2018-11-15T14:11:17-06:00 2017-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2017-01-01 208316475 MAPLE GROVE HOSPITAL CORPORATION MAPL 7635811000 9875 HOSPITAL DRIVE MAPLE GROVE MN 55369 AARON BLOOMQUIST TREASURER 7635205048 2018-11-14 1 LAWRENCE H MOHR CPA P00447603 6128764500 2018-11-14 38.88.188.75 2018-11-14 09:10:33 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2519A5C6D4FE43330A9B665C55E2C286A0409372 2017 2019-02-21 02:37:17Z ANDREW COCHRANE 9875 HOSPITAL DRIVE MAPLE GROVE MN 55369 196171559 0 X WWW.MAPLEGROVEHOSPITAL.ORG X 2007 MN TO EMPOWER OUR CUSTOMERS TO ACHIEVE THEIR BEST HEALTH. 7 2 1230 391 0 0 23029 8910 187035541 195925342 194447 237307 0 0 187253017 196171559 0 0 0 0 65023159 70305142 0 0 0 101954370 98963494 166977529 169268636 20275488 26902923 178680301 173527171 145894609 143321812 32785692 30205359 X TO EMPOWER OUR CUSTOMERS TO ACHIEVE THEIR BEST HEALTH. 0 0 143991696 195079305 MAPLE GROVE HOSPITAL IS A GENERAL, ACUTE CARE HOSPITAL PROVIDING EMERGENCY SERVICES, MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, AND PEDIATRIC SERVICES. MAPLE GROVE HOSPITAL'S MISSION IS EMPOWERING ITS CUSTOMERS TO ACHIEVE THEIR BEST HEALTH.IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, MAPLE GROVE HOSPITAL ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST) IN FURTHERANCE OF ITS CHARITABLE PURPOSE INCLUDING HEALTH RELATED EDUCATIONAL PROGRAMS: SAFETY FAIRS, CAR SEAT CLINICS, MENTAL HEALTH AND FIRST AID CLASSES, AND ASTHMA EDUCATION IN ELEMENTARY SCHOOLS. MAPLE GROVE HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY PRIMARILY THROUGH (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES, AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, MAPLE GROVE HOSPITAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICES TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE. 143991696 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 135 0 1230 1 0 0 0 0 0 0 0 0 0 0 X 7 2 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X AARON BLOOMQUIST 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 J KEVIN CROSTON MD BOARD CHAIR 2.00 50.00 X X 0 965781 46407 AARON BLOOMQUIST TREASURER 2.00 50.00 X X 0 468789 32865 ANDREW HOULTON MD DIRECTOR - PART YEAR 2.00 50.00 X 0 483274 36362 JENNIFER CLOSE DIRECTOR 2.00 50.00 X 0 423351 28981 JEFF WICKLANDER DIRECTOR 2.00 50.00 X 0 484703 45638 JAMES HEREFORD DIRECTOR 2.00 X 0 0 0 DAN FROMM DIRECTOR 2.00 X 0 0 0 SAMANTHA HANSON DIRECTOR 2.00 50.00 X 0 98653 1573 ANDREW COCHRANE PRESIDENT 50.00 X 0 440571 43789 PAMELA DOORENBOS MD VP MEDICAL AFFAIRS 50.00 X 359993 0 20092 STEVEN HORSTMANN VP OPERATIONS 50.00 X 159111 67181 9427 WENDY ULFERTS VP PATIENT CARE/ CHIEF NURSING OFFICER 50.00 X 141178 0 13229 KAREN HALL PHARMACIST 50.00 X 185116 0 25500 SARAH R JOHNSON MANAGER, PHARMACY 50.00 X 168508 0 24535 REBECCA THIESFELD RAUEN DIRECTOR, HUMAN RESOURCES 50.00 X 169048 0 25579 LEAH WANDERSEE DIRECTOR, PROCEDURAL CARE 50.00 X 175977 0 16777 FAITH ZWIRCHITZ DIRECTOR, WOMENS & CHILDREN'S 50.00 X 174497 0 10713 1533428 3432303 381467 68 0 1 0 UNIVERSITY OF MINNESOTA PHYSICIANS 720 WASHINGTON AVE STE 200 MINNEAPOLIS MN 55414 PHYSICIAN SERVICES 1604530 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 DIETARY 1338167 FAIRVIEW HEALTH SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 PHYSICIAN SERVICES 969887 FAVORITE HEALTHCARE STAFFING INC PO BOX 803356 KANSAS CITY MO 64180 STAFFING 677160 CROTHALL LAUNDRY SERVICE INC 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAUNDRY 674884 20 8910 8910 PATIENT REVENUE 621500 195079305 195079305 CONTRACT SERVICES 900099 436639 436639 GIFT SHOP 900099 255124 255124 CMS/EHR PAYMENTS & OTHER 900099 107769 107769 ALL OTHER 621910 46505 46505 195925342 237307 237307 196171559 195079305 0 1083344 X 699019 699019 56079147 47229901 8849246 1929449 1622914 306535 7621790 6359782 1262008 3975737 3309403 666334 20735849 17260521 3475328 121496 101133 20363 57501 47864 9637 19713717 16409698 3304019 248874 207163 41711 1630616 1357325 273291 1707111 1420999 286112 30106 25060 5046 5669949 5669949 8098474 6741170 1357304 1095330 911753 183577 SUPPLIES 22944133 19098696 3845437 BAD DEBT EXPENSE 6540200 6540200 GOVERNMENT TAXES 4686942 4686942 MAINTENANCE AND REPAIRS 2942725 2449524 493201 2740471 2541699 198772 169268636 143991696 25276940 0 1450 1450 34331810 35642857 27878837 27266879 2278244 2347646 454218 729627 147708946 55426728 99619155 92282218 10086702 11359494 3607000 3607000 422885 290000 178680301 173527171 16630165 15792661 129264444 127529151 145894609 143321812 X 32785692 30205359 32785692 30205359 178680301 173527171 X 26902923 916744 -30400000 X X 0 1 X 1 0 X 110943696 29224015 81719681 36765250 26202713 10562537 92282218 X PART X, LINE 2: MAPLE GROVE HOSPITAL EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2017 OR 2016. 1 1 1 X 1 X 275.000000000000 1 1 1 0 0 4807924 4807924 0.02840 27275250 20612715 6662535 0.03940 32083174 20612715 11470459 0.06780 202345 202345 0.00120 202345 202345 0.00120 32285519 20612715 11672804 0.06900 1 2261949 33738135 35008525 -1270390 X 1 1 1 1 MAPLE GROVE HOSPITAL CORPORATION 9875 HOSPITAL DRIVE MAPLE GROVE MN 55369 X X X MAPLE GROVE HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.MAPLEGROVEHOSPITAL.ORG X 1 16 1 WWW.MAPLEGROVEHOSPITAL.ORG 0 1 X 200.000000000000 275.000000000000 X X X X X 1 1 X X X 1 X WWW.MAPLEGROVEHOSPITAL.ORG X WWW.MAPLEGROVEHOSPITAL.ORG X WWW.MAPLEGROVEHOSPITAL.ORG X X X X X 1 X 0 X 1 0 0 MAPLE GROVE HOSPITAL CORPORATION PART V, SECTION B, LINE 5: ONE OF THE KEY OBJECTIVES IN CONDUCTING THE 2016 CHNA WAS TO IDENTIFY HEALTH ISSUES WHICH ARE MOST IMPORTANT TO OUR COMMUNITY MEMBERS AND ESTABLISH OR STRENGTHEN COMMUNITY RELATIONSHIPS TO HELP ADDRESS THESE HEALTH ISSUES. THIS WAS ACCOMPLISHED IN SEVERAL WAYS. A STEERING COMMITTEE COMPOSED OF COMMUNITY LEADERS, SOCIAL SERVICE PROVIDERS, HEALTH CARE PROVIDERS, SCHOOL DISTRICT EMPLOYEES, BUSINESS REPRESENTATIVES AND A PUBLIC HEALTH REPRESENTATIVE GUIDED THE ASSESSMENT PROCESS AND IDENTIFICATION OF HEALTH NEEDS. MAPLE GROVE HOSPITAL CONVENED 5 FOCUS GROUPS FROM TARGET POPULATIONS THROUGHOUT THE COMMUNITY. WE FURTHER INTERVIEWED KEY STAKEHOLDERS FROM LOCAL GOVERNMENT, LAW ENFORCEMENT, EDUCATION, RELIGIOUS AND COMMUNITY-BASED ORGANIZATIONS. LASTLY WE CONDUCTED AN ONLINE SURVEY FOR BUSINESS GROUPS, THE FAITH COMMUNITY AND COMMUNITY MEMBERS. THE ASSESSMENT WAS COMPLETED WORKING IN CONJUNCTION WITH FAIRVIEW AND MAPLE GROVE HOSPITAL. MAPLE GROVE HOSPITAL CORPORATION PART V, SECTION B, LINE 11: OUR MOST RECENT CHNA WAS CONDUCTED IN 2016. THE OVERALL CHNA WAS GUIDED BY THE COMMUNITY ENGAGEMENT ADVISORY TEAM WHICH IS COMPOSED OF COMMUNITY MEMBERS, MAPLE GROVE HOSPITAL EMPLOYEES, AND PUBLIC HEALTH REPRESENTATIVES. DATA USED TO IDENTIFY THE TOP PRIORITIES INCLUDED: DEMOGRAPHIC DATA; QUANTITATIVE DATA FROM THE MINNESOTA HOSPITAL ASSOCIATION, MINNESOTA DEPARTMENT OF HEALTH, HENNEPIN COUNTY SHAPE 2014, COMMUNITY NEED INDEX AND ATTRIBUTED PATIENT DATA; QUALITATIVE DATA FROM FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS, AND COMMUNITY ASSET MAPPING. THE FOLLOWING PRIORITIES WERE IDENTIFIED IN THE ASSESSMENT:-MENTAL HEALTH/SUBSTANCE ABUSE/USE-HEALTHY AGING/SENIOR SERVICES-CANCER PREVENTION, SCREENING, HEALTHY SURVIVORS-INJURY PREVENTION ACROSS THE LIFESPAN-NUTRITION/HEALTHY LIFESTYLES-YOUTH ENGAGEMENT EDUCATION ABOUT HEALTHCARE CAREERS, LEADERSHIP DEVELOPMENT-UNDERSTANDING OF IMMIGRANT CULTURES AND ISSUES RELATED TO HEALTH/DISPARITIES-TRANSPORTATION/HEALTHCARE ACCESSAFTER DISCUSSION OF THE HEALTH PRIORITIES, THE COMMUNITY ENGAGEMENT ADVISORY TEAM VOTED TO FOCUS ON TWO HEALTH PRIORITIES. PRIORITIZATION WAS BASED ON THE FOLLOWING CRITERIA:-HOW WIDESPREAD IS THE HEALTH NEED?-HOW SERIOUS OR IMPORTANT DO YOU THINK THIS HEALTH NEED IS FOR INDIVIDUALS AND/OR THE COMMUNITY?-WHAT IS THE POTENTIAL FOR MAPLE GROVE HOSPITAL AND COMMUNITY PARTNERS TO HAVE A POSITIVE IMPACT ON THIS HEALTH NEED WITHIN 3 TO 4 YEARS?BASED ON THESE CRITERIA, THE TOP NEEDS WERE IDENTIFIED AS:-MENTAL HEALTH/SUBSTANCE ABUSE/USE: 207 VOTES-HEALTHY AGING/SENIOR SERVICES: 169 VOTES-CANCER - PREVENTION, SCREENING, HEALTHY SURVIVORS: 162 VOTES-NUTRITION/HEALTHY LIFESTYLES: 161 VOTES-INJURY PREVENTION ACROSS THE LIFESPAN: 159 VOTES-UNDERSTANDING OF IMMIGRANT CULTURES AND ISSUES RELATED TO HEALTH/DISPARITIES: 157 VOTES-YOUTH ENGAGEMENT EDUCATION ABOUT HEALTHCARE CAREERS, LEADERSHIP DEVELOPMENT: 143 VOTES-TRANSPORTATION/HEALTHCARE ACCESS: 132 VOTESAFTER A REVIEW OF POTENTIAL IMPLEMENTATION PROJECTS TO ADDRESS THESE HEALTH PRIORITIES, A DECISION WAS MADE TO SEPARATE MENTAL HEALTH AND SUBSTANCE ABUSE/USE. THE FINAL HEALTH PRIORITIES FROM THE 2016 CHNA ARE:-MENTAL HEALTH-SUBSTANCE ABUSE/USE AND-HEALTHY AGING/SENIOR SERVICESTHESE HEALTH PRIORITIES ARE BEING ADDRESSED WITH COMMUNITY PARTNERSHIPS, COMMUNITY SUPPORT AND CULTURAL APPROPRIATENESS IN MIND. MAPLE GROVE HOSPITAL IS USING SEVERAL STRATEGIES TO ADDRESS THE IDENTIFIED HEALTH PRIORITIES. PRIORITY 1: MENTAL HEALTH (SYSTEM-WIDE PRIORITY)GOAL - TO SUPPORT THE MENTAL HEALTH OF COMMUNITY MEMBERS ALONG THE MENTAL HEALTH CONTINUUM.OBJECTIVES:I. REDUCE THE STIGMA ASSOCIATED WITH MENTAL HEALTH CONDITIONS STRATEGIES:-INCORPORATED THE "MAKE IT OK" MESSAGE INTO ANNUAL EMPLOYEE TRAINING-ACTION - THE "MAKE IT OK" MESSAGE HAS BEEN INCLUDED IN THE ANNUAL ALL EMPLOYEE TRAINING.-INCORPORATE THE "MAKE IT OK" MESSAGE ON THE MAPLE GROVE HOSPITAL WEBSITE AND IN OUR PUBLIC COMMUNICATIONS DURING MAY - MENTAL HEALTH AWARENESS MONTH-ACTION - USED OUR WEBSITE TO SHARE INFORMATION ABOUT A MAY 18, 2017 YOUTH MENTAL HEALTH FIRST AID CLASS WITH THE COMMUNITY. INCORPORATING ADDITIONAL INFORMATION ON "MAKE IT OK" ON THE WEBSITE HAS BEEN DEFERRED TO 2018. II. INCREASE EDUCATION ABOUT MENTAL HEALTH STRATEGIES:-OFFER A MINIMUM OF FOUR EVIDENCE BASED MENTAL HEALTH FIRST AID (MHFA) CLASSES ACROSS THE SYSTEM ANNUALLY-ACTION - THREE MENTAL HEALTH FIRST AID CLASSES WERE OFFERED TO THE COMMUNITY IN 2017. THESE INCLUDE: -MAY 18, 2017 YOUTH-FOCUSED MHFA CLASS AT MAPLE GROVE HOSPITAL 19 PERSONS ATTENDED. -AUGUST 1, 2017 YOUTH-FOCUSED MHFA CLASS AT WAYZATA SCHOOL DISTRICT 25 PERSONS ATTENDED. -DECEMBER 1, 2017 ADULT-FOCUSED MHFA CLASS AT NORTH MEMORIAL HEALTH OUTPATIENT CENTER 22 PERSONS ATTENDED.-ACTION - INSTEAD OF OFFERING A FOURTH MENTAL HEALTH FIRST AID CLASS IN 2017 WE PARTNERED WITH OTHER HEALTHCARE ORGANIZATIONS TO FINANCIALLY SUPPORT THE TRAINING OF ADDITIONAL YOUTH MENTAL HEALTH FIRST AID INSTRUCTORS. III. IMPROVE ACCESS TO MENTAL HEALTH SERVICES STRATEGIES:-OPENED THE NORTH MEMORIAL HEALTH MENTAL HEALTH & ADDICTION CARE CLINIC (THE NAME CHANGED TO MENTAL HEALTH CLINIC IN 2018)-ACTION - THE CLINIC LOCATED IN ROBBINSDALE OPENED IN DECEMBER 2016 IN RESPONSE TO AN IDENTIFIED COMMUNITY NEED. THE CLINIC HAS 10,300 SQ. FT. AND FOCUSES ON GENERAL MENTAL HEALTH PROBLEMS WITH A SPECIFIC FOCUS ON SERIOUS AND PERSISTENT MENTAL ILLNESS AND POST-TRAUMATIC STRESS DISORDER.-CONTINUED ASSESSMENT OF COMMUNITY NEED AND DEVELOPMENT OF PROGRAMS AS NEED IS IDENTIFIED-ACTION - NORTH MEMORIAL HEALTH CURRENTLY HAS EMERGENCY MEDICINE, A CONSULT SERVICE FOR THE ED, OBSERVATION AND MEDICAL UNITS, AN INPATIENT PSYCHIATRIC UNIT, TWO TRACKS OF PARTIAL HOSPITAL PROGRAMS, TWO TRACKS OF INTENSIVE OUTPATIENT PROGRAMS, OUTPATIENT THERAPY AND PSYCHIATRY AND 3 INTEGRATED BEHAVIORAL HEALTH PROVIDERS IN 4 OF ITS 15 PRIMARY CLINICS. THE CUSTOMER BASE RANGES IN AGES OF 18 TO 90, COMES FROM VARIED ETHNIC BACKGROUNDS WITH A VARIETY OF INSURERS INCLUDING THIRD PARTY PAYERS, MEDICARE AND MEDICAID. MOST OF OUR CUSTOMERS HAVE DIAGNOSES OF PSYCHOSIS, PTSD, AND MOOD DISORDERS. IV. SUPPORT NORTH MEMORIAL HEALTH'S DOMESTIC VIOLENCE ADVOCACY PROGRAM SAFEJOURNEYSTRATEGIES:-ENSURE 24 HOUR ADVOCACY IS PROVIDED BY TRAINED VOLUNTEERS-ACTION - 24 HOUR ADVOCACY IS IN PLACE.-TRAIN 25 TO 30 NEW VOLUNTEERS IN 2017-ACTION - ONE SYSTEM WIDE VOLUNTEER TRAINING WAS HELD IN 2017. VOLUNTEERS SERVE BOTH MAPLE GROVE HOSPITAL AND NORTH MEMORIAL HEALTH HOSPITAL. 23 VOLUNTEER ADVOCATES WERE TRAINED.-INCREASE THE NUMBER OF PARTICIPANTS AT MAPLE GROVE HOSPITAL-ACTION - A TOTAL OF 128 CLIENTS WERE SERVED AT MAPLE GROVE HOSPITAL IN 2017. THERE WERE 152 ENCOUNTERS AT MAPLE GROVE HOSPITAL WHICH INCLUDES DUPLICATE CLIENTS. THERE ARE ALSO 182 CLIENT ENCOUNTERS THAT DO NOT FIT UNDER A HOSPITAL. THESE INCLUDE 169 PHONE CALLS, 6 WALK-INS, AND 7 CLINIC VISITS.-TRAIN NEW FACILITATORS FOR SUPPORT GROUPS-ACTION - NO NEED FOR NEW SUPPORT GROUP FACILITATORS WAS IDENTIFIED AT MAPLE GROVE HOSPITAL IN 2017.-DISTRIBUTE CLIENT EMERGENCY FUNDS TO QUALIFIED CLIENTS-ACTION - SYSTEM-WIDE WE SERVED 23 CLIENTS AND DISTRIBUTED $6,030.50.-PROVIDE COMMUNITY OUTREACH AND EDUCATION ON SAFEJOURNEY-ACTION - NO COMMUNITY OUTREACH AND EDUCATION WAS PROVIDED IN THE MAPLE GROVE HOSPITAL SERVICE AREA. V. WORK WITH COMMUNITY PARTNERS TO COLLECTIVELY IDENTIFY OPPORTUNITIES TO ADDRESS MENTAL HEALTH ISSUES AND SOCIAL CONDITIONS THAT AFFECT MENTAL HEALTH CONDITIONS - CHIP, CCH, WEST METRO HOSPITAL GROUP, LOCAL PUBLIC HEALTH, GOVERNMENT AND OTHERS.STRATEGIES:-CONTINUE ACTIVE INVOLVEMENT IN HENNEPIN COUNTY CHIP AND SOCIAL ISOLATION WORKGROUP-ACTION - CHIP 1.0 ENDED IN 2017. 5 SOCIAL ISOLATION EVENTS WERE HELD IN 2017.-CONTINUE ACTIVE INVOLVEMENT WITH THE CENTER FOR COMMUNITY HEALTH COLLECTIVE ACTION GROUP-ACTION - GROUP CONTINUES TO WORK ON INCREASING AWARENESS OF MENTAL HEALTH FIRST AID CLASSES IN THE METRO COMMUNITY. MAY MENTAL HEALTH AWARENESS MONTH IS A FOCUS FOR GETTING THE WORD OUT ON "MAKE IT OK AND CLASSES FOCUSED ON MENTAL HEALTH. COMMUNITY HEALTH OUTREACH MANAGER CONTINUES TO REPRESENT THE SYSTEM AT MONTHLY MEETINGS.-EXPLORE COMMUNITY PARTNERSHIP OPPORTUNITIES THAT ADDRESS MENTAL HEALTH AND VIOLENCE-ACTION - EXPLORING A COMMUNITY ZERO SUICIDE FOR YOUTH PROJECT WITH COMMUNITY PARTNERS AND MDH. PART V, SECTION B, LINE 11 CONTINUED: PRIORITY 2: SUBSTANCE ABUSE/USE (SYSTEM-WIDE PRIORITY)GOAL - TO CREATE AN ENVIRONMENT WHERE SUBSTANCE ABUSE/USE AMONG THE GENERAL POPULATION AND SUBSTANCE ABUSE/USE AMONG YOUTH IS REDUCED. OBJECTIVES:I. INCREASE AWARENESS OF SUBSTANCE ABUSE/USE ISSUES AMONG YOUTH AND YOUNG ADULTS AND ACTIVITIES TO ADDRESS THESE ISSUES STRATEGIES:-CONTINUE WORKING WITH AND SUPPORTING COMMUNITY COLLABORATIVES SUCH AS PARTNERSHIP FOR CHANGE AND PARTNERS IN PREVENTION-ACTION - ATTEND PARTNERSHIP FOR CHANGE AND PARTNERS IN PREVENTION MEETINGS.-ACTION - FINANCIALLY SUPPORT PARTNERS IN PREVENTION'S UNCOVER THE TRUTH CAMPAIGN WHICH EDUCATES WAYZATA HIGH SCHOOL STUDENTS ABOUT DRUG AND ALCOHOL ISSUES WITH REGARD TO THEIR PEERS.-ACTION - PARTNERSHIP FOR CHANGE, HOUSED OUT OF NORTH MEMORIAL HEALTH HOSPITAL'S TRAUMA DEPARTMENT, LEVERAGES COMMUNITY PARTNERSHIPS TO PREVENT AND REDUCE SUBSTANCE ABUSE IN THE COMMUNITY THROUGH STRATEGIES SUCH AS: -POLD (PLACE OF LAST DRINK) AND RAVE (RESPONSIBLE VENDOR EDUCATION & ENFORCEMENT) -EXPANDED SOCIAL HOST ORDINANCE -MEDICINE ABUSE PREVENTION WORKGROUP WHICH INCLUDES MEDICATION DROP BOXES -MARIJUANA PERCEPTION OF HARM-INCREASE COLLABORATION WITH THE NORTHWEST AND WAYZATA FAMILY SERVICE COLLABORATIVES TO ADDRESS FACTORS THAT INCREASE THE RISK OF SUBSTANCE ABUSE/USE AMONG YOUTH.-ACTION - EXPLORING A COMMUNITY ZERO SUICIDE FOR YOUTH PROJECT WITH COMMUNITY PARTNERS SUCH AS THE FAMILY SERVICE COLLABORATIVES AND MDH. II. IMPROVE ACCESS TO ADDICTION MEDICINE SERVICES STRATEGIES:-OPENED THE NORTH MEMORIAL HEALTH MENTAL HEALTH & ADDICTION CARE CLINIC (THE NAME CHANGED TO MENTAL HEALTH CLINIC IN 2018)-ACTION - THE CLINIC LOCATED IN ROBBINSDALE OPENED IN DECEMBER 2016 IN RESPONSE TO AN IDENTIFIED COMMUNITY NEED. THE CLINIC HAS 10,300 SQ. FT. AND FOCUSES ON GENERAL MENTAL HEALTH PROBLEMS WITH A SPECIFIC FOCUS ON SERIOUS AND PERSISTENT MENTAL ILLNESS AND POST-TRAUMATIC STRESS DISORDER. ORIGINALLY THE CLINIC INCLUDED ADDITION MEDICINE, HOWEVER WHEN OUR ONLY ADDITION MEDICINE PROVIDER LEFT IN EARLY 2017 A REPLACEMENT WAS NOT OBTAINED. SUBSTANCE USE DISORDERS ARE ADDRESSED WITHIN THE CONTEXT OF MENTAL HEALTH CARE, BUT WE NO LONGER PROVIDED ADDICTION SPECIFIC TREATMENT WITHIN THE MENTAL HEALTH CLINIC. -CONTINUED ASSESSMENT OF COMMUNITY NEED AND DEVELOPMENT OF PROGRAMS AS NEED IS IDENTIFIED-ACTION - NORTH MEMORIAL HEALTH CURRENTLY HAS EMERGENCY MEDICINE, A CONSULT SERVICE FOR THE ED, OBSERVATION AND MEDICAL UNITS, AN INPATIENT PSYCHIATRIC UNIT, TWO TRACKS OF PARTIAL HOSPITAL PROGRAMS, TWO TRACKS OF INTENSIVE OUTPATIENT PROGRAMS, OUTPATIENT THERAPY AND PSYCHIATRY AND 3 INTEGRATED BEHAVIORAL HEALTH PROVIDERS IN 4 OF ITS 15 PRIMARY CLINICS. THE CUSTOMER BASE RANGES IN AGE FROM 18 TO 90, COMES FROM VARIED ETHNIC BACKGROUNDS WITH A VARIETY OF INSURERS INCLUDING THIRD PARTY PAYERS, MEDICARE AND MEDICAID. MOST OF OUR CUSTOMERS HAVE DIAGNOSES OF PSYCHOSIS, PTSD, AND MOOD DISORDERS. III. INCREASE AWARENESS OF OPIOID MISUSE AND WORK TO PUT SYSTEMS IN PLACE TO REDUCE THIS MISUSESTRATEGIES:-WORK WITH ICSI (INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT) ON PROGRAM DEVELOPMENT-ACTION - WORKGROUPS HAVE BEEN FORMED AROUND: -ACUTE PRESCRIBING -CHRONIC PRESCRIBING FOR CHRONIC PAIN -HIGH RISK POPULATIONS -PROPER DISPOSAL OF UNUSED OPIOIDS.-CONTINUE INVOLVEMENT WITH PARTNERSHIP FOR CHANGE AND MINNESOTA'S PRESCRIPTION MONITORING PROGRAM (PMP)-ACTION - PARTNERSHIP FOR CHANGE WORKED IN PARTNERSHIP WITH THE PHARMACY DEPARTMENT ON INTEGRATING PMP INTO EPIC, PATIENT PORTAL.-RESEARCH COMMUNITY BASED OPIOID ABUSE PREVENTION PROGRAMS-ACTION - BEING ADDRESSED BY WORK WITH ICSI AND PARTNERSHIP FOR CHANGE.PRIORITY 3: HEALTHY AGING/SENIOR SERVICESGOAL - TO WORK TOGETHER WITH LOCAL GOVERNMENT, OTHER HEALTHCARE SYSTEMS, SOCIAL SERVICE PROVIDERS AND COMMUNITY MEMBERS TO CREATE AN ENVIRONMENT WHERE OUR AGING POPULATION CAN HAVE ACCESS TO THE PROGRAMS AND SERVICES NEEDED TO AGE IN PLACE.OBJECTIVES:I. ADDRESS COMMUNITY-BASED INFRASTRUCTURE CHALLENGES THAT CREATE BARRIERS TO HEALTHY AGING IN MAPLE GROVESTRATEGIES:-CONTINUE WORKING WITH THE CITY OF MAPLE GROVE'S AGE-FRIENDLY MAPLE GROVE INITIATIVE -ACTION - ACTIVE PARTICIPATION ON THE CITY OF MAPLE GROVE'S AGE-FRIENDLY MAPLE GROVE INITIATIVE.II. IMPROVE EDUCATION ABOUT ADVANCE CARE PLANNING STRATEGIES:-OFFER A MINIMUM OF FOUR EVIDENCE BASED RESPECTING CHOICES PRESENTATION IN THE MAPLE GROVE COMMUNITY ASSESSMENT AREA-ACTION - TWO CLASSES WERE OFFERED IN THE MAPLE GROVE ASSESSMENT AREA IN 2017: -TRADITION INDEPENDENT AND ASSISTED LIVING BROOKLYN PARK MN. 25 PARTICIPANTS -PLYMOUTH HEALTHY LIVING FAIR PLYMOUTH MN. 30 PARTICIPANTS -OTHER CLASSES WERE NOT OFFERED DURING 2017 BECAUSE THE ADVANCE CARE PLANNING COORDINATOR LEFT HER POSITION AND WAS NOT REPLACED.-EXPLORE OFFERING A RESPECTING CHOICES TRAIN THE PRESENTER SESSION TO COMMUNITY PARTNERS THAT WOULD OFFER THE RESPECTING CHOICES CLASS TO THE WIDER COMMUNITY-ACTION - DEFERRED UNTIL NEW ADVANCE CARE PLANNING COORDINATOR IS IN PLACE. III. EXPLORE IMPLEMENTING A COMMUNITY BASED FALLS PREVENTION EDUCATION PROGRAM STRATEGIES:-LOOK INTO IMPLEMENTING THE STEPPING ON AND/OR MATTER OF BALANCE PROGRAMS-ACTION - TWO STAFF MEMBERS ATTENDED THE FALL PREVENTION STEPPING ON FACILITATOR TRAINING IN MAY 2017. THE FIRST STEPPING ON CLASS WAS OFFERED AT THE MAPLE GROVE COMMUNITY CENTER IN THE FOURTH QUARTER OF 2017. A 11 PEOPLE COMPLETED THE COURSE.IV. COMMIT MAPLE GROVE HOSPITAL SUPPORT AND RESOURCES TO WORK WITH COMMUNITY PARTNERS TO COLLECTIVELY IDENTIFY OPPORTUNITIES TO ADDRESS ISSUES AND CONDITIONS THAT AFFECT HEALTH AGINGSTRATEGIES:-OFFER FINANCIAL SUPPORT FOR THE CITY OF MAPLE GROVE'S AGE-FRIENDLY MAPLE GROVE INITIATIVE-ACTION - FINANCIAL SUPPORT WAS PROVIDED TO THE CITY OF MAPLE GROVE'S AGE-FRIENDLY INITIATIVE TO SUPPORT THE CONSULTANT HIRED TO ADVANCE THIS WORK.V. WORK WITH COMMUNITY PARTNERS TO REDUCE CONDITIONS THAT NEGATIVELY AFFECT THE MENTAL HEALTH OF SENIORS SUCH AS SOCIAL ISOLATIONSTRATEGIES:-CONTINUE WORKING WITH HENNEPIN COUNTY CHIP SOCIAL ISOLATION COMMITTEE-ACTION - CHIP 1.0 ENDED IN 2017. 5 SOCIAL ISOLATION EVENTS WERE HELD IN 2017.-EXPLORE POTENTIAL PARTNERSHIPS WITH SOCIAL SERVICE GROUPS THAT ADDRESS SOCIAL ISOLATION-ACTION - IN 2017 NORTH MEMORIAL HEALTH COMMUNITY PARAMEDICS CONDUCTED 2,904 IN-HOME ENCOUNTERS. 271 OF THESE HOME ENCOUNTERS WERE IN THE MAPLE GROVE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT AREA. SOCIAL ISOLATION AND FOOD SECURITY ARE ADDRESSED AT EVERY VISIT. THE HEALTH PRIORITIES NOT BEING ADDRESSED DIRECTLY INCLUDE:-CANCER - PREVENTION, SCREENING, HEALTHY SURVIVORS -NUTRITION/HEALTHY LIFESTYLES -INJURY PREVENTION ACROSS THE LIFESPAN -UNDERSTANDING OF IMMIGRANT CULTURES AND ISSUES RELATED TO HEALTH/DISPARITIES-YOUTH ENGAGEMENT - EDUCATION ABOUT HEALTHCARE CAREERS, LEADERSHIP DEVELOPMENT-TRANSPORTATION/HEALTHCARE ACCESS THE COMMUNITY ENGAGEMENT ADVISORY TEAM FELT THAT TO MAKE A MEANINGFUL DIFFERENCE IN THE TOP THREE IDENTIFIED HEALTH PRIORITIES RESOURCES SHOULD BE FOCUSED ON THESE PRIORITIES AND NOT SPREAD ACROSS A MULTITUDE OF PRIORITIES. CANCER PREVENTION, SCREENING AND HEALTHY SURVIVORS IS BEING ADDRESSED BY THE AMERICAN CANCER SOCIETY AND THE CANCER CENTER AT NORTH MEMORIAL HEALTH HOSPITAL. NUTRITION AND HEALTHY LIFESTYLES IS BEING ADDRESSED BY MANY GROUPS SUCH AS THE AMERICAN CANCER SOCIETY, THE AMERICAN HEART ASSOCIATION, THE YMCA AND LOCAL PARK AND RECREATION ASSOCIATIONS. INJURY PREVENTION IS BEING ADDRESSED BY SAFE KIDS OUT OF NORTH MEMORIAL HEALTH AND SENIOR INJURY PREVENTION IS BEING ADDRESSED THROUGH THE HEALTHY AGING/SENIOR SERVICES HEALTH PRIORITY. CULTURAL DIVERSITY IS BEING WOVEN INTO THE TOP THREE PRIORITIES. YOUTH HAVE ACCESS TO VOLUNTEER OPPORTUNITIES THROUGH MAPLE GROVE HOSPITAL'S VOLUNTEER DEPARTMENT. TRANSPORTATION IS BEING DISCUSSED AT THE COUNTY AND LOCAL LEVEL ALONG WITH THE HEALTHY AGING/SENIOR SERVICES PRIORITY. PART III, LINE 2: AMOUNT REPRESENTS THE HOSPITAL'S BAD DEBT PROVISION REDUCED BY THE HOSPITAL'S COST TO CHARGE RATIO WHICH REPRESENTS THE BEST ESTIMATE OF COST FOR THE BAD DEBT PROVISION. PART III, LINE 4: MAPLE GROVE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT. PART III, LINE 8: THE SHORTFALL REPORTED REPRESENTS THE AMOUNT THE MEDICARE REIMBURSEMENT IS LESS THAN THE ESTIMATED COST OF PROVIDING SERVICES TO THOSE PATIENTS. THE METHOD USED TO ESTIMATE THOSE COSTS IS THE COST TO CHARGE RATIO APPROACH WHICH CALCULATES THE RATIO OF TOTAL HOSPITAL COSTS / TOTAL HOSPITAL GROSS REVENUE AND THEM APPLIES THAT RATIO TO TOTAL MEDICARE GROSS REVENUE. PART III, LINE 9B: MAPLE GROVE HOSPITAL CORPORATION HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATION'S INTRANET AND EACH PATIENT IS GIVEN A BROCHURE UPON ADMISSION. PART VI, LINE 2: MAPLE GROVE HOSPITAL WORKS CLOSELY WITH COMMUNITY MEMBERS TO DETERMINE AREAS OF INTEREST AND NEED IN HEALTHCARE SERVICES. (A NEW COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN 2016. WE ARE CURRENTLY ADDRESSING THE NEEDS IDENTIFIED IN OUR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT.) PART VI, LINE 3: MAPLE GROVE HOSPITAL HAS A VERY PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE A DISCOUNT TO UNINSURED MINNESOTA RESIDENTS AS WELL AS A FINANCIAL ASSISTANCE PROGRAM FOR FINANCIALLY QUALIFIED PATIENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE. MAPLE GROVE HOSPITAL IDENTIFIED MINOR OMISSIONS AND ERRORS RELATED TO 501(R) CHARITY CARE PRACTICES DURING TAX YEAR 2016 THAT IMPACTED BOTH 2016 AND 2017, AND WERE DUE TO REASONABLE CAUSE. PRIOR TO THE IMPLEMENTATION OF 501(R), MAPLE GROVE HOSPITAL WAS SUBJECT TO MINNESOTA ATTORNEY GENERAL REQUIREMENTS. THE OMISSIONS AND ERRORS OCCURRED WHEN INTEGRATING 501(R) REQUIREMENTS WITH MINNESOTA ATTORNEY GENERAL REQUIREMENTS. UPON DISCOVERY OF THE OMISSIONS, MAPLE GROVE HOSPITAL POLICIES AND PROCEDURES WERE PROMPTLY REVISED TO PROMOTE AND FACILITATE OVERALL COMPLIANCE WITH BOTH FEDERAL AND STATE REQUIREMENTS. THE REVISED 501(R) POLICY AND PROCEDURES WERE EFFECTIVE 07/17/2017. PART VI, LINE 4: WE SERVE A 27 ZIP-CODE AREA IN THE NORTHWEST SIDE OF THE TWIN CITIES METRO. THIS IS BASED ON THE HOME ZIP CODES FOR 75% OF OUR INPATIENT POPULATION, EXCLUDING NEWBORNS AND NEONATES. WE WORK WITH THE COMMUNITY TO ADDRESS COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 5: MAPLE GROVE HOSPITAL PROVIDES EDUCATIONAL RESOURCES FOR COMMUNITY MEMBERS SUCH AS CLASSES ON HEALTH CARE DIRECTIVES, KIDS SAFETY FAIRS AND SEMINARS ON HEALTH TOPICS. PART VI, LINE 6: MAPLE GROVE HOSPITAL IS A PART OF NORTH MEMORIAL HEALTH SYSTEM, WHICH IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. THROUGH TARGETED OUTREACH, EDUCATION AND PARTNERSHIPS, WE IMPROVE THE HEALTH OF OUR COMMUNITIES BY LISTENING TO THEIR NEEDS AND RESPONDING WITH APPROPRIATE PROGRAMS AND SERVICES. OUR PROGRAMS, MANY OF WHICH HAVE BEEN NATIONALLY RECOGNIZED, RANGE FROM HEALTH EDUCATION AND FREE SCREENING TO TRAINING HEALTH PROFESSIONALS. PART VI, LINE 7: MAPLE GROVE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF MINNESOTA. X X X 0 0 0 0 0 1 1 0 0 J KEVIN CROSTON MD BOARD CHAIR 0 765410 0 191639 0 8732 0 18900 0 27507 0 1012188 0 0 AARON BLOOMQUIST TREASURER 0 380560 0 57321 0 30908 0 18900 0 13965 0 501654 0 0 ANDREW HOULTON MD DIRECTOR - PART YEAR 0 412508 0 63000 0 7766 0 18900 0 17462 0 519636 0 0 JENNIFER CLOSE DIRECTOR 0 420000 0 0 0 3351 0 11769 0 17212 0 452332 0 0 JEFF WICKLANDER DIRECTOR 0 419343 0 63045 0 2315 0 18900 0 26738 0 530341 0 0 ANDREW COCHRANE PRESIDENT 0 350000 0 87500 0 3071 0 18900 0 24889 0 484360 0 0 PAMELA DOORENBOS MD VP MEDICAL AFFAIRS 299757 0 59575 0 661 0 10911 0 9181 0 380085 0 0 0 STEVEN HORSTMANN VP OPERATIONS 132312 66981 26701 0 98 200 4437 2481 979 1530 164527 71192 0 0 WENDY ULFERTS VP PATIENT CARE/ CHIEF NURSING OFFIC 113894 0 26084 0 1200 0 4884 0 8345 0 154407 0 0 0 KAREN HALL PHARMACIST 165994 0 18467 0 655 0 9223 0 16277 0 210616 0 0 0 SARAH R JOHNSON MANAGER, PHARMACY 153002 0 13328 0 2178 0 8317 0 16218 0 193043 0 0 0 REBECCA THIESFELD RAUEN DIRECTOR, HUMAN RESOURCES 142349 0 25740 0 959 0 8405 0 17174 0 194627 0 0 0 LEAH WANDERSEE DIRECTOR, PROCEDURAL CARE 148582 0 25958 0 1437 0 8727 0 8050 0 192754 0 0 0 FAITH ZWIRCHITZ DIRECTOR, WOMENS & CHILDREN'S 148456 0 25939 0 102 0 8720 0 1993 0 185210 0 0 0 PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER IS AN EMPLOYEE OF NORTH MEMORIAL HEALTH CARE. OTHER BOARD MEMBERS LISTED WITH COMPENSATION FROM A RELATED ORGANIZATION ARE OFFICERS AND KEY EMPLOYEES OF NORTH MEMORIAL HEALTH CARE WHO PROVIDE SERVICES TO MAPLE GROVE HOSPITAL AS WELL AS TO ALL OR SOME RELATED ENTITIES AS IDENTIFIED ON SCHEDULE R. AS SUCH, THEIR COMPENSATION LEVELS INCORPORATE SERVICES PROVIDED TO MULTIPLE NORTH MEMORIAL ENTITIES. PART I, LINE 6 NORTH MEMORIAL HEALTH CARE'S ANNUAL INCENTIVE PLAN REQUIRES ACHIEVEMENT OF STATED PERFORMANCE METRICS, WHICH INCLUDE OPERATING CASH FLOW MARGIN. A CITY OF MAPLE GROVE 410873250 56516TBU8 2017-05-25 128801633 REFUNDING OF 2007 BOND SERIES 0 1 0 A 128801633 1020988 127780645 2017 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 NORTH MEMORIAL HEALTH CARE, A RELATED PARTY, PERFORMS MANAGEMENT DUTIES ON BEHALF OF MAPLE GROVE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 MAPLE GROVE HOSPITAL HAS ONE CLASS OF MEMBERS. NORTH MEMORIAL HEALTH CARE ("NORTH MEMORIAL") AND FAIRVIEW HEALTH SERVICES ("FAIRVIEW") ARE THE ONLY MEMBERS OF THE CORPORATION AND BOTH MEMBERS ARE NONPROFIT, TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS IS COMPRISED OF SEVEN VOTING DIRECTORS AND ONE NON-VOTING DIRECTOR, AS FOLLOWS: (A) THE CHIEF EXECUTIVE OFFICER OF NORTH MEMORIAL AND FOUR OTHER DIRECTORS APPOINTED ANNUALLY BY NORTH MEMORIAL (B) THE CHIEF EXECUTIVE OFFICER OF FAIRVIEW AND ONE OTHER DIRECTOR APPOINTED ANNUALLY BY FAIRVIEW AND (C) THE MAPLE GROVE HOSPITAL CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS, AND ONLY THE MEMBERS, MAY TAKE DIRECT ACTION ON THE FOLLOWING MATTERS BY UNANIMOUS MEMBER APPROVAL: (A) AMENDMENTS TO THE ARTICLES OF INCORPORATION; (B) AMENDMENTS TO THE BYLAWS; (C) MERGER OR CONSOLIDATION OF THE CORPORATION (D) SALE, LEASE OR TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (E) JOINT VENTURES AFFECTING SUBSTANTIALLY ALL OF THE ASSETS OR OPERATIONS OF THE CORPORATION; (F) DETERMINATION OF THE NAME UNDER WHICH THE HOSPITAL CONDUCTS BUSINESS; (G) CERTAIN MORTGAGES OR OTHER SECURITY INTERESTS; (H) ISSUANCE OF CAPITAL CALLS; AND (I) DISSOLUTION AND LIQUIDATION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS REVIEW THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEW THE FORM 990 WITH THE MANAGEMENT COMPANY IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE MANAGEMENT COMPANY APPROVES THE FORM 990 AND FORWARDS IT TO THE BOARD FOR ITS REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY POSITIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF NORTH MEMORIAL WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE OF NORTH MEMORIAL INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE ONLINE THROUGH THE OFFICE OF THE ATTORNEY GENERAL VIA THE CHARITY REPORT FILED WITH THE STATE OF MINNESOTA. FORM 990, PART IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 13,998,442. MANAGEMENT AND GENERAL EXPENSES 2,818,524. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,816,966. COLLECTION AGENCY FEES: PROGRAM SERVICE EXPENSES 275,534. MANAGEMENT AND GENERAL EXPENSES 55,477. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 331,011. LAUNDRY FEES: PROGRAM SERVICE EXPENSES 533,764. MANAGEMENT AND GENERAL EXPENSES 107,471. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 641,235. SECURITY FEES: PROGRAM SERVICE EXPENSES 295,318. MANAGEMENT AND GENERAL EXPENSES 59,461. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 354,779. MISCELLANEOUS PURCHASED FEES: PROGRAM SERVICE EXPENSES 1,306,640. MANAGEMENT AND GENERAL EXPENSES 263,086. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,569,726. FORM 990, PART XI, LINE 9: RETURN OF CAPITAL TO MEMBERS -30,400,000. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT PROCESS OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE CURRENT TAX YEAR. FORM 990, PART XI, LINE 9: RETURN OF CAPITAL TO MEMBERS: A RETURN OF CAPITAL IN THE AMOUNT OF $30,400,000 WAS MADE TO THE MEMBERS OF THE ORGANIZATION. THE MEMBERS CONSIST OF NORTH MEMORIAL HEATH CARE AND FAIRVIEW HEALTH SERVICES. ALL MEMBERS ARE REQUIRED TO BE NON-PROFIT, TAX EXEMPT ORGANIZATIONS UNDER IRC SECTION 501(C)(3) PER THE BYLAWS OF THE ORGANIZATION. NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 410729979 ACUTE CARE MN 501(C)(3) LINE 3 NORTH MEMORIAL 0 NORTH MEMORIAL FOUNDATION 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411777966 FUNDRAISING MN 501(C)(3) LINE 7 NORTH MEMORIAL 0 ASSOCIATED HEALTH ASSURANCE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 980343815 INSURANCE BD 501(C)(3) LINE 12B, II NORTH MEMORIAL 0 NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE LLC 9855 HOSPITAL DRIVE MAPLE GROVE MN 55369 260393039 OUTPATIENT SURGERY MN N/A MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 352162215 RADIOLOGY MN N/A NORTH RADIATION THERAPY CENTER 6950 FRANCE AVE S SUITE 200 EDINA MN 55435 743069974 RADIOLOGY MN N/A BLAINE URGENCY CENTER LLC 480 OSBORNE RD NE FRIDLEY MN 55432 461630126 URGENT CARE MN N/A PLYMOUTH CITY CENTER MEDICAL BUILDING 5700 SMETANA DRIVE SUITE 120 MINNETONKA MN 55343 463883617 MEDICAL OFFICE BUILDING MN N/A MINNETONKA AMBULATORY SURGERY CENTER 3300 OAKDALE AVE NORTH ROBBINSDALE MN 55422 465653486 OUTPATIENT SURGERY MN N/A CRYSTAL IMAGING CENTER LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 454265124 RADIOLOGY MN N/A MULTICARE SLEEP CENTER LLC 10600 OLD COUNTY ROAD 15 PLYMOUTH MN 55441 274833673 OUTPATIENT SLEEP CENTER MN N/A OAKDALE HEALTH ENTERPRISES INC 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411546422 AMBULANCE MN N/A C 0 NORTH COLLABORATIVE CARE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 461680666 PRIMARY CARE MN N/A C 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 NORTH MEMORIAL HEALTH CARE (CASH TRANSFER) B 22800000 CASH NORTH MEMORIAL HEALTH CARE (DEBT GUARANTEE) E 89512500 AMOUNT GUARANTEE NORTH MEMORIAL HEALTH CARE (LEASE PAYMENTS) K 458957 AMOUNT PAID NORTH MEMORIAL HEALTH CARE (MANAGEMENT FEE) R 18560617 AMOUNT PAID NORTH MEMORIAL HEALTH CARE (SALARY REIMBURSEMENT) P 11880518 AMOUNT PAID