2017-11-15T09:07:38-06:00 2016-12-31 390859910 Baker Tilly Virchow Krause LLP 225 S 6th St 2300 Minneapolis MN 55402 990 2016-01-01 208316475 Maple Grove Hospital Corporation MAPL 7635811000 9875 Hospital Drive Maple Grove MN 55369 Aaron Bloomquist TREASURER 7635205048 2017-11-13 1 Lawrence H Mohr CPA P00447603 6128764500 38.88.188.75 2017-11-13 14:16:58 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 167182DFA60A41E45EAE2F4EF9C72CA9A698CA21 2016 2021-01-29 14:40:06Z ANDREW COCHRANE 9875 Hospital Drive Maple Grove MN 55369 187253017 0 X www.maplegrovehospital.org X 2007 MN To empower our customers to achieve their best health. 7 2 1170 603 0 0 24874 23029 173570938 187035541 76340 194447 0 0 173672152 187253017 0 0 0 0 61478627 65023159 0 0 0 87074216 101954370 148552843 166977529 25119309 20275488 183066733 178680301 147956493 145894609 35110240 32785692 X TO EMPOWER OUR CUSTOMERS TO ACHIEVE THEIR BEST HEALTH. 0 0 142982693 186800951 Maple Grove Hospital is a GENERAL ACUTE CARE HOSPITAL PROVIDING EMERGENCY SERVICES, MEDICAL AND SURGICAL SERVICES, OBSTETRICAL SERVICES, AND PEDIATRIC SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, MGH ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST) IN FURTHERANCE OF ITS CHARITABLE PURPOSE. MAPLE GROVE HOSPITAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY INCLUDING PROVIDING HEALTH RELATED EDUCATIONAL PROGRAMS SUCH AS SAFETY FAIR, CAR SEAT CLINICS, MENTAL HEALTH AND FIRST AID CLASSES, AND ASTHMA EDUCATION IN ELEMENTARY SCHOOLS. MAPLE GROVE HOSPITAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES, AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, MAPLE GROVE CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE. 142982693 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 115 0 1170 1 0 0 0 0 0 0 0 0 0 0 X 7 2 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Aaron Bloomquist 7635205200 3300 Oakdale Avenue North Robbinsdale MN 55422 J KEVIN CROSTON MD Board Chair 2.00 50.00 X X 0 992503 48711 Dan Fromm Secretary 2.00 0.00 X 0 0 0 David Murphy Board Member 2.00 0.00 X 0 0 0 Tiffany Zitzewitz Board Member 2.00 50.00 X 0 317120 40719 Kelly Macken-Marble Board Member 2.00 50.00 X 0 151150 20365 Jeff Wicklander Board Member 2.00 50.00 X 0 512795 44040 Aaron Bloomquist Treasurer 2.00 50.00 X X 0 348377 23957 TODD OSTENDORF TREASURER (PART YEAR) 2.00 50.00 X X 0 130819 13238 Andrew Cochrane President 50.00 0.00 X 0 571986 43243 Colleen Nadeau VP Patient Care Operations 50.00 0.00 X 224709 0 5716 Pam Doorenbos Medical Doctor 50.00 0.00 X 208281 0 6910 Sarah R Johnson Director of Clinical Support 50.00 0.00 X 194502 0 22910 Karen Hall Pharmacist 50.00 0.00 X 193393 0 21517 Megan Matack Pharmacy Manager 50.00 0.00 X 157360 0 21418 Leah Wandersee Director of Procedural Care 50.00 0.00 X 164412 0 12977 LOREN TAYLOR Former Board Member 2.00 50.00 X 0 30155 0 1142657 3054905 325721 27 1 1 0 University of Minnesota Physicians 720 Washington Ave STE 200 Minneapolis MN 55414 Physician Services 2152647 Aramark Healthcare Food 25271 Network place chiCAGO IL 60673 dietary 1194898 Fairview Health Services 2450 Riverside Avenue Minneapolis MN 55454 Physician Services 841935 Crothall Laundry Service Inc 13028 Collections Center Drive ChiCAGO IL 60693 Laundry 764662 Specialists in General Surgery 3366 Oakdale Ave N Ste 502 Robbinsdale MN 55422 Physician Services 385695 18 23029 23029 Patient Revenue 621500 186800951 186800951 CONTRACT SERVICES 900099 428995 428995 Gift Shop 900099 242154 242154 All Other 621910 44136 44136 CMS/EHR PAYMENTS & OTHER 900099 -480695 -480695 187035541 171599 171599 22848 0 22848 22848 22848 187253017 186800951 0 429037 X 230425 230425 52952332 44317746 8634586 1368014 1143942 224072 6658670 5550261 1108409 3813718 3178353 635365 19445744 16206083 3239661 31973 26646 5327 48150 40128 8022 18861741 15719375 3142366 510081 425102 84979 1694303 1412032 282271 1700999 1417613 283386 32827 27358 5469 6848404 6848404 8362647 6969430 1393217 1037982 865054 172928 Supplies 23329944 19443175 3886769 Bad Debt Expense 11324993 11324993 Government Taxes 4777494 4777494 Maintenance and Repairs 2781309 2317943 463366 1165779 971561 194218 166977529 142982693 23994836 0 1450 1450 30389819 34331810 29415436 27878837 2342653 2278244 576968 454218 146947409 47328254 106168920 99619155 9325879 10086702 3607000 3607000 1238608 422885 183066733 178680301 15361361 16630165 132595132 129264444 147956493 145894609 X 35110240 32785692 35110240 32785692 183066733 178680301 X 20275488 499964 -23100000 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 110231913 24358975 85872938 36715496 22969279 13746217 99619155 X Part X, Line 2: MAPLE GROVE HOSPITAL EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2016 OR 2015. 1 1 1 X 1 X 1 1 0 1 1 3066104 3066104 0.01840 27213754 21316752 5897002 0.03530 30279858 21316752 8963106 0.05370 184890 184890 0.00110 184890 184890 0.00110 30464748 21316752 9147996 0.05480 1 4014200 29988437 33294240 -3305803 X 1 1 1 1 MAPLE GROVE HOSPITAL CORPORATION 9875 Hospital Drive Maple Grove MN 55369 X X X MAPLE GROVE HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X www.maplegrovehospital.org X 1 16 1 www.maplegrovehospital.org 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MAPLEGROVEHOSPITAL.ORG X X X 1 X 0 X 1 0 0 MAPLE GROVE HOSPITAL CORPORATION Part V, Section B, Line 5: One of the key objectives in conducting the 2016 CHNA was to identify health issues which are most important to our community members and establish or strengthen community relationships to help address these health issues. This was accomplished in several ways. A Steering Committee composed of community leaders, social service providers, health care providers, school district employees, business representatives and a public health representative guided the assessment process and identification of health needs. Maple Grove Hospital convened 5 focus groups from target populations throughout the community. We further interviewed key stakeholders from local government, law enforcement, education, religious and community-based organizations. Lastly we conducted an online survey for business groups, the faith community and community members. The assessment was completed working in conjunction with Fairview Maple Grove Medical Center. MAPLE GROVE HOSPITAL CORPORATION Part V, Section B, Line 11: Our most recent CHNA was conducted in 2016. The overall CHNA was guided by the Community Engagement Advisory Team which is composed of community members, Maple Grove Hospital employees, and Public Health representatives. Data used to identify the top priorities included: Demographic data; Quantitative Data from the Minnesota Hospital Association, Minnesota Department of Health, Hennepin County SHAPE 2014, Community Need Index and Attributed Patient Data; Qualitative data from Focus Groups, Key Stakeholder Interviews, and Community Asset Mapping. The following top priorities were identified in the assessment:-Mental Health/Substance Abuse-Healthy Aging/Senior Services-Cancer Prevention, Screening, Healthy Survivors-Injury Prevention Across The Lifespan-Nutrition/Healthy Lifestyles-Youth Engagement Education About Healthcare Careers, Leadership Development-Understanding Of Immigrant Cultures And Issues Related To Health/Disparities-Transportation/Healthcare accessAfter discussion around the top health priorities the Community Engagement Advisory Team voted to prioritize the top two health priorities. Prioritization was based on the following criterion:-How widespread is the health need?-How serious or important do you think this health need is for individuals and/or the community?-What is the potential for Maple Grove Hospital and community partners to have a positive impact on this health need within 3 to 4 years?Based on these criteria, the top needs were identified as:-Mental Health/Substance Abuse - 207 votes-Healthy Aging/Senior Services - 169 votes-Cancer Prevention, Screening, Healthy Survivors - 162 votes-Nutrition/Healthy Lifestyles - 161 votes-Injury Prevention Across The Lifespan - 159 votes-Understanding Of Immigrant Cultures And Issues Related To Health/Disparities - 157 votes-Youth Engagement Education About Healthcare Careers, Leadership Development - 143 votes-Transportation/Healthcare access - 132 votesAfter a review of potential implementation projects to address these health priorities, a decision was made to separate out Mental Health and Substance Abuse. The final top health priorities from the 2016 CHNA are:-Mental Health-Substance Abuse and-Healthy Aging/Senior ServicesThese health priorities will be addressed with community partnerships, community support and cultural appropriateness in mind. Maple Grove Hospital has several strategies that it is using to address the identified health priorities. Priority 1: Mental HealthGoal - To support the mental health of community members along the mental health continuum.Objectives:I. Reduce the stigma associated with mental health conditions Strategies:-Incorporated the Make It Okay message into annual employee training-Incorporate the Make It Okay message on the Maple Grove Hospital website and in our public communications during May - Mental Health Awareness month II. Increase education about mental health Strategies:-Offer a minimum of four evidence based Mental Health First Aid classes across the system annually III. Improve access to Mental Health Services Strategies:-Opened the North Memorial Mental Health & Addiction Care clinic in December 2016-Continued assessment of community need and development of programs as need is identified IV. Support North Memorial Health Care's domestic violence advocacy program SafeJourneyStrategies:-Ensure 24 hour advocacy is provided by trained volunteers-Train 25 to 30 new volunteers in 2017-Increase the number of participants at Maple Grove Hospital-Train new facilitators for support groups-Distribute client emergency funds to qualified clients-Provide community outreach and education on SafeJourney V. Work with community partners to collectively identify opportunities to address mental health issues and social conditions that affect mental health conditions - CHIP, CCH, West Metro Hospital Group, local public health, government and othersStrategies:-Continue active involvement in Hennepin County CHIP and Social Isolation workgroup-Continue active involvement with the Center for Community Health Collective Action Group-Explore community partnership opportunities that address mental health and violencePrograms and activities that will be used to address the above goals include:Make It OK "Make It OK" is a campaign to reduce the stigma of mental illnesses. Organizations that support the Make It OK campaign are working to reduce misperceptions about mental illnesses and encourage open conversations and education about mental illness.Mental Health First Aid USA and Youth Mental Health First Aid USA an evidence based class which has the following goals:-Increased the knowledge of the signs, symptoms and risk factors of mental illness,-Increased knowledge of the impact of mental health and substance use disorders,-Increased awareness of local resources and where to turn for help, and-Building capacity to assess a situation and help an individual in distress.Participants will attend an 8 hours class where they learn an overview of the risk factors of common mental health and substance abuse illnesses and participate in role-playing simulations to learn how to help persons in crisis. The evaluation component is built into the design of the program with pre- and post-tests and a six-month follow up evaluation. These classes will be offered free of charge to the community to eliminate any financial barriers. Active outreach will be made to local schools, churches, and vulnerable populations. Maple Grove Hospital will partner with Fairview and NAMI in offering these classes. Behavioral Health Clinic at North Memorial Medical Health Hospital The North Memorial Mental Health & Addiction Care clinic in Robbinsdale opened in December of 2016 in response to an identified community need. The clinic has 10,300 sq. ft. and focuses on general mental health problems with a specific focus on serious and persistent mental illness, post-traumatic stress disorder and addiction medicine. The Mental Health & Addiction clinic was opened to fill an important service that was not offered for the community North Memorial Health Hospital and Maple Grove Hospital serves. The opening of this clinic has resulted in stronger coordination of care. North Memorial currently has emergency medicine, a consult service for the medical units, an inpatient psychiatric unit, two tracks of partial hospitalization, one intensive outpatient program, a mental health clinic and five psychiatric providers in seven of it 15 primary clinics. The customer base ranges in ages of 18 to 90, comes from varied ethnic backgrounds with a variety of insurers including third party payers, Medicare and Medicaid. Most of our customers have diagnoses of psychosis, PTSD, and mood disorders. Safe Journey is an innovative, volunteer-driven program that provides victims of domestic violence with safety planning, injury documentation, immediate emotional support, legal advocacy, and options for longer-term support. Trained volunteer advocates provide 24-hour on site advocacy to victims of domestic abuse at North Memorial and Maple Grove Hospital as well as individuals in our communities. On-going support is provided by three weekly support groups at both sites; individual counseling by appointment; and follow up calls. Partnerships with Community Organizations and coalitions Maple Grove Hospital has worked and will continue to work with the following groups that have also identified Mental Health as a health priority.-Hennepin County Community Health Improvement Plan (CHIP)-The Center for Community Health (CCH)-Osseo and Wayzata Family Service Collaborative, and-West Metro Hospital Group.The purpose of these partnerships is to identify opportunities where we can collectively work together to address mental health and the social issues that impact mental health. Priority 2: Substance UseGoal - To create an environment where substance abuse among the general population and substance use among youth is reduced. Objectives:I. Increase awareness of substance use issues among youth and young adults and activities to address these issues Strategies:-Continue working with and supporting community collaboratives such as Partnership for Change and Partners in Prevention-Increase collaboration with the Northwest and Wayzata Family Service Collaboratives to address factors that increase the risk of substance use among youth. II. Improve access to addiction medicine services Strategies:-Opened the North Memorial Mental Health & Addiction Care clinic in December 2016-Continued assessment of community need and development of programs as need is identified Continued on Schedule O... MAPLE GROVE HOSPITAL CORPORATION Part V, Section B, Line 24: PER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT, THIRD PARTY LIABILITY AND PROCEDURES THAT ARE NOT MEDICALLY NECESSARY ARE NOT COVERED UNDER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT AND THOSE PATIENTS CAN BE BILLED FULL CHARGES. 1 1 - MINNESOTA DIAGNOSTIC IMAGING PARTNERS LL 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 OUTPATIENT RADIOLOGY Part III, Line 2: AMOUNT REPRESENTS THE HOSPITAL'S BAD DEBT PROVISION REDUCED BY THE HOSPITAL'S COST TO CHARGE RATIO WHICH REPRESENTS THE BEST ESTIMATE OF COST FOR THE BAD DEBT PROVISION. Part III, Line 4: Maple Grove Hospital's audited financial statements do not include a footnote description about bad debt expense. The cost to charge ratio was used to determine the amount on Part III, section A, line 2. We do not have the information necessary to determine which portion of the amount reported on line 2 is community benefit. Part III, Line 8: The shortfall reported represents the amount the Medicare reimbursement is less than the estimated cost of providing services to those patients. The method used to estimate those costs is the Cost to Charge Ratio approach which calculates the ratio of total hospital costs / total hospital gross revenue and them applies that ratio to total Medicare gross revenue. Part III, Line 9b: Maple Grove Hospital Corporation has policies and procedures in place for collection practices that include identification and screening for charity care and financial assistance. The policies are available on the organization's intranet and each patient is given a brochure upon admission. Part VI, Line 2: Maple Grove Hospital works closely with community members to determine areas of interest and need in healthcare services. In 2016 we completed a full Community Health Needs Assessment, including community focus groups, to better understand the community's health needs. Part VI, Line 3: Maple Grove Hospital has a very proactive program to assist uninsured and underinsured patients with their medical bills. We comply with the Attorney General's requirement to provide a discount to uninsured Minnesota residents as well as a financial assistance program for financially qualified patients. We have Patient Financial Advocates as well as a contracted vendor that meets with all of our uninsured inpatients and specific outpatients to assist them in Medical Assistance eligibility and applications. This could include a visit to their residence if they need help in completing assistance applications. Should they not qualify for state or federal assistance programs, we offer and assist them in applying for the hospital's Financial Assistance (Charity Care) Program.In addition, our internal collections department and our collection agencies are well versed in our assistance programs and will assess during their conversations with patients if referral to either a state or federal program or our Charity Care Program would be appropriate. Maple Grove Hospital identified minor omissions and errors related to 501(r) charity care practices during tax year 2016 that were due to reasonable cause. Prior to the implementation of 501(r), Maple Grove Hospital was subject to Minnesota Attorney General requirements. The omissions and errors occurred when integrating 501(r) requirements with Minnesota Attorney General requirements. Upon discovery of the omissions, Maple Grove Hospital policies and procedures were promptly revised to promote and facilitate overall compliance with both federal and state requirements. The revised 501(r) policy and procedures were effective 07/17/2017. Part VI, Line 4: WE SERVE A 27 ZIP-CODE AREA IN THE NORTHWEST SIDE OF THE TWIN CITIES. THIS IS BASED ON THE HOME ZIP CODES FOR 80% OF OUR INPATIENT PATIENT POPULATION. WE WORK WITH THE COMMUNITY TO ADDRESS COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT. Part VI, Line 5: Maple Grove Hospital provides educational opportunities for community members to attend such as Health Care Directives, Kids Safety Fairs, and seminars on health topics. Part VI, Line 6: Maple Grove Hospital is a part of North Memorial Health System, which is committed to improving the health of the communities we serve. Through targeted outreach, education and partnerships, we improve the health of our communities by listening to their needs and responding with appropriate programs and services. Our programs, many of which have been nationally recognized, range from health education and free screenings to training health professionals. Part VI, Line 7: MAPLE GROVE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF MINNESOTA. X X X 0 0 0 0 0 1 1 0 0 J KEVIN CROSTON MD Board Chair 0 705969 0 279409 0 7125 0 18550 0 30161 0 1041214 0 0 Tiffany Zitzewitz Board Member 0 250000 0 66144 0 976 0 18550 0 22169 0 357839 0 0 Kelly Macken-Marble Board Member 0 150000 0 0 0 1150 0 10500 0 9865 0 171515 0 0 Jeff Wicklander Board Member 0 369481 0 141792 0 1522 0 18550 0 25490 0 556835 0 0 Aaron Bloomquist Treasurer 0 291862 0 55076 0 1439 0 15792 0 8165 0 372334 0 0 Andrew Cochrane President 0 349692 0 220089 0 2205 0 18550 0 24693 0 615229 0 0 Colleen Nadeau VP Patient Care Operations 180076 0 44101 0 532 0 4606 0 1110 0 230425 0 0 0 Pam Doorenbos Medical Doctor 175982 0 31978 0 321 0 0 0 6910 0 215191 0 0 0 Sarah R Johnson Director of Clinical Support 151641 0 42692 0 169 0 7773 0 15137 0 217412 0 0 0 Karen Hall Pharmacist 173756 0 19392 0 245 0 6385 0 15132 0 214910 0 0 0 Megan Matack Pharmacy Manager 140198 0 17072 0 90 0 6291 0 15127 0 178778 0 0 0 Leah Wandersee Director of Procedural Care 137979 0 25202 0 1231 0 6527 0 6450 0 177389 0 0 0 LOREN TAYLOR Former Board Member 0 0 0 30155 0 0 0 0 0 0 0 30155 0 0 Part I, Line 3 The Chief Executive Officer is an employee of North Memorial Health Care. Other board members listed with compensation from a related organization are officers and key employees of North Memorial Health Care who provide services to Maple Grove Hospital as well as to all or some related entities as identified on Schedule R. As such, their compensation levels incorporate services provided to multiple North Memorial entities. Part I, Line 6 North Memorial Health Care's annual incentive plan requires achievement of stated performance metrics, which include operating cash flow margin. A CITY OF MAPLE GROVE 410873250 00056516M 2007-05-25 149139758 Construction of a hospital facility 0 1 0 A 12675000 149139758 2686779 146452979 2009 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 Date Rebate Computation Performed Issuer Name: CITY OF MAPLE GROVE Date the Rebate Computation was Performed: 06/05/2012 Form 990, Part VI, Section A, line 3 North Memorial Health Care, a related party, performs management duties on behalf of Maple Grove Hospital. Form 990, Part VI, Section A, line 6 Maple Grove Hospital has one class of members. North Memorial Health Care ("North Memorial") and Fairview Health Services ("Fairview") are the only members of the Corporation and both members are nonprofit, tax-exempt organizations under Section 501(c)(3) of the Internal Revenue Code. Form 990, Part VI, Section A, line 7a The Board of Directors is comprised of seven voting directors and one non-voting director, as follows: (a) The chief executive officer of North Memorial and four other directors appointed annually by North Memorial (b) The chief executive officer of Fairview and one other director appointed annually by Fairview and (c) the Maple Grove Hospital Chief Executive Officer. Form 990, Part VI, Section A, line 7b The members, and only the members, may take direct action on the following matters by unanimous member approval: (a) Amendments to the Articles of Incorporation; (b) Amendments to the bylaws; (c) merger or consolidation of the corporation (d) sale, lease or transfer or other disposition of all or substantially all of the assets of the Corporation; (e) joint ventures affecting substantially all of the assets or operations of the Corporation; (f) determination of the name under which the Hospital conducts business; (g) certain mortgages or other security interests; (h) issuance of capital calls; and (i) dissolution and liquidation of the Corporation. Form 990, Part VI, Section B, line 11b The management company and the board of directors review the Form 990 before it is filed. Representatives from the hospital's independent accounting firm review the Form 990 with the management company in detail and notes for the committee any changes in the Form 990 from prior years. After thorough discussion, the management company approves the Form 990 and forwards it to the board for its review. Form 990, Part VI, Section B, line 12c All members of the board of directors and all employees receive a copy of the conflict of interest policy each year. Each board member and staff member fills out a conflict of interest questionnaire in which they are asked to identify any relationship that would create a conflict of interest. The results are summarized and reviewed to determine any actual or potential conflict and are reported to the board of directors. Form 990, Part VI, Section B, line 15 Compensation for key positions are reviewed by the executive committee of North Memorial working in conjunction with an outside consultant. The executive committee of North Memorial insures that the salary and benefit administration review process is being followed, which includes salary and benefit surveys and comparisons of all positions. The CEO's compensation is sent to the full board for approval. The compensation of all other key positions is approved by the CEO. Form 990, Part VI, Section C, line 19 Governing documents and the conflict of interest policy are available upon request. Financial statements are available online through the office of the attorney general via the charity report filed with the state of Minnesota. Form 990, Part IX, line 11g MEDICAL FEES: Program service expenses 13,058,420. Management and general expenses 2,610,431. Fundraising expenses 0. Total expenses 15,668,851. COLLECTION AGENCY FEES: Program service expenses 211,909. Management and general expenses 42,361. Fundraising expenses 0. Total expenses 254,270. LAUNDRY FEES: Program service expenses 647,057. Management and general expenses 129,349. Fundraising expenses 0. Total expenses 776,406. SECURITY FEES: Program service expenses 484,963. Management and general expenses 96,946. Fundraising expenses 0. Total expenses 581,909. MISCELLANEOUS PURCHASED FEES: Program service expenses 1,317,026. Management and general expenses 263,279. Fundraising expenses 0. Total expenses 1,580,305. Form 990, Part XI, line 9: Return of Capital to members -23,100,000. FORM 990, PART XII, LINE 2C: Neither the oversight process of the audit or the selection process of the independent accountant changed during the current tax year. Form 990, Part XI, Line 9: Return of Capital to Members: A RETURN OF CAPITAL IN THE AMOUNT OF $23,100,000 WAS MADE TO the MEMBERS OF THE ORGANIZATION. THE MEMBERS CONSIST OF NORTH MEMORIAL HEATH CARE AND FAIRVIEW HEALTH SERVICES. ALL MEMBERS ARE REQUIRED TO BE NON-PROFIT, TAX EXEMPT ORGANIZATIONS UNDER IRC SECTION 501(C)(3) PER THE BYLAWS OF THE ORGANIZATION. SCHEDULE H, PART V, SECTION B, LINE 11, CONTINUATION: III. INCREASE AWARENESS OF OPIOID MISUSE AND WORK TO PUT SYSTEMS IN PLACE TO REDUCE THIS MISUSE STRATEGIES: -WORK WITH ICSI (INSTITUTE FOR CLINICAL IMPROVEMENT) ON PROGRAM DEVELOPMENT -CONTINUE INVOLVEMENT WITH PARTNERSHIP FOR CHANGE AND THE PRESCRIPTION DRUG MONITORING PROJECT -RESEARCH COMMUNITY BASED OPIOID ABUSE PREVENTION PROGRAMS PARTNERSHIPS THAT WILL BE USED TO ADDRESS THE ABOVE GOALS INCLUDE: PARTNERSHIP FOR CHANGE IS AN ORGANIZATION COMPRISED OF YOUTH, PARENTS, SCHOOLS, LAW ENFORCEMENT, AND COMMUNITY GROUPS THAT ARE WORKING TOGETHER TO REDUCE DRUG USE AMONG YOUTH AND YOUNG ADULTS IN NORTHWEST HENNEPIN COUNTY. THEIR FOCUS IS CHANGING THE COMMUNITY ENVIRONMENT THAT LEADS TO YOUTH SUBSTANCE USE BY IDENTIFYING AND IMPLEMENTING STRATEGIES THAT WILL AFFECT COMMUNITY ATTITUDES, PERCEPTIONS, AND BELIEFS AROUND ALCOHOL AND OTHER DRUGS. PARTNERSHIP FOR CHANGE SERVES THE BROOKLYN CENTER, OSSEO, AND ROBBINSDALE SCHOOL DISTRICTS, WHICH INCLUDE THE CITIES OF: BROOKLYN CENTER, BROOKLYN PARK, CRYSTAL, GOLDEN VALLEY, MAPLE GROVE, NEW HOPE, OSSEO, PLYMOUTH AND ROBBINSDALE. PARTNERSHIP FOR CHANGE'S MISSION IS TO LEVERAGE COMMUNITY PARTNERSHIPS TO PREVENT AND REDUCE ALCOHOL AND OTHER DRUG USE AMONG YOUTH AND REDUCE SUBSTANCE ABUSE IN THE COMMUNITY. PARTNERSHIP FOR CHANGE IS HOUSED OUT OF NORTH MEMORIAL HEALTH HOSPITAL'S TRAUMA DEPARTMENT. PARTNERS IN PREVENTION IS COMMITTED TO ENSURING THAT EACH AND EVERY CHILD IS SUPPORTED TO MAKE HEALTHY CHOICES. THEIR MISSION STATEMENT IS - BY COLLABORATING WITH COMMUNITY PARTNERS, WE WILL INFLUENCE THE REDUCTION OF SUBSTANCE USE AMONG OUR YOUTH IN OUR COMMUNITY. THEIR VISION IS THAT THE WAYZATA PUBLIC SCHOOLS COMMUNITY IS A HEALTHY, SUBSTANCE-FREE ENVIRONMENT WHERE EVERY CHILD IS CONNECTED TO A CARING ADULT. PARTNERS IN PREVENTION IS HOUSED OUT OF THE WAYZATA SCHOOL DISTRICT. BEHAVIORAL HEALTH CLINIC AT NORTH MEMORIAL HEALTH HOSPITAL - THE NORTH MEMORIAL MENTAL HEALTH & ADDICTION CARE CLINIC IN ROBBINSDALE OPENED IN DECEMBER OF 2016 IN RESPONSE TO AN IDENTIFIED COMMUNITY NEED. THE CLINIC HAS 10,300 SQ. FT. AND FOCUSES ON GENERAL MENTAL HEALTH PROBLEMS WITH A SPECIFIC FOCUS ON SERIOUS AND PERSISTENT MENTAL ILLNESS, POST-TRAUMATIC STRESS DISORDER AND ADDICTION MEDICINE. THE MENTAL HEALTH & ADDICTION CLINIC WAS OPENED TO FILL AN IMPORTANT SERVICE THAT WAS NOT OFFERED FOR THE COMMUNITY NORTH MEMORIAL HEALTH HOSPITAL AND MAPLE GROVE HOSPITAL SERVES. THE OPENING OF THIS CLINIC HAS RESULTED IN STRONGER COORDINATION OF CARE. NORTH MEMORIAL CURRENTLY HAS EMERGENCY MEDICINE, A CONSULT SERVICE FOR THE MEDICAL UNITS, AN INPATIENT PSYCHIATRIC UNIT, TWO TRACKS OF PARTIAL HOSPITALIZATION, ONE INTENSIVE OUTPATIENT PROGRAM, A MENTAL HEALTH CLINIC AND FIVE PSYCHIATRIC PROVIDERS IN SEVEN OF IT 15 PRIMARY CLINICS. THE CUSTOMER BASE RANGES IN AGES OF 18 TO 90, COMES FROM VARIED ETHNIC BACKGROUNDS WITH A VARIETY OF INSURERS INCLUDING THIRD PARTY PAYERS, MEDICARE AND MEDICAID. MOST OF OUR CUSTOMERS HAVE DIAGNOSES OF PSYCHOSIS, PTSD, AND MOOD DISORDERS. PRIORITY 3: HEALTHY AGING/SENIOR SERVICES GOAL - TO WORK TOGETHER WITH LOCAL GOVERNMENT, OTHER HEALTHCARE SYSTEMS, SOCIAL SERVICE PROVIDERS AND COMMUNITY MEMBERS TO CREATE AN ENVIRONMENT WHERE OUR AGING POPULATION CAN HAVE ACCESS TO THE PROGRAMS AND SERVICES NEEDED TO AGE IN PLACE. OBJECTIVES: I. ADDRESS COMMUNITY-BASED INFRASTRUCTURAL CHALLENGES THAT CREATE BARRIERS TO HEALTHY AGING IN MAPLE GROVE STRATEGIES: -CONTINUE WORKING WITH THE CITY OF MAPLE GROVE'S AGE-FRIENDLY MAPLE GROVE INITIATIVE II. IMPROVE EDUCATION ABOUT ADVANCE CARE PLANNING STRATEGIES: -OFFER A MINIMAL OF FOUR EVIDENCE BASED RESPECTING CHOICES PRESENTATION IN THE MAPLE GROVE COMMUNITY ASSESSMENT AREA -EXPLORE OFFERING A RESPECTING CHOICES TRAIN THE PRESENTER SESSION TO COMMUNITY PARTNERS THAT WOULD OFFER THE RESPECTING CHOICES CLASS TO THE WIDER COMMUNITY III. EXPLORE IMPLEMENTING A COMMUNITY BASED FALLS PREVENTION EDUCATION PROGRAM STRATEGIES: -LOOK INTO IMPLEMENTING THE STEPPING ON AND/OR MATTER OF BALANCE PROGRAMS IV. COMMIT MAPLE GROVE HOSPITAL SUPPORT AND RESOURCES TO WORK WITH COMMUNITY PARTNERS TO COLLECTIVELY IDENTIFY OPPORTUNITIES TO ADDRESS ISSUES AND CONDITIONS THAT AFFECT HEALTH AGING STRATEGIES: -OFFER FINANCIAL SUPPORT FOR THE CITY OF MAPLE GROVE'S AGE-FRIENDLY MAPLE GROVE INITIATIVE V. WORK WITH COMMUNITY PARTNERS TO REDUCE CONDITIONS THAT NEGATIVELY AFFECT THE MENTAL HEALTH OF SENIORS SUCH AS SOCIAL ISOLATION STRATEGIES: -CONTINUE WORKING WITH HENNEPIN COUNTY CHIP SOCIAL ISOLATION COMMITTEE -EXPLORE POTENTIAL PARTNERSHIPS WITH SOCIAL SERVICE GROUPS THAT ADDRESS SOCIAL ISOLATION PARTNERSHIPS THAT WILL BE USED TO ADDRESS HEALTHY AGING GOALS INCLUDE: AGE-FRIENDLY MAPLE GROVE IS DRIVEN BY THE COMMUNITY AND HOUSED IN THE CITY OF MAPLE GROVE. IT IS LED BY A GROWING COMMITTEE OF COMMUNITY VOLUNTEERS AND REPRESENTATIVES FROM HOSPITALS, SENIOR HOUSING FACILITIES, FAITH COMMUNITIES, SENIOR SERVICE PROVIDERS AND OTHERS. THE COMMITTEE USES THE WORLD HEALTH ORGANIZATION/AARP AGE-FRIENDLY FRAMEWORK TO GUIDE ITS WORK. AGE-FRIENDLY MAPLE GROVE JOINED THE AARP NETWORK OF AGE-FRIENDLY COMMUNITIES IN 2016. IT RECENTLY COMPLETED A COMMUNITY ASSESSMENT OF OLDER ADULT NEEDS, USING A FIVE-PART STRATEGY TO GATHER INPUT DIRECTLY FROM OLDER ADULTS AS WELL AS FROM COMMUNITY PARTNERS SUCH AS HEALTHCARE, THE POLICE AND FIRE DEPARTMENTS, COMMUNITY PARAMEDICS, AND SENIOR SERVICE PROVIDERS. NEXT STEP IS THE DEVELOPMENT OF AN ACTION PLAN. THIS EXCITING AND IMPORTANT INITIATIVE HAS BEEN STEADILY BUILDING MOMENTUM. FROM AN ENGAGED CITIZEN'S INITIAL CONVERSATIONS WITH THE CITY A FEW YEARS AGO TO AN INITIATIVE SUPPORTED BY THE CITY OF MAPLE GROVE. THIS INITIATIVE IS RESPONDING TO RAPID POPULATION AGING AND WORKING TO BECOME A GOOD PLACE FOR ALL RESIDENTS TO "GROW UP AND GROW OLD." RESPECTING CHOICES IS AN INTERNATIONALLY RECOGNIZED, EVIDENCE-BASED MODEL OF ADVANCE CARE PLANNING THAT CREATES A HEALTHCARE CULTURE OF PERSON-CENTERED CARE; CARE THAT HONORS AN INDIVIDUAL'S GOALS AND VALUES FOR CURRENT AND FUTURE HEALTHCARE. RESPECTING CHOICES COORDINATED, SYSTEMATIC APPROACH TO ADVANCE CARE PLANNING HAS BEEN SUCCESSFULLY REPLICATED IN DIVERSE COMMUNITIES AND CULTURES WORLDWIDE. THEIR MISSION IS GUIDE ORGANIZATIONS AND COMMUNITIES WORLDWIDE TO EFFECTIVELY IMPLEMENT AND SUSTAIN EVIDENCE-BASED SYSTEMS THAT PROVIDE PERSON-CENTERED CARE. STEP ON IS A SEVEN WEEK PROGRAM DESIGNED FOR PEOPLE WHO ARE LIVING AT HOME AND HAVE EXPERIENCED A FALL OR ARE CONCERNED ABOUT FALLING. THE STEPPING ON PROGRAM IS THOROUGHLY RESEARCHED AND IS PROVEN TO PREVENT FALLS. STEPPING ON INCORPORATES A PRACTICAL SET OF EXERCISES THAT WERE SPECIFICALLY DESIGNED TO IMPROVE STRENGTH AND BALANCE AND DELIVERS EXPERT PRESENTATIONS ON A VARIETY OF RELEVANT FALLS RELATED TOPICS INCLUDING VISION, HOME HAZARDS, MEDICINES, BONE HEALTH AND FOOTWEAR. MATTER OF BALANCE IS AN EIGHT SESSION AWARD-WINNING PROGRAM DESIGNED FOR OLDER ADULTS, 60 OR OLDER, WHO ARE CONCERNED ABOUT FALLS OR HAVE HAD A FALL IN THE PAST. THE MATTER OF BALANCE PROGRAM HAS A PROVEN TRACK RECORD OF DECREASING FEAR OF FALLS, DECREASING FALLS, INCREASED UNDERSTANDING OF FALLS CONTROL AND INCREASE IN EXERCISE LEVEL. MATTER OF BALANCE IS OFFERED THROUGH THE METROPOLITAN AREA AGENCY ON AGING. THE HEALTH PRIORITIES NOT BEING ADDRESSED DIRECTLY INCLUDE: -CANCER PREVENTION, SCREENING, HEALTHY SURVIVORS -NUTRITION/HEALTHY LIFESTYLES -INJURY PREVENTION ACROSS THE LIFESPAN -UNDERSTANDING OF IMMIGRANT CULTURES AND ISSUES RELATED TO HEALTH/DISPARITIES -YOUTH ENGAGEMENT EDUCATION ABOUT HEALTHCARE CAREERS, LEADERSHIP DEVELOPMENT -TRANSPORTATION/HEALTHCARE ACCESS THE COMMUNITY HEALTH STEERING COMMITTEE FELT THAT TO REALLY MAKE AN IMPACT IN THE TOP THREE IDENTIFIED HEALTH PRIORITIES RESOURCES SHOULD BE FOCUSED ON THESE PRIORITIES AND NOT SPREAD ACROSS A MULTITUDE OF PRIORITIES. CANCER PREVENTION, SCREENING AND HEALTHY SURVIVORS IS BEING ADDRESSED IN THE AMERICAN CANCER SOCIETY AND THE CANCER CENTER AT NORTH MEMORIAL. NUTRITION AND HEALTHY LIFESTYLES IS BEING ADDRESSED BY MANY GROUPS SUCH AS THE AMERICAN CANCER SOCIETY, THE AMERICAN HEART ASSOCIATION, THE YMCA AND LOCAL PARK AND RECREATION ASSOCIATIONS. INJURY PREVENTION IS BEING ADDRESSED BY SAFE KIDS OUT OF NORTH MEMORIAL AND SENIOR INJURY PREVENTION IS BEING ADDRESSED THROUGH THE HEALTHY AGING/SENIOR SERVICES HEALTH PRIORITY. CULTURAL DIVERSITY IS BEING WOVEN INTO THE TOP THREE PRIORITIES. YOUTH HAVE ACCESS TO VOLUNTEER OPPORTUNITIES THROUGH MAPLE GROVE HOSPITAL'S VOLUNTEER DEPARTMENT. TRANSPORTATION IS BEING DISCUSSED AT THE COUNTY AND LOCAL LEVEL ALONG WITH THE HEALTHY AGING/SENIOR SERVICES PRIORITY. NORTH MEMORIAL HEALTH CARE 3300 Oakdale Avenue North Robbinsdale MN 55422 410729979 Acute Care MN 501(c)(3) Line 3 North Memorial 0 NORTH MEMORIAL FOUNDATION 3300 Oakdale Avenue North Robbinsdale MN 55422 411777966 FUNDRAISING MN 501(c)(3) Line 7 North Memorial 0 Associated Health Assurance 3300 Oakdale Avenue North Robbinsdale MN 55422 980343815 Insurance BD 501(c)(3) Line 12a, I North Memorial 0 NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE LLC 9855 HOSPITAL DRIVE MAPLE GROVE MN 55369 260393039 OUTPATIENT SURGERY MN N/A MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 352162215 RADIOLOGY MN N/A NORTH RADIATION THERAPY CENTER 6950 FRANCE AVE S SUITE 200 EDINA MN 55435 743069974 RADIOLOGY MN N/A BLAINE URGENCY CENTER LLC 480 OSBORNE RD NE FRIDLEY MN 55432 461630126 URGENT CARE MN N/A Plymouth City Center Medical Building 5700 Smetana Drive Suite 120 Minnetonka MN 55343 463883617 Medical Office Building MN N/A MInnetonka ambulatory surgery center 3300 oakdale ave north robbinsdale MN 55422 465653486 outPATIENT SURGERY MN N/A Crystal Imaging Center LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 454265124 RadIOLOGY MN N/A OAKDALE HEALTH ENTERPRISES INC 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411546422 AMBULANCE MN N/A C 0 NORTH COLLABORATIVE CARE 3300 Oakdale Avenue North Robbinsdale MN 55422 461680666 PRIMARY CARE MN N/A C 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 North Memorial Health Care (cash transfer) B 17325000 CASH North Memorial Health Care (Debt Guarantee) E 98138016 AMOUNT GUARANTEE North Memorial Health Care (Lease payments) K 458957 AMOUNT PAID North Memorial Health Care (Management fee) R 17221890 AMOUNT PAID North Memorial Health Care (Salary reimbursement) P 7933741 AMOUNT PAID