2017-05-05T08:13:51-05:00 2016-06-30 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2015-07-01 411813221 CENTRACARE HEALTH SYSTEM CENT 3202512700 1406 6TH AVENUE NORTH ST CLOUD MN 56303 GREGORY R KLUGHERZ VICE PRESIDENT/CFO 3202512700 2017-04-27 1 TODD A JACKSON P00092672 6123324300 2017-04-27 2015 2021-01-29 14:40:06Z KENNETH D HOLMEN MD 1406 6TH AVENUE NORTH ST CLOUD MN 56303 163854415 0 X WWW.CENTRACARE.COM X 1995 MN THE CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 13 10 2269 162 951179 0 177151 79633 176778976 163727195 -1028925 1869058 665361 -6482051 176592563 159193835 1049 0 0 0 109306522 91427299 0 0 40347 83219962 74660800 192527533 166088099 -15934970 -6894264 185298098 173191160 94146535 87735972 91151563 85455188 X THE MISSION OF CENTRACARE HEALTH SYSTEM (CCHS) IS TO OPERATE AN INTEGRATED MULTI-ORGANIZATIONAL HEALTH CARE SYSTEM DESIGNED TO PROVIDE ACCESS TO QUALITY HEALTH CARE SERVICES AT AN AFFORDABLE PRICE. 0 0 72120112 68317830 CENTRACARE HEALTH SYSTEM (CCHS) IS AN INTEGRATED HEALTH SYSTEM, COMPRISED OF FIVE CRITICAL ACCESS HOSPITALS, ONE ACUTE CARE HOSPITAL, A MULTI-SPECIALTY CLINIC, SURGICAL CENTER, RETAIL PHARMACY NETWORK, NURSING HOME AND A FOUNDATION. CCHS SERVES ITS PATIENTS IN 4 MAIN AREAS:MONTICELLO HOSPITAL IS CONSIDERED A DISREGARDED ENTITY FOR PURPOSES OF 990 REPORTING, THUS IT IS INCLUDED WITH THIS 990 FILING. MONTICELLO HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL AND ALSO OPERATES A 10 BED ACUTE REHAB UNIT. IN FISCAL YEAR 2016, THEY HAD 4,612 PATIENT DAYS, 33,400 OUTPATIENT VISITS AND 12,385 EMERGENCY ROOM VISITS' WHICH GENERATED $68,317,830 OF PROGRAM REVENUE AND $59,204,921 OF PROGRAM EXPENSES. 32688973 37347593 CENTRACARE HEALTH - PAYNESVILLE HOSPITAL IS CONSIDERED A DISREGARDED ENTITY FOR PURPOSES OF 990 REPORTING, THUS IT IS INCLUDED WITH THIS 990 FILING. CENTRACARE HEALTH - PAYNESVILLE HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL. IN FISCAL YEAR 2016 THEY HAD 2,585 PATIENT DAYS, 32,888 OUTPATIENT VISITS AND 3,524 EMERGENCY ROOM VISITS. IN FISCAL YEAR 2016, PAYNESVILLE GENERATED $37,347,593 OF PROGRAM REVENUE AND $32,688,973 OF PROGRAM EXPENSE. 24107012 37406262 CENTRACARE LABORATORY SERVICES ALL HOSPITALS UNDER ITS UMBRELLA AS WELL AS CENTRACARE CLINIC. IT ALSO PERFORMS TESTS FOR VARIOUS FACILITIES IN THE REGION. CENTRACARE LABORATORY PERFORMED 1.99 MILLION TESTS IN FISCAL YEAR 2016. IN FISCAL YEAR 2016 CENTRACARE LABORATORY GENERATED $37,406,262 IN PROGRAM REVENUE AND INCURRED $24,107,012 OF EXPENSES. 7497416 7700559 CENTRACARE SURGICAL CENTER PROVIDES ELECTIVE SURGERY PROCEDURES TO PATIENTS IN THE CENTRAL MN REGION. IN FY 2016, THE CENTER PERFORMED 3,519 SURGERIES AND GENERATED $7,700,559 OF PROGRAM REVENUE AND $7,497,416 OF PROGRAM EXPENSE. 7497416 7700559 136413513 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 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 1 1 1 1 0 0 1 253 0 1 2269 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 MN X GREGORY R KLUGHERZ 3202512700 1406 SIXTH AVENUE NORTH ST CLOUD MN 56303 KENNETH D HOLMEN MD PRESIDENT/CEO 21.00 19.00 X X 926091 0 202356 GENE WINDFELDT DIRECTOR, CHAIR 2.00 X X 4500 0 0 MIKE BENUSA DIRECTOR, VICE CHAIR 2.00 X X 2000 0 0 CHRISTIAN SCHMIDT MD DIRECTOR & SURGEON 1.00 39.00 X 0 524266 43906 CHRISTOPHER COBORN DIRECTOR 2.00 2.00 X 1500 0 0 DAVID AGERTER MD DIRECTOR 2.00 2.00 X 1000 0 0 DENISE ROSEN DIRECTOR 2.00 2.00 X 1000 0 0 STEVE LARAWAY DIRECTOR 2.00 X 1500 0 0 TERESA BOHNEN DIRECTOR 2.00 2.00 X 1000 0 0 MOHAMED YASSIN MD DIRECTOR 2.00 X 1500 0 0 MARY JO WILLIAMSON DIRECTOR 2.00 X 2500 0 0 JOSEPH UPHUS DIRECTOR 2.00 X 2000 0 0 ROBERT STOCKER MD DIRECTOR & OB/GYN 2.00 38.00 X 0 548379 19875 GREGORY R KLUGHERZ TREASURER/CFO 25.00 15.00 X 0 693473 137676 PAUL R HARRIS ESQ CORPORATE SECRETARY 25.00 15.00 X 489145 0 102612 JOSEPH D HELLIE VICE PRESIDENT 37.00 3.00 X 257654 0 61273 AMY M PORWOLL VICE PRESIDENT 20.00 20.00 X 217231 143676 77678 DUANE A RASUMUSSON VICE PRESIDENT 20.00 20.00 X 232138 162698 87633 NELSON L ADAMSON MD PHYSICIAN 40.00 X 0 567569 46668 LAWRENCE G STRATE MD PHYSICIAN 40.00 X 0 399437 43219 RANDALL J ZIMMERMAN MD PHYSICIAN 40.00 X 0 389424 45447 HEATHER K SWANSON MD PHYSICIAN 40.00 X 0 373421 45494 TIMOTHY L MALLING MD PHYSICIAN 40.00 X 0 349726 43672 TERENCE R PLADSON MD FORMER OFFICER/TRUSTEE (CEO, RETIRED 12/31/2014) 0.00 0.00 X 391780 0 4938 2532539 4152069 962447 87 1 1 0 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 PHYSICIAN SERVICES 9812562 MAYO MEDICAL LABORATORIES PO BOX 4100 ROCHESTER MN 559034100 LABORATORY SERVICES 3807015 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1406 6TH AVE NORTH ST CLOUD MN 56303 EMERGENCY COVERAGE 2643822 SENN DELANEY 7755 CENTER AVE SUITE 900 HUNTINGTON BEACH CA 92647 CULTURE TRANSFORMATION 2180363 METRO ANESTHESIA CONSULTANT 9855 AETNA AVE NE MONTICELLO MN 55362 ANESTHESIA SERVICES 2088142 30 59873 19760 79633 PATIENT & SERVICE REVENUE 900099 149040601 148089422 951179 SHARED/LEGAL SYSTEM REVENUE 900099 10364005 10364005 OTHER SERVICES PERFORMED 900099 2938773 2938773 403(B) PROGRAM 900099 677652 677652 OTHER REVENUE 900099 112722 112722 593442 593442 163727195 1896018 1896018 5709715 4548078 1161637 1161637 1161637 38897 65857 -26960 -26960 -26960 33256 46645 -13389 -13389 REVENUE FROM JOINT VENTURES 900099 399903 399903 ALL OTHER REVENUE 900099 45202 45202 LOSS ON DEBT REFINANCING 900099 -8075404 -8075404 -7630299 159193835 163221121 951179 -5058098 X 4966759 4966759 69061751 61997147 7037038 27566 3746511 3424258 319910 2343 9309639 8272266 1032785 4588 4342639 3779327 561429 1883 1765282 2217 1763065 226560 24891 201669 28923 2743 26174 6 223788 223788 25457760 19424298 6033462 495799 122307 373466 26 2725657 1923321 801588 748 2695121 362326 2332795 5615979 4513312 1102667 136119 66780 68122 1217 551498 244046 307406 46 1880958 1724185 156773 5089017 4016234 1072783 59832 59832 DRUGS/MEDICAL SUPPLIES 18430644 18330484 100160 BAD DEBT 2972661 2972661 MEDICAID SURCHARGE/MN C 2296589 2296589 4008613 2854289 1152400 1924 166088099 136413513 29634239 40347 17126130 14981246 20382978 17502640 1031106 1446655 2960793 3024467 1414651 7463200 199604581 111074901 84438634 88529680 26122345 21612051 31821461 18631221 185298098 173191160 38990118 36712668 44638396 40726314 6497227 6946003 4020794 3350987 94146535 87735972 X 91151563 85455188 91151563 85455188 185298098 173191160 X -6894264 -822514 2020403 X 0 1 X 1 0 X X 7 ST CLOUD HOSPITAL 410695596 3 1 27846059 0 CENTRACARE CLINIC 411806657 3 1 7847990 0 CENTRACARE HEALTH SYSTEM - MELROSE 411865315 3 1 1118327 0 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE 411924645 3 1 1090183 0 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 411708142 3 1 535085 0 CENTRACARE HEALTH FOUNDATION 411855173 3 1 76952 0 CENTRACARE HEALTH SYSTEM - SAUK CENTRE 452438973 3 1 1118660 0 7 39633256 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X 1 1 PART IV, SECTION E, LINE 3B CENTRACARE HEALTH SYSTEM, AS THE PARENT AND SOLE CORPORATE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS, HAS THE AUTHORITY TO APPROVE CERTAIN GOVERNANCE DECISIONS, AS OUTLINED IN EACH ORGANIZATION'S BYLAWS. FORM 990, SCHEDULE A, PART IV, SECTION E, LINE 3A CENTRACARE HEALTH SYSTEM, AS THE PARENT AND SOLE CORPORATE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS, HAS THE AUTHORITY TO APPOINT OR ELECT A MAJORITY OF THE SUPPORTED ORGANIZATION'S BOARD OF DIRECTORS, AS OUTLINED IN EACH ORGANIZATION'S BYLAWS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28923 28923 0 PART II-B, LINE 1: CCHS PAYS DUES TO SEVERAL ASSOCIATIONS AND GROUPS INCLUDING THE FOLLOWING: THE MINNESOTA HOSPITAL ASSOCIATION (MHA), AMERICAN MEDICAL GROUP (AMA), AND THE AMERICA HOSPITAL ASSOCIATION (AHA), A PORTION OF WHICH RELATES TO LOBBYING ACTIVITIES. FOR FY 2016, MHA HAS DETERMINED THAT 3.7% OR $6,430 OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. THE AMERICAN MEDICAL GROUP HAS DETERMINED THAT 22% OR $2,975 OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. THE AMERICAN HOSPITAL ASSOCIATION HAD DETERMINED 22.12% OR $9,430 OF ITS MEMBERSHIP DUES ARE RELATED TO LOBBYING. THE REMAINDING LOBBYING EXPENSE WAS INCURRED WITH SEVERAL OTHER ORGANIZATIONS. THE TOTAL LOBBYING EXPENSES FOR FY16 TOTALED $28,923. 9335911 9335911 133191359 66780124 66411235 55126691 44270923 10855768 1950620 23854 1926766 88529680 FUNDS HELD BY TRUSTEE UNDER BOND INDENTURES 3777478 C FUNDS HELD BY BOARD FOR FUTURE PROPERTY & EQUIP REPLACEMENT/EXPANSION 17834573 C 21612051 DEFERRED DEBT ACQUISITION COST 198751 OTHER ASSETS 13206928 DUE FROM 3RD PARTY PAYORS 5225542 18631221 PENSION ACCRUAL 319073 DUE TO AFFILIATES 2929928 OTHER LIABILITIES 101986 3350987 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 394028 0 394028 0.00370 20383538 16047287 4336251 0.04110 20777566 16047287 4730279 0.04480 265968 0 265968 0.00250 26065 0 26065 0.00020 292033 292033 0.00270 21069599 16047287 5022312 0.04750 1 2392636 29821054 29859092 -38038 X 1 1 2 1 CENTRACARE HEALTH - MONTICELLO 1013 HART BLVD MONTICELLO MN 55362 X X X X DISTINCT PART REHAB 2 CENTRACARE HEALTH - PAYNESVILLE 200 WEST FIRST STREET PAYNESVILLE MN 56362 X X X X CENTRACARE HEALTH - MONTICELLO 1 0 0 1 X X X X X X X X 15 1 1 0 1 X WWW.CENTRACARE.COM X X 1 15 1 WWW.CENTRACARE.COM 0 0 1 X 175.000000000000 250.000000000000 X X 1 1 X X X X 1 X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X X X X X X 1 X X 1 X X X X X X X 1 X 0 0 CENTRACARE HEALTH - PAYNESVILLE 2 0 0 1 X X X X X X X X 15 1 1 0 1 X WWW.CENTRACARE.COM X X 1 15 1 WWW.CENTRACARE.COM 0 0 1 X 175.000000000000 250.000000000000 X X 1 1 X X X X 1 X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X WWW.CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X X X X X X 1 X X 1 X X X X X X X 0 X 0 0 CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 3J: CENTRACARE HEALTH SYSTEM'S (CCH) CHNA PRIMARY NEEDS WERE IDENTIFIED USING THE CENTER FOR DISEASE CONTROL'S COMMUNITY HEALTH STATUS INDICATORS (CHSI). THE PROCESS ALSO CONSIDERED SECONDARY DATA FROM THE DARTMOUTH ATLAS, ROBERT WOOD JOHNSON, MINNESOTA DEPARTMENT OF HEALTH, US CENSUS BUREAU, MINNESOTA HOSPITAL ASSOCIATION, AND PUBLIC HEALTH DEPARTMENTS FROM APPROPRIATE COUNTIES AND ADDITIONAL FEDERAL AND STATE ENTITIES. CCH DID NOT RECEIVE ANY INPUT OR COMMENTS FROM THE PUBLIC ON THE 2013 CHNA SURVEY. THE CHNA WAS INFORMED BY A COLLABORATIVE AND ONGOING COMMUNITY HEALTH SURVEY JOINTLY FUNDED AND MANAGED WITH A NUMBER OF AREA COUNTIES WHO WERE JOINTLY CONDUCTING COMMUNITY SURVEYS TO INFORM THEIR COMMUNITY HEALTH ASSESSMENTS IN SUPPORT OF DEVELOPMENT OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS.LACK OF CURRENT PUBLIC HEALTH DATA WAS A SIGNIFICANT INFORMATION GAP IN THE CHNA AS THE SURVEY COULD NOT BE COMPLETED IN TIME TO INCLUDE ITS DATA IN THE CCH CHNA. CCH HAS COMMITTED TO A CONTINUING EFFORT WITH PUBLIC HEALTH OFFICIALS TO JOINTLY DEVELOP PRIORITIES WITH THE COUNTIES AS A PART OF ITS ACTION PLANS. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 3J: CENTRACARE HEALTH SYSTEM'S (CCH) CHNA PRIMARY NEEDS WERE IDENTIFIED USING THE CENTER FOR DISEASE CONTROL'S COMMUNITY HEALTH STATUS INDICATORS (CHSI). THE PROCESS ALSO CONSIDERED SECONDARY DATA FROM THE DARTMOUTH ATLAS, ROBERT WOOD JOHNSON, MINNESOTA DEPARTMENT OF HEALTH, US CENSUS BUREAU, MINNESOTA HOSPITAL ASSOCIATION, AND PUBLIC HEALTH DEPARTMENTS FROM APPROPRIATE COUNTIES AND ADDITIONAL FEDERAL AND STATE ENTITIES. CCH DID NOT RECEIVE ANY INPUT OR COMMENTS FROM THE PUBLIC ON THE 2013 CHNA SURVEY. THE CHNA WAS INFORMED BY A COLLABORATIVE AND ONGOING COMMUNITY HEALTH SURVEY JOINTLY FUNDED AND MANAGED WITH A NUMBER OF AREA COUNTIES WHO WERE JOINTLY CONDUCTING COMMUNITY SURVEYS TO INFORM THEIR COMMUNITY HEALTH ASSESSMENTS IN SUPPORT OF DEVELOPMENT OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS.LACK OF CURRENT PUBLIC HEALTH DATA WAS A SIGNIFICANT INFORMATION GAP IN THE CHNA AS THE SURVEY COULD NOT BE COMPLETED IN TIME TO INCLUDE ITS DATA IN THE CCH CHNA. CCH HAS COMMITTED TO A CONTINUING EFFORT WITH PUBLIC HEALTH OFFICIALS TO JOINTLY DEVELOP PRIORITIES WITH THE COUNTIES AS A PART OF ITS ACTION PLANS. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 5: DATA WAS OBTAINED FROM LOCAL COUNTY PUBLIC HEALTH DEPARTMENTS, INCLUDING THEIR MOST RECENT HEALTH ASSESSMENTS AND COMMUNITY REPORTS. IN ADDITION, HEALTH-RELATED INFORMATION WAS COLLECTED FROM AREA NONPROFIT ORGANIZATIONS THAT REGULARLY CONDUCT ASSESSMENTS AND EVALUATIONS OF THE SERVICES THEY PROVIDE AND THEIR TARGETED DEMOGRAPHICS. USEFUL MATERIAL WAS GATHERED FROM THE LOCAL UNITED WAY, CATHOLIC CHARITIES, THE CENTRAL MINNESOTA COUNCIL ON AGING, AND THE TRI-COUNTY ACTION PROGRAM (TRI-CAP). THESE ORGANIZATIONS SUPPORT A BROAD RANGE OF CONSTITUENTS WITH DIVERSE HEALTH-RELATED NEEDS; THEY REPRESENT DEMOGRAPHICS THAT ARE STATISTICALLY MORE LIKELY TO ENCOUNTER HEALTH-RELATED BARRIERS. CCH ALSO CONDUCTED A SERIES OF FOCUS GROUPS THAT INFORMED ITS CHNA. SPECIFICALLY, THE FOCUS GROUPS REPRESENTED POPULATIONS OF COLOR, RECENT IMMIGRANT POPULATIONS, CULTURAL MINORITIES, THOSE WHO WERE AUDIBLY CHALLENGED AND OTHERS WHO WERE DEEMED TO BE UNDER-REPRESENTED OR UNDER-SERVED. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 5: DATA WAS OBTAINED FROM LOCAL COUNTY PUBLIC HEALTH DEPARTMENTS, INCLUDING THEIR MOST RECENT HEALTH ASSESSMENTS AND COMMUNITY REPORTS. IN ADDITION, HEALTH-RELATED INFORMATION WAS COLLECTED FROM AREA NONPROFIT ORGANIZATIONS THAT REGULARLY CONDUCT ASSESSMENTS AND EVALUATIONS OF THE SERVICES THEY PROVIDE AND THEIR TARGETED DEMOGRAPHICS. USEFUL MATERIAL WAS GATHERED FROM THE LOCAL UNITED WAY, CATHOLIC CHARITIES, THE CENTRAL MINNESOTA COUNCIL ON AGING, AND THE TRI-COUNTY ACTION PROGRAM (TRI-CAP). THESE ORGANIZATIONS SUPPORT A BROAD RANGE OF CONSTITUENTS WITH DIVERSE HEALTH-RELATED NEEDS; THEY REPRESENT DEMOGRAPHICS THAT ARE STATISTICALLY MORE LIKELY TO ENCOUNTER HEALTH-RELATED BARRIERS. CCH ALSO CONDUCTED A SERIES OF FOCUS GROUPS THAT INFORMED ITS CHNA. SPECIFICALLY, THE FOCUS GROUPS REPRESENTED POPULATIONS OF COLOR, RECENT IMMIGRANT POPULATIONS, CULTURAL MINORITIES, THOSE WHO WERE AUDIBLY CHALLENGED AND OTHERS WHO WERE DEEMED TO BE UNDER-REPRESENTED OR UNDER-SERVED. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 6A: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE BEGINNING OF ITS FISCAL 2016. THOSE FACILITIES INCLUDED ST. CLOUD HOSPITAL, CENTRACARE HEALTH - MELROSE, CENTRACARE HEALTH - LONG PRAIRIE, CENTRACARE HEALTH - SAUK CENTRE, CENTRACARE HEALTH - MONTICELLO AND CENTRACARE HEALTH - PAYNESVILLE. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 6A: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE BEGINNING OF ITS FISCAL 2016. THOSE FACILITIES INCLUDED ST. CLOUD HOSPITAL, CENTRACARE HEALTH - MELROSE, CENTRACARE HEALTH - LONG PRAIRIE, CENTRACARE HEALTH - SAUK CENTRE, CENTRACARE HEALTH - MONTICELLO AND CENTRACARE HEALTH - PAYNESVILLE. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 7D: IN ADDITION TO MAKING ITS CHNA AVAILABLE TO THE PUBLIC ON ITS WEB SITE AND AT ITS BUSINESS OFFICE, CCH HAS SHARED COPIES OF THE CHNA WITH COUNTY PUBLIC HEALTH OFFICIALS AND, INTERNALLY, WITH INDIVIDUALS WORKING ON QUALITY IMPROVEMENT AND COMMUNITY HEALTH INITIATIVES.CCH HAS ALSO PUBLISHED CONTACT INFORMATION FOR ITS DIRECTOR OF COMMUNITY & GOVERNMENT RELATIONS TO RESPOND TO QUESTIONS OR CONCERNS ABOUT THE CHNA. THE DIRECTOR HAS ALSO PRESENTED RESULTS OF THE CHNA TO COMMUNITY GROUPS AND TO REPRESENTATIVES OF LOCAL FUNDING GROUPS. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 7D: IN ADDITION TO MAKING ITS CHNA AVAILABLE TO THE PUBLIC ON ITS WEB SITE AND AT ITS BUSINESS OFFICE, CCH HAS SHARED COPIES OF THE CHNA WITH COUNTY PUBLIC HEALTH OFFICIALS AND, INTERNALLY, WITH INDIVIDUALS WORKING ON QUALITY IMPROVEMENT AND COMMUNITY HEALTH INITIATIVES.CCH HAS ALSO PUBLISHED CONTACT INFORMATION FOR ITS DIRECTOR OF COMMUNITY & GOVERNMENT RELATIONS TO RESPOND TO QUESTIONS OR CONCERNS ABOUT THE CHNA. THE DIRECTOR HAS ALSO PRESENTED RESULTS OF THE CHNA TO COMMUNITY GROUPS AND TO REPRESENTATIVES OF LOCAL FUNDING GROUPS. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 2: EFFECTIVE OCTOBER 1, 2013, CENTRACARE AND PAYNESVILLE AREA HEALTH CARE SYSTEM EXECUTED A LEASE AND AFFILIATION AGREEMENT AND FORMED CENTRACARE HEALTH - PAYNESVILLE, LLC (DBA CCH - PAYNESVILLE), A MINNESOTA LIMITED LIABILITY COMPANY WITH CENTRACARE AS ITS SOLE MEMBER. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 11: THE NEEDS IDENTIFIED BY THE CHNA ARE CURRENTLY IN ORGANIZATIONAL WORK PLANS AND ARE UNDER IMPLEMENTATION. TO PRIORITIZE IDENTIFIED NEEDS, CHNA ADVISORY TASK FORCE MEMBERS DEVISED A SET OF CRITERIA. THE CRITERIA USED WERE: COMMUNITY IMPACT, POTENTIAL FOR CHANGE, ECONOMIC FEASIBILITY, COMMUNITY ASSETS, AND VALUE AND MISSION. THE PRIORITIZATION PROCESS IDENTIFIED PROCESS IDENTIFIED THE FOLLOWING SIX, BROAD COMMUNITY HEALTH ISSUES: 1 - ADULT OBESITY2 - ADULT DIABETES3 - OLDER ADULT PREVENTABLE HOSPITALIZATIONS4 - STROKE DEATHS5 - CORONARY HEART DISEASE DEATHS6 - CANCER DEATHSCENTRACARE HEALTH WILL MAINTAIN ITS ENGAGEMENTS WITH THE CHNA ADVISORY TASK FORCE TO ENSURE EFFECTIVE COLLABORATION AND COMMUNICATION WITH THE OTHER CENTRACARE HOSPITALS. THE CHNA ADVISORY TASK FORCE WILL CONTINUE TO MEET DURING THE THREE-YEAR PERIOD IN WHICH THE IMPLEMENTATION STRATEGY WILL UNFOLD. DURING THIS TIME THE GROUP WILL:- IDENTIFY WHAT OTHER COMMUNITY ORGANIZATION ARE DOING IN REGARD TO HEALTH PRIORITY AREAS;- DEVELOP SPECIFIC GOALS AND METRICS TO MONITOR AND MEASURE PROGRESS AND OUTCOMES;- COMMUNICATE SHORT-TERM AND LONG-TERM RESULTS OF ACTION PLANS WITHIN THE COMMUNITY.BASED ON THE FINDINGS AND PRIORITIES ESTABLISHED BY THE CHNA, AND AFTER HAVING REVIEWED THE COMMUNITY BENEFITS ACTIVITIES THAT CURRENTLY EXIST, ST. CLOUD HOSPITAL WILL CONTINUE TO SUPPORT THE SYSTEM-WIDE INITIATIVES OUTLINED BELOW AND WILL PARTICIPATE IN LOCALIZED ADAPTIONS (AS DESCRIBED IN THE ACTION STEPS) OF THESE PROGRAMS WITH REGARD TO THE SPECIFIC NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. TO SEE THE SPECIFIC ACTION PLAN FOR EACH OF THE SIX PRIORITY HEALTH AREAS SEE THE FULL IMPLEMENTATION STRATEGY FOR FISCAL YEAR 2016 - 2018 LOCATED ON THE WEBSITE AT HTTP://WWW.CENTRACARE.COM/APP/FILES/PUBLIC/5221/COMMUNITY-HEALTH-NEEDS-ASSESSMENT---CENTRACARE-HEALTH-SYSTEM.PDF.PER GUIDANCE FROM THE IRS, REGULATION 1.501(R)-3(C), THE CHNA FOR CCH ELECTED NOT TO DIRECTLY ADDRESS SEVERAL DETERMINANTS OF HEALTH THAT IT IDENTIFIED IN ITS PROCESS WHICH WERE NOT WITHIN THE ORGANIZATION'S CAPABILITIES OR CORE COMPETENCIES. EXAMPLES OF ISSUES NOT SPECIFICALLY ADDRESSED IN THE CHNA ACTION PLANS INCLUDE HIGH SCHOOL GRADUATION RATES, AFFORDABLE HOUSING OR SUPPORTED HOUSING. (CCH DID SUPPORT AN EFFORT OF THE CITY OF ST. CLOUD TO CONDUCT A HOUSING ASSESSMENT AS A RESULT OF THE CHNA PROCESS AND IS ALREADY THE LARGEST AREA PROVIDER OF SUPPORTED HOUSING DUE TO ITS EXTENSIVE CHEMICAL DEPENDENCY PROGRAMS AND SENIOR HOUSING PROGRAMS.) CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 11: THE NEEDS IDENTIFIED BY THE CHNA ARE CURRENTLY IN ORGANIZATIONAL WORK PLANS AND ARE UNDER IMPLEMENTATION. TO PRIORITIZE IDENTIFIED NEEDS, CHNA ADVISORY TASK FORCE MEMBERS DEVISED A SET OF CRITERIA. THE CRITERIA USED WERE: COMMUNITY IMPACT, POTENTIAL FOR CHANGE, ECONOMIC FEASIBILITY, COMMUNITY ASSETS, AND VALUE AND MISSION. THE PRIORITIZATION PROCESS IDENTIFIED PROCESS IDENTIFIED THE FOLLOWING SIX, BROAD COMMUNITY HEALTH ISSUES: 1 - ADULT OBESITY2 - ADULT DIABETES3 - OLDER ADULT PREVENTABLE HOSPITALIZATIONS4 - STROKE DEATHS5 - CORONARY HEART DISEASE DEATHS6 - CANCER DEATHSCENTRACARE HEALTH WILL MAINTAIN ITS ENGAGEMENTS WITH THE CHNA ADVISORY TASK FORCE TO ENSURE EFFECTIVE COLLABORATION AND COMMUNICATION WITH THE OTHER CENTRACARE HOSPITALS. THE CHNA ADVISORY TASK FORCE WILL CONTINUE TO MEET DURING THE THREE-YEAR PERIOD IN WHICH THE IMPLEMENTATION STRATEGY WILL UNFOLD. DURING THIS TIME THE GROUP WILL:- IDENTIFY WHAT OTHER COMMUNITY ORGANIZATION ARE DOING IN REGARD TO HEALTH PRIORITY AREAS;- DEVELOP SPECIFIC GOALS AND METRICS TO MONITOR AND MEASURE PROGRESS AND OUTCOMES;- COMMUNICATE SHORT-TERM AND LONG-TERM RESULTS OF ACTION PLANS WITHIN THE COMMUNITY.BASED ON THE FINDINGS AND PRIORITIES ESTABLISHED BY THE CHNA, AND AFTER HAVING REVIEWED THE COMMUNITY BENEFITS ACTIVITIES THAT CURRENTLY EXIST, ST. CLOUD HOSPITAL WILL CONTINUE TO SUPPORT THE SYSTEM-WIDE INITIATIVES OUTLINED BELOW AND WILL PARTICIPATE IN LOCALIZED ADAPTIONS (AS DESCRIBED IN THE ACTION STEPS) OF THESE PROGRAMS WITH REGARD TO THE SPECIFIC NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. TO SEE THE SPECIFIC ACTION PLAN FOR EACH OF THE SIX PRIORITY HEALTH AREAS SEE THE FULL IMPLEMENTATION STRATEGY FOR FISCAL YEAR 2016 - 2018 LOCATED ON THE WEBSITE AT HTTP://WWW.CENTRACARE.COM/APP/FILES/PUBLIC/5221/COMMUNITY-HEALTH-NEEDS-ASSESSMENT---CENTRACARE-HEALTH-SYSTEM.PDF.PER GUIDANCE FROM THE IRS, REGULATION 1.501(R)-3(C), THE CHNA FOR CCH ELECTED NOT TO DIRECTLY ADDRESS SEVERAL DETERMINANTS OF HEALTH THAT IT IDENTIFIED IN ITS PROCESS WHICH WERE NOT WITHIN THE ORGANIZATION'S CAPABILITIES OR CORE COMPETENCIES. EXAMPLES OF ISSUES NOT SPECIFICALLY ADDRESSED IN THE CHNA ACTION PLANS INCLUDE HIGH SCHOOL GRADUATION RATES, AFFORDABLE HOUSING OR SUPPORTED HOUSING. (CCH DID SUPPORT AN EFFORT OF THE CITY OF ST. CLOUD TO CONDUCT A HOUSING ASSESSMENT AS A RESULT OF THE CHNA PROCESS AND IS ALREADY THE LARGEST AREA PROVIDER OF SUPPORTED HOUSING DUE TO ITS EXTENSIVE CHEMICAL DEPENDENCY PROGRAMS AND SENIOR HOUSING PROGRAMS.) CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 13H: PER AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL, THE ORGANIZATION PROVIDES A DISCOUNT TO THE UNINSURED EQUAL TO THE AVERAGE DISCOUNT OF OUR LARGEST (BY VOLUME) NON-GOVERNMENTAL PAYOR.THE HOSPITALS OF CENTRACARE HEALTH ALSO OFFER A DISCOUNT TO UNINSURED PATIENTS. THERE IS A SEPARATE UNINSURED DISCOUNT POLICY. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 13H: PER AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL, THE ORGANIZATION PROVIDES A DISCOUNT TO THE UNINSURED EQUAL TO THE AVERAGE DISCOUNT OF OUR LARGEST (BY VOLUME) NON-GOVERNMENTAL PAYOR.THE HOSPITALS OF CENTRACARE HEALTH ALSO OFFER A DISCOUNT TO UNINSURED PATIENTS. THERE IS A SEPARATE UNINSURED DISCOUNT POLICY. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 16I: PATIENTS WHO ARE AT A SELF PAY STATUS RECEIVE CHARITY CARE INFORMATION EITHER VIA A TELEPHONE CALL OR A LETTER. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 16I: PATIENTS WHO ARE AT A SELF PAY STATUS RECEIVE CHARITY CARE INFORMATION EITHER VIA A TELEPHONE CALL OR A LETTER. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 18D: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE LAWSUITS AND LIENS ON RESIDENCES AS WELL. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 18D: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE LAWSUITS AND LIENS ON RESIDENCES AS WELL. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 19D: THE ORGANIZATION CONTRACTS WITH SEVERAL COLLECTION AGENCIES TO ATTEMPT TO COLLECT PATIENT BALANCES. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 19D: THE ORGANIZATION CONTRACTS WITH SEVERAL COLLECTION AGENCIES TO ATTEMPT TO COLLECT PATIENT BALANCES. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY CARE INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST A PATIENT. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY CARE INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST A PATIENT. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 22D: FOR ALL HOSPITALS OF CENTRACARE WITH FINANCIAL ASSISTANCE, ELIGIBLE INDIVIDUALS WILL NOT BE CHARGED MORE FOR EMERGENT AND MEDICALLY NECESSARY CARE, USING THE LOOK BACK METHOD OF (AVERAGE GENERALLY BILLED) AGB AS DESCRIBED IN THE 501(R) REGULATIONS, THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WITH INSURANCE COVERING EMERGENCY AND MEDICALLY NECESSARY CARE. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 22D: FOR ALL HOSPITALS OF CENTRACARE WITH FINANCIAL ASSISTANCE, ELIGIBLE INDIVIDUALS WILL NOT BE CHARGED MORE FOR EMERGENT AND MEDICALLY NECESSARY CARE, USING THE LOOK BACK METHOD OF (AVERAGE GENERALLY BILLED) AGB AS DESCRIBED IN THE 501(R) REGULATIONS, THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WITH INSURANCE COVERING EMERGENCY AND MEDICALLY NECESSARY CARE. 8 1 - MONTICELLO CARE CENTER 1104 EAST RIVER STREET MONTICELLO MN 55362 SKILLED NURSING FACILITY 2 - MONTICELLO CLINIC 1001 HART BLVD STE 100 MONTICELLO MN 55362 CLINIC 3 - KORONIS MANOR CARE CENTER 200 WEST FIRST STREET PAYNESVILLE MN 56362 SKILLED NURSING FACILITY 4 - CCH PAYNESVILLE- BELGRADE CLINIC 505 NELSON AVENUE BELGRADE MN 56312 CLINIC 5 - CCH PAYNESVILLE - COLD SPRING CLINIC 308 FIFTH AVENUE SOUTH COLD SPRING MN 56320 CLINIC 6 - CCH PAYNESVILLE - EDEN VALLEY CLINIC 405 MEEKER AVENUE EDEN VALLEY MN 56362 CLINIC 7 - CCH PAYNESVILLE - PAYNESVILLE CLINIC 200 WEST FIRST STREET PAYNESVILLE MN 56362 CLINIC 8 - CCH PAYNESVILLE - RICHMOND CLINIC 130 FIRST STREET NE RICHMOND MN 56368 CLINIC PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE HOSPITALS' TOTAL EXPENSES (NET OF BAD DEBT) WERE REDUCED BY OTHER OPERATING REVENUE (NET OF HER INCENTIVE REVENUE) AND ALSO BY MEDICAID SURCHARGE AND TAXES, AND THEN DIVIDED BY TOTAL PATIENT REVENUE TO DETERMINE COST TO CHARGE RATIO. PART III, LINE 2: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PART III, LINE 4: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THE HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CENTRACARE FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY CENTRACARE. PART III, LINE 8: THE SHORTFALL OF $38,038 IN TREATING MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT IN ITS ENTIRETY. THE HOSPITALS PROVIDES AN EXCELLENT LEVEL OF CARE TO THE PEOPLE IN THE COMMUNITY. DESPITE THE SHORTFALL IN REIMBURSEMENT FORM MEDICARE, THE HOSPITALS CONTINUES TO PROVIDE ESSENTIAL HEALTHCARE SERVICES TO THE POPULATION. THE AMOUNT ON LINE 7 OF PART III WAS DETERMINED BY UTILIZING THE MEDICARE COST REPORT UTILIZING KEY SECTIONS OF THAT REPORT, PRIMARILY THE D SERIES AND E SERIES. PART III, LINE 9B: THE COLLECTION POLICIES AT THE HOSPITALS REQUIRE COLLECTION STAFF TO OFFER CHARITY TO PATIENTS WHO INDICATE THAT PAYMENT MAY BE AN ISSUE. IF A PATIENT DOES QUALIFY FOR FULL CHARITY, ALL OTHER COLLECTION EFFORTS MUST CEASE, IF A PATIENT QUALIFIES FOR PARTIAL CHARITY, COLLECTION EFFORTS WILL CONTINUE ON THE BALANCE OF THE ACCOUNT. THESE PROVISIONS APPLY TO BOTH HOSPITAL EMPLOYED COLLECTION STAFF AND COLLECTION AGENCY STAFF. NO PATIENTS, WHETHER THEY QUALIFY FOR CHARITY OR NOT, ARE REPORTED TO CREDIT RATING AGENCIES. PART VI, LINE 2: THE ORGANIZATIONS' STRATEGIC PLANNING ASSESSES THE NEEDS OF THE COMMUNITY AND PATIENTS THROUGH PATIENT SATISFACTION SURVEYS, COMMENT CARDS, COMMUNITY ASSESSMENTS AND A DIVERSE OPERATING COMMITTEE THAT REPRESENTS THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS AND RECOMMENDATIONS FOR HEALTH CARE SERVICES. PART VI, LINE 3: INPATIENTS WHO ARE SELF PAY ARE IDENTIFIED, AND A REPRESENTATIVE OF MONTICELLO'S OR PAYNESVILLE'S BILLING DEPARTMENT EXPLAINS THE CHARITY CARE POLICY TO PATIENTS. THEY ALSO EXPLAIN THE SELF PAY DISCOUNT AND SCREENS THE PATIENT FOR ELIGIBILITY FOR ANY STATE OR FEDERAL PROGRAMS. THEY ALSO ASSIST THE PATIENT WITH ANY PAPERWORK REQUIRED TO APPLY FOR SUCH PROGRAMS. OUTPATIENTS WHO ARE SELF PAY RECEIVE AN AUTOMATIC SELF PAY DISCOUNT. IF THE PATIENT DOES NOT REMIT PAYMENT, COLLECTION STAFF ATTEMPT TO REACH THE PATIENT BY PHONE. PATIENTS ARE TOLD ABOUT THE CHARITY PROGRAM. FOR BOTH INPATIENTS AND OUTPATIENTS, ALL STATEMENTS CONTAIN A LETTER REGARDING THE AVAILABILITY OF CHARITY CARE. ALSO ALL PRECOLLECTION LETTERS HAVE THIS SAME LANGUAGE INDICATING THE AVAILABILITY AND PROCESS OF OBTAINING CHARITY CARE. PART VI, LINE 4: CENTRACARE HEALTH - MONTICELLO IS LOCATED IN CENTRAL MINNESOTA IN WRIGHT COUNTY. THE ESTIMATED 2016 CENSUS SHOWS A POPULATION OF 18,964, WITH A PROJECTED 2021 GROWTH PERCENTAGE OF 4.3% TO 19,784 POPULATION LEVEL. THIS AREA OF THE STATE IS SHOWING A SIGNIFICANT INCREASE IN POPULATION AND IS EXPECTED TO CONTINUE INTO THE FUTURE. THE AGE DEMOGRAPHICS OF THE REGION ARE AS FOLLOWS: 0-24: 5.8%, 25-44: -5.0%, 45-64: 6.6%, 65+ 17.8%.THE ESTIMATED 2016 CENSUS DATA ETHNICITY BREAKDOWN FOR MONTICELLO, MN WAS AS FOLLOWS: CAUCASIAN: 92.1%, ASIAN: 1.0%, AFRICAN AMERICAN: 1.4%, MULTIPLE RACES 2.35%, OTHER: 3.15%.CENTRACARE HEALTH - PAYNESVILLE IS LOCATED IN CENTRAL MINNESOTA IN STEARNS COUNTY. THE ESTIMATED 2016 CENSUS SHOWS A POPULATION OF 6,061 AND IS PROJECTED TO DECREASE TO 6,024 BY 2021 WHICH REPRESENTS A .60% DECREASE. THIS AREA OF THE STATE IS SHOWING A SLIGHT DECREASE IN POPULATION AND IS EXPECTED TO CONTINUE INTO THE FUTURE. THE AGE DEMOGRAPHICS OF THE REGION ARE AS FOLLOWS: 0-24: -1.4%, 25-44: 4.1%, 45-64: -10.0%, 65+: 7.1%.THE ESTIMATED 2016 CENSUS DATA ETHNICITY BREAKDOWN FOR PAYNESVILLE, MN WAS AS FOLLOWS: CAUCASIAN: 97.5%, ASIAN: .4%, AND AFRICAN AMERICAN: .3%, MULTIPLE RACES: 1.0%, OTHER: .8% PART VI, LINE 5: THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY IN SEVERAL IMPORTANT WAYS. ONE OF THESE WAYS IS THROUGH THE COMMUNITY COLLABORATION COMMITTEE (CCC), A STANDING COMMITTEE OF THE CENTRACARE HEALTH FOUNDATION. THE CCC HAS A MEMBERSHIP OF OVER 30 PERSONS REPRESENTING HEALTHCARE AND COMMUNITY NEEDS ACROSS CENTRAL MINNESOTA. THE CCC MEETS MONTHLY TO DISCUSS WAYS TO ADDRESS TYPICAL HEALTH ISSUES THROUGH AWARENESS BUILDING, EDUCATION AND/OR AN INTERVENTION PROJECT. THERE ARE SEVERAL COMMUNITY HEALTH OUTREACH INITIATIVES THAT THE FOUNDATION IS INVOLVED WITH. THESE INITIATIVES INCLUDE: 1) BLEND CHILDHOOD OBESITY COALITION OF CENTRAL MINNESOTA (GOAL IS TO REDUCE THE INCIDENCE OF CHILDHOOD OBESITY BY 2016), 2) SMOKE FREE COMMUNITIES (CONTINUED EFFORTS TO CREATE CLEAN INDOOR AND OUTDOOR AIR FOR ALL), 3) TOBACCO CESSATION SERVICES CLINICS (COLLABORATION WITH CLINIC, 4) CENTRACARE CLINIC TEAM BASED CARE PILOT, 5) ST. CLOUD HOSPITAL - TRANSITION OF CARE PILOT (CREATE MORE SEAMLESS INTEGRATION FROM CARE SETTING TO CARE SETTING, AND 6) CLINIC - DIVERSITY AND CULTURAL COMPETENCY TRAINING. PART VI, LINE 6: THE ORGANIZATION IS PART OF CENTRACARE HEALTH SYSTEM (CCHS) WHICH PROVIDES A BROAD RANGE OF HEALTH CARE SERVICES TO THE PATIENTS OF CENTRAL MINNESOTA. CCHS IS DEDICATED TO IMPROVING THE HEALTH OF PEOPLE LIVING AND WORKING IN THE COMMUNITIES IT SERVES. TO ACCOMPLISH ITS GOALS IT WORKS ACTIVELY WITH ITS AFFILIATE HEALTH CARE ORGANIZATIONS. CCHS CONTINUES TO FOCUS ON PROVIDING THE BEST CARE POSSIBLE AND IN REINVESTING INTO THE COMMUNITY. CCHS ALSO PROMOTES WELLNESS BY SPONSORING PROGRAMS AND EVENTS IN LOCAL COMMUNITIES THAT FOCUS ON HEALTHY EATING AND EXERCISE, AND BY CONDUCTING SCREENINGS FOR CONDITIONS SUCH AS HIGH BLOOD PRESSURE. PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X X X X 0 1 0 0 0 1 1 0 0 KENNETH D HOLMEN MD PRESIDENT/CEO 779021 0 131040 0 16030 0 185139 0 22096 0 1133326 0 0 0 CHRISTIAN SCHMIDT MD DIRECTOR & SURGEON 0 449472 0 53987 0 20807 0 19875 0 24785 0 568926 0 0 ROBERT STOCKER MD DIRECTOR & OB/GYN 0 451994 0 94449 0 1936 0 19875 0 754 0 569008 0 0 GREGORY R KLUGHERZ TREASURER/CFO 0 459245 0 109050 0 125178 0 121417 0 20312 0 835202 0 99007 PAUL R HARRIS ESQ CORPORATE SECRETARY 341435 0 83490 0 64220 0 75984 0 35840 0 600969 0 42887 0 JOSEPH D HELLIE VICE PRESIDENT 207659 0 47840 0 2155 0 36794 0 26473 0 320921 0 0 0 AMY M PORWOLL VICE PRESIDENT 147880 143386 66846 0 2505 290 27924 25676 13368 20546 258523 189898 0 0 DUANE A RASUMUSSON VICE PRESIDENT 163881 123293 59325 0 8932 39405 40549 29834 10458 12035 283145 204567 0 39155 NELSON L ADAMSON MD PHYSICIAN 0 498830 0 60945 0 7794 0 20702 0 26720 0 614991 0 0 LAWRENCE G STRATE MD PHYSICIAN 0 355221 0 42209 0 2007 0 21102 0 22870 0 443409 0 0 RANDALL J ZIMMERMAN MD PHYSICIAN 0 339428 0 48466 0 1530 0 19781 0 26420 0 435625 0 0 HEATHER K SWANSON MD PHYSICIAN 0 324272 0 48015 0 1134 0 20827 0 25420 0 419668 0 0 TIMOTHY L MALLING MD PHYSICIAN 0 302548 0 45994 0 1184 0 20153 0 24273 0 394152 0 0 TERENCE R PLADSON MD FORMER OFFICER/TRUSTEE (CEO, RETIRED 103772 0 144822 0 143186 0 3242 0 2226 0 397248 0 10438 0 PART I, LINE 4B THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRRED NON-QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO THE FORM 990, THE AMOUNTS LISTED IN SECTION VII AND IN SCHEDULE J REFLECT THIS TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON THE FORM 990. ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: KENNETH D HOLMEN - PAID $0; ACCRUED $185,139 GREGORY R KLUGHERZ - PAID $99,007; ACCRUED $105,517 PAUL R HARRIS - PAID $42,887; ACCRUED $58,473 AMY M PORWOLL - PAID $0; ACCRUED $31,794 DUANE A RASMUSSEN - PAID $39,155; ACCRUED $48,443 JOSEPH D HELLIE - PAID $0; ACCRUED $18,419 TERENCE R PLADSON - PAID $10,438; ACCRUED $0 PART I, LINE 6 THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: STEWARDSHIP, THROUGH A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR SAINT CLOUD HOSPITAL AND/OR CENTRACARE HEALTH SYSTEM AS WELL THROUGH ACHIEVING METRICS FOR AN IDENTIFIED COST REDUCTION PROGRAM; QUALITY, THROUGH ACHIEVING SAINT CLOUD HOSPITAL AND SYSTEM QUALITY METRICS; PATIENT EXPERIENCE, THROUGH ACHIEVEMENT OF PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; AND PEOPLE/EMPLOYEES, THROUGH ACHIEVEMENT OF SPECIFIED EMPLOYMENT SATISFACTION GOALS AND HIRING AND/OR RETENTION GOALS. THE INCENTIVE COMPENSATION PAID OUT IS NOT A PORTION OR PERCENTAGE OF ACTUAL NET EARNINGS OF ANY CENTRACARE HEALTH SYSTEM AFFILIATE, HOWEVER NET EARNINGS GOALS ARE REQUIRED TO BE MET BEFORE THE INCENTIVE COMPENSATION IS PAID. A THE CITY OF ST CLOUD 416005515 78916VBB5 2009-08-10 201078369 HEALTH CARE REVENUE BONDS 2008D 1 0 0 B THE CITY OF ST CLOUD 416005515 78916VBX7 2010-02-03 187558690 HEALTH CARE REVENUE BONDS 2010AB 1 0 0 C THE CITY OF ST CLOUD 416005515 2011-12-28 10000000 HEALTH CARE REVENUE BONDS 2011A 0 0 0 D THE CITY OF ST CLOUD 416005515 2011-12-28 31445000 HEALTH CARE REVENUE BONDS 2011B 0 0 0 A 121425000 80000000 201078369 1954596 199123773 2013 1 0 1 1 B 47760000 76700000 187558690 2797296 2076662 182684732 2010 1 0 1 1 C 10000000 150000 9850000 2015 0 0 0 1 D 31445000 31445000 2012 1 0 1 1 A 0 1 0 1 1 0.00410 0.00410 0 0 1 B 0 1 0 1 1 0.02190 0.02190 0 0 1 C 0 0 0 1 1 0.01710 0.01710 0 0 1 D 0 0 0 0 0.00720 0.00720 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 05/12/2016 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2014 A THE CITY OF ST CLOUD 416005515 78916VCZ1 2014-11-19 48876925 HEALTH CARE REVENUE BONDS 2014B 0 0 0 B THE CITY OF ST CLOUD 416005515 2014-08-01 128310000 HEALTH CARE REVENUE BONDS 2014 0 0 0 C THE CITY OF ST CLOUD 416005515 78916VDR8 2016-05-12 216598436 HEALTH CARE REVENUE BONDS, SERIES 2016A 0 0 0 A 48876925 550981 48325944 2010 0 1 1 1 B 128310000 15000000 113310000 2016 1 0 1 1 C 216598436 178686745 1760260 1312900 51697867 0 1 0 1 A 0 1 0 1 1 0.02350 0.02350 0 0 1 B 0 1 0 0 0.00610 0.00610 0 0 1 C 0 1 0 1 1 0.00820 0.00820 0 0 0 A 0 1 0 0 0 0 0 0 1 B 0 0 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 FORM 990, PART VI, SECTION B, LINE 11 ANNUALLY AT THE BOARD'S APRIL MEETING, PRIOR TO FILING WITH THE IRS, THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW THE IRS FORM 990 WITH THE STAFF, TO ASK QUESTIONS AND SEEK CLARIFICATIONS, AND TO APPROVE THE FINAL DOCUMENT. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE TWICE A YEAR. ALL STAFF SIGN CONFLICTS OF INTEREST FORMS ON AN ANNUAL BASIS. THE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AS WELL AS THE CORPORATE COMPLIANCE GROUP (A COMPLIANCE COMMITTEE WHICH INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRES ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD. THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTERESTS RELATED TO BOARD AND STAFF AND TO ALERT AFFECTED PARTIES WHEN A CONFLICT ARISES. WHEN AN ACTUAL CONFLICT ARISES, THE AFFECTED PARTY IS ASKED TO RECUSE HIM/HER SELF FROM THE DECISION MAKING PROCESS. THE CORPORATE COMPLIANCE OFFICER ATTENDS BOARD MEETINGS AND SPECIFIED BOARD COMMITTEE MEETINGS WHERE CONFLICT ISSUES MAY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION AND BENEFITS OF THE PRESIDENT AND THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT REQUIRED BY LAW TO BE MADE AVAILABLE TO THE PUBLIC AND CENTRACARE HEALTH SYSTEM DOES NOT MAKE THEM AVAILABLE. FORM 990, PART IX, LINE 11G MISCELLANEOUS: PROGRAM SERVICE EXPENSES 12,144,947. MANAGEMENT AND GENERAL EXPENSES 4,641,740. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,786,687. CONTRACTED SERVICES/PURCH SVCS: PROGRAM SERVICE EXPENSES 7,279,351. MANAGEMENT AND GENERAL EXPENSES 1,391,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,671,073. FORM 990, PART XI, LINE 9: PENSION PLAN ADJUSTMENT -119,697. NET EQUITY TRANSFERS BTWN RELATED ORGS 1,746,048. NON-CONTROLLING INTEREST DISTRIBUTION -400,000. NON-CONTROLLING INTEREST NET INCOME 794,052. 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