2018-05-15T08:24:22-05:00 2017-06-30 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2016-07-01 411924645 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE CENT 3207322141 20 SE NINTH STREET LONG PRAIRIE MN 56347 CRAIG BROMAN PRESIDENT 3207322141 2018-05-01 1 TODD A JACKSON P00092672 6123324300 2018-05-01 2016 2022-09-23 18:48:47Z CENTRACARE HEALTH - LONG PRAIRIE DR KENNETH D HOLMEN 20 SE NINTH STREET LONG PRAIRIE MN 56347 32847504 0 X WWW.CENTRACARE.COM X 1999 MN CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 5 0 326 50 0 0 192503 218547 29339862 31097020 273056 559147 566048 630898 30371469 32505612 51900 77074 0 0 18129564 18347104 0 0 0 10881573 11632703 29063037 30056881 1308432 2448731 56767875 74944386 38666151 55228511 18101724 19715875 X CENTRACARE HEALTH WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 0 0 15649850 77074 19775657 CCH - LONG PRAIRIE IS PART OF A LARGER INTEGRATED HEALTH CARE DELIVERY SYSTEM KNOWN AS CENTRACARE HEALTH, A SYSTEM RECOGNIZED FOR BEING A LEADER IN PROVIDING HIGH-QUALITY, COMPREHENSIVE CARE THROUGHOUT THE REGION. CCH - LONG PRAIRIE IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE SERVICES IN THE AREAS OF MEDICAL, SURGICAL, DIAGNOSTIC, AND OBSTETRICS ALONG WITH OTHER SERVICES OF 24 HOUR EMERGENCY ROOM, IMAGING, LABORATORY, REHABILITATION, AND CHEMOTHERAPY TO THE COMMUNITY OF LONG PRAIRIE AND THE SURROUNDING AREA. THERE WERE 562 ADMITS, 2,235 INPATIENT DAYS, AND 30,336 OUTPATIENT VISITS DURING FISCAL YEAR 2017. 4864895 6216145 CCH - LONG PRAIRIE OPERATES THE LONG PRAIRIE CLINIC WHICH IS CONVENIENTLY CONNECTED TO THE LONG PRAIRIE HOSPITAL FOR THE HEALTH CARE NEEDS OF THE COMMUNITY. LONG PRAIRIE CLINIC PROVIDES HEALTH CARE THROUGH A MIXTURE OF PHYSICIANS AND MIDLEVEL PROVIDERS. THERE WERE 20,301 CLINIC VISITS, 705 SURGEON CLINIC VISITS, AND 413 OPTHALMOLOGIST CLINIC VISITS DURING FISCAL YEAR 2017.CCH - LONG PRAIRIE ALSO OPERATES THE EAGLE VALLEY CLINIC IN EAGLE BEND, MN WHICH PROVIDES HEALTH CARE FOR BOTH THE CLARISSA AND EAGLE BEND COMMUNITIES AND SURROUNDING AREAS. THE EAGLE VALLEY CLINIC PROVIDES HEALTH CARE THROUGH THE USE OF MIDLEVEL PROVIDERS WITH OVERSIGHT OF THE PHYSICIANS FROM THE LONG PRAIRIE CLINIC. THERE WERE 1,213 CLINIC VISITS DURING FISCAL YEAR 2017. 4696448 5702171 THE CCH - LONG PRAIRIE CARE CENTER IS AN ATTACHED 70 BED SKILLED NURSING FACILITY THAT PROVIDES QUALITY, COMPASSIONATE CARE WITH AN EMPHASIS ON ENHANCING EACH RESIDENT'S PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL WELL-BEING. THERE WERE 23,527 RESIDENT DAYS DURING FISCAL YEAR 2017. 25211193 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 49 0 1 326 1 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X LARRY KNUTSON 3207327240 20 SOUTHEAST NINTH STREET LONG PRAIRIE MN 56347 KENNETH D HOLMEN MD CEO 1.00 39.00 X X 0 1293753 26581 CRAIG J BROMAN PRESIDENT 1.00 39.00 X X 0 1082537 52031 DAVID TILSTRA MD CPE VICE PRESIDENT 1.00 39.00 X X 0 563499 90054 PAUL R HARRIS ESQ CORPORATE SECRETARY 2.00 38.00 X X 0 504874 83489 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 1.00 39.00 X X 0 798201 43401 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 39.50 0.50 X 0 268930 47670 WINN H GREGORY MD PHYSICIAN 40.00 X 0 384298 33185 RYAN C SCOTT DO PHYSICIAN 40.00 X 0 369344 40135 RENE ELDIDY MD PHYSICIAN 40.00 X 0 328781 45468 DEBORAH P RASMUSSEN MD PHYSICIAN 40.00 X 0 321031 43479 YUN CHAU B LEE MD PHYSICIAN 40.00 X 0 592812 45336 0 6508060 550829 8 0 1 0 WHITESELL MEDICAL STAFFING 1630 ANDERSON AVE SUITE 100 BUFFALO MN 55303 PHYSICIAN SERVICES 524278 CENTRAL MN DIAGNOSTIC INC 150 10TH ST NW MILACA MN 56353 MRI/CT SERVICES 509495 JOHNSON CONTROLS INC 402 GREAT OAK DRIVE BLDG B WAITE PARK MN 56387 BUILDING EFFICIENCY 406160 HAMMEL GREEN AND ABRAHAMSON PO BOX 86 MINNEAPOLIS MN 55486 ARCHITECT SERVICES 402720 WEST CENTRAL ANESTHESIA PC 520 COUNTRY OAK DRIVE SAUK CENTRE MN 56370 CRNA SERVICES 357343 6 218547 218547 PATIENT AND RESIDENT SERVICE REVE 900099 30703350 30703350 OTHER PROGRAM REVENUE 900099 393670 393670 31097020 530538 530538 33945 0 33945 33945 33945 28609 0 28609 28609 28609 938845 341892 596953 596953 32505612 31693973 0 593092 X 74250 74250 2824 2824 14016047 11257499 2758548 588012 472283 115729 2950631 2369907 580724 792414 636456 155958 4194 3369 825 21530 17293 4237 1273 1273 21573 21573 4112404 3303027 809377 54182 43518 10664 83937 67417 16520 381602 306498 75104 45413 36475 8938 53499 42970 10529 726616 583608 143008 187827 150860 36967 SUPPLIES 3563131 3563131 BAD DEBT 834418 834418 MEDICAID/MN CARE 647481 647481 MEDICAL EQUIPMENT RENTA 400837 400837 492786 395799 96987 30056881 25211193 4845688 0 1738685 3147485 4948640 4814055 314512 327806 136026 84477 52542169 10855124 9494843 41687045 39357393 13650389 428120 428850 349656 10804279 56767875 74944386 3052104 2420581 14325 9185 2212608 2090355 33387114 50708390 38666151 55228511 X 18052574 19659180 49150 56695 18101724 19715875 56767875 74944386 X 2448731 471983 -1306563 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1273 1273 0 PART II-B, LINE 1: CENTRACARE - LONG PRAIRIE PAID $1,273 TO SATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 0 0 312427 312427 8909654 4956205 3953449 35316942 220535 35096407 8003146 5678384 2324762 41687045 ASSETS INTERNALLY DESIGNATED FOR CAPITAL ACQUISITIONS 6469494 C FUNDS HELD WITH TRUST - UNDER BOND INDENTURE 7180895 C 13650389 DEFERRED DEBT ACQUISITION 265167 DUE FROM AFFILIATES 10539112 10804279 ASSET RETIREMENT OBLIGATION 131202 BOND PREMIUM 33106877 THIRD PARTY PAYOR SETTLEMENTS 172000 CAPITAL LEASES 38815 DUE TO AFFILIATES 17259496 50708390 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 1 X 175.000000000000 1 X 1 1 1 0 1 1 320824 320824 0.01100 8665562 6957509 1708053 0.05850 8986386 6957509 2028877 0.06950 19020 19020 0.00070 396 396 0.00000 19416 19416 0.00070 9005802 6957509 2048293 0.07020 1 834418 8181745 8178090 3655 X 1 1 1 1 CENTRACARE HEALTH - LONG PRAIRIE 20 NINTH STRET SOUTHEAST LONG PRAIRIE MN 56347 X X X X RURAL HEALTH CLINIC, SKILLED LONG-TERM CARE FACILITY CENTRACARE HEALTH - LONG PRAIRIE 1 0 0 1 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 1 1 X X X X 1 X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X X X X X X X 1 X X 1 X X X X X X X 1 X 0 0 CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 3J: CENTRACARE HEALTH'S (CCH) CHNA PRIMARY NEEDS WERE IDENTIFIED USING THE CENTER FOR DISEASE CONTROL'S COMMUNITY HEALTH STATUS INDICATORS (CHSI). THE PROCESS ALSO CONSIDERED SECONDARY DATA FROM THE DARTMOUTH ATLAS, ROBERT WOOD JOHNSON, MINNESOTA DEPARTMENT OF HEALTH, US CENSUS BUREAU, MINNESOTA HOSPITAL ASSOCIATION, AND PUBLIC HEALTH DEPARTMENTS FROM APPROPRIATE COUNTIES AND ADDITIONAL FEDERAL AND STATE ENTITIES. THE CHNA WAS INFORMED BY A COLLABORATIVE AND ONGOING COMMUNITY HEALTH SURVEY JOINTLY FUNDED AND MANAGED WITH A NUMBER OF AREA COUNTIES WHO WERE JOINTLY CONDUCTING COMMUNITY SURVEYS TO INFORM THEIR COMMUNITY HEALTH ASSESSMENTS IN SUPPORT OF DEVELOPMENT OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS.LACK OF CURRENT PUBLIC HEALTH DATA WAS A SIGNIFICANT INFORMATION GAP IN THE CHNA AS THE SURVEY COULD NOT BE COMPLETED IN TIME TO INCLUDE ITS DATA IN THE CCH CHNA. CCH HAS COMMITTED TO A CONTINUING EFFORT WITH PUBLIC HEALTH OFFICIALS TO JOINTLY DEVELOP PRIORITIES WITH THE COUNTIES AS A PART OF ITS ACTION PLANS. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 5: DATA WAS OBTAINED FROM LOCAL COUNTY PUBLIC HEALTH DEPARTMENTS, INCLUDING THEIR MOST RECENT HEALTH ASSESSMENTS AND COMMUNITY REPORTS. IN ADDITION, HEALTH-RELATED INFORMATION WAS COLLECTED FROM AREA NONPROFIT ORGANIZATIONS THAT REGULARLY CONDUCT ASSESSMENTS AND EVALUATIONS OF THE SERVICES THEY PROVIDE AND THEIR TARGETED DEMOGRAPHICS. USEFUL MATERIAL WAS GATHERED FROM THE LOCAL UNITED WAY, CATHOLIC CHARITIES, THE CENTRAL MINNESOTA COUNCIL ON AGING, AND THE TRI-COUNTY ACTION PROGRAM (TRI-CAP). THESE ORGANIZATIONS SUPPORT A BROAD RANGE OF CONSTITUENTS WITH DIVERSE HEALTH-RELATED NEEDS; THEY REPRESENT DEMOGRAPHICS THAT ARE STATISTICALLY MORE LIKELY TO ENCOUNTER HEALTH-RELATED BARRIERS. CCH ALSO CONDUCTED A SERIES OF FOCUS GROUPS THAT INFORMED ITS CHNA. SPECIFICALLY, THE FOCUS GROUPS REPRESENTED POPULATIONS OF COLOR, RECENT IMMIGRANT POPULATIONS, CULTURAL MINORITIES, THOSE WHO WERE AUDIBLY CHALLENGED AND OTHERS WHO WERE DEEMED TO BE UNDER-REPRESENTED OR UNDER-SERVED. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 6A: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE BEGINNING OF ITS FISCAL YEAR 2016. THOSE FACILITIES INCLUDED ST. CLOUD HOSPITAL, CENTRACARE HEALTH - MELROSE, CENTRACARE HEALTH - LONG PRAIRIE, CENTRACARE HEALTH - SAUK CENTRE, CENTRACARE HEALTH - MONTICELLO AND CENTRACARE HEALTH - PAYNESVILLE.EACH HOSPITAL PREPARED INDIVIDUAL ACTION PLANS TO THE CHNA BASED ON SPECIFIC INPUT FROM THOSE COMMUNITIES. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 11: THE NEEDS IDENTIFIED BY THE CHNA ARE CURRENTLY IN ORGANIZATIONAL WORK PLANS AND ARE UNDER IMPLEMENTATION. TO PRIORITIZE IDENTIFIED NEEDS, CHNA ADVISORY TASK FORCE MEMBERS DEVISED A SET OF CRITERIA. THE CRITERIA USED WERE: COMMUNITY IMPACT, POTENTIAL FOR CHANGE, ECONOMIC FEASIBILITY, COMMUNITY ASSETS, AND VALUE AND MISSION. THE PRIORITIZATION PROCESS IDENTIFIED THE FOLLOWING SIX, BROAD COMMUNITY HEALTH ISSUES: 1 - ADULT OBESITY2 - ADULT DIABETES3 - OLDER ADULT PREVENTABLE HOSPITALIZATIONS4 - STROKE DEATHS5 - CORONARY HEART DISEASE DEATHS6 - CANCER DEATHSST. CLOUD HOSPITAL WILL MAINTAIN ITS ENGAGEMENTS WITH THE CHNA ADVISORY TASK FORCE TO ENSURE EFFECTIVE COLLABORATION AND COMMUNICATION WITH THE OTHER CENTRACARE HOSPITALS. THE CHNA ADVISORY TASK FORCE WILL CONTINUE TO MEET DURING THE THREE-YEAR PERIOD IN WHICH THE IMPLEMENTATION STRATEGY WILL UNFOLD. DURING THIS TIME THE GROUP WILL:- IDENTIFY WHAT OTHER COMMUNITY ORGANIZATION ARE DOING IN REGARD TO HEALTH PRIORITY AREAS;- DEVELOP SPECIFIC GOALS AND METRICS TO MONITOR AND MEASURE PROGRESS AND OUTCOMES;- COMMUNICATE SHORT-TERM AND LONG-TERM RESULTS OF ACTION PLANS WITHIN THE COMMUNITY.BASED ON THE FINDINGS AND PRIORITIES ESTABLISHED BY THE CHNA, AND AFTER HAVING REVIEWED THE COMMUNITY BENEFITS ACTIVITIES THAT CURRENTLY EXIST, ST. CLOUD HOSPITAL WILL CONTINUE TO SUPPORT THE SYSTEM-WIDE INITIATIVES OUTLINED BELOW AND WILL PARTICIPATE IN LOCALIZED ADAPTIONS (AS DESCRIBED IN THE ACTION STEPS) OF THESE PROGRAMS WITH REGARD TO THE SPECIFIC NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. TO SEE THE SPECIFIC ACTION PLAN FOR EACH OF THE SIX PRIORITY HEALTH AREAS SEE THE FULL IMPLEMENTATION STRATEGY FOR FISCAL YEAR 2016 - 2018 LOCATED ON THE WEBSITE AT:HTTP://WWW.CENTRACARE.COM/APP/FILES/PUBLIC/5221/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-CENTRACARE-HEALTH-SYSTEM.PDFPER GUIDANCE FROM THE IRS, REGULATION 1.501(R)-3(C), THE CHNA FOR CCH ELECTED NOT TO DIRECTLY ADDRESS SEVERAL DETERMINANTS OF HEALTH THAT IT IDENTIFIED IN ITS PROCESS WHICH WERE NOT WITHIN THE ORGANIZATION'S CAPABILITIES OR CORE COMPETENCIES. EXAMPLES OF ISSUES NOT SPECIFICALLY ADDRESSED IN THE CHNA ACTION PLANS INCLUDE HIGH SCHOOL GRADUATION RATES, AFFORDABLE HOUSING OR SUPPORTED HOUSING. CCH DID SUPPORT AN EFFORT OF THE CITY OF ST. CLOUD TO CONDUCT A HOUSING ASSESSMENT AS A RESULT OF THE CHNA PROCESS AND IS ALREADY THE LARGEST AREA PROVIDER OF SUPPORTED HOUSING DUE TO ITS EXTENSIVE CHEMICAL DEPENDENCY PROGRAMS AND SENIOR HOUSING PROGRAMS. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 16J: PATIENTS WHO ARE AT A SELF PAY STATUS RECEIVE FINANCIAL ASSISTANCE INFORMATION EITHER VIA A TELEPHONE CALL OR ON BILLING STATEMENTS. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 18E: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE GARNISHMENTS & LAWSUITS AS WELL. ALL LEGAL ACTIONS ARE REVIEWED & APPROVED BY CCH MANAMGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 19E: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE GARNISHMENTS & LAWSUITS AS WELL. ALL LEGAL ACTIONS ARE REVIEWED & APPROVED BY CCH MANAMGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST THE PATIENT. 3 1 - LONG PRAIRIE CARE CENTER 20 NINTH STREET SE LONG PRAIRIE MN 56347 SKILLED NURSING FACILITY 2 - LONG PRAIRIE CLINIC 20 NINTH STREET SE LONG PRAIRIE MN 56347 CLINIC 3 - EAGLE VALLEY CLINIC 815 HWY 71 SOUTH EAGLE BEND MN 56446 CLINIC PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE ORGANIZATIONS TOTAL EXPENSES WERE REDUCED BY THEIR NON-OPERATING REVENUE, MEDICAID SURCHARGE AND MN CARE TAX. THE NET TOTAL EXPENSES WERE THEN DIVIDED BY GROSS CHARGES TO DETERMINE THE COST TO CHARGE RATIO. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 834,418. 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 AMOUNT ON LINE 7 OF PART III WAS DETERMINED BY UTILIZING KEY SECTIONS OF THE MEDICARE COST REPORT, PRIMARILY THE D SERIES AND E SERIES. PART III, LINE 9B: THE COLLECTION POLICIES AT THE ORGANIZATION REQUIRE COLLECTION STAFF TO OFFER CHARITY CARE TO PATIENTS WHO INDICATE THAT PAYMENT MAY BE AN ISSUE. IF A PATIENT DOES QUALIFY FOR FULL CHARITY CARE, ALL OTHER COLLECTION EFFORTS MUST CEASE. IF A PATIENT QUALIFIES FOR PARTIAL CHARITY CARE, 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 CARE OR NOT, ARE REPORTED TO CREDIT REPORTING AGENCIES. PART VI, LINE 2: THE ORGANIZATIONS' STRATEGIC PLANNING ASSESSES THE NEEDS OF THE COMMUNITY AND PATIENTS THROUGH PATIENT SATISFACTION SURVEYS, COMMENT CARDS, COMMUNITY ASSESSMENTS AND A DIVERSE OPERATING COMMITTEE THAT REPRESENTS THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS AND RECOMMENDATIONS FOR HEALTH CARE SERVICES. PART VI, LINE 3: INPATIENTS WHO ARE SELF PAY ARE IDENTIFIED, AND A REPRESENTATIVE OF THE ORGANIZATION'S BILLING DEPARTMENT EXPLAINS THE CHARITY CARE POLICY TO PATIENTS. THEY ALSO EXPLAIN THE SELF PAY DISCOUNT AND SCREENS THE PATIENT FOR ELIGIBILITY FOR ANY STATE OR FEDERAL PROGRAMS. THEY ALSO ASSIST THE PATIENT WITH ANY PAPERWORK REQUIRED TO APPLY FOR SUCH PROGRAMS. OUTPATIENTS WHO ARE SELF PAY RECEIVE AN AUTOMATIC SELF PAY DISCOUNT. IF THE PATIENT DOES NOT REMIT PAYMENT, COLLECTION STAFF ATTEMPT TO REACH THE PATIENT BY PHONE. PATIENTS ARE TOLD ABOUT THE CHARITY PROGRAM. FOR BOTH INPATIENTS AND OUTPATIENTS, ALL STATEMENTS CONTAIN A LETTER REGARDING THE AVAILABILITY OF CHARITY CARE. ALSO ALL PRECOLLECTION LETTERS HAVE THIS SAME LANGUAGE INDICATING THE AVAILABILITY AND PROCESS OF OBTAINING CHARITY CARE. PART VI, LINE 4: LONG PRAIRIE IS LOCATED IN TODD COUNTY, MINNESOTA. THE ESTIMATED 2017 POPULATION SHOWS 6,716 RESIDENTS WITH AN ESTIMATED DECLINE TO 6,675 BY 2022. THIS AREA HAS SEEN DECLINES IN ITS POPULATION AND PROJECTIONS INDICATE THAT WILL CONTINUE. THE PROJECTED GROWTH BY AGE BRACKET FROM 2017 TO 2022 IS AS FOLLOWS: 0-17: 2.5%, 18-44: 0.4%, 45-64: -10.0%, 65+: 5.9%. THE ESTIMATED 2017 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 78.7%, AFRICAN AMERICAN: .5%, ASIAN: 1.3%, HISPANIC: 17.8%, OTHER: 1.8%. PART VI, LINE 5: THE ORGANIZATION HAS A COMMUNITY BASED OPERATING COMMITTEE THAT MEETS ON A MONTHLY BASIS TO REVIEW VARIOUS ASPECTS OF THE FACILITY AND PROVIDE INPUT ON THOSE ASPECTS FROM A COMMUNITY PERSPECTIVE. THE ORGANIZATION PARTICIPATES IN THE COMMUNITY BLOOD DRIVES BY PROVIDING FOOD AND SUPPLIES FOR BOTH THE WORKERS AND BLOOD DONORS. THE FACILITY ALSO SPONSORS A HEALTH FAIR ON AN ANNUAL BASIS FOR THE LOCAL AND SURROUNDING COMMUNITIES. PART VI, LINE 6: THE ORGANIZATION IS PART OF CENTRACARE HEALTH SYSTEM (CCHS) WHICH PROVIDES A BROAD RANGE OF HEALTH CARE SERVICES TO THE PATIENTS OF CENTRAL MINNESOTA. CCHS IS DEDICATED TO IMPROVING THE HEALTH OF PEOPLE LIVING AND WORKING IN THE COMMUNITIES IT SERVES. TO ACCOMPLISH ITS GOALS IT WORKS ACTIVELY WITH ITS AFFILIATE HEALTH CARE ORGANIZATIONS. CCHS CONTINUES TO FOCUS ON PROVIDING THE BEST CARE POSSIBLE AND IN REINVESTING INTO THE COMMUNITY. CCHS ALSO PROMOTES WELLNESS BY SPONSORING PROGRAMS AND EVENTS IN LOCAL COMMUNITIES THAT FOCUS ON HEALTHY EATING AND EXERCISE, AND BY CONDUCTING SCREENINGS FOR CONDITIONS SUCH AS HIGH BLOOD PRESSURE. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 CENTRACARE FOUNDATION 1406 6TH AVE NORTH ST CLOUD MN 56303 411855173 501(C)(3) 65000 PROGRAM SUPPORT 1 PART I, LINE 2: CENTRACARE HEALTH SYSTEM, INCLUDING CCH - LONG PRAIRIE, 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 COMMUNICATIONS DEPARTMENT AND THE COMMUNICATIONS/MARKETING SPECIALIST RESPONSIBLE FOR CENTRACARE CLINIC; THE DIRECTOR OF 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 FROM THE CENTRACARE HEALTH EXECUTIVE COUNCIL. INDIVIDUALS AND DEPARTMENTS FROM 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. 0 1 0 0 0 0 1 0 0 KENNETH D HOLMEN MD CEO 0 1056216 0 218278 0 19259 0 9275 0 23212 0 1326240 0 0 CRAIG J BROMAN PRESIDENT 0 774848 0 141148 0 166541 0 35775 0 22555 0 1140867 0 128772 DAVID TILSTRA MD CPE VICE PRESIDENT 0 390396 0 101271 0 71832 0 65629 0 29254 0 658382 0 53652 PAUL R HARRIS ESQ CORPORATE SECRETARY 0 371496 0 65685 0 67693 0 56781 0 31458 0 593113 0 52707 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 0 575712 0 88532 0 133957 0 26845 0 22462 0 847508 0 104969 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 0 203854 0 27038 0 38038 0 24319 0 24651 0 317900 0 21619 WINN H GREGORY MD PHYSICIAN 0 382708 0 0 0 1590 0 14769 0 22433 0 421500 0 0 RYAN C SCOTT DO PHYSICIAN 0 320901 0 70 0 48373 0 15130 0 25985 0 410459 0 0 RENE ELDIDY MD PHYSICIAN 0 257816 0 69544 0 1421 0 22542 0 25085 0 376408 0 0 DEBORAH P RASMUSSEN MD PHYSICIAN 0 250863 0 69194 0 974 0 21779 0 22700 0 365510 0 0 YUN CHAU B LEE MD PHYSICIAN 0 537813 0 175 0 54824 0 33703 0 13477 0 639992 0 0 PART I, LINE 3 THE COMPENSATION PAID TO THE PRESIDENT AND VICE-PRESIDENTS (NON-MEDICAL PROVIDERS) IS DETERMINED BY CENTRACARE HEALTH SYSTEM, A RELATED ORGANIZATION. CENTRACARE HEALTH SYSTEM USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED NON-QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO FORM 990, THE AMOUNTS LISTED IN PART VII AND SCHEDULE J, PART II, COLUMN C, REFLECT TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON FORM 990 - ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF AND WHEN IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: KENNETH D. HOLMEN, MD - PAID $0; ACCRUED $0 DAVID TILSTRA, MD, CPE - PAID $53,652; ACCRUED $35,053 GREGORY R KLUGHERZ - PAID $104,969; ACCRUED $0 PAUL R HARRIS - PAID $52,707; ACCRUED $32,842 CRAIG J BROMAN - PAID $128,772; ACCRUED $0 DANIEL J SWENSON - PAID $43,238; ACCRUED $10,300 PART I, LINE 6 THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR CENTRACARE CLINIC OR CENTRACARE HEALTH SYSTEM; ACHIEVEMENT OF IMPROVEMENT IN PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; ACHIEVEMENT OF IMPROVEMENT IN OVERALL EMPLOYMENT ENGAGEMENT SCORES; AND ACHIEVEMENT OF UP TO THREE INDIVIDUAL GOALS WHICH ARE TIED TO THE CENTRACARE SYSTEM'S STRATEGIC PLAN. 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 INCENTIVE COMPENSATION IS PAID. FORM 990, PART VI, SECTION A, LINE 6 CENTRACARE HEALTH SYSTEM, A MINNESOTA NONPROFIT ASSOCIATION, IS THE SOLE MEMBER OF CENTRACARE HEALTH SYSTEM - LONG PRAIRIE. FORM 990, PART VI, SECTION A, LINE 7A ALL BOARD MEMBERS ARE APPOINTED BY CENTRACARE HEALTH SYSTEM, THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS ARE RESERVED FOR ACTION BY CENTRACARE HEALTH SYSTEM, THE SOLE MEMBER: 1. ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. 2. APPOINTMENT OF DIRECTORS AND OFFICERS. 3. APPROVAL OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY DEBTS TO BE INCURRED. 4. APPROVAL OF ALL STRATEGIC PLANS. 5. DETERMINATION OF THE DISSOLUTION OF OR THE DISCONTINUATION OF THE BUSINESS OF THE CORPORATION. 6. APPROVAL OF ANY TRANSACTION WHICH MAY AFFECT THE CORPORATION'S STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXATION. FORM 990, PART VI, SECTION B, LINE 11B ANNUALLY, AT THE BOARD OF DIRECTORS' MEETING, PRIOR TO FILING WITH THE IRS, THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW THE FORM 990 WITH STAFF TO ASK QUESTIONS AND SEEK CLARIFICATIONS AND TO APPROVE THE FINAL DOCUMENT. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE TWICE A YEAR. ALL STAFF SIGN CONFLICTS OF INTEREST FORMS ON AN ANNUAL BASIS. THE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AS WELL AS THE CORPORATE COMPLIANCE GROUP (A COMPLIANCE COMMITTEE WHICH INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRES ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD. THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTERESTS RELATED TO BOARD AND STAFF AND TO ALERT AFFECTED PARTIES WHEN A CONFLICT ARISES. WHEN AN ACTUAL CONFLICT ARISES, THE AFFECTED PARTY IS ASKED TO RECUSE HIM/HER SELF FROM THE DECISION MAKING PROCESS. THE CORPORATE COMPLIANCE OFFICER ATTENDS BOARD MEETINGS AND SPECIFIED BOARD COMMITTEE MEETINGS WHERE CONFLICT ISSUES MAY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION AND BENEFITS OF THE PRESIDENT ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS DONE MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. COULD HOSPITAL TO PERFORM SERVICES. FORM 990, PART VI, QUESTION 15B: THE COMPENSATION AND BENEFITS OF THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS COMPLETED IN MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. CLOUD HOSPITAL TO PERFORM THESE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES DO AN ANNUAL REPORT TO THE COMMUNITY IN WHICH FINANCIAL RESULTS ARE REPORTED TO AND DISCUSSED WITH THE PUBLIC. THIS REPORT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE. FORM 990, PART IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 2,232,015. MANAGEMENT AND GENERAL EXPENSES 546,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,778,950. CONTRACTED/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,056,072. MANAGEMENT AND GENERAL EXPENSES 258,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,314,853. BANK CHARGES: PROGRAM SERVICE EXPENSES 14,940. MANAGEMENT AND GENERAL EXPENSES 3,661. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,601. FORM 990, PART XI, LINE 9: EQUITY TRANSFER TO CENTRACARE HEALTH SYSTEM -1,306,563. 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