2017-11-14T11:02:28-06:00 2016-12-31 135665207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2016-01-01 390908320 AMERY REGIONAL MEDICAL CENTER INC AMER 7152688000 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DEBRA RUDQUIST PRESIDENT & CEO 7152688000 2017-11-14 1 MONROE JORDAN GIERL P01413237 6123055000 198.174.110.146 2017-11-14 11:02:04 CS P 1A39D2BAC3E977A191A219CBBAAA8778AA2E0A5D 282CC43464B9830A349574F670F0BA37F913502D 2016 2021-01-29 14:40:06Z DEBRA RUDQUIST 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 58046183 0 X WWW.AMERYMEDICALCENTER.ORG X 1954 WI SEE PART III, LINE 1 - ORGANIZATION'S MISSION" 11 5 484 28 0 0 51974 298279 54193515 57300642 132342 69771 820256 170590 55198087 57839282 40315 71766 0 0 33444138 36447344 0 0 0 19194327 19614652 52678780 56133762 2519307 1705520 63067420 58452023 40523350 34202433 22544070 24249590 X AMERY REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDEACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THEHEALTH AND WELLNESS OF ITS COMMUNITY. 0 0 49610571 71766 57300642 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 49610571 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 484 1 0 0 0 0 0 0 0 0 0 0 X 11 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X JASON LUHRS - CFO 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 X DAN DRAXLER DIRECTOR 1.00 0.25 X 1200 0 0 HEIDI ERSPAMER DIRECTOR & SECRETARY 1.00 0.25 X 1200 0 0 JAMES A LEADHOLM JR DIRECTOR & VICE CHAIR 1.00 0.25 X 1200 0 0 DANIEL LIEN DIRECTOR & CHAIR 1.00 0.25 X 1200 0 0 RANAE NYGAARD DIRECTOR 0.25 0.25 X 1200 0 0 DAVID RASMUSSEN DIRECTOR 0.25 0.25 X 1200 0 0 KATHRYN WALKER DIRECTOR 0.25 0.25 X 1100 0 0 ROSS R BULLARD DIRECTOR & TREASURER 1.00 47.00 X 0 210942 57881 DYLAN COE MD DIRECTOR 0.25 35.75 X 0 241620 70987 MARTIN E RICHARDS MD DIRECTOR 0.25 44.75 X 0 450110 50937 ANN SEAGREN MD DIRECTOR 0.25 49.75 X 0 280265 70511 TED WEGLEITNER DIRECTOR 0.25 44.75 X 0 521283 106696 MARYANN SCOGLIO CANP DIRECTOR 0.25 39.75 X 0 205568 42110 JASON J LUHRS CFO 0.50 49.50 X 0 204194 60376 SANDRA M REED VP - AMBULATORY CARE 60.00 X 154249 0 35786 DEBRA RUDQUIST CHIEF EXECUTIVE OFFICER 55.00 X 0 313468 73944 JOYCE R SCHAEFER VP-PATIENT CARE 50.00 X 163810 0 35900 PATRICK SURA MD CHIEF MEDICAL OFFICER 1.00 70.00 X 0 617152 53359 MARK A TRYGGESTAD DIRECTOR OF PHARMACY 48.00 X 166960 0 16831 MARK T MOIOFFER PHARMACIST 40.00 X 126027 0 34622 FREDERICK KOSMACH PHYSICIAN ASSISTANT 44.00 X 127189 0 32194 VICKI D ZIGLINSKI DIRECTOR-PATIENT FINANCIAL 48.00 X 106152 0 32664 ANTHONY GOULD DIRECTOR - REHAB SERVICES 40.00 X 107276 0 32805 JOANNE L JACKSON FORMER HR, PR AND MKTG DIRECTOR 50.00 X 136297 0 22943 1096260 3044602 830546 14 1 1 0 RIVER VALLEY ANESTHESIA INC PO BOX 118 NEW RICHMOND WI 54017 NURSE ANESTHITISTS 889704 HEALOGICS WOUND CARE 28525 NETWORK PLACE CHICAGO IL 60673 WOUND HEALING MANAGEMENT 458496 NXC IMAGING 2118 4TH AVE S MINNEAPOLIS MN 554042642 PROFESSIONAL SERVICES 375689 SHARED MEDICAL TECHNOLOGY INC 202 W NEWTON ST RICE LAKE WI 54868 PROFESSIONAL SERVICES 327637 COMPHEALTH INC PO BOX 972651 DALLAS TX 753972651 PROFESSIONAL SERVICES 310598 19 237405 60874 298279 NET PATIENT SERVICE 621110 56458445 56458445 OTHER OPERATING 900099 421985 421985 SUBSIDIARY REVENUE 900099 256866 256866 FITNESS CENTER 624110 163346 163346 57300642 153829 153829 75046 118087 -43041 -43041 -43041 4756 88814 -84058 -84058 -84058 CAFETERIA AND OTHER 900099 213631 213631 213631 57839282 57300642 0 240361 71766 71766 398045 398045 30460651 27914877 2545774 439062 368284 70778 3750285 3145729 604556 1399301 1173730 225571 9898 9898 110 110 3466109 2877300 588809 356476 16931 339545 469928 286193 183735 301528 263214 38314 731701 730361 1340 104558 64424 40134 13190 4494 8696 981536 981536 3124421 2946844 177577 134174 134174 DRUG EXPENSE 3518009 3518009 MEDICAL SUPPLY & EQUIP. 2561608 2558360 3248 EQUIP. RENT & REPAIR 1514072 958738 555334 OTHER EXPENSE 1502450 1178800 323650 824884 550871 274013 56133762 49610571 6523191 0 1750 5570 18661151 15837030 6878269 5615195 702782 685849 468782 51785 56311773 31320800 26055373 24990973 8405752 8552008 1893561 2713613 63067420 58452023 7196904 7470083 33326446 26732350 40523350 34202433 X 22544070 24249590 22544070 24249590 63067420 58452023 1705520 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 0 0 PART II-B, LINE 1: AMERY REGIONAL MEDICAL CENTER, INC. 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. 1072735 1072735 26487689 12482260 14005429 21501069 13959487 7541582 7250280 4879053 2371227 24990973 X PART X, LINE 2: AMERY REGIONAL MEDICAL CENTER, 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 X 1 X 1 X 1 1 0 1 1 458944 458944 0.00820 6956826 4615528 2341298 0.04170 7415770 4615528 2800242 0.04990 24 4184 369915 15649 354266 0.00630 7 252 30922 30922 0.00060 11 621 114152 114152 0.00200 42 5057 514989 15649 499340 0.00890 42 5057 7930759 4631177 3299582 0.05880 0 1137485 790642 19567810 19846479 -278669 X 1 1 1 1 AMERY REGIONAL MEDICAL CENTER 265 GRIFFIN STREET EAST AMERY WI 54001 WWW.AMERYMEDICALCENTER.ORG CAH CERT LICENSE 1010 X X X X AMERY REGIONAL MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X WWW.AMERYMEDICALCENTER.ORG X 1 15 1 WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX 0 1 X 200.000000000000 250.000000000000 X X X 1 1 X X X X 1 X WWW.AMERYMEDICALCENTER.ORG X WWW.AMERYMEDICALCENTER.ORG X WWW.AMERYMEDICALCENTER.ORG X X X X X 1 X 0 X X X X 1 X 0 0 AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: AS A PART OF COUNTY-WIDE ASSESSMENTS, SURVEYS AND LISTENING SESSIONS INCLUDED:1. STATE, LOCAL, TRIBAL, OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT(OR EQUIVALENT DEPARTMENT OR AGENCY) WITH KNOWLEDGE, INFORMATION, OREXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY (THE POLK COUNTY 2020 COMMUNITY HEALTH IMPROVEMENT PLAN, CONDUCTED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT).2. MEMBERS OF MEDICALLY UNDERSERVED, LOW ]INCOME, AND MINORITYPOPULATIONS IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING ORREPRESENTING THE INTERESTS OF SUCH POPULATIONS (COMMUNITY SURVEYS). AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDED IN THE 2015 HEALTHPARTNERS CHNA WERE:- HUDSON HOSPITAL, HUDSON, WI.- WESTFIELDS HOSPITAL, NEW RICHMOND, WI.- LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, STILLWATER, MN.- PARK NICOLLET METHODIST HOSPITAL, ST. LOUIS PARK, MN- REGIONS HOSPITAL, ST. PAUL, MN AMERY REGIONAL MEDICAL CENTER, INC. 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 CAREPRIORITY 4: IMPROVE SERVICE INTEGRATIONPRIORITY 5: PROMOTE CHANGE IN UNHEALTHY LIFESTYLES (TOBACCO / ALCOHOL / SUBSTANCE ABUSE)A FULL REPORT OF ARMC'S 2015 CHNA AND ANNUAL IMPLEMENTATION PLAN UPDATE IS POSTED ON ARMC'S WEBPAGE AT WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX 6 1 - ARMC REHAB SERVICES 220 N KELLER AVENUE AMERY WI 54001 REHABILITATION 2 - LUCK MEDICAL CLINIC 137 FIRST AVENUE LUCK WI 54853 RURAL HEALTH CLINIC 3 - TURTLE LAKE MEDICAL CLINIC 550 MARTIN AVENUE TURTLE LAKE WI 54889 RURAL HEALTH CLINIC 4 - CLEAR LAKE CLINIC 357 THIRD AVENUE CLEAR LAKE WI 54005 RURAL HEALTH CLINIC 5 - LUCK PT & FITNESS 2547 STATE ROAD 35 SUITE 5 LUCK WI 54853 PHYSICAL THERAPY 6 - AMERY REGIONAL MEDICAL CENTER WEST 230 DERONDA STREET AMERY WI 54001 10 BED INPATIENT DPU OF AMERY PART III, LINE 2: AMERY REGIONAL MEDICAL CENTER (ARMC) USES A COST TO CHARGE METHODOLOGY. PART III, LINE 3: ARMC USES THE COST TO CHARGE METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. ARMC IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN ITS SERVICE AREA THAT ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH ARMC ALSO INCLUDES AS A COMMUNITY BENEFIT. PART III, LINE 4: ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE: THE FINANCIAL STATEMENTS DO NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOLLOWING IS PART OF ARMC'S PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY:ACCOUNTS RECEIVABLE ARE REDUCED BY AN ANNUAL ALLOWANCE FOR DOUBTFUL ACCOUNTS OR CHARITY CARE, BASED ON ESTABLISHED GUIDELINES FOR IDENTIFYING UNCOLLECTIBLE PATIENT ACCOUNTS AND CLASSIFYING THESE ACCOUNTS AS EITHER DOUBTFUL ACCOUNTS OR CHARITY. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ARMC'S MANAGEMENT PERIODICALLY ASSESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE BY TAKING INTO CONSIDERATION BY PAYER CATEGORY, THE EXPECTED NET COLLECTIONS, ACCOUNTS RECEIVABLE AGING, HISTORICAL COLLECTIONS EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR CHARITY CARE IS CHARGES FOR UNINSURED PATIENTS. PATIENTS WHO ARE INSURED ARE ASSESSED SEPARATELY FOR COLLECTABILITY FROM UNINSURED PATIENTS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO ESTABLISH THE NET REALIZABLE VALUE OF PATIENT ACCOUNTS RECEIVABLE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE. ARMC PROVIDED MEDICAL CARE WITHOUT CHARGE OR A REDUCED COST TO PATIENTS WHO WERE DETERMINED TO BE UNABLE TO PAY (CHARITY CARE) OF $790,642 AND $695,683 FOR THE YEARS ENDED 12/31/16 AND 12/31/15 RESPECTIVELY, AND PROVIDED MEDICAL CARE TO PATIENTS WHO WERE DETERMINED TO BE ABLE, BUT UNWILLING TO PAY (DOUBTFUL ACCOUNTS) OF $1,137,485 AND $1,896,101 FOR THE YEARS ENDED 12/31/16 AND 12/31/15 RESPECTIVELY. ACCORDINGLY, ARMC DOES NOT SEPARATE ALLOWANCE ACCOUNTS FOR DOUBTFUL ACCOUNTS AND CHARITY CARE. PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE ARMC IS INCURRING THE COST OF PROVIDING SERVICES TO MEDICARE PATIENTS AND NOT GETTING PAID COMPLETELY BY MEDICARE FOR THE COST OF PROVIDING THESE SERVICES. PART III, LINE 9B: ARMC IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. AS PART OF THIS MISSION, ARMC ADMINISTERS A FINANCIAL ASSISTANCE PROGRAM TO HELP PATIENTS WHO NEED MEDICAL CARE BUT HAVE DIFFICULTY WITH RELATED MEDICAL EXPENSES. IN ARMC FACILITIES, NON-ELECTIVE PROFESSIONAL MEDICAL SERVICES WILL BE PROVIDED WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY AND FINANCIAL ASSISTANCE WILL BE MADE AVAILABLE. PROGRAM ELIGIBILITY IS BASED ON INCOME, ASSETS, LIABILITIES, AND FAMILY SIZE UTILIZING A SLIDING DISCOUNT BASED ON THE LATEST HEALTH AND HUMAN/SERVICES (HHS) FEDERAL POVERTY GUIDELINES. PATIENTS IN NEED OF FINANCIAL ASSISTANCE ARE SENT AN APPLICATION AND FOLLOWED UP IN COORDINATION WITH THE HEALTH BENEFITS COUNSELOR. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. PART VI, LINE 7, REPORTS FILED WITH STATES WI 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, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, HUDSON HOSPITAL, WESTFIELDS HOSPITAL, ARMC, 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 STUDY AREA IS DEFINED AS DAKOTA, HENNEPIN, RAMSEY, SCOTT, AND WASHINGTON COUNTIES IN MINNESOTA AND POLK AND ST. CROIX COUNTIES IN WISCONSIN. ARMC'S SPECIFIC STUDY AREA IS DEFINED AS:- POLK COUNTYDATA ELEMENTS REGARDING ALL SEVEN COUNTIES IN THE STUDY AREA WERE INCLUDED IN THE REPORT FOR COMPARISON, AND WERE 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 POLK COUNTY, INCLUDING: OVERALL POPULATION, POPULATION BY RACE AND ETHNICITY, MEDIAN AGE, MEDIAN HOUSEHOLD INCOME, POVERTY LEVELS, FOOD INSECURITY, AND EDUCATIONAL ATTAINMENT.- HEALTH DATA COLLECTION: ARMC PARTICIPATED IN A COUNTY-WIDE INITIATIVE TO ANALYZE THE HEALTH OF RESIDENTS IN THE COMMUNITY, THE POLK COUNTY 2020 COMMUNITY HEALTH IMPROVEMENT PLAN VERSION 2014-2016.- COMMUNITY INPUT: AS A PART OF THE COUNTY-WIDE ASSESSMENT, SURVEYS WERE CONDUCTED TO GATHER INPUT FROM COMMUNITY RESIDENTS. IN ADDITION, ARMC CONDUCTED A COMMUNITY CONVERSATION ON AUGUST 20, 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 ARMC'S CHNA AND IMPLEMENTATION PLAN IS POSTED ON ARMC'S WEBPAGE AT HTTP://WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX. PART VI, LINE 3 ARMC'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS THAT ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE, ARE REFERRED TO ARMC'S HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH ARMC AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON THE ARMC'S INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION. PART VI, LINE 4 ARMC SERVICE AREA INCLUDES FIFTEEN DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES THREE RURAL HEALTH CLINICS IN LUCK, TURTLE LAKE, & CLEAR LAKE WHICH ARE ALL MEDICALLY UNDERSERVED AREAS. THE ARMC COMMUNITY IS ALSO CONSIDERED A MENTAL HEALTH MEDICALLY UNDERSERVED AREA. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS PATIENTS FROM OUTSIDE ARMC'S NORMAL SERVICE AREA. PART VI, LINE 5 TEN OF ARMC'S THIRTEEN BOARD MEMBERS LIVE IN ARMC'S SERVICE AREA. ARMC HAS AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, AND OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN ARMC'S COMMUNITY. PART VI, LINE 6 HEALTHPARTNERS AND ARMC HAVE HAD A LONG-STANDING RELATIONSHIP, WITH HEALTHPARTNERS EMPLOYING AND SOURCING PHYSICIANS AND MID-LEVEL PRACTITIONERS TO ARMC FOR ARMC'S PRIMARY CARE CLINICS. AS OF 2014, ARMC BECAME PART OF THE HEALTHPARTNERS FAMILY OF MISSION-DRIVEN NON-PROFIT ORGANIZATIONS. AS PART OF THE HEALTHPARTNERS FAMILY, ARMC USES HEALTHPARTNERS' INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM, PARTICIPATES IN COORDINATED CHNA PROCESSES AND IMPLEMENTATION STRATEGIES, ACCESSES CENTRALIZED SUPPORT SERVICES IN FINANCE, LEGAL, IS&T, AND QUALITY. THE FOUR HEALTHPARTNERS HOSPITALS IN THE ST. CROIX VALLEY - STILLWATER MN AND HUDSON, NEW RICHMOND, AND AMERY WI - WORK TOGETHER TO ESTABLISH ACCESSIBLE AND COORDINATED SPECIALTY SERVICES IN THE VALLEY FOR THE BENEFIT OF VALLEY RESIDENTS. EXAMPLES OF THESE SERVICES INCLUDE RADIATION THERAPY ON THE NEW RICHMOND CAMPUS, BREAST DIAGNOSTICS ON THE STILLWATER CAMPUS, AND GERIATRIC BEHAVIORAL HEALTH SERVICES ON THE ARMC CAMPUS. HEALTHPARTNERS INCLUDES INSURANCE AND HMO (HEALTH MAINTENANCE ORGANIZATION) ENTITIES THAT PROVIDE CARE COORDINATION, DISEASE MANAGEMENT, ON-LINE CARE FOR BASIC CONDITIONS, A 24 HOUR/7 DAY PER WEEK NURSE LINE, AND OTHER SERVICES THAT ENHANCE CARE FOR MEMBERS, PATIENTS AND THE COMMUNITY. 1 AMERICAN CANCER SOCIETY 250 WILLIAMS STREE NW ATLANTA GA 30303 131788491 501(C)(3) 5000 PROGRAM SUPPORT 1 PART I, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH ARMC'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO ARMC'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. X X 0 1 0 0 0 0 0 0 0 ROSS R BULLARD DIRECTOR & TREASURER 0 179063 0 27125 0 4754 0 31170 0 26711 0 268823 0 0 DYLAN COE MD DIRECTOR 0 182442 0 0 0 59178 0 53766 0 17221 0 312607 0 0 MARTIN E RICHARDS MD DIRECTOR 0 361661 0 0 0 88449 0 19875 0 31062 0 501047 0 0 ANN SEAGREN MD DIRECTOR 0 187054 0 0 0 93211 0 41321 0 29190 0 350776 0 0 TED WEGLEITNER DIRECTOR 0 380178 0 130432 0 10673 0 74602 0 32094 0 627979 0 6196 MARYANN SCOGLIO CANP DIRECTOR 0 148942 0 0 0 56626 0 15775 0 26335 0 247678 0 0 JASON J LUHRS CFO 0 167211 0 30978 0 6005 0 34077 0 26299 0 264570 0 0 SANDRA M REED VP - AMBULATORY CARE 127827 0 20268 0 6154 0 4807 0 30979 0 190035 0 0 0 DEBRA RUDQUIST CHIEF EXECUTIVE OFFICER 0 245042 0 59123 0 9303 0 45760 0 28184 0 387412 0 0 JOYCE R SCHAEFER VP-PATIENT CARE 140413 0 22138 0 1259 0 5229 0 30671 0 199710 0 0 0 PATRICK SURA MD CHIEF MEDICAL OFFICER 0 385457 0 4375 0 227320 0 19875 0 33484 0 670511 0 0 MARK A TRYGGESTAD DIRECTOR OF PHARMACY 162981 0 0 0 3979 0 4832 0 11999 0 183791 0 0 0 MARK T MOIOFFER PHARMACIST 124081 0 0 0 1946 0 4101 0 30521 0 160649 0 0 0 FREDERICK KOSMACH PHYSICIAN ASSISTANT 126800 0 0 0 389 0 3715 0 28479 0 159383 0 0 0 JOANNE L JACKSON FORMER HR, PR AND MKTG DIRECTOR 122388 0 9350 0 4559 0 4138 0 18805 0 159240 0 0 0 PART I, LINE 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: TED WEGLEITNER $36,015 PART II 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 DIRECTORS, OFFICERS AND FORMER OFFICER: 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. A VILLAGE OF LUCK WISCONSIN 396006307 2011-04-28 8500000 REFINANCE EXISTING DEBT 0 0 0 B CITY OF AMERY WISCONSIN 396005378 2011-04-13 8500000 REFINANCE EXISTING DEBT 0 0 0 C VILLAGE OF CLEAR LAKE WISCONSIN 396006238 2011-03-29 8500000 REFINANCE EXISTING DEBT 0 0 0 D TOWN OF BLACK BROOK POLK COUNTY WISCONSIN 391169876 2011-05-13 6150000 REFINANCE EXISTING DEBT 0 0 0 A 2487044 8500000 170000 8330000 2007 1 0 1 1 B 2487044 8500000 170000 8330000 2007 1 0 1 1 C 2487044 8500000 170000 8330000 2007 1 0 1 1 D 1803259 6150000 123000 6027000 2007 1 0 1 1 A 0 0 0 0 0.00110 0.00110 1 0 0 B 0 0 0 0 0.00110 0.00110 1 0 0 C 0 0 0 0 0.00110 0.00110 1 0 0 D 0 0 0 0 0.00110 0.00110 1 0 0 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 C 0 1 0 0 1 0 0 0 0 D 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 D 0 FORM 990, SCHEDULE K, PART IV, LINE 2A THRU 2C REBATE CALCULATION IS NOT DUE BUT EVERY 5 YEARS. THERE IS NO REBATE CACLULATION DUE FOR ANY BONDS LISTED IN SCHEDULE K, PART I. A TOWN OF LINCOLN POLK COUNTY WISCONSIN 391406159 2011-05-31 6150000 REFINANCE EXISTING DEBT 0 0 0 A 1803259 6150000 123000 1709792 4317208 2007 1 0 1 1 A 0 0 0 0 0.00110 0.00110 1 0 0 A 0 1 0 0 1 0 0 0 0 A 0 FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER (ARMC), A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN 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 PLANS 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 (LAKEVIEW HEALTH), 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). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF ARMC. GHI IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) A WISCONSIN NON-STOCK CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). BENEFIT TO THE COMMUNITY: 1. COMMUNITY HEALTH IMPROVEMENT SERVICES: $ 251,008 COMMUNITY HEALTH EDUCATION - ARMC HELPS EDUCATE THE LOCAL COMMUNITIES IN REGARDS TO HEALTH ISSUES BY PROVIDING THE FOLLOWING TYPES OF COMMUNITY EDUCATION: CPR/BLS CLASSES, MONTHLY DIABETES SUPPORT GROUP REACHING 120 INDIVIDUALS, EXPECTANT PARENTS/PRE-NATAL AND BREASTFEEDING CLASSES REACHING OVER 40 PARENTS, 11 HEALTH FAIRS REACHING APPROXIMATELY 1450 INDIVIDUALS WITH FOCUS ON HEART HEALTH, STROKE PREVENTION, WOUND HEALING, DIABETES EDUCATION, AND NUTRITION, ONE BIKE SAFETY RODEO WITH EMPHASIS ON INJURY PREVENTION THROUGH HELMET FITTINGS AND GIVEAWAYS, 7 CAR SEAT SAFETY CHECKS, DRIVERS EDUCATION BY EMT/AMBULANCE TO HIGH SCHOOL STUDENTS ON TOPICS SUCH AS DISTRACTED DRIVING, SEATBELT USE, DRINKING AND DRIVING, GARDENING CLASS, 16 MENTAL HEALTH FOCUSED COMMUNITY EDUCATION CLASSES WITH A REACH OF OVER 570 INDIVIDUALS, WOUND HEALING CLINICAL TRAINING PROVIDED TO SURROUNDING HEALTHCARE FACILITIES, AND 18 LOCAL NEWS RADIO SPOTS OVER THE COURSE OF 2016 THAT FEATURED NUTRITION AND WOUND HEALING TOPICS. FOR THE FIRST TIME IN 2016, ARMC OFFERED AT LEAST ONE FREE COMMUNITY EDUCATION CLASS EVERY MONTH. REGISTERED DIETITIANS ALSO STARTED OFFERING TWO DIFFERENT MEDICAL NUTRITION THERAPY CLASSES WITH A FOCUS ON HEALTHY WEIGHT AND DIABETES PREVENTION. ARMC PROVIDES EDUCATION AT OUR SCHOOLS BY HOLDING A 3RD GRADE HEALTH FAIR REACHING 225 STUDENTS FROM AMERY, CLEAR LAKE, CLAYTON, AND TURTLE LAKE. POWERUP, A COMMUNITY-WIDE INITIATIVE TO MAKE IT EASY, FUN AND POPULAR TO EAT BETTER AND BE ACTIVE SO YOUTH CAN REACH THEIR FULL POTENTIAL MADE ITS DEBUT IN THE AMERY AREA WITH GREAT SUCCESS. SOME EXAMPLES INCLUDE: ALL 732 STUDENTS FROM LIEN ELEMENTARY AND AMERY INTERMEDIATE COMPLETED THEIR FIRST SCHOOL CHALLENGE, WHICH ENCOURAGES KIDS TO "TRY FOR 5" FRUITS AND VEGETABLES EVERY DAY. THEIR PARTICIPATION RAISED A COMBINED TOTAL OF $1848 POWERUP BUCKS WHICH WAS USED TO PURCHASED WELLNESS EQUIPMENT. A TOTAL OF FOUR FREE COOKING CLASSES FOR KIDS EXCEEDED CAPACITY WITH 10+ KIDS AT EACH CLASS. NINE OPEN GYMS WERE HELD DURING THE WINTER MONTHS TO GIVE FAMILIES A SPACE TO BE ACTIVE REGARDLESS OF THE WEATHER. A FREE FAMILY 2K RUN/WALK HAD OVER 120 PARTICIPANTS. COMMUNITY-BASED CLINICAL SERVICES - $ 2,960 ARMC PROVIDED 7 FLU SHOT CLINICS AT SURROUNDING AREA BUSINESSES, IMMUNIZING APPROXIMATELY 100 INDIVIDUALS. BEHAVIORAL HEALTH SCREENED 20 TEENS FOR DEPRESSION, SUICIDAL THOUGHTS AND STRESSORS IN GENERAL AT THE AMERY AND CLAYTON HIGH SCHOOL. HEALTH CARE SUPPORT SERVICES - $ 148,371 SOCIAL WORKER, HEALTH BENEFIT COUNSELORS, AND PATIENT FINANCIAL SERVICES REPRESENTATIVES PROVIDE HEALTH CARE SUPPORT SERVICES TO INDIVIDUALS ON A ONE-ON-ONE BASIS. THESE STAFF MEMBERS HELP EDUCATE AND ASSIST INDIVIDUALS WITH ADVANCE DIRECTIVE SUPPORT, INFORMATION AND REFERRAL SERVICES, ENROLLMENT ASSISTANCE IN GOVERNMENT PROGRAMS, FINDING OTHER SOURCES OF PAYMENT, AND ACCESSING SERVICES BEYOND MEDICAL CARE. ARMC SPENT $ 89,891 IN STAFF TIME TO ASSIST PATIENTS IN ENROLLING IN PUBLIC MEDICAL PROGRAMS, FREE DRUG PROGRAMS, AND REFER INDIVIDUALS TO COMMUNITY SERVICES/PUBLIC HEALTH ASSISTANCE. ARMC OPERATES A VAN TRANSPORTATION SERVICE FOR ITS RURAL PATIENT POPULATION. PATIENTS WHO ARE UNABLE TO ARRANGE THEIR OWN TRANSPORTATION TO ARMC FOR CARE AND TREATMENT MAY SCHEDULE A TRANSPORT. PERSONS WHO USE THE SERVICE ARE ASKED TO PAY $2.00 PER RIDE. OVER 1,300 PATIENTS USED THIS SERVICE IN 2016, WITH REVENUE OF $2537 AND OPERATING COST OF $ 58,480. SOCIAL & ENVIRONMENTAL IMPROVEMENT ACTIVITIES DUE TO THE HEALTH PROFESSIONAL SHORTAGE AREA IN THE ARMC SERVICE AREA, NUMEROUS RESOURCES WERE INVESTED IN PHYSICIAN AND ADVANCED PRACTICE PROVIDER RECRUITMENT, TOTALING AT LEAST $ 24,500. ARMC WELCOMED FOUR, NEW ADVANCED PRACTICE PROVIDERS, A SECOND PSYCHIATRIST, A PSYCHIATRY NURSE PRACTITIONER AND TWO NEW FAMILY MEDICINE PHYSICIANS. ARMC PARTNERED WITH THE CITY OF AMERY TO OFFER ADDITIONAL GARDENING PLOTS AT THE COMMUNITY GARDEN LOCATED ON ARMC GROUNDS. A TOTAL OF 12 RAISED GARDEN BEDS WERE PLANTED AND HARVESTED IN 2016. A GARDEN SHED WAS BUILT BY AMERY HIGH SCHOOL STUDENTS AS PART OF THE BUILDING TRADES CLASS, WITH CONTRIBUTIONS FROM LAMBERTS LUMBER, AMERY HIGH SCHOOL, AND AMERY HEALTH & WELLNESS FOUNDATION. FORM 990, PART III, LINE 4A GARDEN TOOLS WERE DONATED BY AMERY TRUVALUE HARDWARE AND HUNGRY TURTLE INSTITUTE. AMERY EMS PARTICIPATES IN COUNTY-WIDE AND REGIONAL EMERGENCY PREPAREDNESS PLANNING ACTIVITIES TO PLAN FOR LARGE SCALE EVENTS THAT WOULD QUICKLY OVERCOME LOCAL RESOURCES. 2. HEALTH PROFESSIONAL EDUCATION: $ 30,822 STUDENTS IN NURSING, PHYSICIAN ASSISTANT PROGRAMS, PHYSICAL THERAPY, RADIOLOGIC TECHNOLOGY, MEDICAL RECORDS, MEDICAL ASSISTANT, LAB TECHNICIAN, NURSE PRACTITIONERS, AND MEDICAL ADMINISTRATIVE ASSISTANTS, STUDY AT ARMC. ARMC ALSO HAS AN AGREEMENT WITH UNIVERSITY OF MINNESOTA-DULUTH FOR FIRST YEAR AND SECOND YEAR MEDICAL STUDENT ROTATIONS. IN ADDITION, ARMC ACTIVELY COLLABORATES WITH THE WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) TO HELP EDUCATE AND TRAIN YOUNG NURSES. FOR THE YEAR 2016, ARMC PROVIDED CLINICAL TRAINING FOR 96 NURSES, 2 MED STUDENTS, 1 PHLEBOTOMY STUDENT, 1 DIAGNOSTIC TECHNICIAN STUDENT, 4 PHARMACY STUDENTS, AND 2 MEDICAL ASSISTANTS. QUARTERLY CONTINUING MEDICAL EDUCATION THROUGH WOUND HEALING WERE OFFERED BOTH LOCALLY AND VIA WEB MEETING FORMAT TO ALL PROVIDER TYPES TO EDUCATE ON ISSUES SPECIFIC TO CHRONIC WOUNDS. EACH YEAR ARMC AND THE FOUNDATION PROVIDE SEVEN $1,000 SCHOLARSHIPS TO LOCAL HIGH SCHOOL SENIORS PURSUING A CAREER IN A HEALTH-RELATED FIELD. ARMC'S SHARE OF THE COST WAS $3,500. 3. SUBSIDIZED HEALTH SERVICES: NONE 4. FINANCIAL CONTRIBUTIONS: $ 187,976 CASH DONATIONS - ARMC HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS TOTALING $ 25,411. IN-KIND DONATIONS - IN-KIND SERVICES DONATED INCLUDED STAFF HOURS SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK SUCH AS: VALLEY BEHAVIORAL HEALTH STEERING COMMITTEE, DEMENTIA FRIENDLY COMMUNITIES COALITION, NORTHWESTERN WISCONSIN HEALTHCARE COALITION, POLK COUNTY INFECTION PREVENTION COORDINATORS MEETING, INJURY PREVENTION COMMITTEE, REGIONAL TRAUMA ADVISORY COMMITTEE, UNITED WAY OF ST. CROIX VALLEY, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY COMMUNITY HEALTH IMPROVEMENT PLANNING GROUP, AND THE POLK COUNTY OBESITY PREVENTION GROUP. ARMC ATHLETIC TRAINERS ARE IN BOTH AMERY AND LUCK SCHOOL DISTRICTS, PROVIDING OVER 2000 HOURS OF ATHLETIC TRAINING AND SUPPORT FOR A MINIMAL FEE TOTALING $ 13,112, WITH THE BENEFIT OF DONATED SERVICES TOTALING $ 73,824. ARMC HOSTED TWO BLOOD DRIVES COLLECTING A TOTAL OF 56 UNITS OF BLOOD FROM 62 INDIVIDUALS IN SUPPORT OF THE AMERICAN RED CROSS. ARMC PROVIDES MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS WITH A HEALTH FOCUS SUCH AS THE AMERICAN RED CROSS, BABY & ME, PRENATAL & BREASTFEEDING SUPPORT, DAVITA KIDNEY SMART, AND WITC NURSING PROGRAM TOTALING $ 5,042. IN ORDER TO HELP COMBAT POVERTY, ARMC PROVIDES THE LOCAL FOOD SHELF, AMERY AREA FOOD SHELF, WITH FREE RENT, HEAT AND SHELVING FOR FOOD ITEMS. IN 2016, A TOTAL OF $ 74,892 WAS PROVIDED TO THIS LOCAL PROGRAM. 5. COMMUNITY BUILDING ACTIVITIES: $ 14,263 PHYSICAL IMPROVEMENTS AND HOUSING - ARMC HAS A REPRESENTATIVE ON THE AMERY WALKABILITY COMMITTEE DEFINING AND IMPROVING WALKING SPACES AND BIKE PATH DEVELOPMENT. ECONOMIC DEVELOPMENT - ARMC HAS A REPRESENTATIVE ON THE AMERY ECONOMIC DEVELOPMENT BOARD WHICH MEETS MONTHLY TO WORK ON ECONOMIC DEVELOPMENT AND THE CREATION OF JOBS IN THE AMERY AREA THROUGH PROCESSES INCLUDING HOTEL STUDY, INDUSTRIAL PARKS, AND HOUSING STUDY. COMMUNITY SUPPORT - ARMC COORDINATED THE PURCHASE, INSTALLATION, AND REGISTRATION OF A "FREE LITTLE LIBRARY" LOCATED ON THE ARMC CAMPUS. FREE LITTLE LIBRARY IS A "TAKE A BOOK, LEAVE A BOOK" PERMANENT INSTALLATION AND IS AVAILABLE TO ALL COMMUNITY MEMBERS. THE MISSION OF FREE LITTLE LIBRARY IS TO PROMOTE LITERACY AND THE LOVE OF READING BY BUILDING FREE BOOK EXCHANGES WORLDWIDE AND TO BUILD A SENSE OF COMMUNITY AS WE SHARE SKILLS, CREATIVITY AND WISDOM ACROSS GENERATIONS. ARMC PROVIDES MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS WITHOUT A HEALTH FOCUS SUCH AS THE GIRL SCOUTS AND POLK COUNTY EXTENSION TOTALING $ 185. ENVIRONMENTAL IMPROVEMENTS - ARMC HAS A REPRESENTATIVE ATTEND THE ANNUAL CLEANMED CONFERENCE WHICH IS A NATIONAL ENVIRONMENTAL CONFERENCE FOR LEADERS IN HEALTH CARE SUSTAINABILITY. ARMC CONTINUES TO BE A SUSTAINABILITY CHAMPION AND HOSTS AN ELECTRONICS RECYCLING EVENT, RECYCLING 6,600 POUNDS FROM OUR AREA COMMUNITIES. WORKFORCE DEVELOPMENT - ARMC HAS REPRESENTATIVES SERVE ON THE WITC MEDICAL ASSISTANT ADVISORY COMMITTEE, WITC ADVISORY COUNCIL, AND WITC HEALTH INFORMATION TECHNOLOGY ADVISORY COMMITTEE. A MOCK INTERVIEW DAY AT WITC WAS ATTENDED BY 2 ARMC STAFF INTENDED FOR STUDENTS CURRENTLY ENROLLED IN THE NURSING, MEDICAL ASSISTANT AND MEDICAL ADMINISTRATIVE SPECIALIST PROGRAMS. THIS INCLUDED PRACTICE INTERVIEW QUESTIONS AND RESUME REVIEW. 6. COMMUNITY BENEFIT OPERATIONS: $ 29,033 IN 2016 EXTENSIVE STAFF TRAINING WAS CONDUCTED ON THE TOPIC OF COMMUNITY BENEFIT AND ACCURATELY CAPTURING OUR COMMUNITY BENEFIT ACTIVITIES. ALL DEPARTMENTS WERE REPRESENTED AND WE CONTINUE TO WORK TOWARD ACCURATE AND COMPLETE REPORTING THROUGH THE USE OF CBISA, A WEB-BASED REPORTING PROGRAM. ARMC HAD A REPRESENTATIVE ATTEND THE WISCONSIN HEALTH ASSOCIATION POPULATION HEALTH SUMMIT WHICH HAD NATIONAL EXPERTS SPEAK ON AREAS OF COMPLIANCE, CHNA PROCESS, AND BEST PRACTICES, HELPING TO CREATE HEALTHY COMMUNITIES IN WISCONSIN. 7. ORGANIZATION AWARDS AND ACHIEVEMENTS PRACTICE GREENHEALTH PARTNER FOR CHANGE - WISCONSIN SUSTAINABLE BUSINESS COUNCIL GREEN PROFESSIONAL AWARD - WISCONSIN SUSTAINABLE BUSINESS COUNCIL THE CENTERS FOR MEDICARE SERVICES FIVE-STAR QUALITY RATING - ARMC ACHIEVED FOUR OUT OF FIVE STARS, WHICH MEANS WE ARE AMONG THE ELITE AS ONLY 20 PERCENT OF U.S. HOSPITALS ACHIEVED THIS RATING AND ONLY 2.2 ACHIEVED FIVE STARS. FORM 990, PART VI, SECTION A, LINE 6 RH WISCONSIN, INC. IS THE CLASS A MEMBER AND GHI IS THE CLASS B MEMBER OF ARMC. FORM 990, PART VI, SECTION A, LINE 7A ARMC'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN 13 PERSONS APPOINTED AS FOLLOWS: - 7 COMMUNITY REPRESENTATIVES APPOINTED BY THE CLASS A MEMBER (RH-WISCONSIN), FROM RECOMMENDATIONS BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. - 3 REPRESENTATIVES APPOINTED BY THE CLASS B MEMBER (GHI). - 3 HEALTH CARE PROVIDERS NOMINATED BY THE PHYSICIAN GROUP STAFFING ARMC'S PRIMARY CARE CLINIC, AND APPOINTED BY THE CLASS B MEMBER (GHI). - THE PRESIDENT AND CHIEF MEDICAL OFFICER OF ARMC SIT IN EX-OFFICIO CAPACITIES, WITHOUT THE RIGHT TO VOTE. FORM 990, PART VI, SECTION A, LINE 7B THE CLASS A AND CLASS B MEMBERS (RH WISCONSIN, INC. AND GHI RESPECTIVELY) BOTH MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS IMPACTING MEMBERSHIP - RESIGNATION OF A MEMBER - DISSOLUTION - ANY CHANGE IN THE FUNDAMENTAL NATURE OR PURPOSE - MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION - DISPOSITION OF SUBSTANTIALLY ALL ASSETS. ONLY THE CLASS A MEMBER MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS NOT IMPACTING MEMBERSHIP - ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS - ESTABLISHMENT OF NEW ENTITIES OR SIGNIFICANT RELATIONSHIPS WITH OTHER ENTITIES - UNBUDGETED EXPENDITURES IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - GUARANTEEING THE DEBT OF ANY OTHER PERSON OR ENTITY - A LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - TRANSFER OF ASSETS TO ANOTHER ENTITY - APPOINTMENT OF THE PRESIDENT AND THE BOARD CHAIR. FORM 990, PART VI, SECTION B, LINE 11B ARMC'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF ARMC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF ARMC, GHI'S INTERNAL LEGAL DEPARTMENT AND ARMC'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 ARMC. ARMC 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 IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE ARMC 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 CHAIR AND THE CEO. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 ARMC'S CEO AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS) OR BY GROUP HEALTH PLAN, INC. (GHI), BOTH OF WHICH ARE RELATED ORGANIZATIONS, OR BY ARMC. GHI, REGIONS, AND ARMC HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF ARMC'S CEO 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 EXECUTIVE COMMITTEE OF REGIONS, THE COMPENSATION COMMITTEE OF GHI OR THE ARMC EXECUTIVE COMMITTEE (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES 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 ARMC'S BOARD OF DIRECTORS INPUT, THE ST CROIX VALLEY EXECUTIVE LEADER CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH ARMC'S BOARD APPROVAL, DETERMINES THE COMPENSATION OF THE ARMC CEO. THE ARMC BOARD HAS DELEGATED TO THE CEO THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL ARMC-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE ARMC EXECUTIVE COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2. FORM 990, PART VI, SECTION C, LINE 18 ARMC 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM ARMC OR HEALTHPARTNERS, INC. FORM 990, PART VI, SECTION C, LINE 19 ARMC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 990, PART VII, SEC A, LN 1A, COL (B) - RELATED ORGANIZATION AVERAGE HOURS DIRECTORS AND OFFICERS OF ARMC ARE EMPLOYED AND COMPENSATED BY GHI, INC., REGIONS HOSPITAL OR ARMC. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. 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 - 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CLAIMSHEALTHCARE SERVICES L 225221