2018-05-15T08:21:48-05:00 2017-06-30 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2016-07-01 411813221 CENTRACARE HEALTH SYSTEM CENT 3202512700 1406 6TH AVENUE NORTH ST CLOUD MN 56303 GREGORY R KLUGHERZ VICE PRESIDENT/CFO 3202512700 2018-05-03 1 TODD A JACKSON P00092672 6123324300 2016 2022-09-23 18:48:47Z KENNETH D HOLMEN MD 1406 6TH AVENUE NORTH ST CLOUD MN 56303 221441952 0 X WWW.CENTRACARE.COM X 1995 MN THE CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 13 10 2413 280 0 0 79633 1214113 163727195 206045833 1869058 2091866 -6482051 4887876 159193835 214239688 0 20477 0 0 91427299 113617042 0 0 0 74660800 105772114 166088099 219409633 -6894264 -5169945 173191160 243270436 87735972 139293816 85455188 103976620 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. 0 0 112369691 20477 121642704 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 2017, THEY HAD 4,482 PATIENT DAYS, 34,700 OUTPATIENT VISITS AND 12,614 EMERGENCY ROOM VISITS' WHICH GENERATED $70,693,032 OF PROGRAM REVENUE AND $68,403,410 OF PROGRAM EXPENSES. 35596760 38283432 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 2017 THEY HAD 2,955 PATIENT DAYS, 37,889 OUTPATIENT VISITS AND 3,691 EMERGENCY ROOM VISITS. IN FISCAL YEAR 2017, PAYNESVILLE GENERATED $38,283,432 OF PROGRAM REVENUE AND $35,596,760 OF PROGRAM EXPENSE. 24197441 40885409 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 2.06 MILLION TESTS IN FISCAL YEAR 2017. IN FISCAL YEAR 2017 CENTRACARE LABORATORY GENERATED $40,885,409 IN PROGRAM REVENUE AND INCURRED $25,197,441 OF EXPENSES. 9313305 8499939 CENTRACARE SURGICAL CENTER PROVIDES ELECTIVE SURGERY PROCEDURES TO PATIENTS IN THE CENTRAL MN REGION. IN FY 2017, THE CENTER PERFORMED 4,166 SURGERIES AND GENERATED $8,499,939 OF PROGRAM REVENUE AND $9,313,306 OF PROGRAM EXPENSE. 9313305 8499939 181477197 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 305 0 1 2413 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 1 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 1293753 0 26581 GENE WINDFELDT DIRECTOR, CHAIR 2.00 X X 4500 0 0 MIKE BENUSA DIRECTOR, VICE CHAIR 2.00 X X 2000 0 0 CHRISTIAN SCHMIDT MD DIRECTOR & SURGEON 1.00 39.00 X 0 529710 57691 DAVID ROBERTS MD DIRECTOR & GASTROENTEROLOGIST 2.00 38.00 X 0 656652 61195 ROBERT STOCKER MD DIRECTOR & OB/GYN 2.00 38.00 X 0 529415 29925 CHRISTOPHER COBORN DIRECTOR 2.00 2.00 X 1500 0 0 DAVID AGERTER MD DIRECTOR 2.00 2.00 X 1500 0 0 DENISE ROSIN DIRECTOR 2.00 X 1500 0 0 STEVE LARAWAY DIRECTOR 2.00 X 2000 0 0 TERESA BOHNEN DIRECTOR 2.00 2.00 X 1500 0 0 MOHAMED YASSIN MD DIRECTOR 2.00 X 1500 0 0 MARY JO WILLIAMSON DIRECTOR 2.00 X 1500 0 0 JOSEPH UPHUS DIRECTOR 2.00 X 2000 0 0 GREGORY R KLUGHERZ TREASURER/CFO 25.00 15.00 X 0 798201 43401 PAUL R HARRIS ESQ CORPORATE SECRETARY 25.00 15.00 X 504874 0 83489 AMY M PORWOLL VICE PRESIDENT 20.00 20.00 X 391565 0 74370 DUANE A RASUMUSSON VICE PRESIDENT 20.00 20.00 X 453340 0 42243 THOMAS SCHRUP MD VICE PRESIDENT 20.00 20.00 X 395075 0 51017 KURT OTTO VICE PRESIDENT 20.00 20.00 X 302800 0 57945 JOY PLAMANN VICE PRESIDENT 20.00 20.00 X 203254 0 41895 KELLY MACKEN-MARBLE VICE PRESIDENT 20.00 20.00 X 193399 0 7478 NELSON L ADAMSON MD PHYSICIAN 40.00 X 0 579220 62698 LAWRENCE G STRATE MD PHYSICIAN 40.00 X 0 393589 45305 RANDALL J ZIMMERMAN MD PHYSICIAN 40.00 X 0 417163 54848 HEATHER K SWANSON MD PHYSICIAN 40.00 X 0 345816 52376 TIMOTHY L MALLING MD PHYSICIAN 40.00 X 0 391632 48744 3757560 4641398 841201 149 0 1 0 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 PHYSICIAN SERVICES 5624164 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 3747752 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1200 6TH AVE N ST CLOUD MN 56303 EMERGENCY COVERAGE 3000907 METRO ANESTHESIA CONSULTANT 9855 AETNA AVE NE MONTICELLO MN 55362 ANESTHESIA SERVICES 2175764 STELLIS HEALTH PA 1700 HIGHWAY 25 NORTH BUFFALO MN 55313 UROLOGY SERVICES 1638252 20 71235 1142878 1214113 PATIENT & SERVICE REVENUE 900099 156527651 156527651 RELATED ORG CONTRACTED SERVICES 900099 30255992 30255992 SHARED EMPLOYEE BENEFITS 900099 19222333 19222333 HEALTH/TECH INCENTIVES 900099 39857 39857 206045833 1327954 1327954 7806612 6887130 919482 919482 919482 763912 0 763912 763912 763912 1517877 315134 1202743 1202743 ALL OTHER REVENUE 900099 2008816 2008816 REVENUE FROM JOINT VENTURES 900099 1256835 1256835 LOSS ON DEBT FINANCING 900099 -500000 -500000 2765651 214239688 209311484 0 3714091 X 5875 5875 14602 14602 5662690 4548196 1114494 72381643 58135957 14245686 6627519 5323134 1304385 20977249 16848643 4128606 7967941 6399742 1568199 1506778 1210224 296554 34272 27527 6745 40987 40987 71995 71995 53344127 42845281 10498846 812717 652763 159954 1939809 1558028 381781 1437390 1154492 282898 381717 306590 75127 1555517 1249370 306147 2234684 1794868 439816 9155616 7353667 1801949 1229187 987266 241921 DRUGS/MEDICAL SUPPLIES 21821300 21821300 BAD DEBT 2696727 2696727 MEDICAID SURCHARGE/MN C 2391089 2391089 5118202 4110869 1007333 219409633 181477197 37932436 0 14981246 15371703 17502640 18336626 1446655 3034698 3024467 3128411 7463200 7183185 254398282 115728252 88529680 138670030 21612051 33112025 2447239 18631221 21986519 173191160 243270436 36712668 44230431 40726314 65375867 6946003 15015541 3350987 14671977 87735972 139293816 X 85455188 103976620 85455188 103976620 173191160 243270436 X -5169945 1689504 22001873 X 0 1 X 1 0 X X 7 ST CLOUD HOSPITAL 410695596 3 1 59591603 0 CENTRACARE CLINIC 411806657 3 1 16662142 0 CENTRACARE HEALTH SYSTEM - MELROSE 411865315 3 1 2551162 0 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE 411924645 3 1 2288731 0 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 411708142 3 1 0 0 CENTRACARE HEALTH FOUNDATION 411855173 3 1 171018 0 CENTRACARE HEALTH SYSTEM - SAUK CENTRE 452438973 3 1 2182963 0 7 83447619 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X 1 1 SCHEDULE A, PART IV, SECTION E, LINE 3A CENTRACARE HEALTH SYSTEM, AS THE PARENT AND/OR SOLE CORPORATE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS, HAS THE AUTHORITY TO APPOINT OR ELECT A MAJORITY OF THE SUPPORTED ORGANIZATION'S BOARD OF DIRECTORS, AS OUTLINED IN EACH ORGANIZATION'S BYLAWS. SCHEDULE A, PART IV, SECTION A, LINE 3B CENTRACARE HEALTH SYSTEM, AS THE PARENT AND/OR SOLE CORPORATE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS, HAS THE AUTHORITY TO APPROVE CERTAIN GOVERNANCE DECISIONS, AS OUTLINED IN EACH ORGANIZATION'S BYLAWS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 40987 40987 0 PART II-B, LINE 1: CENTRACARE HEALTH SYSTEM PAID $40,987 TO SATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 13709439 13709439 181643293 72445245 109198048 56386806 43258156 13128650 2658744 24851 2633893 138670030 FUNDS HELD BY TRUSTEE UNDER BOND INDENTURES 3317462 C FUNDS HELD BY BOARD FOR FUTURE PROPERTY & EQUIP REPLACEMENT/EXPANSION 21598767 C INVESTMENT IN JOINT VENTURES 7213342 C INVEST IN MUTUAL SERVICE CORP 982454 C 33112025 OTHER ASSETS 514075 DUE FROM AFFILIATES 21472444 21986519 PENSION ACCRUAL 238433 DUE TO AFFILIATES 13433488 ASSET RETIRMENT OBLIGATION 1000056 14671977 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 AND CCH - PAYNESVILLE, AS DISREGARDED LLCS UNDER INTERNAL REVENUE SERVICE REGULATIONS, ACHIEVE TAX-EXEMPT TREATMENT BASED ON THE EXEMPT STATUS OF THEIR PARENT, CENTRACARE HEALTH SYSTEM. AT JUNE 30, 2017 AND 2016, THERE WERE NO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 433005 0 433005 0.00400 20237072 17400419 2836653 0.02630 20670077 17400419 3269658 0.03030 94477 94477 0.00090 22574 22574 0.00020 117051 117051 0.00110 20787128 17400419 3386709 0.03140 1 1947542 31983959 32236611 -252652 X 1 1 1 MONTICELLO CANCER CENTER RADIATION & ONCOLOGY SERVICES 0.60000 0.00000 0.00000 2 1 CENTRACARE HEALTH - MONTICELLO 1013 HART BLVD MONTICELLO MN 55362 X X X X DISTINCT PART REHAB 2 CENTRACARE HEALTH - PAYNESVILLE 200 WEST FIRST STREET PAYNESVILLE MN 56362 X X X X CENTRACARE HEALTH - MONTICELLO 1 0 0 1 X X X X X X X 15 1 1 0 1 X WWW.CENTRACARE.COM X X 1 15 1 WWW.CENTRACARE.COM 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 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 WWW.CENTRACARE.COM X X 1 15 1 WWW.CENTRACARE.COM 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 - 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. 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. CENTRACARE HEALTH - MONTICELLO 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. 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. 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 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 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: 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 501(R) 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: 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 501(R) REGULATIONS, THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WITH INSURANCE COVERING EMERGENCY AND MEDICALLY NECESSARY CARE. 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 MANAMGEMENT 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 MANAMGEMENT 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 MANAMGEMENT 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 MANAMGEMENT PRIOR TO INITIATING. 8 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 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 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 SHORTFALL OF $252,652 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 7 OF PART III WAS DETERMINED BY UTILIZING KEY SECTION OF THE MEDICARE COST 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 2017 CENSUS SHOWS A POPULATION OF 19,225, WITH A PROJECTED 2022 GROWTH PERCENTAGE OF 4.6% TO 20,109 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 2017 TO 2022 IS AS FOLLOWS: 0-17: 1.4%, 18-44: 1.2%, 45-64: 6.2%, 65+: 19.1%. THE ESTIMATED 2017 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 89.6%, AFRICAN AMERICAN: .1.4%, ASIAN: 1.1%, HISPANIC: 5.5%, OTHER: 2.4%. CENTRACARE HEALTH - PAYNESVILLE IS LOCATED IN CENTRAL MINNESOTA IN STEARNS COUNTY. THE ESTIMATED 2017 CENSUS SHOWS A POPULATION OF 6,148 AND IS PROJECTED TO INCREASE SLIGHTLY TO 6,165 BY 2022 WHICH REPRESENTS A .30% INCREASE. THE PROJECTED GROWTH BY AGE BRACKET FROM 2017 TO 2022 IS AS FOLLOWS: 0-17: -0.4%, 18-44: 3.7%, 45-64: -9.0%, 65+: 7.1%. THE ESTIMATED 2017 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 96.2%, AFRICAN AMERICAN: .3%, ASIAN: .4%, HISPANIC: 2.1%, OTHER: 1.0%. 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 (GOAL IS TO REDUCE THE INCIDENCE OF CHILDHOOD OBESITY BY 2016), 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 SCHOLARSHIPS 8 14602 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 1056216 0 218278 0 19259 0 9275 0 23212 0 1326240 0 0 0 CHRISTIAN SCHMIDT MD DIRECTOR & SURGEON 0 491348 0 19137 0 19225 0 31415 0 29145 0 590270 0 0 DAVID ROBERTS MD DIRECTOR & GASTROENTEROLOGIST 0 601936 0 33549 0 21167 0 34920 0 29238 0 720810 0 0 ROBERT STOCKER MD DIRECTOR & OB/GYN 0 466228 0 62199 0 988 0 29425 0 3725 0 562565 0 0 GREGORY R KLUGHERZ TREASURER/CFO 0 575712 0 88532 0 133957 0 26845 0 22462 0 847508 0 104969 PAUL R HARRIS ESQ CORPORATE SECRETARY 371496 0 65685 0 67693 0 56781 0 31458 0 593113 0 52707 0 AMY M PORWOLL VICE PRESIDENT 311938 0 54269 0 25358 0 50212 0 27570 0 469347 0 0 0 DUANE A RASUMUSSON VICE PRESIDENT 338139 0 53467 0 61734 0 24936 0 21358 0 499634 0 43465 0 THOMAS SCHRUP MD VICE PRESIDENT 321789 0 63874 0 9412 0 26591 0 47258 0 468924 0 0 0 KURT OTTO VICE PRESIDENT 225910 0 30671 0 46219 0 32787 0 27168 0 362755 0 27670 0 JOY PLAMANN VICE PRESIDENT 187529 0 7858 0 7867 0 15595 0 28120 0 246969 0 0 0 KELLY MACKEN-MARBLE VICE PRESIDENT 117440 0 50000 0 25959 0 0 0 58043 0 251442 0 0 0 NELSON L ADAMSON MD PHYSICIAN 0 526759 0 33040 0 19421 0 34622 0 31638 0 645480 0 0 LAWRENCE G STRATE MD PHYSICIAN 0 374561 0 18040 0 988 0 22845 0 26455 0 442889 0 0 RANDALL J ZIMMERMAN MD PHYSICIAN 0 390174 0 26377 0 612 0 28572 0 29792 0 475527 0 0 HEATHER K SWANSON MD PHYSICIAN 0 319397 0 25907 0 512 0 24550 0 30766 0 401132 0 0 TIMOTHY L MALLING MD PHYSICIAN 0 365230 0 25832 0 570 0 27044 0 24802 0 443478 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 $0; ACCRUED $0 GREGORY R KLUGHERZ - PAID $104,969; ACCRUED $0 PAUL R HARRIS - PAID $52,707; ACCRUED $32,842 AMY M PORWOLL - PAID $0; ACCRUED $23,258 DUANE A RASMUSSEN - PAID $43,465; ACCRUED $0 KURT OTTO - PAID $27,670; ACCRUED $17,695 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 78916VBB5 2009-08-10 201078369 HEALTH CARE REVENUE BONDS 2008D 1 0 0 B THE CITY OF ST CLOUD 416005515 78916VBX7 2010-02-03 187558690 HEALTH CARE REVENUE BONDS 2010AB 1 0 0 C THE CITY OF ST CLOUD 416005515 2011-12-28 10000000 HEALTH CARE REVENUE BONDS 2011A 0 0 0 D THE CITY OF ST CLOUD 416005515 2011-12-28 31445000 HEALTH CARE REVENUE BONDS 2011B 0 0 0 A 121425000 80000000 201078369 1954596 199123773 2013 1 0 1 1 B 47760000 76700000 187558690 2797296 2076662 182684732 2010 1 0 1 1 C 10000000 150000 9850000 2015 0 0 0 1 D 31445000 31445000 2012 1 0 1 1 A 0 1 0 1 1 0.00000 0.00400 0.00400 0 0 1 B 0 1 0 1 1 0.00000 0.02100 0.02100 0 0 1 C 0 0 0 1 1 0.01520 0.00000 0.01520 0 0 1 D 0 0 0 0 0.00000 0.00610 0.00610 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 1 0 0 0 1 D 0 0 1 1 0 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: 05/12/2016 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2014 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 12/01/2016 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 06/28/2012 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2015 A THE CITY OF ST CLOUD 416005515 78916VCZ1 2014-11-19 48876925 HEALTH CARE REVENUE BONDS 2014B 0 0 0 B THE CITY OF ST CLOUD 416005515 2014-08-01 128310000 HEALTH CARE REVENUE BONDS 2014B 0 0 0 C THE CITY OF ST CLOUD 416005515 78916VDR8 2016-05-12 216598436 HEALTH CARE REVENUE BONDS 2016A 0 0 0 A 48876925 550981 48325944 2010 0 1 1 1 B 128310000 15000000 113310000 2016 1 0 1 1 C 216598436 17041930 1760260 41958441 8267444 11377567 2017 0 1 0 1 A 0 1 0 1 1 0.00000 0.02260 0.02260 0 0 1 B 0 1 0 0 0.00000 0.00550 0.00550 0 0 1 C 0 1 0 1 1 0.00000 0.00820 0.00820 0 0 0 A 0 0 1 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 FORM 990, PART VI, SECTION A, LINE 4 CENTRACARE HEALTH (CCH) AMENDED ITS GOVERNING DOCUMENTS TO INCREASE THE CCH BOARD AUTHORITY AND CONTROL TO OPERATE THE INTEGRATED HEALTH SYSTEM. THE NUMBER OF CCH BOARD POSITIONS FOR THE EMPLOYED PHYSICIANS INCREASED BY TWO AND REPRESENTATION FOR THE BISHOP AND/OR PRIORESS AND THE CHAIR OF THE ST. CLOUD HOSPITAL (SCH) BOARD WAS ADDED. THE CURRENT CCH BOARD APPOINTMENT PROCESS BASED ON ENTITY WAS REMOVED AND A SELF-PERPETUATING BOARD NOMINATION PROCESS THROUGH A CCH NOMINATING COMMITTEE WAS ADOPTED. CCH COULD NOW TAKE ACTION ON ITS OWN INITIATIVES FOR MOST FUNCTIONS WITHOUT PRIOR ACTION OF SCH OR OPERATING COMMITTEES, BUT CCH WILL GENERALLY SEEK CONSULTATION WITH THE OTHER ENTITY BOARDS. 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 9,555,758. MANAGEMENT AND GENERAL EXPENSES 2,341,551. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,897,309. PURCH/CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 33,050,479. MANAGEMENT AND GENERAL EXPENSES 8,098,719. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,149,198. BANK FEES: PROGRAM SERVICE EXPENSES 239,044. MANAGEMENT AND GENERAL EXPENSES 58,576. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 297,620. FORM 990, PART XI, LINE 9: PENSION PLAN ADJUSTMENT 137,000. NET EQUITY TRANSFERS BTWN RELATED ORGS 22,586,759. NON-CONTROLLING INTEREST DISTRIBUTION -2,199,999. NON-CONTROLLING INTEREST NET INCOME 1,455,963. OTHER ADJUSTMENTS 22,150. 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