2017-11-14T15:23:48-06:00 2016-12-31 135665207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2016-01-01 410811697 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC LAKE 9528836584 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DOUGLAS E JOHNSON CFO 9528836584 2017-11-14 1 MONROE JORDAN GIERL P01413237 6123055000 198.174.110.146 2017-11-14 15:23:25 CS P 1A39D2BAC3E977A191A219CBBAAA8778AA2E0A5D 282CC43464B9830A349574F670F0BA37F913502D 2016 2017-02-10 21:41:12Z DOUGLAS E JOHNSON 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 117458957 0 X WWW.LAKEVIEW.ORG X 1880 MN SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS 9 8 1246 270 0 0 161890 650454 102438860 116751882 11806 10121 21241 6265 102633797 117418722 164340 165967 0 0 50555039 53645203 0 0 0 41941176 47519148 92660555 101330318 9973242 16088404 56184449 65996525 21027058 19025211 35157391 46971314 X TO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY. 0 0 87674616 165967 111393234 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 87674616 1 0 0 1 0 0 0 0 0 0 1 0 0 0 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 0 0 0 1 0 0 1 1246 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X DOUGLAS JOHNSON 6514304581 927 CHURCHILL STREET WEST STILLWATER MN 55082 X ARBA-DELLA BECK DIRECTOR 0.08 X 0 0 0 REBECCA BILLINGSLEY DIRECTOR & VICE CHAIR 0.08 X 0 0 0 BRUCE BARTIE DO DIRECTOR 0.08 X 0 0 0 ELIZABETH BRADSHAW DIRECTOR 0.08 X 0 0 0 PHILLIP DONALDSON DIRECTOR 0.08 X 0 0 0 DAVID REAMER DIRECTOR 0.08 X 0 0 0 C ANDREW ROLLWAGEN DIRECTOR 0.08 X 0 0 0 JIM SCHUG DIRECTOR & CHAIR 0.08 X 0 0 0 JOHN S MISA MD DIRECTOR 0.50 49.50 X 0 557263 97212 TED WEGLEITNER CEO 40.00 15.00 X X 0 521283 106696 NICK MEYER DIRECTOR 0.08 X 0 0 0 DENISE PONTRELLI DIRECTOR 0.08 X 0 0 0 JULIE SCHMIDT DIRECTOR 0.08 X 0 0 0 DOUGLAS E JOHNSON CFO & TREASURER 24.70 30.30 X 372676 0 76277 PAUL L ERICKSON EXEC. DIR. - DEVELOPMENT 51.00 2.00 X 124489 0 50112 THOMAS S ANDERSON VP - MEDICAL AFFAIRS 55.00 X 0 364280 52041 CYNTHIA A APPLESETH MANAGER - PHARMACY 45.00 X 165230 0 79155 JEFFREY W MAANUM LEAD ULTRASOUND TECH. 40.00 X 147470 0 49756 ROBBI HAGELBERG CNO 40.00 X 203524 0 24205 MICHELLE A KRAFT DIRECTOR OF FINANCE 47.00 X 149557 0 19937 STEPHANIE NOE NEONATAL NURSE PRACTIONER 40.00 X 140163 0 38143 JEFFREY J ROBERTSON FORMER CEO 0.00 X 574771 0 28812 1877880 1442826 622346 61 1 1 0 KRAUS-ANDERSON CONSTRUCTION CO 525 S 8TH ST MINNEAPOLIS MN 55404 CONSTRUCTION SERVICES 7106671 REGIONS HOSPITAL 640 JACKSON ST ST PAUL MN 551012595 ANCILLARY TESTING SERVICES 365910 BWBR ARCHITECTS 380 ST PETER ST STE 600 ST PAUL MN 55102 ARCHITECTURAL SERVICES 340425 QUEST DIAGNOSTICS 1355 MITTEL BLVD WOODDALE IL 60675 LAB SERVICES 314950 MOHAGEN HANSEN ARCHITECTURAL GROUP 1000 TWELVE OAKS CTR WAYZATA MN 55391 ARCHITECTURAL SERVICES 302396 25 629628 20826 650454 NET PATIENT REVENUE 623990 111393234 111393234 OTHER REVENUE 900099 4945168 4945168 CAFETERIA 722210 319115 319115 GIFT SHOP 453220 94365 94365 116751882 10121 10121 46500 40235 6265 6265 6265 117418722 111393234 0 5375034 165967 165967 623554 623554 43977535 40036401 3941134 1965845 1876551 89294 4077623 4013054 64569 3000646 2864348 136298 22664 9125 13539 7500 7500 3854956 878504 2976452 108200 99319 8881 1100928 944998 155930 553726 174689 379037 2151092 1412836 738256 106976 99337 7639 75160 39524 35636 3964872 3365813 599059 333331 44673 288658 MEDICAL & PHARMACY SUPP 29315343 29244882 70461 EQUIPMENT & MAINTENANCE 2691751 1420134 1271617 TAXES & ASSESSMENTS 1962678 1962678 OTHER EXPENSE 1077252 798007 279245 192719 186454 6265 101330318 87674616 13655702 0 16861991 19062723 9017810 11808536 2142993 1925420 369911 161670 48773422 16207405 25723350 32566017 1207577 860817 472159 56184449 65996525 10873009 11325733 10154049 7699478 21027058 19025211 X 35157391 46971314 35157391 46971314 56184449 65996525 X 16088404 -4274481 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 0 0 PART II-B, LINE 1: LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 2951767 2951767 22490171 4359155 18131016 326621 124703 201918 21325913 10842338 10483575 1678950 881209 797741 32566017 PENSION LIABILITIES 7699478 7699478 X PART X, LINE 2: LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2016 OR 2015 FOR UNRECOGNIZED TAX BENEFITS. 1 1 1 X 1 X 275.000000000000 1 1 1 0 1 1 1534841 1534841 0.01510 2226600 805301 1421299 0.01400 6665145 4951368 1713777 0.01690 10426586 5756669 4669917 0.04600 444790 25080 419710 0.00410 119859 119859 0.00120 8036876 3952759 4084117 0.04030 165967 165967 0.00160 8767492 3977839 4789653 0.04720 19194078 9734508 9459570 0.09320 1 1834600 28139258 30130415 -1991157 X 1 1 1 1 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 927 CHURCHILL STREET W STILLWATER MN 55082 WWW.LAKEVIEWHEALTH.ORG/ 8029322 X X X LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X HTTP://WWW.LAKEVIEWHEALTH.ORG/CHNA X HTTP://WWW.LAKEVIEWHEALTH.ORG/CHNA X 1 15 1 HTTP://WWW.LAKEVIEWHEALTH.ORG/CHNA 0 1 X 200.000000000000 275.000000000000 X X X 1 1 X X X 1 X HTTP://WWW.LAKEVIEWHEALTH.ORG/POLICIES X HTTP://WWW.LAKEVIEWHEALTH.ORG/CHARITY-CARE-APPLICATION X HTTP://WWW.LAKEVIEWHEALTH.ORG/POLICIES X X X X X X 1 X 0 X X X X 1 X 0 1 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 5: AS PART OF THE DATA COLLECTION PROCESS FOR THE MOST RECENT CHNA THAT WAS CONDUCTED IN 2015, LAKEVIEW HOSPITAL CONDUCTED TWO COMMUNITY CONVERSATIONS DURING THE SUMMER OF 2015 TO GATHER INPUT FROM VARIOUS GROUPS IN THE COMMUNITY, INCLUDING REPRESENTATIVES OF UNDERSERVED POPULATIONS. THESE CONVERSATIONS INCLUDED INDIVIDUALS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; FEDERAL, STATE OR LOCAL HEALTH DEPARTMENT OR AGENCIES WITH INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED, INCLUDING PUBLIC SCHOOL REPRESENTATION; AND LEADERS, REPRESENTATIVES OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDED IN THE 2015 CHNA INCLUDED REGIONS HOSPITAL, HUDSON HOSPITAL, WESTFIELDS HOSPITAL, AMERY REGIONAL MEDICAL CENTER, AND PARK NICOLLET METHODIST HOSPITAL. LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 11: THE 2015 HEALTHPARTNERS CHNA CONDUCTED RESULTED IN THE FOLLOWING PRIORITIES:PRIORITY 1: INCREASE ACCESS TO MENTAL HEALTHPRIORITY 2: PROMOTE POSITIVE BEHAVIORS TO REDUCE OBESITY (NUTRITION / PHYSICAL ACTIVITY)PRIORITY 3: INCREASE ACCESS TO PRIMARY AND PREVENTIVE CARE PRIORITY 4: IMPROVE SERVICE INTEGRATIONPRIORITY 5: PROMOTE CHANGE IN UNHEALTHY LIFESTYLES (TOBACCO / ALCOHOL / SUBSTANCE ABUSE)A FULL REPORT OF LAKEVIEW HOSPITAL'S 2015 CHNA AND ANNUAL IMPLEMENTATION PLAN UPDATE IS POSTED ON THEIR WEBPAGE AT HTTP://WWW.LAKEVIEWHEALTH.ORG/CHNA WHICH PROVIDES A DETAILED DESCRIPTION OF ALL THE ACTIVITIES.ACTIONS THE HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH OF THE COMMUNITY AND HAS USED THE ABOVE FINDINGS AND HEALTH PRIORITIES TO CREATE A HOSPITAL SPECIFIC IMPLEMENTATION PLAN. THE HOSPITAL'S IMPLEMENTATION PLAN IDENTIFIES OBJECTIVES AND ACTION STEPS FOR EACH PRIORITY. EACH OBJECTIVE IDENTIFIES ONE WAY THAT THE HOSPITAL WILL POSITIVELY IMPACT THE HEALTH OF THE COMMUNITY. THE ACTION STEPS DEMONSTRATE STRATEGIES THAT THE HOSPITAL WILL TAKE TO CARRY OUT EACH OBJECTIVE. LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS LISTED ON THE BACK OF THE PATIENT STATEMENT PER THE MINNESOTA ATTORNEY GENERAL (AG) AGREEMENT. LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 24: WHEN A PATIENT IS UNINSURED THERE HAVE BEEN INSTANCES WHERE A PORTION OF THE BALANCE IS COVERED BY THE UNINSURED DISCOUNT AND THE REMAINING BALANCE IS COVERED BY CHARITY CARE. EXAMPLE: AN UNINSURED PATIENT HAS $1,000 IN GROSS CHARGES FOR AN EMERGENCY ROOM VISIT. THE PATIENT QUALIFIES FOR CHARITY CARE AND ALSO IS ELIGIBLE FOR THE UNINSURED DISCOUNT. A PORTION OF THE GROSS CHARGES IS COVERED BY THE UNINSURED DISCOUNT AND THE REMAINDER BY CHARITY CARE, WHICH MAY TOTAL AN AMOUNT EQUAL TO THE GROSS CHARGE FOR THAT VISIT. PART I, LINE 7: ACTUAL COSTS WERE ESTIMATED USING A COST-TO-CHARGE RATIO AND EXCLUDING BAD DEBT. PART I, LINE 7E: COMMUNITY HEALTH IMPROVEMENT SERVICES LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (HOSPITAL) IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITY. THE HOSPITAL PROVIDED COMMUNITY ACTIVITIES AND PROGRAMS WHICH WERE SUBSIDIZED BY THE HOSPITAL IN ORDER TO IMPROVE COMMUNITY HEALTH. VARIOUS EVENTS INCLUDED, BUT WERE NOT LIMITED TO, THE FOLLOWING: DIABETES EDUCATION CLASSES, INCLUDING LIFE STEPS TO PREVENTION, STEP OUT DIABETES, AND HEALTHY WEIGHT FOR LIFE; POWERUP FOR KIDS WEEK, INCLUDING VEGETABLE GIVEAWAYS AND PRESCRIPTIONS TO USE AT GROCERY STORES TO PURCHASE VEGETABLES, TO PROMOTE BETTER EATING AND ACTIVE LIVES SO YOUTH CAN REACH THEIR FULL POTENTIAL; LADIES NIGHT OUT TO SUPPORT AND PROMOTE WOMEN'S HEALTH; HOPS FOR HEALTH TO SUPPORT MEN'S HEALTH; AND THE TEDDY BEAR CLINIC PROGRAM WHICH HELPS KINDERGARTNERS LEARN MORE ABOUT THE HEALTH CARE ENVIRONMENT, ALLEVIATING THE STRESS AND ANXIETY THAT IS SOMETIMES ASSOCIATED WITH COMING TO THE HOSPITAL. SUPPORT CLASSES INCLUDED: BREAST CANCER SUPPORT GROUP, MENOPAUSE SURVIVAL GUIDE, DIABETES SUPPORT GROUPS, FREEDOM FROM SMOKING, BREASTFEEDING CLASS, TAI CHI FOR ARTHRITIS, VEIN SCREENING, HAND AND WRIST ARTHRITIS, PELVIC HEALTH, AND VARIOUS OTHER EDUCATIONAL CLASSES FOR THE COMMUNITY. THE NET COST OF PROVIDING COMMUNITY HEALTH IMPROVEMENT AND OPERATIONS ASSOCIATED WITH OFFERING ALMOST 200 CLASSES IN 2016 WAS $398,360. PART I, LINE 7F: HEALTH PROFESSIONS EDUCATION THE HOSPITAL COORDINATES AND SUPPORTS WEEKLY CONTINUING MEDICAL EDUCATION (CME) PROGRAMS FOR STAFF AND COMMUNITY EDUCATION. TOTAL DIRECT COSTS FOR STIPENDS, PURCHASED SERVICES, SUPPLIES, ROOM RENTALS AND INDIRECT COSTS FOR THE YEAR WERE $99,400. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES THE HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES, EVEN AT A FINANCIAL LOSS. IN 2016, LOSS ON SERVICES FOR INPATIENT AND OUTPATIENT HEALTH SERVICES INCLUDING CLINICAL NUTRITION, NEONATAL SERVICES, LABOR AND DELIVERY, AND HOMECARE AND HOSPICE SERVICES TOTALED $3,341,000. PART I, LINE 7I: CONTRIBUTIONS FOR COMMUNITY BENEFIT GRANTS TO SUPPORT HEALTH SERVICES FOR YOUTH AND ADULTS IN THE COMMUNITY INCLUDED: ABIJAH'S HOPE, AMERICAN DIABETES ASSOCIATION, CANVAS HEALTH, CENTURY COLLEGE, COMMUNITY THREAD, ESR, FAMILYMEANS, GRANITE HOUSE, OPERATION GRACE, OUR COMMUNITY KITCHEN, PROJECT LIFE, ST. ANDREW' RESOURCE CENTER, GRIEF AND CARE SUPPORT THROUGH ST. CROIX CHAPLAINCY, TREEHOUSE, VALLEY OUTREACH, YOUNGLIFE, YOUTH ADVANTAGE AND YOUTH SERVICE BUREAU.THE HOSPITAL'S CASH DONATIONS TO COMMUNITY-BASED TAX-EXEMPT ORGANIZATIONS IN THE FORM OF SPONSORSHIPS, GRANTS OR SUPPLIES FOR MEDICAL MISSION TRIPS TOTALED $166,000. PART III, LINE 4: THE "ACTUAL COST" OF BAD DEBT INCLUDED IN COMMUNITY BENEFIT IS ESTIMATED. BAD DEBT EXPENSE REPRESENTS THOSE ACCOUNTS RECEIVABLE WRITTEN OFF FROM PATIENTS THAT HAVE THE ABILITY TO PAY, AS DETERMINED FROM CHARITY CARE APPLICATIONS AND OTHER DOCUMENTATION, BUT CHOOSE NOT TO. THE BAD DEBT AMOUNT IS THE RECEIVABLE AFTER INSURANCE PAYMENT AND ADJUSTMENTS HAVE ALREADY BEEN MADE, INCLUDING ADJUSTMENTS FOR SELF-PAY IN ACCORDANCE WITH THE AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL'S OFFICE. SINCE REDUCTIONS HAVE ALREADY BEEN MADE FOR DISCOUNTS AND OTHER ALLOWANCES, THE ENTIRE BALANCE IS CONSIDERED BAD DEBT AND NO FURTHER REDUCTIONS ARE CONSIDERED.THE PROVISIONS FOR BAD DEBT FOOTNOTE IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS IS INCLUDED IN SECTION 1, PART (P), PAGES 11 AND 12. PART III, LINE 8: THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS:1) IT PROVIDES SERVICES TO A SIGNIFICANT PORTION OF OUR SERVICE POPULATION AT A NEGATIVE MARGIN; 2) THE HOSPITAL WOULD DISCONTINUE PROVIDING SERVICES TO MEDICARE PATIENTS IF THE DECISION WERE BASED STRICTLY ON A FINANCIAL BASIS; 3) THERE IS A COMMUNITY NEED TO PROVIDE THESE SERVICES LOCALLY; 4) IF THE HOSPITAL DID NOT PROVIDE THESE SERVICES; THEY WOULD BECOME THE OBLIGATION OF THE GOVERNMENT. PART III, LINE 9B: IN THE EVENT OF NONPAYMENT, THE HOSPITAL IS COMMITTED TO MAKING REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE BEFORE INITIATING COLLECTION ACTIONS. THE HOSPITAL'S BUSINESS OFFICE HAS THE AUTHORITY AND RESPONSIBILITY FOR DETERMINING WHETHER THE HOSPITAL HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE AND WHETHER THE HOSPITAL IS AUTHORIZED TO ENGAGE IN SPECIFIC COLLECTION ACTIONS WHICH ARE DESCRIBED IN THE HOSPITAL'S BILLING & COLLECTIONS POLICY FOUND ON THE PUBLIC WEBSITE, HTTP://WWW.LAKEVIEWHEALTH.ORG/CHARITY-CARE-APPLICATION. PART III, SECTION A, LINE 2: BAD DEBT EXPENSE METHODOLOGY SEE FINANCIAL STATEMENT FOOTNOTE PROVIDED IN RESPONSE TO PART III, SECTION A, LINE 4. PART VI, LINE 2: IN 2015, A COMPREHENSIVE, SIX-STEP COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") COLLABORATION WAS CONDUCTED FOR HEALTHPARTNERS AND ITS HOSPITALS (REGIONS HOSPITAL, THE HOSPITAL, HUDSON HOSPITAL , WESTFIELDS HOSPITAL, AMERY REGIONAL MEDICAL CENTER, AND PARK NICOLLET METHODIST HOSPITAL) BY COMMUNITY HOSPITAL CONSULTING TO DETERMINE THE GREATEST HEALTH NEEDS IN THE COMMUNITIES THEY SERVE. THESE HOSPITALS SERVE SIMILAR COMMUNITIES AND HAVE OVERLAPPING STUDY AREAS. THE SYSTEM'S STUDY AREA IS DEFINED AS DAKOTA, HENNEPIN, RAMSEY, SCOTT, AND WASHINGTON COUNTIES IN MINNESOTA AND POLK AND ST. CROIX COUNTIES IN WISCONSIN. THE HOSPITAL'S SPECIFIC STUDY AREA IS DEFINED AS: - WASHINGTON COUNTY - ST. CROIX COUNTY - RAMSEY COUNTY DATA ELEMENTS REGARDING ALL SEVEN COUNTIES IN THE SYSTEM'S STUDY AREA ARE INCLUDED IN THIS REPORT FOR COMPARISON, AND ARE ALSO PROVIDED AS AN OPPORTUNITY FOR THE HOSPITALS TO WORK TOGETHER TO MEET THE NEEDS IDENTIFIED IN THE OVERLAPPING COUNTIES.- DEMOGRAPHICS: CHC CONSULTING ANALYZED THE MOST CURRENT DEMOGRAPHICS OF RESIDENTS IN WASHINGTON, ST. CROIX, AND RAMSEY COUNTIES INCLUDING: OVERALL POPULATION, POPULATION BY RACE AND ETHNICITY, MEDIAN AGE, MEDIAN HOUSEHOLD INCOME, POVERTY LEVELS, FOOD INSECURITY, AND EDUCATIONAL ATTAINMENT.- HEALTH DATA COLLECTION: CHC CONSULTING ANALYZED THE MOST CURRENT HEALTH DATA AVAILABLE PERTAINING TO RESIDENTS IN WASHINGTON, ST. CROIX, AND RAMSEY COUNTIES INCLUDING: MORTALITY RATES, CHRONIC CONDITIONS, HEALTH BEHAVIORS, MENTAL HEALTH, COMMUNICABLE DISEASES, PREVENTION AND FATALITY.- COMMUNITY INPUT: AS A PART OF COUNTY-WIDE ASSESSMENTS, SURVEYS AND LISTENING SESSIONS WERE CONDUCTED TO GATHER INPUT FROM COMMUNITY RESIDENTS. IN ADDITION, THE HOSPITAL CONDUCTED COMMUNITY CONVERSATIONS ON MAY 15, 2015 AND JULY 15, 2015 TO GAIN INSIGHT SURROUNDING SIGNIFICANT HEALTH NEEDS.- FINAL PRIORITIZED NEEDS - MENTAL AND BEHAVIORAL HEALTH - ACCESS AND AFFORDABILITY - CHRONIC DISEASE AND ILLNESS PREVENTION - EQUITABLE CAREA FULL REPORT OF THE HOSPITAL'S CHNA AND IMPLEMENTATION PLAN IS POSTED ON THEIR WEBPAGE AT HTTP://WWW.LAKEVIEWHEALTH.ORG/CHNA. PART VI, LINE 3: THE HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO HAVE A NEED FOR MEDICALLY NECESSARY TREATMENT BUT ARE UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. THE HOSPITAL IS COMPLIANT WITH THE 501R FEDERAL REGULATIONS, AND PROVIDES EASY ACCESS TO THE FINANCIAL ASSISTANCE PROGRAM INCLUDING THE FINANCIAL ASSISTANCE POLICY (FAP), APPLICATION, AND PLAIN LANGUAGE SUMMARY. THE FINANCIAL ASSISTANCE PROGRAM AND LISTS OF PROVIDERS COVERED BY THE PROGRAM IS ALSO WIDELY PUBLICIZED AND AVAILABLE ON THE HOSPITAL'S WEBSITE. TO INFORM AND EDUCATE PATIENTS ABOUT THE FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, EACH PATIENT IS OFFERED AND PROVIDED WITH THE FINANCIAL ASSISTANCE PROGRAM POLICY AT REGISTRATION. THIS INFORMATION IS ALSO IS ALSO PROVIDED IN PUBLIC LOCATIONS, INCLUDING REGISTRATION, ON PATIENT STATEMENTS, AND LAKEVIEW'S PUBLIC WEBSITE, WWW.LAKEVIEWHEALTH.ORG.IN ADDITION TO FINANCIAL COUNSELING, THE HOSPITAL HAS STAFF SOCIAL WORKERS AND CASE MANAGERS TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE.TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE, EACH PATIENT BILLING STATEMENT AND COLLECTIONS LETTER PRODUCED BY THE HOSPITAL INCLUDE THE FOLLOWING NOTICE: "LAKEVIEW HOSPITAL OFFERS A FINANCIAL ASSISTANCE PROGRAM. FOR COPIES OF OUR APPLICATION, FINANCIAL ASSISTANCE POLICY, AND PLAIN LANGUAGE SUMMARY, WHICH INCLUDE INFORMATION ON ELIGIBILITY AND HOW WE CALCULATE FINANCIAL ASSISTANCE, PLEASE VISIT WWW.LAKEVIEWHEALTH.ORG. OUR PATIENT FINANCIAL SERVICES TEAM CAN HELP YOU ENROLL IN THIS PROGRAM. PLEASE CALL 651-430-4533." PART VI, LINE 4: THE HOSPITAL SERVES THE EASTERN TWIN CITIES' METRO AREA AND WESTERN WISCONSIN. THE HOSPITAL'S CORE SERVICE AREA INCLUDES STILLWATER, BAYPORT, LAKE ELMO, LAKELAND, AND MARINE ON ST. CROIX, MN ALONG WITH HOULTON AND SOMERSET, WI. PRIMARY SERVICE AREAS ARE HUDSON, NEW RICHMOND AND STAR PRAIRIE, WI, AND AFTON, MN. SECONDARY SERVICE AREAS ARE NEARBY CITIES IN EASTERN MINNESOTA AND WESTERN WISCONSIN.CENSUS FIGURES FOR 2013 SHOW THE FOLLOWING FOR WASHINGTON COUNTY:TOTAL POPULATION: 246,683- PERSONS UNDER 5 YEARS: 6.2%- PERSONS UNDER 18 YEARS: 25.4%- PERSONS 65 YEARS AND OVER: 12.3% IT IS ESTIMATED THAT THE 65 AND OLDER GROUP IN WASHINGTON COUNTY WILL GROW BY 350% BY 2030.- POPULATION CHANGE FROM 2010 TO 2013: +3.6%- FEMALES: 50.5%- WHITE PERSONS: 87.9%- PERSONS OF COLOR: 12.1%- LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 9.3%- HIGH SCHOOL GRADUATES: 95.9%- BACHELOR'S DEGREE OR HIGHER: 40.5%- PERSONS BELOW POVERTY LEVEL 2009 - 2013: 5.7%- MEDIAN HOUSEHOLD INCOME IN WASHINGTON COUNTY FROM 2009 - 2013 WAS $81,540. PART VI, LINE 5: THE HOSPITAL PROVIDED EDUCATION SCHOLARSHIPS TO PEOPLE WITH DIABETES THAT REQUIRED NUTRITION AND LIFE-STYLE EDUCATION; THE HOSPITAL ALSO PROVIDED FREE LAB AND PHARMACY SERVICES FOR PATIENTS OF THE ST. CROIX FAMILY MEDICAL CENTER, A LOCAL MEDICAL CLINIC THAT PROVIDES FREE AND DISCOUNTED SERVICES FOR INDIGENT AND LOW INCOME PATIENTS OF THE AREA. FOR ADDITIONAL DISCUSSION, SEE FORM 990, SCHEDULE O - "EXEMPT PURPOSE AND ACHIEVEMENTS". PART VI, LINE 6: AS A MEMBER OF STILLWATER HEALTH SYSTEM, THE HOSPITAL PARTICIPATES WITH THE MULTI-SPECIALTY CLINIC AND HEALTH SYSTEM LEADERSHIP WITHIN OUR OVERALL ORGANIZATION IN PROVIDING ACCESS TO CARE, SUPPORT GROUPS, EDUCATIONAL ACTIVITIES, AND FINANCIAL CONTRIBUTIONS TO THE MARKET AREA DESCRIBED ABOVE. THE MULTI-SPECIALTY CLINIC FURTHER PARTICIPATES IN MINNESOTA COMMUNITY MEASUREMENT, PRACTICES AND MEASURES PROVIDER, PERFORMANCE WITH SPECIFIC PREVENTIVE CARE METRICS AND SPECIFIC CHRONIC DISEASE MANAGEMENT METRICS. IN 2011, THE STILLWATER HEALTH SYSTEM AFFILIATED WITH HEALTHPARTNERS. THE MISSION OF HEALTHPARTNERS IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES MN PART VI, LINE 7: STATES RECEIVING COMMUNITY BENEFIT REPORT THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH MINNESOTA THROUGH THE MINNESOTA HOSPITAL ASSOCIATION (MHA). 1 PORTICO HEALTHNET 1690 UNIVERSITY AVE W STE 250 ST PAUL MN 55104 411814659 501 (C)(3) 14688 CASH AMOUNT PROGRAM SUPPORT FAMILY MEANS 1875 NORTHWESTERN AVENUE STILLWATER MN 55082 416045574 501 (C)(3) 30000 CASH AMOUNT PROGRAM SUPPORT CANVAS HEALTH 7066 STILLWATER BLVD N OAKDALE MN 55128 410955577 501 (C)(3) 10500 CASH AMOUNT PROGRAM SUPPORT 16 PART I, LINE 2: LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE HOSPITAL'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE HOSPITAL'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. X X X X 1 1 0 0 0 0 0 0 0 JOHN S MISA MD DIRECTOR 0 434975 0 103547 0 18741 0 71637 0 25575 0 654475 0 47843 TED WEGLEITNER CEO 0 380178 0 130432 0 10673 0 74602 0 32094 0 627979 0 6196 DOUGLAS E JOHNSON CFO & TREASURER 272057 0 74284 0 26335 0 42843 0 33434 0 448953 0 0 0 PAUL L ERICKSON EXEC. DIR. - DEVELOPMENT 115067 0 7908 0 1514 0 20750 0 29362 0 174601 0 0 0 THOMAS S ANDERSON VP - MEDICAL AFFAIRS 0 193471 0 16389 0 154420 0 22885 0 29156 0 416321 0 0 CYNTHIA A APPLESETH MANAGER - PHARMACY 155009 0 9971 0 250 0 51249 0 27906 0 244385 0 0 0 JEFFREY W MAANUM LEAD ULTRASOUND TECH. 147470 0 0 0 0 0 19772 0 29984 0 197226 0 0 0 ROBBI HAGELBERG CNO 189278 0 14227 0 19 0 6299 0 17906 0 227729 0 0 0 MICHELLE A KRAFT DIRECTOR OF FINANCE 134125 0 15432 0 0 0 8418 0 11519 0 169494 0 0 0 STEPHANIE NOE NEONATAL NURSE PRACTIONER 140126 0 0 0 37 0 8049 0 30094 0 178306 0 0 0 JEFFREY J ROBERTSON FORMER CEO 0 0 137136 0 437635 0 0 0 28812 0 603583 0 0 0 PART I, LINES 4A-B SCHEDULE J PART I, LINE 4A THE AMOUNT OF SEVERANCE COMPENSATION PROVIDED TO EACH OF THE INDIVIDUALS ON SEVERANCE DURING 2016 IS AS FOLLOWS: JEFFREY ROBERTSON $437,635 SCHEDULE J PARK I , LINE 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTORS AND OFFICERS: JOHN S. MISA, MD $ 46,794 TED WEGLITNER $ 36,015 990, SCHEDULE J, PART II, COLUMN F: PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTOR: JOHN S. MISA, MD $ 47,843 TED WEGLEITNER 6,196 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. 990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS CORPORATE STRUCTURE, PURPOSE, GOVERNANCE LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (THE HOSPITAL) IS A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS "HEALTHPARTNERS". FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED SYSTEM OF HEALTH CARE DELIVERY AND HEALTH CARE FINANCING ORGANIZATIONS, AND IS ONE OF THE LARGEST CONSUMER-GOVERNED ORGANIZATIONS IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS PROVIDES A FULL-RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLAN'S SERVE MORE THAN 1.6 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,700 PHYSICIANS AND DENTISTS, SIX OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 100 OWNED AND LEASED PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND 24 DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO CONTRACTS WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS LOCATED PRIMARILY IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN THE HEALTHPARTNERS FAMILY, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2016 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (SHS), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). SHS IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. THE HOSPITAL AND SHS ARE PART OF THE LAKEVIEW HEALTH SYSTEM (LAKEVIEW HEALTH) ALONG WITH THE LAKEVIEW MEMORIAL HOSPITAL FOUNDATION, A MINNESOTA 501(C) (3) TAX EXEMPT ORGANIZATION (THE FOUNDATION) AND STILLWATER MEDICAL GROUP (SMG), A MINNESOTA 501(C) (3) TAX EXEMPT ORGANIZATION. SHS IS ALSO THE SOLE CORPORATE MEMBER OF THE FOUNDATION AND SMG. HEALTHPARTNERS AND THE HOSPITAL ALSO PARTNER WITH OTHER PLANS, CARE PROVIDERS AND NON-PROFIT ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION; TO INCREASE ACCESS, CREATE AND DISSEMINATE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY AND COLLABORATE ON SYSTEM IMPROVEMENTS. THE HOSPITAL CONTINUES TO BE AN INTEGRAL PART OF THE STILLWATER COMMUNITY AND SURROUNDING AREA - A VITAL AND NECESSARY COMMUNITY RESOURCE SINCE 1880, THE FIFTH OLDEST HOSPITAL, AND SECOND OLDEST CONTINUALLY OPERATING HOSPITAL IN MINNESOTA. THE HOSPITAL IS DESIGNATED A LEVEL 3 TRAUMA HOSPITAL AND HAS MEDICAL STAFF IN A VARIETY OF SPECIALTIES, INCLUDING FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, OB/GYN, GENERAL SURGERY, ORTHOPEDICS, OTOLARYNGOLOGY, OCCUPATIONAL HEALTH, EMERGENCY MEDICINE, HOSPITALISTS, NEUROLOGY, ONCOLOGY, UROLOGY, CARDIOLOGY, SPORTS MEDICINE,, GASTROENTEROLOGY, RADIOLOGY, PATHOLOGY AND ANESTHESIOLOGY. COURTESY AND CONSULTING STAFF PROVIDE ADDITIONAL SERVICES, INCLUDING PAIN MANAGEMENT, AND INFECTIOUS DISEASE, PULMONARY/SLEEP MEDICINE AND ORAL SURGERY. CHARITY CARE: CHARITY CARE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES: PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY; PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER; AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES, OR SPECIAL FINANCIAL HARDSHIP, WARRANT SPECIAL CONSIDERATION. THE HOSPITAL PROVIDED $1,174,646 IN FREE OR DISCOUNTED CARE TO LOW-INCOME AND UNINSURED PATIENTS. GOVERNMENT-SPONSORED MEANS-TESTED HEALTH CARE: THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT CARE, INCLUDING EMERGENCY DEPARTMENT SERVICES TO MEDICAID PATIENTS. PAYMENTS RECEIVED FOR THESE SERVICES ARE BELOW THE COST OF CARE PROVIDED. THE HOSPITAL'S EXPENSE TO COVER UNREIMBURSED MEDICAID COSTS FOR PATIENTS TOTALED $1,422,143. BENEFIT TO THE COMMUNITY: THE HOSPITAL WORKS IN COLLABORATIVE PARTNERSHIP WITH THE COMMUNITY TO IMPROVE HEALTH AND WELL-BEING. THE LAKEVIEW HEALTH ORGANIZATIONS, THE COMMUNITY AND THE HOSPITAL ACCOMPLISHED A GREAT DEAL IN 2016. OUR PARTNERSHIP WAS ADVANCED ON APRIL 1, 2011, WITH A FORMAL AFFILIATION WITH HEALTHPARTNERS AND ITS FAMILY OF HEALTH CARE ORGANIZATIONS. ADVANCEMENTS WERE MADE TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. THE HOSPITAL CONTINUES TO GROW ITS REPUTATION FOR EXCELLENT CLINICAL OUTCOMES AND SERVICE. 1. COMMUNITY HEALTH SERVICES: THE HOSPITAL PARTICIPATED IN COMMUNITY-BASED COLLABORATIVE EFFORTS TO IMPROVE ACCESS TO COMMUNITY AND MENTAL HEALTH SERVICES: -THE COMMUNITY HEALTH ACTION TEAM (CHAT) FOCUSED DISCUSSION ON MENTAL HEALTH ACCESS AND STIGMA REDUCTION. THE HOSPITAL AND COMMUNITY PARTNERS SUPPORTED TRAINING FOR THE MAKE IT OK (MIO) ANTI-STIGMA CAMPAIGN. MIO AMBASSADORS' TRAINING WAS HELD FOR 25 COMMUNITY MEMBERS IN MARCH 2016. -THE HOSPITAL PROVIDES REPRESENTATION AT CONNECT COMMUNITY COLLABORATIVE FOR MENTAL AND CHEMICAL HEALTH. -BEHAVIORAL HEALTH SUMMIT GROUP: THE HOSPITAL IS AN ACTIVE PARTICIPANT IN THE WASHINGTON COUNTY SUMMIT WHICH EXPLORES PRIORITY NEEDS IN THE AREA OF BEHAVIORAL/MENTAL HEALTH AND SUBSTANCE ABUSE. -POWERUP IS A COMMUNITY-BASED INITIATIVE FOCUSED ON CHILDHOOD OBESITY PREVENTION. WORKING WITH SCHOOLS, BUSINESSES, THE FAITH COMMUNITY AND LOCAL ORGANIZATIONS AND LEADERS, POWERUP MAKES IT FUN AND POPULAR FOR KIDS AND FAMILIES TO EAT BETTER AND MOVE MORE. KEY PROGRAMS INCLUDE: POWERUP SCHOOL CHALLENGE INSPIRED MORE THAN 10,000 CHILDREN PLUS SCHOOL STAFF IN MORE THAN 30 SCHOOLS TO EAT MORE FRUITS AND VEGETABLES. MORE THAN 40,000 FAMILIES AND CHILDREN WERE REACHED THROUGH EVENTS, CLASSES, OUTREACH, PROGRAMS AND RESOURCES TO PROMOTE BETTER EATING, FAMILY MEALS, PHYSICAL ACTIVITY, REDUCED SCREEN TIME AND FEWER SUGARY DRINKS. OPEN GYMS, IN PARTNERSHIP WITH LOCAL SCHOOLS, HAVE EXPANDED TO INCLUDE MULTI-SITE OFFERINGS ON A WEEKLY BASIS. BETTER SHELF FOR BETTER HEALTH PROJECTS CONTINUES TO TRANSFORM FOOD SHELVES AND INCREASE ACCESS TO HEALTHY CHOICES FOR LOW INCOME COMMUNITY MEMBERS. -THE HOSPITAL HELD TWO AMERICAN RED CROSS BLOOD DRIVES IN 2016, ON THE HOSPITAL CAMPUS, WITH 50 STAFF AND COMMUNITY MEMBERS VOLUNTEERING FOR THIS CAUSE. -CONTINUED FACILITATION OF THE LOCAL CANCER SUPPORT GROUP, IN COLLABORATION WITH THE CANCER CENTER OF WESTERN WISCONSIN. FORM 990, PART III, LINE 4A -THE HOSPITAL SPONSORED AND COORDINATED ALMOST 200 COMMUNITY BENEFIT CLASSES, EVENTS AND SUPPORT GROUPS DURING THE YEAR AT A NET COST OF APPROXIMATELY $398,300. 2. HEALTH PROFESSIONAL EDUCATION: THE HOSPITAL COORDINATES AND SUPPORTS WEEKLY CONTINUING MEDICAL EDUCATION (CME) PROGRAMS FOR STAFF AND COMMUNITY EDUCATION. TOTAL DIRECT COSTS FOR STIPENDS, PURCHASED SERVICES, SUPPLIES, ROOM RENTALS AND INDIRECT COSTS FOR THE YEAR WERE $99,400. 3. SUBSIDIZED HEALTH SERVICES: THE HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES, EVEN AT A FINANCIAL LOSS. IN 2016, LOSS ON SERVICES FOR INPATIENT AND OUTPATIENT HEALTH SERVICES, INCLUDING HOSPITAL OUTPATIENT SERVICES (CLINICAL DIABETES AND NUTRITION), NEONATAL SERVICES, AND HOMECARE AND HOSPICE SERVICES, TOTALED $3,341,000. STILLWATER AREA SCHOOLS WELLNESS PROGRAM AND CENTER OPERATES AT THE LARGEST HIGH SCHOOL IN THE SERVICE AREA. THE WELLNESS CENTER IS A PHYSICAL SPACE IN THE HIGH SCHOOL IN COLLABORATION WITH FAMILYMEANS, YOUTH SERVICE BUREAU, THE HOSPITAL'S POWERUP INITIATIVE, LAKEVIEW HEALTH AND INDEPENDENT SCHOOL DISTRICT 834. THIS COLLABORATION PROVIDES SERVICES TO YOUTH AT LOW TO NO-COST FOR MENTAL HEALTH, CHEMICAL HEALTH AND NUTRITION ISSUES. THE WELLNESS CENTER PROGRAM EXPERIENCED 4,485 CONTACTS FOR CHEMICAL AND MENTAL HEALTH ISSUES (2,460 STUDENTS, 1,350 STAFF AND 675 PARENT CONTACTS) IN 2016. 4. FINANCIAL CONTRIBUTIONS: TO ADDRESS HEALTH CARE ACCESS FOR UNINSURED AND UNDER-INSURED PATIENTS, THE HOSPITAL PROVIDES FUNDING TO PORTICO HEALTHNET (PORTICO). PORTICO IS A NONPROFIT ORGANIZATION THAT HELPED 213 PEOPLE IN 2016 ENROLL IN FREE OR LOW-COST HEALTH COVERAGE PROGRAMS. GRANTS TO SUPPORT HEALTH SERVICES FOR YOUTH AND ADULTS IN THE COMMUNITY INCLUDED: ABIJAH'S HOPE, AMERICAN DIABETES ASSOCIATION, CANVAS HEALTH, CENTURY COLLEGE, COMMUNITY THREAD, ESR, FAMILYMEANS, GRANITE HOUSE, OPERATION GRACE, OUR COMMUNITY KITCHEN, PROJECT LIFE, ST. ANDREW' RESOURCE CENTER, GRIEF AND CARE SUPPORT THROUGH ST. CROIX CHAPLAINCY, TREEHOUSE, VALLEY OUTREACH, YOUNGLIFE, YOUTH ADVANTAGE AND YOUTH SERVICE BUREAU. IN ADDITION, THE FOLLOWING ORGANIZATIONS AND PROGRAMS WERE SUPPORTED FOR OVERALL COMMUNITY BENEFIT: AMERICAN CANCER SOCIETY, AMERICAN DIABETES ASSOCIATION, AMERY REGIONAL MEDICAL CENTER FOUNDATION, BREAST CANCER AWARENESS, CAMP ODAYIN, CANVAS HEALTH, CHURCH OF ST. MARY, ESR, FAMILYMEANS, GLOBAL HEALTH MINISTRIES, GOOD SAMARITAN SOCIETY STILLWATER, HOPE HOUSE, MAHTOMEDI AREA EDUCATION FOUNDATION, MINNESOTA ORGANIZATION FOR FETAL ALCOHOL SYNDROME, MINNESOTA HOSPITAL ASSOCIATION, NORTHERN STAR COUNCIL BSA, PARTNERSHIP PLAN, RED CROSS, REGIONS HOSPITAL FOUNDATION, STILLWATER SUNRISE ROTARY, ST. ANNE CATHOLIC SCHOOL, STILLWATER HIGH SCHOOL, ST. CROIX COUNTY HEALTHIER TOGETHER, SISTER KENNEY FOUNDATION - COURAGE CENTER; UNITED WAY WASHINGTON COUNTY EAST, VALLEY CHAMBER CHORALE, AND YOUNGLIFE . THE HOSPITAL'S CASH DONATIONS TO COMMUNITY-BASED TAX-EXEMPT ORGANIZATIONS IN THE FORM OF SPONSORSHIPS, GRANTS OR SUPPLIES FOR MEDICAL MISSION TRIPS TOTALED $166,000. 5. COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL PROVIDES LEADERSHIP AND PARTICIPATES IN A NUMBER OF STRATEGIC COMMUNITY COLLABORATIONS AND INITIATIVES, INCLUDING: CHAT (COMMUNITY HEALTH ACTION TEAM): CONVENES NONPROFIT AND COMMUNITY LEADERS ON A MONTHLY BASIS TO COLLABORATE ON ADDRESSING PRIORITY COMMUNITY HEALTH NEEDS. CONNECT: COLLABORATIVE MISSION IS TO PREVENT AND REDUCE YOUTH ALCOHOL, TOBACCO AND OTHER DRUG USE THROUGH PARTNERSHIP, EDUCATION, INTERVENTION AND COMMUNITY CHANGE. WASHINGTON COUNTY COMMUNITY LEADERSHIP TEAM (CLT): THE HOSPITAL COLLABORATES ON BOTH TOBACCO CESSATION AND OBESITY INITIATIVES. HEALTHIER TOGETHER: FOCUSED ON A NUMBER OF HEALTH PRIORITIES, INCLUDING ALCOHOL AND SUBSTANCE ABUSE, IN ST. CROIX COUNTY, WI. THE HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION BUILDING, HEALTH IMPROVEMENT ADVOCACY AND WORKFORCE DEVELOPMENT. THE HOSPITAL COLLECTED 51.4 TONS OF RECYCLING FOR A COST SAVINGS OF $3,440. THE HOSPITAL PARTICIPATES IN A PROGRAM WHERE FOOD WASTE FROM THE CAFETERIA IS SAVED IN BARRELS AND PICKED UP BY AN AREA FARMER WHO FEEDS THE SCRAPS TO PIG LIVESTOCK. THIS HELPS THE ENVIRONMENT BY REDUCING WASTE, AND ALSO REDUCES THE TAXES THE HOSPITAL PAYS ON GARBAGE BASED ON WEIGHT. IN 2016, 36,800 POUNDS OF FOOD WASTE WAS DIVERTED FROM THE LANDFILL. THE COMMUNITY PHARMACY GATHERED 83 POUNDS OF MEDICATIONS FOR DISPOSAL IN 2016. THE HOSPITAL INPATIENT/OUTPATIENT PHARMACY COLLECTED 25 POUNDS OF MEDICATIONS FOR DISPOSAL IN 2016. CONTINUED SUPPORT FOR THE ST. CROIX VALLEY FAITH COMMUNITY NURSE PROGRAM, WHICH IS A HEALTH CARE MINISTRY PROVIDING PHYSICAL, EMOTIONAL AND SPIRITUAL CARE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES SERVED BY LOCAL CONGREGATIONS. THE PARISH NURSE PROMOTES A GREATER UNDERSTANDING OF HEALTH-RELATED ISSUES AND ADDRESSES THESE CONCERNS THROUGH INFORMATION AND EDUCATION. SUPPORTED THE PRESCRIPTION ASSISTANCE PROGRAM. A STAFF MEMBER AT THE HOSPITAL, FUNDED BY THE FOUNDATION, ASSISTS PATIENTS WHO HAVE DIFFICULTY AFFORDING THEIR MEDICATIONS. 6. COMMUNITY BENEFIT OPERATIONS: THE HOSPITAL STAFF TIME TO COLLECT, ANALYZE AND REPORT COMMUNITY BENEFITS FOR 2016 WAS APPROXIMATELY 70 HOURS. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA); PLEASE REFER TO THE SCHEDULE H NARRATIVE IN THIS 990 REPORT. THE NET 2016 COMMUNITY BENEFIT CONTRIBUTION EQUALED $9,459,600 OR 9.3% OF TOTAL EXPENSES. THIS FIGURE IS REPORTED AT COST PER THE CATHOLIC HEALTH ASSOCIATION (CHA) COMMUNITY BENEFIT REPORTING GUIDELINES. 7. ORGANIZATION AWARDS AND ACHIEVEMENTS: PATIENT SATISFACTION SCORES - THE HOSPITAL CONTINUES TO PERFORM IN THE TOP DECILE FOR PATIENT EXPERIENCE. (SOURCE - NRC PICKER) RECIPIENT OF A 2016 GREENHEALTH PARTNER FOR CHANGE AWARD BY PRACTICE GREENHEALTH FOR SIGNIFICANT ACHIEVEMENT IN SUSTAINABILITY THE HOSPITAL WAS DESIGNATED BY THE MINNESOTA DEPARTMENT OF HEALTH AS A STROKE READY HOSPITAL THE HOSPITAL ACHIEVED LEADER IN LGBT HEALTHCARE EQUALITY STATUS BY THE NATIONAL LGBT HEALTHCARE EQUALITY INDEX, HUMAN RIGHTS CAMPAIGN FOUNDATION IN 2016. THE JOINT COMMISSION RECOGNITION OF THE HOSPITAL AS A TOP PERFORMER ON KEY QUALITY MEASURES (PNEUMONIA, SURGICAL CARE, VTE) THE HOSPITAL RECEIVED THE HEALTHGRADES OUTSTANDING PATIENT EXPERIENCE AWARD THE HOSPITAL RECEIVED THE "PATRIOTIC EMPLOYER" AWARD AND HONOR ON NOVEMBER 9, 2016 FROM THE OFFICE OF SECRETARY OF DEFENSE IN RECOGNITION OF OUR SUPPORT OF EMPLOYEE PARTICIPATION IN NATIONAL GUARD AND RESERVE FORCE THE HOSPITAL WAS NAMED A FIVE-STAR HOSPITAL BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) (2016). ONLY 250 HOSPITALS OUT OF THE 3500 MEDICARE-CERTIFIED ACUTE READY HOSPITALS IN THE U.S. WERE AWARDED THIS DESIGNATION. THE HOSPITAL WAS RECOGNIZED BY THE MINNESOTA HOSPITAL ASSOCIATION FOR OUTSTANDING DEDICATION AND COMMITMENT TO IMPROVING PATIENT SAFETY THROUGH PARTICIPATION IN THE PARTNERSHIP FOR PATIENTS MHA HOSPITAL ENGAGEMENT NETWORK 2.0. (2016) COMPARION MEDICAL ANALYTICS RANKED SURGICAL CARE AT THE HOSPITAL IN THE TOP 90TH PERCENTILE IN THE NATION, WITH HIGH SCORES IN PATIENT SAFETY AND SATISFACTION (2016). THE HOSPITAL WAS ACKNOWLEDGED AS A COMMUNITY VALUE FIVE-STAR HOSPITAL BY CLEVERLEY + ASSOCIATES, A RANKING EARNED BY THE TOP 20 PERCENT OF HOSPITALS IN THE NATION. THE COMMUNITY VALUE INDEX DEMONSTRATES THAT THE HOSPITAL PROVIDES VALUE TO THE COMMUNITY, REINVESTS IN THE FACILITY, MAINTAINS A LOW COST STRUCTURE, HAS REASONABLE CHARGES, AND PROVIDES HIGH QUALITY CARE TO PATIENTS. (2016) THREE PHYSICIANS FROM SMG AND THE HOSPITAL WERE SELECTED AS MPLS. ST. PAUL MAGAZINE'S 2016 TOP DOCTORS. KEVIN BJORK, MD, GENERAL SURGERY; CANDY COREY, MD, ONCOLOGY; AND LAURA DEAN, MD, OB/GYN, WERE SELECTED BY THEIR PEERS FOR THIS HONOR BASED ON THE EXCEPTIONAL CARE THEY PROVIDE. CMS AWARDED LAKEVIEW HOMECARE 5 (OF 5) STAR RATING FOR THE AGENCY PERFORMING BETTER IN 9 MEASURED CARE PRACTICES AND OUTCOMES THAN OTHER HOMECARE AGENCIES THE HOSPITAL BIRTH CENTER HAS BEEN NAMED TO THE WOMEN'S CHOICE AWARD LIST AS ONE OF THE BEST PLACES IN THE COUNTRY TO HAVE A BABY (2016) FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS SHS. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER RATIFIES THE PERSONS ELECTED TO THE HOSPITAL BOARD, AT LEAST 75% OF WHOM MUST BE COMMUNITY LEADERS. THE CHIEF EXECUTIVE OFFICER OF THE SOLE MEMBER SERVES AS AN EX OFFICIO NON-VOTING HOSPITAL BOARD MEMBER. ADDITIONALLY, HEALTHPARTNERS AS THE SOLE MEMBER OF SHS APPOINTS ONE PERSON TO THE HOSPITAL BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS CUSTOMARY POWERS INCLUDING APPROVAL OF HIGHLY SIGNIFICANT ACTIONS OF THE HOSPITAL'S BOARD OF DIRECTORS. THESE INCLUDE AMENDMENT OF THE GOVERNING DOCUMENTS; APPROVAL OF STRATEGIC PLANS AND ANNUAL BUDGETS; MERGER, CONSOLIDATION OR SUBSTANTIAL AFFILIATION WITH ANOTHER ENTITY; APPOINTMENT OF THE PRESIDENT OF THE HOSPITAL; AND INCURRENCE OF DEBT. FORM 990, PART VI, SECTION B, LINE 11B THE HOSPITAL'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE HOSPITAL, GHI'S INTERNAL LEGAL DEPARTMENT AND THE HOSPITAL'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. THE HOSPITAL MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THE HOSPITAL MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED T THE FULL BOARD OF DIRECTORS IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT THE MEETING. THIS PROCESS IS DOCUMENTED IN THE WRITTEN MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARD OF DIRECTORS MONITORS POTENTIAL CONFLICTS OF INTEREST OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES, BY MAINTAINING A CONFLICT OF INTEREST POLICY. ANNUALLY, UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. A REPORT OF THESE POTENTIAL CONFLICTS IS SHARED WITH THE GOVERNANCE COMMITTEE, THE CHAIR AND THE CEO. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (HOSPITAL) PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY GROUP HEALTH PLAN, INC. (GHI), OR BY STILLWATER HEALTH SYSTEM (SHS), BOTH OF WHICH ARE RELATED ORGANIZATIONS OR BY THE HOSPITAL. GHI, SHS AND THE HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE HOSPITAL'S PRESIDENT AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE GHI BOARD OF DIRECTORS (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE COMPENSATION COMMITTEE OF THE SHS OR THE COMPENSATION COMMITTEE OF GHI (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES ARE DETERMINED FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEES MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH THE HOSPITAL'S BOARD OF DIRECTORS INPUT, THE GHI EVP AND CHIEF ADMINISTRATIVE OFFICER CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH THE COMPENSATION COMMITTEE OF THE SHS'S APPROVAL, DETERMINES THE COMPENSATION OF THE HOSPITAL PRESIDENT. THE HOSPITAL BOARD HAS DELEGATED TO THE PRESIDENT THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL HOSPITAL-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE COMPENSATION COMMITTEE OF THE SHS. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE HOSPITAL OR HEALTHPARTNERS. THE HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE. 990, PART VII, SECT A, LN 1A, COL B: AVERAGE HOURS - RELATED ORGANIZATION AVERAGE WEEKLY HOURS: THE COMPENSATED BOARD MEMBERS AND OFFICERS OF THE HOSPITAL ARE EMPLOYED AND COMPENSATED BY THE HOSPITAL, GHI OR PARK NICOLLET. THE COMPENSATED BOARD MEMBERS AND OFFICERS DEVOTE THEIR TIME TO MULTIPLE RELATED ORGANIZATIONS. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE -4,436,156. CHANGE IN PENSION LIABILITY VALUATION 161,675. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 0 HPI - RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 0 HEALTHPARTNERS INSTITUTE 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411670163 HEALTHCARE EDUCATION & RESEARCH MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 412011453 POST HOSPITALIZATION PATIENT CARE MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410956618 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411888902 PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY 0 RHSC INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411891928 HEALTHCARE STAFFING MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC 0 RH-WISCONSIN 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE I1 HPI - RAMSEY 0 PHYSICIANS NECK AND BACK CLINICS 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 270684883 SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC 0 HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390804125 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 0 HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391279567 PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC 0 LAKEVIEW MEMORIAL HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411386635 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 509(A)(3) TYPE II STILLWATER HEALTH SYSTEM 0 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 830379473 PHYSICIANS GROUP MN 501(C)(3) 509(A)(3 TYPE III) STILLWATER HEALTH SYSTEM 0 STILLWATER HEALTH SYSTEM 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 300221189 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 0 WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390808442 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 0 WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391770913 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 509(A)(3) TYPE I WESTFIELDS HOSPITAL INC 0 RAMSEY INTEGRATED HEALTH SERVICES 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411503090 IN-HOME PATIENT CARE MN 501(C)(3) 509(A)(2) HPI - RAMSEY 0 PARK NICOLLET HEALTH SERVICES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 363465840 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) HEALTHPARTNERS INC 0 PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 237346465 GRANTS TO SERVE THE COMMUNITY MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410132080 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET HEALTH CARE PRODUCTS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 010638901 HEALTHCARE PRODUCTS MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET CLINIC 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410834920 HEALTHCARE MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PNMC HOLDINGS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411741792 HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET CLINIC 0 AMERY REGIONAL MEDICAL CENTER INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390908320 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391726539 PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) AMERY REGIONAL MEDICAL CENTER INC 0 HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411629390 THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC C 0 HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 522365151 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683568 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683523 MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC C 0 DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 451297583 PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411236798 MEDICAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC C 0 PARK NICOLLET ENTERPRISES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411656735 REAL ESTATE FOR RELATED ORGANIZATIONS MN PARK NICOLLET HEALTH SERVICES C 0 1 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES L 4295561 CASH AMOUNT