEALTH MANAGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - MONTICELLO 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 MANAGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - PAYNESVILLE 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 MANAGEMENT PRIOR TO INITIATING. RICE MEMORIAL HOSPITAL 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 CARRIS HEALTH MANAGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - MONTICELLO: PART V, SECTION B, LINE 7A: THE HOSPTIAL'S CHNA CAN BE FOUND ON IT'S WEBSITE AT WWW.CENTRACARE.COM/APP/FILES/PUBLIC/3004/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-MONTICELLO.PDF. CENTRACARE HEALTH - PAYNESVILLE: PART V, SECTION B, LINE 7A: THE HOSPTIAL'S CHNA CAN BE FOUND ON IT'S WEBSITE AT WWW.CENTRACARE.COM/APP/FILES/PUBLIC/5220/COMMUNITY-HEALTH-NEEDS-ASSESSMENT---PAYNESVILLE.PDF. CENTRACARE HEALTH - MONTICELLO: PART V, SECTION B, LINE 10A: THE HOSPTIAL'S ACTION PLAN CAN BE FOUND ON IT'S WEBSITE AT WWW.CENTRACARE.COM/APP/FILES/PUBLIC/3004/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-MONTICELLO.PDF. 11 1 - MONTICELLO CARE CENTER 1104 EAST RIVER STREET MONTICELLO MN 55362 SKILLED NURSING FACILITY 2 - MONTICELLO CLINIC 1001 HART BLVD STE 100 MONTICELLO MN 55362 CLINIC 3 - KORONIS MANOR CARE CENTER 200 WEST FIRST STREET PAYNESVILLE MN 56362 SKILLED NURSING FACILITY 4 - CCH PAYNESVILLE- BELGRADE CLINIC 505 NELSON AVENUE BELGRADE MN 56312 CLINIC 5 - CCH PAYNESVILLE - COLD SPRING CLINIC 308 FIFTH AVENUE SOUTH COLD SPRING MN 56320 CLINIC 6 - CCH PAYNESVILLE - EDEN VALLEY CLINIC 405 MEEKER AVENUE EDEN VALLEY MN 56362 CLINIC 7 - CCH PAYNESVILLE - PAYNESVILLE CLINIC 200 WEST FIRST STREET PAYNESVILLE MN 56362 CLINIC 8 - CCH PAYNESVILLE - RICHMOND CLINIC 130 FIRST STREET NE RICHMOND MN 56368 CLINIC 9 - RICE CARE CENTER 1801 WILLMAR AVE SW WILLMAR MN 56201 SKILLED NURSING FACILITY 10 - RICE HOME MEDICAL 1033 19TH AVE SW WILLMAR MN 56201 DURABLE MEDICAL EQUIPMENT PROVIDER 11 - CARRIS HEALTH SURGERY CENTER WILLMAR 1310 1ST STREET S WILLMAR MN 56201 AMBULATORY SURGICAL CENTER PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE HOSPITALS' TOTAL EXPENSES (NET OF BAD DEBT) WERE REDUCED BY OTHER OPERATING REVENUE (NET OF HER INCENTIVE REVENUE) AND ALSO BY MEDICAID SURCHARGE AND TAXES, AND THEN DIVIDED BY TOTAL PATIENT REVENUE TO DETERMINE COST TO CHARGE RATIO. 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 FOR UNCOLLECTIBLE 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 ANYMODIFICATIONS 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 SHORTFALL OF $853,881 IN TREATING MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT IN ITS ENTIRETY. THE HOSPITALS PROVIDE AN EXCELLENT LEVEL OF CARE TO THE PEOPLE IN THE COMMUNITY. DESPITE THE SHORTFALL IN REIMBURSEMENT FORM MEDICARE, THE HOSPITALS CONTINUE TO PROVIDE ESSENTIAL HEALTHCARE SERVICES TO THE POPULATION. THE AMOUNT ON LINE 6 OF PART III WAS DETERMINED BY UTILIZING THE MEDICARE COST REPORT UTILIZING KEY SECTIONS OF THAT REPORT, PRIMARILY THE D SERIES AND E SERIES. PART III, LINE 9B: THE COLLECTION POLICIES AT THE HOSPITALS 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 RATING 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: CENTRACARE HEALTH - MONTICELLO IS LOCATED IN CENTRAL MINNESOTA IN WRIGHT COUNTY. THE ESTIMATED 2018 CENSUS SHOWS A POPULATION OF 19,439, WITH A PROJECTED 2023 GROWTH PERCENTAGE OF 4.7% TO 20,344 POPULATION LEVEL. THIS AREA OF THE STATE IS SHOWING A SIGNIFICANT INCREASE IN POPULATION AND IS EXPECTED TO CONTINUE INTO THE FUTURE. THE PROJECTED GROWTH BY AGE BRACKET FROM 2018 TO 2023 IS AS FOLLOWS: 0-17: 1.7%, 18-44: 1.2%, 45-64: 5.7%, 65+: 19.6%. THE ESTIMATED 2018 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 89.6%, AFRICAN AMERICAN: 1.4%, ASIAN: 1.2%, HISPANIC: 5.3%, OTHER: 2.5%. CENTRACARE HEALTH - PAYNESVILLE IS LOCATED IN CENTRAL MINNESOTA IN STEARNS COUNTY. THE ESTIMATED 2018 CENSUS SHOWS A POPULATION OF 6,236 AND IS PROJECTED TO INCREASE SLIGHTLY TO 6,319 BY 2023 WHICH REPRESENTS A 1.30% INCREASE. THE PROJECTED GROWTH BY AGE BRACKET FROM 2018 TO 2023 IS AS FOLLOWS: 0-17: 1.5%, 18-44: 3.9%, 45-64: -8.1%, 65+: 8.3%. THE ESTIMATED 2018 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 95.9%, AFRICAN AMERICAN: .3%, ASIAN: .4%, HISPANIC: 2.3%, OTHER: 1.1%. CARRIS HEALTH - RICE MEMORIAL HOSPITAL IS LOCATED IN WILLMAR, MINNESOTA IN KANDIYOHI COUNTY. THE ESTIMATED 2017 CENSUS SHOWS A POPULATION OF 42,743 AND IS PROJECTED TO INCREASE SLIGHTLY TO XXXX BY 2023 WHICH REPRESENTS A X.XX% INCREASE. THE PROJECTED GROWTH BY AGE BRACKET FROM 2018 TO 2023 IS AS FOLLOWS: PART VI, LINE 5: THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY IN SEVERAL IMPORTANT WAYS. ONE OF THESE WAYS IS THROUGH THE COMMUNITY COLLABORATION COMMITTEE (CCC), A STANDING COMMITTEE OF THE CENTRACARE HEALTH FOUNDATION. THE CCC HAS A MEMBERSHIP OF OVER 30 PERSONS REPRESENTING HEALTHCARE AND COMMUNITY NEEDS ACROSS CENTRAL MINNESOTA. THE CCC MEETS MONTHLY TO DISCUSS WAYS TO ADDRESS TYPICAL HEALTH ISSUES THROUGH AWARENESS BUILDING, EDUCATION AND/OR AN INTERVENTION PROJECT. THERE ARE SEVERAL COMMUNITY HEALTH OUTREACH INITIATIVES THAT THE FOUNDATION IS INVOLVED WITH. THESE INITIATIVES INCLUDE: 1) BLEND CHILDHOOD OBESITY COALITION OF CENTRAL MINNESOTA, 2) SMOKE FREE COMMUNITIES (CONTINUED EFFORTS TO CREATE CLEAN INDOOR AND OUTDOOR AIR FOR ALL), 3) TOBACCO CESSATION SERVICES CLINICS (COLLABORATION WITH CLINIC), 4) CENTRACARE CLINIC TEAM BASED CARE PILOT, 5) ST. CLOUD HOSPITAL - TRANSITION OF CARE PILOT (CREATE MORE SEAMLESS INTEGRATION FROM CARE SETTING TO CARE SETTING, AND 6) CLINIC - DIVERSITY AND CULTURAL COMPETENCY TRAINING. 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 ST CLOUD STATE UNIVERSITY 720 FOURTH AVE SOUTH ST CLOUD MN 56301 411687554 STATE GOVERNMENT 5600 WORKPLACE & PATIENT DIVERSITY 1 0 SCHOLARSHIPS 22 80978 PART I, LINE 2: CENTRACARE HEALTH SYSTEM 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 FORM 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 1 1 0 0 KENNETH D HOLMEN MD PRESIDENT/CEO 1095784 0 273662 0 219199 0 16195 0 23317 0 1628157 0 185139 0 CHRISTIAN SCHMIDT MD DIRECTOR & SURGEON 0 706748 0 33080 0 18774 0 20250 0 28293 0 807145 0 0 ROBERT STOCKER MD DIRECTOR & OB/GYN 0 503855 0 66387 0 774 0 20250 0 3838 0 595104 0 0 DONALD JURGENS MD DIRECTOR/PHYSICIAN 0 809438 0 21725 0 20355 0 20250 0 26611 0 898379 0 0 SHARON RUGGIERO MD DIRECTOR/PHYSICIAN 0 222436 0 28807 0 18762 0 19120 0 11261 0 300386 0 0 GREGORY R KLUGHERZ TREASURER/CFO 595405 0 120905 0 125541 0 16200 0 22684 0 880735 0 105613 0 PAUL R HARRIS ESQ CORPORATE SECRETARY 385014 0 89704 0 73809 0 83771 0 31592 0 663890 0 58526 0 AMY M PORWOLL VICE PRESIDENT 335336 0 69076 0 161540 0 70071 0 27654 0 663677 0 147600 0 DUANE A RASUMUSSON VICE PRESIDENT 349812 0 73018 0 136390 0 21471 0 21473 0 602164 0 118265 0 THOMAS SCHRUP MD VICE PRESIDENT 341240 0 77840 0 11038 0 54032 0 25013 0 509163 0 0 0 KURT OTTO MD VICE PRESIDENT 249586 0 54655 0 51157 0 56279 0 27052 0 438729 0 32743 0 JOY PLAMANN VICE PRESIDENT 228841 0 47798 0 12183 0 56622 0 30421 0 375865 0 0 0 KELLY MACKEN-MARBLE VICE PRESIDENT 294718 0 97031 0 41672 0 57445 0 45878 0 536744 0 0 0 NELSON L ADAMSON MD PHYSICIAN 0 521598 0 31725 0 19188 0 20250 0 31457 0 624218 0 0 LAWRENCE G STRATE MD PHYSICIAN 0 381697 0 21730 0 774 0 17111 0 25661 0 446973 0 0 RANDALL J ZIMMERMAN MD PHYSICIAN 0 381520 0 30824 0 12744 0 20817 0 28440 0 474345 0 0 KURT A HABBEN MD PHYSICIAN 0 338651 0 30039 0 162 0 21322 0 24261 0 414435 0 0 TIMOTHY L MALLING MD PHYSICIAN 0 387611 0 29897 0 379 0 21306 0 23953 0 463146 0 0 PART I, LINE 4B THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRRED 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 THE FORM 990, THE AMOUNTS LISTED IN SECTION VII AND IN SCHEDULE J REFLECT THIS TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON THE FORM 990. ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: KENNETH D HOLMEN - PAID $199,538; ACCRUED $0 GREGORY R KLUGHERZ - PAID $105,613; ACCRUED $0 PAUL R HARRIS - PAID $58,526; ACCRUED $67,163 AMY M PORWOLL - PAID $147,600; ACCRUED $49,307 DUANE A RASMUSSEN - PAID $118,265; ACCRUED $0 KURT OTTO - PAID $32,743; ACCRUED $38,659 THOMAS SCHRUP - PAID $0; ACCRUED $33,070 JOY PLAMANN - PAID $0; ACCRUED $34,509 KELLY MACKEN-MARBLE - PAID $0; ACCRUED $48,750 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. A THE CITY OF ST CLOUD 416005515 2011-12-28 10000000 HEALTH CARE REVENUE BONDS 2011A 0 0 0 B THE CITY OF ST CLOUD 416005515 2011-12-28 31445000 HEALTH CARE REVENUE BONDS 2011B 0 0 0 C THE CITY OF ST CLOUD 416005515 78916VCZ1 2014-11-19 48876925 HEALTH CARE REVENUE BONDS 2014B 0 0 0 D THE CITY OF ST CLOUD 416005515 2014-08-01 128310000 HEALTH CARE REVENUE BONDS 2014 0 0 0 A 10000000 150000 9850000 2015 0 0 1 1 B 31445000 31445000 2012 1 0 1 1 C 48876925 550981 48325944 2010 0 1 1 1 D 128310000 15000000 113310000 2016 1 0 1 1 A 0 0 0 1 1 0.01480 0.01480 0 0 1 B 0 0 0 0 0.00680 0.00680 0 0 1 C 0 1 0 1 1 0.02400 0.02400 0 0 1 D 0 1 0 0 0.00600 0.00600 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 0 1 1 0 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 02/23/2017 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 02/23/2017 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 07/19/2017 A THE CITY OF ST CLOUD 416005515 78916VDR8 2016-05-12 216598436 HEALTH CARE REVENUE BONDS 2016A 0 0 0 A 216598436 161480506 1760260 53357670 2017 0 1 1 1 A 0 1 0 1 1 0.03260 0.03260 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART III, LINE 2 AS OF JANUARY 1, 2018 CARRIS HEALTH, LLC IS PART OF CENTRACARE HEALTH SYSTEM. CARRIS HEALTH, LLC INCLUDES THE SUBSIDIARY CARRIS HEALTH - RICE MEMORIAL HOSPITAL, WHICH HAS 136 LICENSED BEDS, AND PROVIDES INPATIENT AND OUTPATIENT SERVICES. INPATIENT SERVICES INCLUDE MEDICAL AND SURGICAL CARE, BIRTHING SERVICES, PEDIATRIC SERVICES, BEHAVIORAL HEALTH CARE SERVICES, AND REHABILITATION SERVICES. OUTPATIENT SERVICES INCLUDE EMERGENCY ROOM SERVICES, DIALYSIS, IMAGING, RESPIRATORY THERAPY, A REHABILITATION CENTER, SAME DAY SURGERY AND OTHER AMBULATORY CARE SERVICES. CARRIS HEALTH ALSO OFFERS A CERTIFIED SKILLED NURSING FACILITY LOCATED IN WILLMAR, MN WITH 78 LICENSED BEDS AND AS OF MAY 2018 A BRAND NEW ACCREDITED AMBULATORY SURGICAL CENTER LOCATED IN WILLMAR, MN. THE CARRIS HEALTH SURGICAL CENTER WILLMAR IS UTILIZED BY 30+ PHYSICIANS. CARRIS HEALTH ALSO OFFERS A DURABLE MEDICAL EQUIPMENT PROVIDER, RICE HOME MEDICAL. RICE HOME MEDICAL IS A LEADING RETAIL PROVIDER OF MEDICAL EQUIPMENT AND SUPPLIES THROUGHOUT WESTERN MINNESOTA. RICE HOME MEDICAL WAS FOUNDED IN 1988 AND IS HEADQUARTERED IN WILLMAR, MN. RICE HOME MEDICAL OFFERS MEDICAL EQUIPMENT AND SUPPLIES FOR RESPIRATORY, MOBILITY, COMPLEX MOBILITY, WOMEN'S HEALTH, INDEPENDENT LIVING, HOME MODIFICATIONS AND OTHER HEALTHCARE RELATED EQUIPMENT AND SERVICES. RICE HOME MEDICAL HAS LOCATIONS IN WILLMAR, ALEXANDRIA, REDWOOD AND MADISON, MN. EACH YEAR IT SERVES MORE THAN 20,000 PATIENTS. FORM 990, PART VI, SECTION B, LINE 11B ANNUALLY AT THE BOARD'S APRIL MEETING, PRIOR TO FILING WITH THE IRS, THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW THE IRS FORM 990 WITH THE 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 AND 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. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT REQUIRED BY LAW TO BE MADE AVAILABLE TO THE PUBLIC AND CENTRACARE HEALTH SYSTEM DOES NOT MAKE THEM AVAILABLE. FORM 990, PART IX, LINE 11G MEDICAL/OTHER FEES: PROGRAM SERVICE EXPENSES 10,619,737. MANAGEMENT AND GENERAL EXPENSES 2,066,215. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,685,952. CONTRACTED SERVICES/PURCH SVCS: PROGRAM SERVICE EXPENSES 41,757,823. MANAGEMENT AND GENERAL EXPENSES 8,124,553. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,882,376. FORM 990, PART XI, LINE 9: PENSION PLAN ADJUSTMENT 92,565. NET EQUITY TRANSFERS BTWN RELATED ORGS 46,619,895. NON-CONTROLLING INTEREST NET INCOME -2,570,598. ACQUISITION OF CARRIS HEALTH 685,122. OTHER ADJUSTMENTS 990,324. CENTRACARE SURGERY CENTER LLC 1406 6TH AVE N ST CLOUD MN 56303 611514974 SURGICAL CENTER MN 11235305 4342669 CENTRACARE HEALTH SYSTEM CENTRACARE HEALTH - MONTICELLO 1013 HART BLVD MONTICELLO MN 55362 461584944 HEALTHCARE MN 72670260 64007478 CENTRACARE HEALTH SYSTEM CENTRACARE HEALTH - PAYNESVILLE 200 W200 WEST FIRST STREET PAYNESVILLE MN 56362 433298651 HEALTHCARE MN 43341238 27393615 CENTRACARE HEALTH SYSTEM CENTRAL MINNESOTA HEALTH NETWORK LLC (FKA CIN LLC) 1406 6TH AVE N ST CLOUD MN 56303 473924684 CLINICAL INEGRATED NETWORK MN 0 -966580 CENTRACARE HEALTH SYSTEM CENTRAL MINNESOTA ACO LLC 1406 6TH AVE N ST CLOUD MN 56303 474591476 ACCREDITED CARE ORGANIZATION MN 5464 -568139 CENTRACARE HEALTH SYSTEM CARRIS HEALTH LLC 301 BECKER AVE SW WILLMAR MN 56201 823166379 HEALTH CARE SYSTEM MN 74926839 144468560 CENTRACARE HEALTH SYSTEM CENTRAL MINNESOTA IHP LLC 1406 6TH AVE NORTH ST CLOUD MN 56303 HEALTHCARE MN CENTRACARE HEALTH SYSTEM ALBANY CLINIC PROPERTY LLC 1406 6TH AVE NORTH ST CLOUD MN 56303 HEALTHCARE MN CENTRACARE HEALTH SYSTEM CENTRACARE PROVIDER SERVICES LLC 1406 6TH AVE NORTH ST CLOUD MN 56303 HEALTHCARE MN CENTRACARE HEALTH SYSTEM 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-LONG PRAIRIE 20 SE 9TH STREET LONG PRAIRIE MN 56347 411924645 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) 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 CENTRACARE HEALTH SYSTEM - MONTICELLO RELATED 8385593 9350727 0 1 0.60000 MONTICELLO SURGERY CENTER 1013 HART BLVD MONTICELLO MN 55362 813593057 AMBULATORY SURGERY CENTER MN CENTRACARE HEALTH SYSTEM RELATED 1190689 870336 0 1 0.37630 BENSON MEDICAL LLC 1228 ATLANTIC AVENUE BENSON MN 56215 203149203 HEALTHCARE MN AFFILIATED COMMUNITY HEALTH NETWORK INC RELATED 0 1 0.50000 CENTRACARE HOLDINGS INC 1406 6TH AVE N ST CLOUD MN 56303 472688595 INVESTMENTS/PHARMACY MN CENTRACARE HEALTH SYSTEM C 6945650 6263320 1.00000 1 AFFILIATED COMMUNITY MEDICAL CENTERS PA 301 BECKER AVE SW WILLMAR MN 56201 HEALTH CARE SYSTEM MN CARRIS HEALTH LLC C 60820240 160927024 1.00000 0 AFFILIATED COMMUNITY HEALTH NETWORK INC 101 WILLMAR AVE SW WILLMAR MN 56201 HEALTH NETWORK MN CARRIS HEALTH LLC C 1.00000 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 CENTRACARE HEALTH - LONG PRAIRIE A 117706 ARMS LENGTH CENTRACARE PHARMACY SERVICES INC A 70473 ARMS LENGTH CENTRACARE CLINIC A 6547836 ARMS LENGTH ST CLOUD HOSPITAL A 147228 ARMS LENGTH CENTRACARE HEALTH - LONG PRAIRIE D 1965534 ARMS LENGTH ST CLOUD HOSPITAL O 370320 ARMS LENGTH CENTRACARE CLINIC P 8426114 ARMS LENGTH ST CLOUD HOSPITAL P 1911768 ARMS LENGTH CENTRACARE HEALTH - LONG PRAIRIE Q 2958609 ARMS LENGTH CENTRACARE HEALTH - MELROSE Q 3201809 ARMS LENGTH CENTRACARE HEALTH - SAUK CENTRE Q 3066574 ARMS LENGTH CENTRACARE PHARMACY SERVICES INC Q 235462 ARMS LENGTH CENTRACARE CLINIC Q 30037324 ARMS LENGTH ST CLOUD HOSPITAL Q 75189452 ARMS LENGTH CENTRACARE CLINIC R 64182053 ARMS LENGTH CENTRACARE PHARMACY SERVICES INC R 1194588 ARMS LENGTH CMEP R 100731 ARMS LENGTH CENTRACARE HEALTH - LONG PRAIRIE S 1546514 ARMS LENGTH CENTRACARE HEALTH - SAUK CENTRE S 2982614 ARMS LENGTH CENTRACARE HEALTH - MELROSE S 6888550 ARMS LENGTH ST CLOUD HOSPITAL S 95564918 ARMS LENGTH CENTRACARE HEALTH FOUNDATION S 325324 ARMS LENGTH