2018-08-13T12:34:19-05:00 2017-09-30 420714325 RSM US LLP 227 W FIRST ST STE 700 DULUTH MN 558021926 990 2016-10-01 410745522 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE CENTER AITK 2189272121 200 BUNKER HILL DRIVE AITKIN MN 56431 CASEY JOHNSON CFO 2189272121 2018-08-09 1 MARY BETH SANTORI P00023783 2187275025 2018-08-09 2016 2022-09-23 18:48:47Z TODD SANDBERG 200 BUNKER HILL DRIVE AITKIN MN 56431 73318484 0 X WWW.RIVERWOODHEALTHCARE.COM X 1948 MN INPATIENT AND OUTPATIENT MEDICAL CARE AND THREE PRIMARY CARE CLINICS. 11 10 458 90 -2761 -2761 814613 859050 59022793 59887338 650842 1335833 190207 341053 60678455 62423274 0 261697 0 0 27487544 29078742 14240 21480 170118 30025807 30216063 57527591 59577982 3150864 2845292 81835029 85323954 41122759 40428848 40712270 44895106 X TO IMPROVE HEALTH BY PROVIDING HIGH QUALITY, COMPASSIONATE AND PERSONALIZED CARE. 0 0 49894506 261697 60628657 RIVERWOOD HEALTHCARE CENTER STRIVES TO DELIVER THE HIGHEST QUALITY PATIENT-CENTERED CARE. WE CONTINUALLY EXAMINE EMERGING HEALTHCARE NEEDS OF THE COMMUNITIES WE SERVE THROUGHOUT AITKIN COUNTY AND THE GARRISON AND MILLE LACS AREA. WITH A STRONG FOCUS ON HEALTH, WELLNESS AND PREVENTION, THE CENTER STRIVES TO EDUCATE AND INFORM ITS PATIENTS AND THE COMMUNITY ON HEALTH ISSUES. THE COMMUNITY'S AND PATIENT'S NEEDS ARE LISTENED TO AND INCORPORATED IN OUR MISSION STATEMENT, STRATEGIC PLAN AND VISION.IN 2017, RIVERWOOD LAUNCHED AN EXPANSION AND RENOVATION PROJECT FOR A NEW KIDNEY DIALYSIS FACILITY, IN PARTNERSHIP WITH CENTRACARE HEALTH. THE DIALYSIS UNIT WILL NOT ONLY PROVIDE CLOSE TO HOME NECESSARY CARE FOR RENAL PATIENTS, BUT ALSO WILL BE OF HELP TO FAMILY MEMBERS AND FRIENDS IN THEIR SUPPORT OF THE PATIENT, SINCE THE NEED TO TRAVEL FAR FROM HOME FOR CARE WILL BE REDUCED. THE RENOVATION PART OF THE BUILDING PROJECT REDESIGNS SPECIALTY CARE AREAS, ALLOWING FOR EXPANSION OF SERVICE LINES AND PROVIDING EASIER ACCESS TO PATIENTS WHILE ADDING ADDITIONAL IMAGING CAPABILITIES. THE RENOVATION OF THE PRIMARY CARE CLINICS SUPPORTS THE PATIENT CENTERED CARE MODEL AND TEAM BASED APPROACH ALLOWING FOR CONTINUATION OF ADVANCED COORDINATED CARE. THE BUILDING PROJECT FURTHERS RIVERWOOD'S GOAL OF GIVING ENHANCED ACCESS TO PRIMARY AND SPECIALTY CARE SERVICES.RIVERWOOD WAS RANKED IN THE TOP 20 CRITICAL ACCESS HOSPITAL'S IN THE NATION. THIS RECOGNITION IS BASED ON A RATING SYSTEM THAT EVALUATES RURAL AND CRITICAL ACCESS HOSPITALS AND LOOKS AT VARIOUS MARKET, VALUE-BASED AND FINANCIAL MEASURES. RIVERWOOD STRIVES TO ENSURE THAT CONSISTENT, HIGH QUALITY CARE IS CONTINUALLY DELIVERED AND THIS ACHIEVEMENT IS AN INDICATION THAT THE COMMUNITY CAN COUNT ON RIVERWOOD TO DELIVER THE SERVICES NEEDED NOW AND INTO THE FUTURE. WITH A FOCUSED CONCERN FOR THE COMMUNITY'S NEEDS, THIS RECOGNITION IS ANOTHER TESTAMENT THAT WE HAVE A BLUE PRINT FOR SUCCESS AS WE TRANSITION INTO VALUE-BASED CARE.RIVERWOOD HAS ATTAINED BABY FRIENDLY HOSPITAL DESIGNATION WHICH MOVES US CLOSER TO MEETING IMPORTANT PUBLIC HEALTH GOALS OF INCREASING THE PROPORTION OF LIVE BIRTHS THAT OCCUR IN FACILITIES THAT PROVIDE RECOMMENDED CARE FOR MOTHERS AND BABIES. IN ADDITION TO THIS, MOMMY AND ME CLASSES ARE OFFERED FREE OF CHARGE COVERING EDUCATIONAL TOPICS SUCH AS CHALLENGES FOR NEW MOMS, INFANT FEEDING AND LACTATION, FIRST YEAR OF DEVELOPMENT, SAFE SLEEP FOR BABIES, WEIGHT MANAGEMENT AND NUTRITION, SPEECH, LANGUAGE AND SOCIAL DEVELOPMENT.RIVERWOOD PURSUED AND ACHIEVED HEALTH CARE HOME (HCH) CERTIFICATION, THRU THE MINNESOTA DEPARTMENT OF HEALTH, FOR ITS THREE PRIMARY CARE CLINICS. THE FOCUS OF THE CERTIFICATION IS THE REDESIGN OF CARE DELIVERY AND MEANINGFUL ENGAGEMENT OF PATIENTS IN THEIR CARE. THIS PROVIDES A SHIFT FROM A MEDICAL MODEL OF HEALTH CARE TO A FOCUS ON LINKING PRIMARY CARE OF THE PATIENT WITH WELLNESS, PREVENTION, SELF-MANAGEMENT AND COMMUNITY SERVICES. THIS ACHIEVEMENT SUPPORTS OUR GOAL OF MAINTAINING AND EXPANDING MENTAL AND BEHAVIORAL HEALTH SERVICES. RIVERWOOD HAS DESIGNATIONS AS A LEVEL III TRAUMA CENTER, A COMPREHENSIVE ADVANCED LIFE SUPPORT HOSPITAL AND A LEVEL I HEART ATTACK PROGRAM. RIVERWOOD ATTAINED COMMISSION ON CANCER (COC) ACCREDITATION WHICH IMPROVES THE QUALITY OF PATIENT CARE THROUGH VARIOUS CANCER RELATED PROGRAMS. FOCUSING ON THE FULL SPECTRUM OF CANCER CARE, THE PROGRAM INCLUDES EMPHASIS ON PREVENTION, EARLY DIAGNOSIS, CANCER STAGING, OPTIMAL TREATMENT, LIFELONG FOLLOW UP FOR RECURRENT DISEASE AND END OF LIFE CARE.RIVERWOOD DEVELOPED A "FARM TO RIVERWOOD" PROGRAM THAT CONTRACTS WITH LOCAL FARMERS. THIS ENABLES THE HOSPITAL TO OFFER NUTRIENT DENSE, MINIMALLY PROCESSED FARM FRESH FOODS FOR FEATURE IN SPECIAL MEALS TO PATIENTS, GUESTS AND STAFF. THIS ENDEAVOR SUPPORTS RIVERWOODS GOAL TO HELP IMPROVE THE HEALTH OF THE POPULATION AND FOSTER POSITIVE BEHAVIORAL HEALTH THROUGH ENCOURAGING HEALTHY EATING ALL WHILE SUPPORTING AND PARTNERING WITH LOCAL VENDORS.RIVERWOOD SUPPORTS THE HEALTH OF THE COMMUNITY IN VARIOUS WAYS. HEALTH AND WELLNESS COACHING IS OFFERED FREE OF CHARGE. FREE BLOOD GLUCOSE MONITORS, SCALES, BLOOD PRESSURE CUFFS, ETC. ARE PROVIDED TO PATIENTS AT NO COST. DIABETES SUPPORT IS OFFERED THRU A SERIES OF NATIONAL DIABETES PREVENTION PROGRAM CLASSES AS WELL AS INDIVIDUAL APPOINTMENTS AND GROUP CLASSES. WELLNESS AND PHYSICAL ACTIVITIES INCLUDE SUPPORT OF AREA SCHOOL SPORTS, COMMUNITY WALKS/RUNS, AND FITNESS AND WELLNESS PROGRAMS. EDUCATING THE COMMUNITY ABOUT DRUG ABUSE, PREVENTION AND TREATMENT IS PART OF RIVERWOOD'S ONGOING COORDINATED EFFORTS ALONG WITH AITKIN COUNTY HEALTH AND HUMAN SERVICES, LOCAL LAW ENFORCEMENT AGENCIES, ETC. DEVELOPMENT IS UNDERWAY FOR A PROGRAM FOR THOSE ADDICTED TO OPIOIDS. COMMUNITY EDUCATION ON PRESCRIPTION DRUG DEPENDENCE AND HOW TO PREVENT IT IS BEING PROVIDED. FINANCIAL SUPPORT AND ASSISTANCE FOR PATIENTS IS OFFERED THRU RIVERWOOD'S CONFIDENTIAL FINANCIAL COUNSELING SERVICES (TELEPHONE 218-927-8284). RIVERWOOD PLACES CONTINUING EMPHASIS ON WORKING TOWARDS THE GOALS AS DEFINED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT LAST COMPLETED IN 2016. WITH IDENTIFIED PRIORITY HEALTH ISSUES OF MENTAL HEALTH, NUTRITION, PHYSICAL ACTIVITY AND WEIGHT, HEART DISEASE AND STROKE, DIABETES, ACCESS TO HEALTHCARE SERVICES, INJURY AND VIOLENCE AND SUBSTANCE ABUSE, WE KEEP THE NEEDS OF OUR PATIENTS AT THE FOREFRONT OF OUR ENDEAVORS. OUR PROGRESS AND SUCCESSES EACH YEAR ARE DUE TO OUR CONTINUAL FOCUS ON ADDRESSING OUR COMMUNITY'S HEALTH CARE NEEDS. 49894506 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 67 0 1 458 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 MN X JUDY TURNER 2189272121 200 BUNKER HILL DRIVE AITKIN MN 56431 JEFF EHNSTROM MD DIRECTOR/PHYSICIAN 40.00 X 396129 0 40595 STEVE WILSON DIRECTOR 1.00 X 0 0 0 ALISON MATALAMAKI TREASURER 1.00 X X 0 0 0 MIKE PAULBECK FORMER CHAIRMAN 1.00 X X 0 0 0 JARED LUNDGREN DIRECTOR 1.00 X 0 0 0 TOM LUNDBERG DIRECTOR 1.00 X 0 0 0 TIMOTHY DIRKS MD DIRECTOR 1.00 X 0 0 0 DAVID MEYER FORMER SECRETARY 1.00 X X 0 0 0 KATHLEEN RYAN VICE CHAIRMAN 1.00 X X 0 0 0 CHAD GROSS CHAIRMAN 1.00 X X 0 0 0 CHRISTINE BRIGHT SECRETARY 1.00 X X 0 0 0 CHAD COOPER CEO 39.90 0.10 X 387437 0 40345 CASEY JOHNSON CFO 39.90 0.10 X 149234 0 38790 CYNTHIA BAKER COO 40.00 X 125795 0 19685 MARK HEGGEM MD CMO 40.00 X 275908 0 39612 JEFFREY RAPP MD PHYSICIAN 40.00 X 294141 0 34274 JIM HARRIS MD ER MEDICAL DIRECTOR 40.00 X 333149 0 37062 DAVID TAYLOR MD PHYSICIAN 40.00 X 317568 0 20065 DONALD HUGHES MD PHYSICIAN 40.00 X 288995 0 38004 JOSELITO BURGOS JR MD PHYSICIAN 40.00 X 250153 0 45650 2818509 0 354082 40 0 1 0 LIFE GUARD ANESTHESIA SERVICES INC 29561 395TH PLACE AITKIN MN 56431 ANESTHESIA PROF SVCS 1240465 CUYUNA RANGE HOSITAL DISTRICT 320 E MAIN CROSBY MN 56441 MEDICAL/SURGICAL PROF SVCS 1225667 CENTRAL MINNESOTA DIAGNOSTICS INC 150 10TH STREET NW MILACA MN 56353 RADIOLOGY PROF SVCS 1160059 CUYUNA REGIONAL MEDICAL CENTER 320 E MAIN CROSBY MN 56441 MEDICAL/SURGICAL PROF SVCS 1095704 ALLINA HEALTH SYSTEM NW 7710 PO BOX 9383 MINNEAPOLIS MN 55440 MEDICAL & INFO TECH PROF SVCS 961917 10 279803 393980 185267 859050 NET PATIENT SERVICE REVENUE 621500 59411554 59411554 EQUITY IN EARNINGS OF AFFILIATES 900099 263222 265983 -2761 ELECTRONIC HEALTH RECORD INCENTIV 621500 212562 212562 59887338 817486 817486 11411557 2000 10895210 0 516347 2000 518347 518347 OTHER REVENUE 900099 220211 220211 CAFETERIA 900099 120842 120842 341053 62423274 60628657 -2761 938328 X 256697 256697 5000 5000 1615280 455038 1160242 21793210 18845367 2846767 101076 812574 730898 81676 3351082 2989821 361261 1506596 1304775 201821 25411 25411 79714 79714 2035 2035 21480 21480 9033281 8128107 903719 1455 116632 116632 1679601 975487 693825 10289 217780 217780 667055 544844 122211 74304 58230 15552 522 62630 43264 18738 628 930438 772264 158174 3746360 3109479 636881 262718 262718 DRUGS 5258412 5258412 MEDICAL SUPPLIES 3323132 3290070 33062 PROVISION FOR DOUBTFUL 1697472 1697472 REPAIRS & MAINTENANCE 1111310 1022934 86618 1758 1927778 406347 1488521 32910 59577982 49894506 9513358 170118 15708 5194208 335845 14248725 12193420 1526643 1692421 435898 604456 66341075 38892019 28628633 27449056 28497776 30489791 8145801 7700602 81835029 85323954 6521073 7274666 23429624 20353904 11172062 12800278 41122759 40428848 X 39868052 43476529 844218 1418577 40712270 44895106 81835029 85323954 X 2845292 763185 574359 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2035 2035 0 PART II-B, LINE 1: RIVERWOOD HEALTHCARE CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 564552 650 50390 615592 530721 10600 38231 15000 564552 558330 75 -22684 5000 530721 406564 134710 27056 2000 8000 558330 380978 15063 26281 15758 406564 0.37560 0.43710 0.18730 0 1 1 1327070 1327070 33302042 15776006 17526036 26573924 20605570 5968354 5138039 2510443 2627596 27449056 ASSETS LIMITED FOR RESERVE ACCOUNTS 688320 BENEFICIAL INTEREST IN NET ASSETS-HOSPITAL FOUNDATION 1418577 INVESTMENT IN CENTRAL MINNESOTA DIAGNOSTICS, INC. 991537 ASSETS LIMITED BY AGREEMENT FOR DEFERRED COMPENSATION 1513075 ASSETS LIMITED BY AGREEMENT FOR WORKER'S COMPENSATION 238000 ASSETS LIMITED BY BOARD FOR FUNDED DEPRECIATION 2851093 7700602 X 61816034 763185 -1368425 -605240 62421274 2000 2000 62423274 57633198 -2000 -2000 57635198 1942784 1942784 59577982 PART V, LINE 4: TO BE USED AND DISTRIBUTED AS A SCHOLARSHIP OR EDUCATIONAL FUND TO AID IN THE EDUCATION AND RECRUITMENT OF HEALTH CARE PROFESSIONALS FOR RIVERWOOD HEALTHCARE CENTER. PART X, LINE 2: NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE CENTER HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES -1,697,472. DECREASE IN INTEREST IN NET ASSETS - AITKIN COMMUNITY HOSPITAL FOUNDATION 574,359. CONTRIBUTIONS TO RIVERWOOD FOUNDATION -245,312. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT 2,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT -2,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 1,697,472. CONTRIBUTIONS TO RIVERWOOD FOUNDATION 245,312. X X 1 VELA STRATEGY PO BOX 54 SAUK RAPIDS MN 56379 GRANT WRITING 0 275000 9780 265220 JAYNES JONES W5758 BAYSIDE DRIVE SPOONER WI 54801 GRANT WRITING 0 0 11700 -11700 275000 21480 253520 MN PART I, LINE 1 RIVERWOOD HEALTHCARE CENTER PAYS FOR THE PROFESSIONAL FUNDRAISERS, BUT THE FUNDRAISING ACTIVITIES ARE DONE THROUGH THE RIVERWOOD HEALTHCARE CENTER FOUNDATION. THE FOUNDATION RAISED FUNDS THROUGH THE FOLLOWING ACTIVITIES: MAIL SOLICITATIONS, EMAIL SOLICITATIONS, IN-PERSON SOLICITATIONS, PHONE SOLICITATIONS, AND SPECIAL FUNDRAISING EVENTS. PART I, LINE 2 RIVERWOOD HEALTHCARE CENTER PAYS FOR THE PROFESSIONAL FUNDRAISERS (COLUMN V), BUT WHETHER THE GROSS RECEIPTS ARE RECEIVED BY THE RIVERWOOD HEALTHCARE CENTER FOUNDATION OR THE RIVERWOOD HEALTHCARE CENTER IS DEPENDENT ON THE GRANTOR (COLUMN IV). 1 1 1 X 1 X 1 1 0 1 1 819090 819090 0.01420 8934680 7824538 1110142 0.01920 9753770 7824538 1929232 0.03340 759327 759327 0.01310 18940 18940 0.00030 778267 778267 0.01340 10532037 7824538 2707499 0.04680 1 1697472 351400 21378813 21513812 -134999 X 1 1 1 1 RIVERWOOD HEALTHCARE CENTER 200 BUNKER HILL DRIVE AITKIN MN 56431 375729 X X X X AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X 1 15 0 1 0 1 X 200.000000000000 200.000000000000 X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X 1 X 0 0 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 5: RIVERWOOD HEALTHCARE CENTER SELECTED A GROUP OF 150 LOCAL RESIDENTS AND RECOMMENDED THE NAMES TO THE INDEPENDENT VENDOR RESEARCH CONSULTANTS, INC. (PRC), FOR INCLUSION IN AN ONLINE QUESTIONNAIRE. THE RESPONSES TO THE QUESTIONNAIRE WERE USED TO A FORM A COMMUNITY HEALTH PANEL. OF THE TOTAL ABOVE, 102 RESPONSES WERE RECEIVED BACK. FEEDBACK AND RESPONSES WERE RECEIVED FROM AREA SCHOOL DISTRICTS, LOCAL LAW ENFORCEMENT, AITKIN COUNTY HEALTH AND HUMAN SERVICES, AREA BUSINESSES AND COMMUNITY LEADERS, AND AREA HEALTHCARE PROFESSIONALS. AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 11: THE MISSION OF RIVERWOOD HEALTHCARE CENTER IS TO PROVIDE HIGH QUALITY, COMPASSIONATE, AND PERSONALIZED CARE. THE IMPLEMENTATION STRATEGY IS DESIGNED TO ADDRESS THE HEALTH CARE NEEDS OF THE PEOPLE OF AITKIN COUNTY, AND THEIR UNIQUE CHARACTERISTICS AND HEALTHCARE NEEDS. THE IMPLEMENTATION STRATEGIES ARE BASED ON RIVERWOOD'S CURRENT PROGRAMMING, SURVEY DATA, AND COMMUNITY INPUT. RIVERWOOD'S STRATEGIC PLAN IS DEVELOPED BY ITS LEADERSHIP TEAM AND REVIEWED ANNUALLY. THE IMPLEMENTATION STRATEGY ALSO IDENTIFIES HOW EXISTING AND PLANNED RIVERWOOD SERVICES, PARTNERSHIPS AND PROGRAMS WILL BE UTILIZED TO HELP ADDRESS COMMUNITY HEALTH NEEDS. THE IMPLEMENTATION STRATEGY FOR THE HEALTH OF AITKIN COUNTY CHNA IS THE HOSPITAL/COMMUNITY PLAN FOR ADDRESSING THE COMMUNITY HEALTH NEEDS. IRS NOTICE 2011-52 DICTATES THE CONTENTS OF AN IMPLEMENTATION STRATEGY, AND STATES THAT THE HOSPITAL MUST ADDRESS HOW IT BOTH INTENDS AND DOES NOT INTEND TO ADDRESS THE IDENTIFIED COMMUNITY HEALTH NEEDS. RIVERWOOD HEALTHCARE CENTER'S IMPLEMENTATION STRATEGY IS DESCRIBED IN THIS SECTION OF THE REPORT. WE WILL CONTINUE TO STAY THE COURSE AND FOLLOW OUR STRATEGIC PLAN. WE WILL CREATE THE FUTURE WE SEEK BY FOCUSING ON SIX CRITICAL STRATEGIC GOALS:(1) QUALITY: OUR CUSTOMERS ARE DEMANDING MORE EFFICIENCY, BETTER QUALITY, AND SUPERIOR SAFETY. WE WILL LEAD IN DELIVERING ON THESE REQUIREMENTS THROUGH IMPROVED DATA, REPORTING AND PROCESS IMPROVEMENTS.(2) PEOPLE: OUR PEOPLE ARE KEY. WE WILL INSPIRE THEIR TRUST, IMPROVE THEIR SKILLS, AND DEVELOP LEADERSHIP AND ENGAGEMENT THAT LEADS US INTO A STRONGER FUTURE.(3) STEWARDSHIP: WE WILL ACHIEVE OPERATING MARGINS THAT ENSURE LONG-TERM FINANCIAL STRENGTH AND THE CAPACITY TO CONTINUE TO INVEST FOR THE BENEFIT OF PATIENTS AND FAMILIES.(4) GROWTH: WE WILL GROW OUR PRIMARY CARE SERVICES AND SHARE OF OUR MARKET. WE INTEND TO BUILD THE CONFIDENCE OF OUR COMMUNITY IN THEIR ABILITY AND DESIRE TO STAY LOCAL FOR CARE AND KNOW THAT WHEN THEY NEED SPECIALIZED OR TERTIARY CARE WE WILL MAKE THE TRANSITION EASY.RIVERWOOD'S ADDRESSING OF NEEDSRIVERWOOD'S IMPLEMENTATION STRATEGY WILL ADDRESS ALL THE IDENTIFIED PRIORITIES. PRIORITY HEALTH ISSUES TO BE ADDRESSED WILL FOCUS ON DEVELOPING AND/OR SUPPORTING STRATEGIES AND INITIATIVES TO IMPROVE: 1) MENTAL HEALTH 2) NUTRITION, PHYSICAL ACTIVITY AND WEIGHT 3) HEART DISEASE AND STROKE4) DIABETES5) ACCESS TO HEALTHCARE SERVICES6) INJURY AND VIOLENCE 7) SUBSTANCE ABUSETHE ONLY ISSUES THAT WILL NOT BE ADDRESSED IS FAMILY PLANNING, SINCE THE HOSPITAL HAS LIMITED RESOURCES TO ADDRESS UNINTENDED PREGNANCIES FOR TEENS. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS TO BETTER MEET THE NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA FOR ACTION.CONCLUSION IN ADDITION TO SPECIFIC STRATEGIES AND MISSION DRIVEN PROGRAMS, RIVERWOOD HEALTHCARE CENTER WILL CONTINUE TO BUILD ITS PATIENT-CENTERED HEALTHCARE HOME (PCHH) AS IT ADDRESSES COMMUNITY NEEDS. IT IS WHAT ALIGNS WITH THE HOSPITAL STRATEGIC PLAN AND WITH THE CHNA. WE KNOW THAT THE PCHH IS NOT ONLY THE WAVE OF THE FUTURE, BUT WILL POSITIVELY IMPACT THE HEALTH OF THE PEOPLE OF AITKIN COUNTY. RHCC BUILDS EVALUATIVE MEASURES AND GOALS INTO ALL OF ITS PROGRAMS AND SERVICES. IN ADDITION, THE CHNA PLAN IS REVIEWED AND REWRITTEN EVERY 3 YEARS. RHCC'S MANAGEMENT TEAM WILL CONTINUE TO PLAY A LEADERSHIP ROLE IN THE IMPLEMENTATION STRATEGIES AND MONITOR ITS PROGRESS, AND MAKE ADJUSTMENTS TO STRATEGIES AS NEEDED. AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 16J: THE HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO IS AVAILABLE TO TALK WITH ANY PATIENT WHO FEELS THEY MAY HAVE DIFFICULTY PAYING THEIR BILL. SHE IS A TRAINED MNSURE NAVIGATOR AND CAN ASSIST ANYONE WITH CHECKING TO SEE IF THEY QUALIFY FOR MEDICAL ASSISTANCE, MNCARE OR IF THEY COULD PURCHASE AN INSURANCE. SHE OFFERS INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP) AND CAN ANSWER ANY QUESTIONS ON APPLYING FOR AND GETTING COMMUNITY CARE THROUGH THE HOSPITAL. ALL THE HOSPITAL'S PATIENT ACCOUNTS REPRESENTATIVES ARE EDUCATED ABOUT COMMUNITY CARE AND IF PATIENTS INDICATE THEY DON'T FEEL THEY CAN PAY, STAFF WILL GET THEM THE FAP AND APPLICATION. NURSING, PHYSICIANS AND ALL PATIENT CARE STAFF ARE EDUCATED ABOUT FAP AND SHARE PATIENTS WHO INDICATED A NEED. RIVERWOOD ALSO HAS DAILY PATIENT CENTERED BEDSIDE ROUNDING WHERE ALL INPATIENTS AND THEIR FAMILIES GET TO MEET WITH THE HOSPITAL'S HEALTHCARE TEAM, WHICH INCLUDES THE FINANCIAL COUNSELOR. EVERY TEAM MEMBER INTRODUCES THEMSELVES AND EXPLAINS WHAT THEY DO, WITH THE FINANCIAL COUNSELOR INFORMING THE PATIENT ABOUT HER AVAILABILITY TO ASSIST THEM WITH ANY OF THEIR INSURANCE OR FINANCIAL NEEDS. EACH INPATIENT ALSO GETS A FOLDER OF BROCHURES OF HEALTHCARE INFORMATION AS PART OF THEIR STAY. THIS FOLDER CONTAINS INFORMATION REGARDING THE FAP AND LISTS THE FINANCIAL COUNSELORS CONTACT INFORMATION, SHOULD A PATIENT WANT TO MAKE CONTACT AFTER DISCHARGE FROM THE FACILITY. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE HTTPS://RIVERWOODHEALTHCARE.ORG/WP-CONTENT/UPLOADS/2016/10/2016-RHCC-CHNA-REPORT-AITKIN-COUNTY-MN.PDF PART V, LINE 16A, FAP WEBSITE HTTPS://RIVERWOODHEALTHCARE.ORG/WP-CONTENT/UPLOADS/2018/06/COMMUNITY-CARE-AND-UNINSURED-POLICY.PDF PART V, LINE 16B, FAP APPLICATION WEBSITE HTTPS://RIVERWOODHEALTHCARE.ORG/WP-CONTENT/UPLOADS/2018/06/COMMUNITY-CARE-AND-UNINSURED-POLICY.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY HTTPS://RIVERWOODHEALTHCARE.ORG/WP-CONTENT/UPLOADS/2018/06/COMMUNITY-CARE-AND-UNINSURED-POLICY.PDF PART V, LINE 7B, CHNA - OTHER WEBSITE HTTP://AITKINCOUNTY.HEALTHFORECAST.NET/2016%20PRC%20CHNA%20REPORT%20-%20AITKIN%20COUNTY,%20MN.PDF 3 1 - RIVERWOOD AITKIN CLINIC 200 BUNKER HILL DRIVE AITKIN MN 56431 CLINIC 2 - RIVERWOOD MCGREGOR CLINIC 2 E CENTRAL AVENUE AITKIN MN 56431 CLINIC 3 - RIVERWOOD GARRISON CLINIC 27278 STATE HWY 18 GARRISON MN 56450 CLINIC PART I, LINE 3C: IN ADDITION TO INCOME BASED TESTING, OUR CHARITY CARE POLICY REQUIRES THAT AN APPLICANT MUST HAVE RECEIVED A DENIAL FROM EITHER MEDICAID (MINNESOTA ASSISTANCE) OR OTHER STATE SUBSIDIZED HEALTHCARE PROGRAMS (MINNESOTA CARE OR GMAC). PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2017 MEDICARE COST REPORT. PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $1,697,472. PART I LINE 6A THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH MINNESOTA. THIS INFORMATION IS AVAILABLE ON THE MINNESOTA HOSPITAL ASSOCIATION WEBSITE. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: MANAGEMENT DETERMINES THE ALLOWANCES FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND THEN USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PART III, LINE 3: THE HOSPITAL LOOKS AT THE NUMBER OF CHARITY CARE APPLICATIONS SENT TO POTENTIAL APPLICANTS AND COMES UP WITH AN APPROVAL RATIO BASED ON RETURNED APPLICATIONS. THE PERCENTAGE OF UNRETURNED APPLICATIONS IS THEN MULTIPLIED BY THE TOTAL DOLLAR AMOUNT OF BAD DEBT EXPENSE. PART III, LINE 4: FROM FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS - "ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE VALUE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ONGOING ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY INSURANCE COVERAGE (INCLUDING COPAYMENT AND DEDUCTIBLE AMOUNTS FROM PATIENTS), THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH PRIVATE-PAY PATIENTS, THE CENTER RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS HISTORICAL EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.THE CENTER FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE REVISED AS NEEDED IN FUTURE PERIODS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF PRIVATE-PAY RECEIVABLES HAS DECREASED FROM 61.3 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2016, TO 54.7 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2017.THE CENTER HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2017 OR 2016. THE CENTER DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS.RECEIVABLES OR PAYABLES RELATED TO ESTIMATED SETTLEMENTS WITH GOVERNMENT PAYORS ARE REPORTED AS THIRD-PARTY PAYOR SETTLEMENTS RECEIVABLE OR PAYABLE." PART III, LINE 8: RECONCILIATION OF TOTAL MEDICARE PROGRAM AND WHAT IS ALLOWED ON THE COST REPORT:AITKIN COMMUNITY HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF CERTAIN COSTS (LESS 2% MEDICARE SEQUESTRATION). THE HOPSITAL FACILITY'S TOTAL MEDICARE SHORTFALL IS $708,322, OF WHICH A SHORTFALL OF $134,999 (CONSISTING OF $21,378,813 NET REVENUE AND $21,513,812 COST) IS INCLUDED ON PART III, SECTION B, LINES 5-7, AND A SHORTFALL OF $573,324 (CONSISTING OF $5,971,263 NET REVENUE AND $6,544,587 COST) REPRESENT ALL OTHER MEDICARE SERVICES NOT INCLUDED IN THE ANNUAL COST REPORT.THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: AITKIN COMMUNITY HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY TO THE UNINSURED AND TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. THE HOSPITAL EMPLOYS A FULL TIME FINANCIAL COUNSELOR WHO WORKS WITH PATIENTS TO EVALUATE ELIGIBILITY AND REDIRECT THEM AS NEEDED TO LOCAL STATE OR COUNTY STAFF FOR ASSISTANCE WITH APPLICATIONS FOR GOVERNMENTAL ASSISTANCE PROGRAMS. UPON RECEIPT OF DENIAL, PATIENT WILL BE PROVIDED A CHARITY CARE APPLICATION. DEPENDING ON THE PATIENT'S INCOME AND THE GUIDELINES, THEY WILL BE PROVIDED A WAIVER OF ALL CHARGES OR A REDUCTION IN THEIR MEDICAL CHARGES. THE HOSPITAL'S BILLING STAFF, PATIENT ACCESS STAFF AND OUTSIDE COLLECTION AGENCIES ARE ALL EDUCATED AND AWARE OF THE CHARITY CARE ASSISTANCE PROGRAM AND IN THE COURSE OF THEIR EVERYDAY WORK WILL OFFER PATIENTS THIS INFORMATION IF THEY EXPRESS A NEED FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: NEEDS ASSESSMENT:AITKIN COMMUNITY HOSPITAL PERFORMS A COMMUNITY NEEDS ASSESSMENT TO EVALUATE THE HEALTH CARE NEEDS OF THE COMMUNITY EVERY 3 YEARS WITH AN OUTSIDE CONSULTING FIRM. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:AITKIN COMMUNITY HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY TO THE UNINSURED AND TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. THE HOSPITAL EMPLOYS A FULL TIME FINANCIAL COUNSELOR WHO WORKS WITH PATIENTS TO EVALUATE ELIGIBILITY AND REDIRECT THEM AS NEEDED TO LOCAL STATE OR COUNTY STAFF FOR ASSISTANCE WITH APPLICATIONS FOR GOVERNMENTAL ASSISTANCE PROGRAMS. UPON RECEIPT OF DENIAL, PATIENT WILL BE PROVIDED A CHARITY CARE APPLICATION OR SLIDING FEE SCALE APPLICATION. DEPENDING ON THE PATIENT'S INCOME AND THE GUIDELINES, THEY WILL BE PROVIDED A WAIVER OF ALL CHARGES OR A REDUCTION IN THEIR MEDICAL CHARGES. RIVERWOOD'S EMPLOYED FINANCIAL COUNSELOR IS A MNSURE NAVIGATOR, TRAINED AND CERTIFIED BY THE STATE OF MINNESOTA, AND IS AVAILABLE TO ASSIST PATIENTS WITH CHECKING FOR THEIR POSSIBLE ELIGIBILITY FOR MEDICAL ASSISTANCE, MNSURE, OR TO PURCHASE INSURANCE.THE HOSPITAL'S BILLING STAFF, PATIENT ACCESS STAFF AND OUTSIDE COLLECTION AGENCIES ARE ALL EDUCATED AND AWARE OF THE CHARITY CARE ASSISTANCE PROGRAM AND SLIDING FEE SCALE AND IN THE COURSE OF THEIR EVERYDAY WORK WILL OFFER PATIENTS THIS INFORMATION IF THEY EXPRESS A NEED FOR FINANCIAL ASSISTANCE. NURSING PROVIDERS AND ALL HEALTHCARE STAFF ARE ALSO AWARE OF THE ASSISTANCE PROGRAM AND CAN HELP DIRECT PATIENTS TO THE FINANCIAL COUNSELOR. PART VI, LINE 4: COMMUNITY INFORMATION:AITKIN COMMUNITY HOSPITAL, INC. D.B.A. RIVERWOOD HEALTHCARE CENTER (RIVERWOOD), A 501(C)3 NON-PROFIT CORPORATION, IS SITUATED IN THE CENTER OF AITKIN COUNTY. IT WAS FOUNDED IN 1948 AND IS LOCATED AT 200 BUNKER HILL DRIVE IN AITKIN, MN (POP. 1984). RIVERWOOD IS A 25 BED ACUTE-CARE CRITICAL ACCESS HOSPITAL AND HAS THREE RURAL HEALTH CLINICS IN AITKIN, MCGREGOR AND GARRISON. ALL THREE CLINICS ARE LOCATED IN A MEDICALLY UNDERSERVED AREA (MUA). RIVERWOOD OFFERS PATIENTS A CONTINUUM OF CARE INCLUDING INPATIENT, OUTPATIENT, SPECIALTY, SURGICAL AND EMERGENCY SERVICES. THE DISTANCE TO THE NEXT HOSPITAL IS 17 MILES. DULUTH AND ST. CLOUD ARE THE TWO CLOSEST CITIES WITH TERTIARY CARE CENTERS BOTH APPROXIMATELY 90 MILES FROM AITKIN.RIVERWOOD SERVES THE RESIDENTS OF AITKIN COUNTY (POP. 16,149) THE EAST SIDE OF CROW WING COUNTY (POP. 61,009) AND MILLE LACS COUNTY (POP. 26,169). THE GEOGRAPHIC AREA OF THESE COUNTIES IS RURAL.SPECIAL POPULATIONS SERVED INCLUDE THOSE WITH A HIGH RATE OF POVERTY AND UNEMPLOYMENT WITH AITKIN, CROW WING AND MILLE LACS COUNTIES. IN 2007, THE ESTIMATED PERCENTAGES OF THESE THREE COUNTIES WITH POPULATIONS BELOW POVERTY LEVEL WERE RESPECTIVELY: AITKIN - 13.4%, CROW WING - 9.3%, MILLE LACS - 9.5%. ADDITIONALLY, ACCORDING TO THE MINNESOTA DEPARTMENT OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, THE UNEMPLOYMENT RATE IN AITKIN COUNTY SKYROCKETED TO 10.5% IN JANUARY 2009, WHICH IS NEARLY 4 PERCENTAGE POINTS OVER THE STATE AVERAGE OF 6.9%. THE DEPARTMENT OF LABOR AND INDUSTRY CONSIDERS AITKIN COUNTY TO BE A "LABOR SURPLUS AREA". OTHER SPECIAL POPULATIONS SERVED ALSO INCLUDE THE ELDERLY. THE LARGEST PERCENTAGE OF RIVERWOOD'S CURRENT PATIENT BASE CONSISTS OF PATIENTS OVER THE AGE OF 65. POPULATION PROJECTIONS INDICATE THAT BETWEEN THE YEARS OF 2005-2030, A 50% OVERALL INCREASE IS EXPECTED IN AITKIN COUNTY WITH THE 65+ AGE GROUP BY 120%. AITKIN COUNTY HAS THE OLDEST MEDIAN POPULATION IN MINNESOTA. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:IN FURTHERANCE OF ITS CHARITABLE PURPOSE, THE CENTER PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED SERVICE PROGRAMS AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY, A LARGE NUMBER OF HEALTH RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 RIVERWOOD HEALTHCARE CENTER & COMMUNITY HOSPITAL FOUNDATION 200 BUNKER HILL AITKIN MN 56431 411738787 501(C)(3) 245312 GENERAL OPERATIONS 1 0 X X X X X X 0 0 0 0 0 0 0 0 0 JEFF EHNSTROM MD DIRECTOR/PHYSICIAN 386612 0 9517 0 0 0 10600 0 29995 0 436724 0 0 0 CHAD COOPER CEO 332592 0 47645 0 7200 0 10600 0 29745 0 427782 0 0 0 CASEY JOHNSON CFO 141904 0 7330 0 0 0 6482 0 32308 0 188024 0 0 0 MARK HEGGEM MD CMO 268578 0 7330 0 0 0 10600 0 29012 0 315520 0 0 0 JEFFREY RAPP MD PHYSICIAN 288641 0 5500 0 0 0 10600 0 23674 0 328415 0 0 0 JIM HARRIS MD ER MEDICAL DIRECTOR 323149 0 10000 0 0 0 10600 0 26462 0 370211 0 0 0 DAVID TAYLOR MD PHYSICIAN 307568 0 10000 0 0 0 10600 0 9465 0 337633 0 0 0 DONALD HUGHES MD PHYSICIAN 279478 0 9517 0 0 0 10600 0 27404 0 326999 0 0 0 JOSELITO BURGOS JR MD PHYSICIAN 240636 0 9517 0 0 0 10600 0 35050 0 295803 0 0 0 PART I, LINE 3 RIVERWOOD HAS A COMPENSATION COMMITTEE OF THE BOARD WHICH MEETS ANNUALLY TO REVIEW, DISCUSS AND RECOMMEND APPROVAL TO THE FULL BOARD OF THE ANNUAL INCENTIVE COMPENSATION GOALS FOR THE CEO AND CERTAIN MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM. ANNUALLY, THE COMMITTEE ALSO REVIEWS COMPENSATION OF THE CEO AS WELL AS MEMBERS OF THE EXECUTIVE LEADERSHIP TO ENSURE STATED COMPENSATION FALLS WITHIN A FAIR MARKET VALUE RANGE. IN DOING SO, THE COMMITTEE RELIES HEAVILY ON A COMPENSATION SURVEY(S) WHICH IS CONDUCTED BY AN EXTERNAL COMPENSATION CONSULTANT GENERALLY EVERY 2 YEARS, ALONG WITH ANY OTHER DATA OR FACTORS WHICH THE COMMITTEE MAY DEEM RELEVANT FROM TIME TO TIME. UPON RECOMMENDATION FROM THE COMPENSATION COMMITTEE, THE FULL BOARD IS RESPONSIBLE FOR APPROVING COMPENSATION OF THE CEO AS WELL AS THE ANNUAL INCENTIVE COMPENSATION GOALS AND ASSOCIATED METRICS. A CITY OF AITKIN 416004918 2016-05-17 5985025 REFINANCE DEBT WHICH FINANCED CONSTRUCTION OF NEW HOSPITAL IN 2001 0 0 0 B CITY OF MCGREGOR 410906736 2016-05-17 8000000 REFINANCE DEBT WHICH FINANCED CONSTRUCTION OF NEW HOSPITAL IN 2001 0 0 0 C CITY OF TAMARACK 411315842 2016-05-17 8000000 REFINANCE DEBT WHICH FINANCED CONSTRUCTION OF NEW HOSPITAL IN 2001 0 0 0 A 385364 5985025 89142 5895883 2013 1 0 1 1 B 515104 8000000 119153 7880847 2013 1 0 1 1 C 515104 8000000 119153 7880847 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 JENNIFER EHNSTROM FAMILY MEMBER OF BOARD MEMBER JEFFREY EHNSTROM, MD 17136 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 RIVERWOOD HEALTHCARE CENTER HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A RIVERWOOD HEALTHCARE CENTER HAS MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD HAS AUTHORIZED THE FINANCE COMMITTEE TO REVIEW AND APPROVE THE 990 AFTER PREPARATION. AFTER APPROVAL BY THE FINANCE COMMITTEE, THE 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. CONFLICTS ARE DISCUSSED, REVIEWED, AND FORMS ARE SIGNED ANNUALLY BY EACH BOARD MEMBER. THIS IS DONE AT THE HOSPITAL'S ANNUAL REORGANIZATIONAL MEETING. SECTION 1. PURPOSE THE PURPOSE OF THIS POLICY IS TO PROVIDE A MEANS BY WHICH TO ADDRESS ANY CONFLICT OF INTEREST INVOLVING THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, AND EMPLOYEES THAT AFFECT OR HAVE THE POTENTIAL TO AFFECT THE SAFETY OR QUALITY OF CARE, TREATMENT, AND SERVICES. SECTION 2. PERSONS CONCERNED THIS STATEMENT IS DIRECTED NOT ONLY TO BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, BUT TO ALL EMPLOYEES OR NON-EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF RHCC FOR EXAMPLE, THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL, AND ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING RHCC. SECTION 3. AREAS IN WHICH CONFLICT MAY ARISE CONFLICTS OF INTEREST MAY ARISE IN THE RELATIONS OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WITH ANY OF THE FOLLOWING THIRD PARTIES: 1. PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO RHCC. 2. PERSONS AND FIRMS FROM WHOM RHCC LEASES PROPERTY AND EQUIPMENT. 3. PERSONS AND FIRMS WITH WHOM RHCC IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES, OR OTHER PROPERTY. 4. COMPETING OR AFFINITY ORGANIZATIONS. 5. DONORS AND OTHERS SUPPORTING RHCC. 6. AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF RHCC. 7. FAMILY MEMBERS, FRIENDS, AND OTHER EMPLOYEES. SECTION 4. NATURE OF CONFLICTING INTEREST A CONFLICTING INTEREST MAY BE DEFINED AS AN INTEREST, DIRECT OR INDIRECT, WITH ANY PERSONS OR FIRMS MENTIONED IN SECTION 3. SUCH AN INTEREST MIGHT ARISE THROUGH: SECTION 5. INTERPRETATION OF THIS STATEMENT OF POLICY THE AREAS OF CONFLICTING INTEREST LISTED IN SECTION 3, AND THE RELATIONS IN THOSE AREAS WHICH MAY GIVE RISE TO CONFLICT, AS LISTED IN SECTION 4, ARE NOT EXHAUSTIVE. CONFLICTS MIGHT ARISE IN OTHER AREAS OR THROUGH OTHER RELATIONS. IT IS ASSUMED THAT THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. THE FACT THAT ONE OF THE INTERESTS DESCRIBED IN SECTION 4 EXISTS DOES NOT NECESSARILY MEAN THAT A CONFLICT EXISTS, OR THAT THE CONFLICT, IF IT EXISTS, IS MATERIAL ENOUGH TO BE OF PRACTICAL IMPORTANCE, OR IF MATERIAL, THAT UPON FULL DISCLOSURE OF ALL RELEVANT FACTS AND CIRCUMSTANCES IT IS NECESSARILY ADVERSE TO THE INTERESTS OF RHCC. HOWEVER, IT IS THE POLICY OF THE GOVERNING BOARD THAT THE EXISTENCE OF ANY OF THE INTERESTS DESCRIBED IN SECTION 4 SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. SECTION 6. DISCLOSURE POLICY AND PROCEDURE PROCEDURES FOR ADDRESSING CONFLICTS OF INTEREST TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: 1. THE CONFLICTING INTEREST AND ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE GOVERNING BOARD OF DIRECTORS OR TO A COMMITTEE WITH BOARD-DELEGATED POWERS; 2. THE PERSON WITH THE CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL BE EXCLUDED FROM THE DISCUSSION AND VOTE ON APPROVAL OF SUCH TRANSACTION; 3. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 4. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER RHCC CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST; 5. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN RHCC'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO RHCC, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. DISCLOSURE DISCLOSURE IN RHCC SHOULD BE MADE TO THE CHIEF EXECUTIVE OFFICER (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE GOVERNING BOARD OF DIRECTORS. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE GOVERNING BOARD CHAIR (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE GOVERNING BOARD VICE-CHAIR) WHO SHALL BRING THESE MATTERS TO THE GOVERNING BOARD. DECISION THE GOVERNING BOARD OF DIRECTORS OR A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO RHCC. IN THE CASE OF A CONFLICT INVOLVING A MEMBER OF THE GOVERNING BOARD OF DIRECTORS, THE GOVERNING BOARD OR COMMITTEE REVIEWING THE MATTER SHALL CONSIDER THE DISABLING GUIDELINES ATTACHED HERETO. THE DECISION OF THE GOVERNING BOARD OR COMMITTEE ON THESE MATTERS WILL REST IN ITS SOLE DISCRETION, AND ITS CONCERN MUST BE THE WELFARE OF RHCC AND THE ADVANCEMENT OF RHCC'S PURPOSE. SECTION 7. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY 1. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. 2. IF, AFTER HEARING THE RESPONSE OF THE PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THAT THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH MAY INCLUDE NO ACTION, REPRIMAND, REQUEST FOR RESIGNATION OR REMOVAL FROM THE BOARD OF DIRECTORS AS THE FACTS AND CIRCUMSTANCES MAY WARRANT. SECTION 9. COMPENSATION 1. A VOTING MEMBER OF THE BOARD OF DIRECTORS WHO RECEIVES COMPENSATION FOR PROVISION OF SERVICES AS AN EMPLOYEE OR CONTRACTOR, DIRECTLY OR INDIRECTLY, FROM RHCC IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO MEMBER OF THE BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. 4. PHYSICIANS WHO RECEIVE COMPENSATION FROM RHCC, WHETHER DIRECTLY OR INDIRECTLY OR AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS. NO PHYSICIAN, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING PHYSICIAN COMPENSATION. SECTION 10. ANNUAL STATEMENTS EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING OR FOUNDATION BOARD DELEGATED POWERS, AND ALL LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON-- 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2. HAS READ AND UNDERSTANDS THE POLICY; 3. HAS AGREED TO COMPLY WITH THE POLICY; AND 4. UNDERSTANDS THAT RHCC IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15A RIVERWOOD HAS A COMPENSATION COMMITTEE OF THE BOARD WHICH MEETS ANNUALLY TO REVIEW, DISCUSS AND RECOMMEND APPROVAL TO THE FULL BOARD OF THE ANNUAL INCENTIVE COMPENSATION GOALS FOR THE CEO AND CERTAIN MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM. ANNUALLY, THE COMMITTEE ALSO REVIEWS COMPENSATION OF THE CEO AS WELL AS MEMBERS OF THE EXECUTIVE LEADERSHIP TO ENSURE STATED COMPENSATION FALLS WITHIN A FAIR MARKET VALUE RANGE. IN DOING SO, THE COMMITTEE RELIES HEAVILY ON A COMPENSATION SURVEY(S) WHICH IS CONDUCTED BY AN EXTERNAL COMPENSATION CONSULTANT GENERALLY EVERY 2 YEARS, ALONG WITH ANY OTHER DATA OR FACTORS WHICH THE COMMITTEE MAY DEEM RELEVANT FROM TIME TO TIME. UPON RECOMMENDATION FROM THE COMPENSATION COMMITTEE, THE FULL BOARD IS RESPONSIBLE FOR APPROVING COMPENSATION OF THE CEO AS WELL AS THE ANNUAL INCENTIVE COMPENSATION GOALS AND ASSOCIATED METRICS. DOCUMENTATION AND RECORD KEEPING IS MAINTAINED FOR BOTH COMPENSATION COMMITTEE AND BOARD MEETINGS WHERE COMPENSATION DISCUSSIONS AND/OR DECISIONS OCCUR. THE FULL PROCESS AS SUMMARIZED ABOVE LAST OCCURRED FOR THE CEO IN THE LATER PART OF CALENDAR YEAR 2016. FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT, WHICH PROVIDES AN OVERVIEW OF THE ORGANIZATION'S FINANCIAL STATUS, IS MADE AVAILABLE TO THE PUBLIC FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). IT IS MAILED TO MEMBERS OF THE ORGANIZATION, ORGANIZATIONS THAT WE HAVE FINANCING WITH, AND IS AVAILABLE ON OUR WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,287,038. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,287,038. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 4,841,069. MANAGEMENT AND GENERAL EXPENSES 903,719. FUNDRAISING EXPENSES 1,455. TOTAL EXPENSES 5,746,243. FORM 990, PART XI, LINE 9: INCREASE IN INTEREST IN NET ASSETS OF AITKIN COMMUNITY HOSPITAL FOUNDATION 574,359. RIVERWOOD HEALTH CARE CENTER FOUNDATION 200 BUNKER HILL DRIVE AITKIN MN 56431 411738787 SUPPORT MN 501(C)(3) LINE 12A, I N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0