2016-11-14T10:09:20-06:00 2015-12-31 135665207 KPMG LLP 4200 WELLS FARGO CENTER 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2015-01-01 363465840 PARK NICOLLET HEALTH SERVICES PARK 9529933108 6500 EXCELSIOR BOULEVARD ST LOUIS PARK MN 55426 CATHERINE LENAGH VP & CFO 9529933108 2016-11-14 1 ANN LAMOUREUX P00691316 6123055000 2015 2017-02-10 21:41:12Z CATHERINE LENAGH 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 93242718 0 X WWW.PARKNICOLLET.COM X 1986 MN TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY 17 0 9923 0 39035 20979 212 25000 94579879 93167342 7529 7736 22372 38380 94609992 93238458 43925 27550 0 0 14806324 12544873 0 0 0 77460383 79086929 92310632 91659352 2299360 1579106 158432454 143932712 156143957 140268693 2288497 3664019 X OUR MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. 0 0 14635308 14937851 PARK NICOLLET HEALTH SERVICES, IN ADDITION TO BEING A SUBSIDIARY OF HEALTHPARTNERS, IS THE PARENT IN A SYSTEM OF RELATED HEALTHCARE ORGANIZATIONS INCLUDING, PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET CLINIC, PARK NICOLLET HEALTH CARE PRODUCTS, PARK NICOLLET INSTITUTE, AND TRIA ORTHOPAEDIC CENTER. PARK NICOLLET HEALTH SERVICES IS EMPLOYING AND SOURCING SENIOR LEADERS TO ITS SUBSIDARIES. 65154118 27550 78258144 TRIA ORTHOPAEDIC CENTER IS A LIMITED LIABILITY COMPANY THAT IS FULLY OWNED BY PARK NICOLLET HEALTH SERVICES, A NONPROFIT INTEGRATED CARE DELIVERY SYSTEM. TRIA ORTHOPAEDIC CENTER IS A LEADER IN ORTHOPAEDIC TREATMENT, PROVIDING COMPREHENSIVE CARE FROM DIAGNOSIS, TO TREATMENT, TO REHABILITATION, EVEN SURGERY AT ONE CONVENIENT LOCATION IN BLOOMINGTON, MINNESOTA. TRIA ORTHOPAEDIC CENTER HAS OVER 40 HIGHLY-TRAINED ORTHOPAEDIC DOCTORS WITH A VARIETY OF SUB-SPECIALTIES SUCH AS SPORTS MEDICINE, ACUTE INJURY, SHOULDER, KNEE, SPINE, HAND AND WRIST, FOOT AND ANKLE, HIP AND FRACTURES. FOR IMMEDIATE ORTHOPAEDIC NEEDS, TRIA OFFERS WALK-IN CARE SEVEN DAYS A WEEK THROUGH THE ACUTE INJURY CLINIC, WITH NO APPOINTMENT NEEDED. TRIA'S SPORTS MEDICINE SPECIALISTS HAVE SERVED AS OFFICIAL TEAM PHYSICIANS FOR MINNESOTA'S PRO SPORTS TEAMS FOR OVER 25 YEARS. TRIA ORTHOPAEDIC CENTER'S MISSION IS TO PROVIDE OUR PATIENTS AND COMMUNITY WITH EXCEPTIONAL ORTHOPAEDIC CARE AND SERVICES SUPPORTED BY INNOVATIVE EDUCATION AND RESEARCH. OUR VISION IS TO BECOME THE NATIONAL LEADER IN PROVIDING MUSCULOSKELETAL CARE, DRIVING INNOVATION IN IMPROVING HEALTH CARE.CORE VALUESPATIENTS:OUR PATIENTS COME FIRSTPEOPLE:OUR PEOPLE ARE OUR GREATEST ASSETORTHOPAEDICS:ORTHOPAEDICS IS OUR FOCUSRESEARCH:RESEARCH IS FUNDAMENTAL TO IMPROVING PATIENT CAREEDUCATION:EDUCATION ENHANCES OUR PROFESSION AND PATIENT CAREGROWTH:SUSTAINABLE GROWTH CREATES VALUECOMMUNITY:WE WILL BE A GOOD NEIGHBOR IN OUR COMMUNITYCOMMUNITY SERVICES SUMMARYANNUALLY, TRIA TRAINS THREE SPORTS MEDICINE FELLOWS. APPROXIMATELY 100 MEDICAL SCHOOL STUDENTS, AND RESIDENTS ROTATE THROUGH TRIA EACH YEAR.TRIA CONTINUES TO LEAD THE WAY IN OUTCOMES MEASUREMENT. PATIENT COMPLETE EXTENSIVE PRE AND POST SURVEYS TO ASSESS FUNCTIONAL OUTCOMES ON EIGHT DIFFERENT PROCEDURE TYPES. SOME OF TRIA'S PATIENT REGISTRIES ARE NOW AMONGST THE MOST EXTENSIVE IN THE INDUSTRY. EVERY TUESDAY MORNING TRIA PROVIDES PROFESSIONAL EDUCATION SESSIONS FOR APPROXIMATELY 1000 ATTENDEES, INCLUDING OUR STAFF, FELLOWS, CLINICAL STAFF IN THE AREA, NUMEROUS STUDENTS, AND RESIDENTS TRIA'S ANNUAL ORTHOPAEDIC & SPORTS MEDICINE CONFERENCE DREW OVER 200 PROFESSIONALS.TRIA'S PHYSICIANS AND STAFF HAD 17 PUBLICATIONS, 29 PRSENTATIONS, AND 4 BOOK CHAPTERS. THEIR OUTCOMES PROGRAM ENROLLED 1,624 PATIENTS.THE TRIA INSTITUTE PROVIDES SEVERAL SESSIONS OF A "DAY IN THE LIFE OF AN ORTHOPAEDIC PROVIDER PROGRAM." THIS EDUCATIONAL PROGRAM IS FOR STUDENTS IN OUR COMMUNITY THAT WOULD LIKE TO LEARN MORE ABOUT THE HEALTHCARE PROFESSION, SPECIFICALLY ORTHOPAEDICS, AND INCLUDES THE SHADOWING OF TRIA CLINICIANS. THERE WERE 150 ATTENDEES IN THESE SESSIONS. OVER 150 FREE MINNESOTA STATE HIGH SCHOOL LEAGUE PRE-PARTICIPATION EXAMS WERE PROVIDED FOR AREA HIGH SCHOOL ATHLETES PRIOR TO THE FALL SEASON. IN ADDITION, TRIA GAVE FAMILIES THE OPTION TO ALSO HAVE A BASELINE IMPACT TEST AND A MOVEMENT SCREEN AT THE TIME OF THE EXAM. ADDITIONAL PRE-PARTICIPATION PHYSICALS WERE SUBSIDIZED FOR THE STUDENT ATHLETES AT DAKOTA COUNTY TECHNICAL COLLEGE AND HOCKEY PLAYERS FOR THE MINNESOTA MAGICIANS JUNIOR HOCKEY TEAM.TRIA PROVIDED MEDICAL COVERAGE FOR NUMEROUS MAJOR SPORTING EVENTS IN THE COMMUNITY IN THE PAST YEAR INCLUDING THE THE U.S. POND HOCKEY CHAMPIONSHIPS AT LAKE NOKOMIS IN JANUARY, THE NCHC AND WCHA COLLEGE HOCKEY TOURNAMENTS IN MARCH, THE PINKYSWEAR KID'S TRIATHLON AT LAKE NOKOMIS IN AUGUST, AND THE PINKYSWEAR MESS FEST IN SEPTEMBER. TRIA WAS ALSO THE OFFICIAL MEDICAL PROVIDER WITH ON-SITE MEDICAL CARE FOR EVENTS OF THE 2015 NATIONAL SENIOR GAMES. THIS EVENT WAS A 14 DAY EVENT INCLUDING 22 DIFFERENT SPORTS HELD AT OVER 22 VENUES ACROSS THE TWIN CITIES WITH OVER 10,000 SENIOR ATHLETES COMPETING. IN ADDITION, TRIA PROVIDED ON-SITE MEDICAL CARE AT NUMEROUS YOUTH SPORT TOURNAMENTS IN MULTIPLE SPORTS SUCH AS FOOTBALL, SOCCER, SOFTBALL, HOCKEY, JUDO, AND BASKETBALL THROUGHOUT THE YEAR.TRIA EMPLOYEES RAISE MONEY FOR THOSE IN NEED THROUGH THE JEANS FOR A CAUSE PROGRAM. EMPLOYEES WHO CONTRIBUTE $5 ARE ALLOWED TO WEAR JEANS ON FRIDAYS. THE WEARING OF JEANS FOR THE CAUSE BUTTONS SIGNIFIES THE FUND RAISING ASPECT OF THE PROGRAM TO PATIENTS. OVER $4500 WAS RAISED FOR COMMUNITY CHARITIES THROUGHOUT THE YEAR.TRIA TEAM MEMBERS PARTICIPATE IN VOLUNTEER ACTIVITIES INCLUDING PACKING FOOD FOR THE SECOND HARVEST HEARTLAND FOOD SHELF; BUILDING DRESSER AND PARTICIPATING IN MATTRESS RACING DOWN BUCK HILL; COLLECTING DONATIONS FOR FOOD DRIVES, HOLIDAY TOY DRIVES AND BACK TO SCHOOL DRIVES FOR V.E.A.P.; RUNNING IN THE JINGLE BELL RUN FOR THE ARTHRITIS FOUNDATION, AND LASTLY TRIA SUPPORTED V.E.A.P BY ATTENDING THE YEARLY GALA, A TOAST TO VEAP AND THEIR GOLF TOURNAMENT. TRIA PROVIDED FREE GRIP STRENGTH SCREENINGS, EDUCATION AROUND SPORTS MEDICINE AND ORTHOPAEDIC INJURIES, AND INTERACTIVE GAMES FOR THOUSANDS OF PEOPLE AT THE PREP 45 DAY EVENT AT THE MINNESOTA STATE FAIR.TRIA'S PHYSICIANS AND PROFESSIONAL STAFF, INCLUDING PHYSICAL THERAPISTS AND HAND THERAPISTS, FREQUENTLY SPEAK TO COMMUNITY GROUPS. THIS PAST YEAR 9 SUCH SESSIONS WERE PROVIDED. 79789426 1 1 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 126 0 1 9923 1 1 1 0 0 0 0 0 0 0 0 0 X 17 0 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 CA X CATHERINE LENAGH 9529933108 6500 EXCELSIOR BOULEVARD ST LOUIS PARK MN 55426 X PARK NICOLLET GROUP RETURN -SEE SCH DIRECTORS 30.00 X 0 5842981 1037317 PARK NICOLLET GROUP RETURN -SEE SCH OFFICERS 55.00 X 8041195 2221814 2103755 PARK NICOLLET GROUP RETURN -SEE SCH HIGHEST COMPENSATED EMPLOY 1.00 55.00 X 0 5092061 331606 PARK NICOLLET GROUP RETURN -SEE SCH FORMER 0.00 X 0 1441094 128130 8041195 14597950 3600808 21 1 1 0 0 25000 25000 PATIENT SERVICES 621400 78255165 78255165 SERVICES TO AFFILIATES EXEMPT ORG 561000 11340662 11340662 PREMIER PURCHASING 900099 3571515 3545841 25674 93167342 7736 7736 26300 4260 22040 22040 22040 MISCELLANEOUS SERVICES 541900 16340 2979 13361 16340 93238458 93144647 39035 29776 X 27550 27550 8041195 8041195 1732743 1732743 545825 545825 1529999 173472 1356527 695111 695111 19773 19773 55064708 45130866 9933842 825664 8234 817430 940637 664395 276242 216515 176960 39555 5327859 3796204 1531655 9459 4690 4769 7583 3832 3751 3459921 3221657 238264 771901 9978 761923 MEDICAL SUPPLIES AND EQ 8621980 8606226 15754 BAD DEBT 1975666 1975666 MN CARE TAX 1342907 1342907 IND EXP ALL - SHARED EX 0 14635308 -14635308 502356 11481 490875 91659352 79789426 11869926 0 2706582 3558861 108537720 91967869 9575066 10231754 510890 472939 697673 678100 65738376 40675430 26568595 25062946 7712231 9831354 2123697 2128889 158432454 143932712 97153446 95651006 58990511 44617687 156143957 140268693 X 2288497 3664019 2288497 3664019 158432454 143932712 X 1579106 -203584 X 0 1 X 1 0 X 212 25000 25212 90025611 94357206 93739106 94603823 93195995 465921741 90025611 94357206 93739106 94604035 93220995 465946953 0 0 0 465946953 32337 39587 59118 23734 34036 188812 32337 39587 59118 23734 34036 188812 90057948 94396793 93798224 94627769 93255031 466135765 0.99960 0.99690 0.00040 0.00310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 87743 87743 91659352 1460411365 91659352 1460499108 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 210630 51106 143687 87743 493166 250000 250000 250000 250000 1000000 1500000 PART II-B, LINE 1: PARK NICOLLET HEALTH SERVICES INCURS LOBBYING EXPENSES ON BEHALF OF PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET INSTITUTE, PARK NICOLLET HEALTH CARE PRODUCTS AND PARK NICOLLET CLINIC. OTHER EXEMPT EXPENSES RELATE TO THE MANAGEMENT EXPENSES INCURRED BY PARK NICOLLET HEALTH SERVICES ON BEHALF OF EACH ENTITY. 105211 32020 49500 87731 68853 36358 105211 76400 30953 38500 68853 52482 23918 76400 40627 11855 52482 1.00000 0 1 1 1917864 1917864 21134 21134 0 41630733 21104996 20525737 22168645 19549300 2619345 25062946 INVESTMENT IN TRI-CARE 4185980 C INVESTMENT IN PREMIER 5532146 C OTHER INVESTMENTS 113228 C 9831354 DUE TO AND FROM RELATED PARTIES 19612473 CONTINGENT MALPRACTICE LIABILITY 23097363 POST RETIREMENT OBLIGATION 1907851 44617687 X PART V, LINE 4: THE TERM ENDOWMENT FUNDS FOR USE WITHIN PARK NICOLLET HEALTH SERVICES ARE FOR THE CARING FOR COLLEAGUES PROGRAM. PART X, LINE 2: HPIC, HPSI, HPA, HPAI, HPCMC, PNE, AND DSI, (THE TAXABLE GROUP) ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE DIFFERENCES BETWEEN THE FINANCIAL AND INCOME TAX REPORTING BASIS OF ASSETS AND LIABILITIES BASED ON ENACTED TAX RATES AND LAWS. THE DEFERRED INCOME TAX PROVISION OR BENEFIT GENERALLY REFLECTS THE NET CHANGE IN DEFERRED INCOME TAX ASSETS AND LIABILITIES DURING THE YEAR. THE CURRENT INCOME TAX PROVISION REFLECTS THE TAX CONSEQUENCES OF REVENUES AND EXPENSES CURRENTLY TAXABLE OR DEDUCTIBLE ON VARIOUS INCOME TAX RETURNS FOR THE YEAR REPORTED. PARK NICOLLET HEALTH SERVICES' 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. TRIA ORTHOPAEDIC CENTER RESEARCH RECORDED NO LIABILITIES AT DECEMBER 31, 2015 OR 2014 FOR UNRECOGNIZED TAX BENEFITS. 1 REGIONS HOSPITAL FOUNDATION 640 JACKSON STREET ST PAUL MN 55101 411888902 501C3 10000 HOSPITAL PROGRAM SUPPORT 1 SCHEDULE I, PART IV OCCASIONALLY PARK NICOLLET HEALTH SERVICES GRANTS MONIES TO OTHER TAX-EXEMPT ORGANIZATIONS OR FOUNDATIONS CONDUCTING PROGRAMS AND/OR RESEARCH THAT WILL ULTIMATELY BENEFIT THOSE SERVED BY PARK NICOLLET HEALTH SERVICES AND AFFILIATES. MONEY GRANTED TO OTHER ORGANIZATIONS ARE MONITORED BY LEADERS OF PARK NICOLLET HEALTH SERVICES. X X X X X 1 1 0 0 0 0 0 1 0 PARK NICOLLET GROUP RETURN -SEE SCH DIRECTORS 0 4886430 0 636956 0 319595 0 651560 0 385757 0 6880298 0 86717 PARK NICOLLET GROUP RETURN -SEE SCH OFFICERS 6233262 1656340 1143985 405064 663948 160410 1084662 268496 595719 154878 9721576 2645188 400172 103603 PARK NICOLLET GROUP RETURN -SEE SCH HIGHEST COMPENSATED EMPLOY 0 4696277 0 148966 0 246818 0 124215 0 207391 0 5423667 0 0 PARK NICOLLET GROUP RETURN -SEE SCH FORMER 0 417931 0 220654 0 802509 0 48981 0 79149 0 1569224 0 116311 PART I, LINE 3 THE PARK NICOLLET HEALTH SERVICES' BOARD OF DIRECTORS IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER EXECUTIVES. PART I, LINES 4A-B DETAILED INFORMATION ON PARK NICOLLET HEALTH SERVICES COMPENSATION CAN BE FOUND ON THE PARK NICOLLET GROUP RETURN (EIN 45-5023260). SCHEDULE J PART I, LINE 4A THE AMOUNT OF SEVERANCE COMPENSATION AND BENEFITS PROVIDED TO EACH OF THE INDIVIDUALS ON SEVERANCE DURING 2015 IS AS FOLLOWS: SHEILA MCMILLAN $101,077 BRETT LONG $250,204 JULIE FLASCHENRIEM $334,821 SCHEDULE J, PART I, LINE 4B: SENIOR LEADERS OF PARK NICOLLET HEALTH SERVICES AND AFFILIATES ARE GIVEN THE OPPORTUNITY TO PARTICIPATE IN THE CAPITAL ACCUMULATION ACCOUNT PLAN. THE CAPITAL ACCUMULATION ACCOUNT PLAN (CAA PLAN) PARTICIPATION IS LIMITED TO SENIOR LEADERS AND ALL THE VICE PRESIDENTS. EACH PARTICIPANT RECEIVES AN ANNUAL ALLOWANCE EQUAL TO THE SUM OF (I) A STATED PERCENT OF SALARY, (II) VOLUNTARY SALARY DEFERRALS. THE ALLOWANCE IS CREDITED TO A BOOKKEEPING ACCOUNT. EARNINGS ARE CREDITED TO THE ACCOUNT BASED ON THE PERFORMANCE OF SIMULATED INVESTMENTS. BENEFITS VEST UPON THE EARLIEST OF REMAINING EMPLOYED TO AN ELECTIVE VESTING DATE (TWO YEARS TO AGE 68), INVOLUNTARY TERMINATION WITHOUT CAUSE, DISABILITY, DEATH, OR NOT COMPETING FOR 24 MONTHS FOLLOWING VOLUNTARY OR FOR-CAUSE TERMINATION. BENEFITS ARE PAID IN A SINGLE LUMP SUM UPON VESTING. PARTICIPANTS ARE GENERAL CREDITORS OF THE EMPLOYER FOR THE PAYMENT OF THE BENEFITS. THE FOLLOWING PARTICIPANTS RECEIVED PAYOUTS FROM A PARK NICOLLET HEALTH SERVICES, RELATED TO CAA PLAN: STEVEN CONNELLY, MD $ 59,768 JULIE FLASCHENRIEM $ 40,178 LAURA FRAZIER $ 27,724 ROXANNA GAPSTUR $ 36,785 DAVID HOMANS, MD $ 49,620 CATHERINE LENAGH $ 25,549 BRETT LONG $ 30,024 SHEILA MCMILLAN $ 12,129 JOHN MISA, MD $ 48,487 DUANE SPIEGLE $ 21,040 THEODORE WEGLEITNER $ 33,980 CATHERINE KLUGHERZ $ 19,353 KATHERINE TARVESTAD $ 32,668 CYNTHIA TOHER, MD $ 48,578 JOSHUA ZIMMERMAN MD $ 31,427 KRISTI LYON $ 16,628 JOAN SANDSTROM $ 32,165 OFFICERS AND DIRECTORS EMPLOYED BY HEALTHPARTNERS, INC HAVE DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II WHICH INCLUDE AMOUNTS FROM A NONQUALIFIED 457(F) PLAN, THE FOLLOWING PARTICIPANTS RECEIVED PAYOUTS: BABETTTE APLAND $ 9,615 BRIAN RANK, MD $ 33,761 NANCY MCCLURE $ 24,314 BARBARA TRETHEWAY $ 69,674 BETHAL AVERBECK $ 21,918 DAVID DZIUK $ 17,727 MEGAN REMARK $ 13,3114A THE AMOUNT OF SEVERANCE COMPENSATION AND BENEFITS PROVIDED TO EACH OF THE INDIVIDUALS ON SEVERANCE DURING 2015 IS AS FOLLOWS: SHEILA MCMILLAN $101,077 BRETT LONG $250,204 JULIE FLASCHENRIEM $334,821 SCHEDULE J, PART I, LINE 4B: SENIOR LEADERS OF PARK NICOLLET HEALTH SERVICES AND AFFILIATES ARE GIVEN THE OPPORTUNITY TO PARTICIPATE IN THE CAPITAL ACCUMULATION ACCOUNT PLAN. THE CAPITAL ACCUMULATION ACCOUNT PLAN (CAA PLAN) PARTICIPATION IS LIMITED TO SENIOR LEADERS AND ALL THE VICE PRESIDENTS. EACH PARTICIPANT RECEIVES AN ANNUAL ALLOWANCE EQUAL TO THE SUM OF (I) A STATED PERCENT OF SALARY, (II) VOLUNTARY SALARY DEFERRALS. THE ALLOWANCE IS CREDITED TO A BOOKKEEPING ACCOUNT. EARNINGS ARE CREDITED TO THE ACCOUNT BASED ON THE PERFORMANCE OF SIMULATED INVESTMENTS. BENEFITS VEST UPON THE EARLIEST OF REMAINING EMPLOYED TO AN ELECTIVE VESTING DATE (TWO YEARS TO AGE 68), INVOLUNTARY TERMINATION WITHOUT CAUSE, DISABILITY, DEATH, OR NOT COMPETING FOR 24 MONTHS FOLLOWING VOLUNTARY OR FOR-CAUSE TERMINATION. BENEFITS ARE PAID IN A SINGLE LUMP SUM UPON VESTING. PARTICIPANTS ARE GENERAL CREDITORS OF THE EMPLOYER FOR THE PAYMENT OF THE BENEFITS. THE FOLLOWING PARTICIPANTS RECEIVED PAYOUTS FROM A RELATED ORGANIZATION, PARK NICOLLET HEALTH SERVICES, RELATED TO CAA PLAN: STEVEN CONNELLY, MD $ 59,768 JULIE FLASCHENRIEM $ 40,178 LAURA FRAZIER $ 27,724 ROXANNA GAPSTUR $ 36,785 DAVID HOMANS, MD $ 49,620 CATHERINE LENAGH $ 25,549 BRETT LONG $ 30,024 SHEILA MCMILLAN $ 12,129 JOHN MISA, MD $ 48,487 DUANE SPIEGLE $ 21,040 THEODORE WEGLEITNER $ 33,980 CATHERINE KLUGHERZ $ 19,353 KATHERINE TARVESTAD $ 32,668 CYNTHIA TOHER, MD $ 48,578 JOSHUA ZIMMERMAN MD $ 31,427 KRISTI LYON $ 16,628 JOAN SANDSTROM $ 32,165 OFFICERS AND DIRECTORS EMPLOYED BY HEALTHPARTNERS, INC HAVE DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II WHICH INCLUDE AMOUNTS FROM A NONQUALIFIED 457(F) PLAN, THE FOLLOWING PARTICIPANTS RECEIVED PAYOUTS: BABETTTE APLAND $ 9,615 BRIAN RANK, MD $ 33,761 NANCY MCCLURE $ 24,314 BARBARA TRETHEWAY $ 69,674 BETHAL AVERBECK $ 21,918 DAVID DZIUK $ 17,727 MEGAN REMARK $ 13,311 PART I, LINE 7 SCHEDULE J, PART I, LINE 7: ALL PHYSICIANS, EMPLOYED BY AND SEEING PATIENTS FOR PARK NICOLLET HEALTH SERVICES AND AFFILIATES, ARE ELIGIBLE FOR A 3% ACCESS INCENTIVE PAYOUT BASED ON THEIR DEPARTMENT REACHING CERTAIN GOALS INCLUDING ACCESS FOR PATIENTS AND QUALITY INITIATIVES. IN THEIR ROLES AS EXECUTIVES EMPLOYED BY PARK NICOLLET HEALTH SERVICES, THE EXECUTIVES ARE ELIGIBLE FOR INCENTIVE PAYOUTS. THE INCENTIVE AWARD WILL BE 30% FOR THE CFO, COO, CMO AND 25% FOR ALL OTHER EXECUTIVES WITH AN OPPORTUNITY FOR INCENTIVE CREDIT ABOVE THE TARGET LEVEL. THE ULTIMATE PAYOUT INCLUDES A REDUCTION/INCREASE MULTIPLIER DEPENDING ON WHETHER THE CONSOLIDATED PARK NICOLLET HEALTH SERVICES ORGANIZATION REACHED THAT YEAR'S OPERATING MARGIN GOAL AS SET BY THE BOARD OF DIRECTORS. EACH PARTICIPANT WILL BE RESPONSIBLE FOR TWO FINANCIAL GOALS, AND NOT LESS THAN THREE AND NOT MORE THAN FIVE INDIVIDUAL STRATEGIC OBJECTIVES. IN THEIR ROLES AS MANAGEMENT EMPLOYED BY PARK NICOLLET HEALTH SERVICES, CERTAIN MANAGERS ARE ELIGIBLE FOR INCENTIVE PAYOUTS. THE INCENTIVE AWARD WILL BE 15% OF THEIR ANNUAL BASE PAY COMPENSATION WITH AN OPPORTUNITY FOR INCENTIVE CREDIT ABOVE THE TARGET LEVEL. THE ULTIMATE PAYOUT INCLUDES A REDUCTION/INCREASE MULTIPLIER DEPENDING ON WHETHER THE CONSOLIDATED PARK NICOLLET HEALTH SERVICES ORGANIZATION REACHED THAT YEAR'S OPERATING MARGIN GOAL AS SET BY THE BOARD OF DIRECTORS. INCENTIVE PAYMENTS ARE A FUNCTION OF BOTH INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. THE PARTICIPANT MUST BE ASSIGNED AT LEAST THREE, AND NOT MORE THAN FOUR FOCUSED INCENTIVE OBJECTIVE, ONE OF WHICH MUST BE FINANCIAL IN NATURE. FORM 990, PART VI, SECTION A, LINE 6 HEALTHPARTNERS, INC IS THE SOLE MEMBER OF PARK NICOLLET HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 7A THE PERSONS WHO SERVE AS THE BOARD OF DIRECTORS OF HEALTHPARTNERS, INC. ALSO SERVE AS THE BOARD OF DIRECTORS OF PNHS. HEALTHPARTNERS, INC. IS A MINNESOTA LICENSED HEALTH MAINTENANCE ORGANIZATION. THE BOARD OF HEALTHPARTNERS, INC. IS COMPRISED OF A MAJORITY OF DIRECTORS WHO ARE ELECTED BY HMO MEMBERS (PERSONS HOLDING HMO CONTRACTS), AND A MINORITY OF DIRECTORS WHO ARE EITHER HEALTH CARE PROFESSIONALS APPOINTED BY THE BOARD OR WHO ARE SERVING EX OFFICIO. FORM 990, PART VI, SECTION A, LINE 7B PNHS' BYLAWS ESTABLISH THAT THE PERSONS SERVING AS THE BOARD OF DIRECTORS OF THE SOLE MEMBER, ALSO SERVE AS THE BOARD OF DIRECTORS OF PNHS. IN THE EVENT THAT THE PNHS BOARD OF DIRECTORS WERE EVER COMPOSED OF PERSONS WHO ARE NOT ALSO CONTEMPORANEOUSLY SERVING AS THE DIRECTORS OF THE SOLE MEMBER, THEN THE SOLE MEMBER WOULD EXERCISE CUSTOMARY RESERVE POWERS WITH RESPECT TO THE PNHS BOARD OF DIRECTORS (E.G. APPROVAL OF BUDGETS, APPROVAL OF MERGER, APPROVAL OF APPOINTMENT OF THE CHIEF EXECUTIVE OFFICER, APPROVAL OF DISSOLUTION, ETC.). FORM 990, PART VI, SECTION B, LINE 11 PARK NICOLLET HEALTH SERVICES PREPARES THE FORM 990 WITHIN THE FINANCE DEPARTMENT WITH ASSISTANCE FROM INDIVIDUALS IN HUMAN RESOURCES, MARKETING, AND OPERATIONS. UPON COMPLETION OF GATHERING THE NECESSARY INFORMATION FOR THE RETURN, THE FORM WAS COMPILED AND DRAFTS WERE REVIEWED BY THE ASSISTANT CONTROLLER - ACCOUNTING OPERATIONS, VICE PRESIDENT OF FINANCE, CHIEF FINANCIAL OFFICER, THE LAW DEPARTMENT, THE AUDIT AND COMPLIANCE COMMITTEE AND PARK NICOLLET'S ACCOUNTING FIRM. AFTER ALL REVIEWS WERE COMPLETE; THE FORM 990 WAS GIVEN TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C AT PARK NICOLLET HEALTH SERVICES ALL KEY EMPLOYEES, DIRECTORS, AND OFFICERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE STATEMENT EACH YEAR; HOWEVER THE OBLIGATION TO REPORT POTENTIAL CONFLICTS IS ONGOING. PARK NICOLLET HEALTH SERVICES BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES PURSUANT TO ITS CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ALL BOARD MEMBERS AND OFFICERS ANNUALLY ARE PROVIDED A COPY OF THE POLICY AND REQUIRED TO COMPLETE A QUESTIONNAIRE INDENTIFYING ANY POTENTIAL CONFLICTS OF INTEREST. THE GENERAL COUNCEL REVIEWS THE COMPLETED QUESTIONNAIRES AND PROVIDES A REPORT TO THE GOVERNANCE COMMITTEE OF THE BOARD. THE REPORT IDENTIFIES ANY SIGNIFICANT POTENTIAL CONFLICTS DISCLOSED IN THE COMPLETED QUESTIONNAIRES. A WRITTEN REPORT IS PROVIDED TO THE CHAIR AND CHIEF EXECUTIVE OFFICER (CEO). BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 PARK NICOLLET HAS AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF ITS PRESIDENT AND ITS OTHER OFFICERS. EVERY THREE YEARS, UNDER THE DIRECTION OF THE BOARD OF DIRECTORS' COMPENSATION AND LEADERSHIP DEVELOPMENT COMMITTEE (COMPENSATION COMMITTEE), A TOTAL COMPENSATION MARKET REVIEW IS COMPLETED BY AN EXTERNAL COMPENSATION CONSULTANT. THE REVIEW INCLUDES ALL COMPONENTS OF COMPENSATION; BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE INDEPENDENT BOARD COMPENSATION COMMITTEE. BASED ON THIS MARKET DATA, THE COMPENSATION COMMITTEE DETERMINES MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES FOR EACH OFFICER. IN INTERIM YEARS, GROUP HEALTH PLAN, INC. (AN AFFILIATE OF PNHS) HUMAN RESOURCES STAFF, UNDER THE DIRECTION OF THE COMPENSATION COMMITTEE, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMPENSATION COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMPENSATION COMMITTEE REVIEWS AND APPROVES EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, COMMITTEE MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMPENSATION COMMITTEE 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. THE BOARD HAS DELEGATED TO THE TO THE PRESIDENT & CEO (WITH AUTHORITY TO FURTHER DELEGATE TO EXECUTIVES WITH LEADERSHIP ROLES OF PARK NICOLLET OFFICERS) THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL PARK NICOLLET OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMPENSATION COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE COMPENSATION COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND W2 STATEMENTS. FORM 990, PART VI, SECTION C, LINE 19 PARK NICOLLET HEALTH SERVICES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. PARK NICOLLET HEALTH SERVICES MAILS ITS CONSOLIDATED AUDITED FINANCIAL STATEMENTS TO FINANCIAL INSTITUTIONS, GOVERNMENTAL INSTITUTIONS, BOARD MEMBERS, MEDIA REPRESENTATIVES, VENDORS, AND THE MINNESTOA HOSPITAL ASSOCIATIONS(MHA) PARK NICOLLET HEALTH SERVICES DISCLOSES QUARTERLY FINANCIAL STATEMENTS TO BONDHOLDERS AND MHA. THE ANNUAL AUDITED AND QUARTERLY FINANCIAL STATEMENTS ARE ALSO POSTED AT EMMA.MSRB.ORG. THE FORMS 990 ARE AVAILABLE UPON REQUEST OR FROM THE STATE OF MINNESOTA OR AT GUIDESTAR.ORG. FORM 990, PART VII PURSUANT TO TREASURY REG SECTION 1.6033-2(D)(5), PARK NICOLLET HEALTH SERVICES HAS ELECTED TO REPORT INFORMATION ABOUT CONTRIBUTIONS, GIFTS & GRANTS, COMPENSATION, AND OTHER INFORMATION ABOUT OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, FORMER EMPLOYEES, CERTAIN OTHER HIGHLY PAID EMPLOYEES, CERTAIN PROFESSIONAL CONTRACTORS AND CERTAIN OTHER CONTRACTORS ON A CONSOLIDATED BASIS FOR ALL MEMBERS OF THE GROUP, INCLUDING THE PARENT ORGANIZATION, ON THE GROUP RETURN OF PARK NICOLLET GROUP RETURN (EIN 45-5023260). FORM 990, PART IX, LINE 11G EMPLOYEES OF AFFILIATES: PROGRAM SERVICE EXPENSES 22,482,480. MANAGEMENT AND GENERAL EXPENSES 6,251,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,734,229. MANAGEMENT CONSULTANTS: PROGRAM SERVICE EXPENSES 11,456. MANAGEMENT AND GENERAL EXPENSES 2,638,124. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,649,580. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 22,636,930. MANAGEMENT AND GENERAL EXPENSES 1,043,969. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,680,899. FORM 990, PART XI, LINE 9: POST RETIREMENT OBLIGATION -178,584. GRANTS RUN THROUGH THE FOUNDATION -25,000. DEFERRED COMPENSATION TRUST 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411809020 INVESTMENTS MN 1629458 PARK NICOLLET HEALTH SERVICES TRIA ORTHOPEDIC CENTER LLC 8100 NORTHLAND DRIVE BLOOMINGTON MN 55431 200034003 HEALTH CARE MN PARK NICOLLET HEALTH SERVICES HEALTHPARTNERS EAST SIDE HOLDING LLC 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 201282428 REAL ESTATE HOLDING COMPANY DE N/A HEALTHPARTNERS PROPERTY DEVELOPMENT COMPANY LLC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 455122853 PROPERTY DEVELOPMENT MN N/A PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410132080 HEALTH CARE MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 237346465 GRANTS TO SERVE THE COMMUNITY MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET CLINIC 3800 PARK NICOLLET BLVD ST LOUIS PARK MN 55416 410834920 HEALTH CARE MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET INSTITUTE 3800 PARK NICOLLET BLVD ST LOUIS PARK MN 55416 410961862 HEALTH CARE RESEARCH MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET HEALTH CARE PRODUCTS 3800 PARK NICOLLET BLVD ST LOUIS PARK MN 55416 010638901 HEALTH CARE PRODUCTS MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 1 PNMC HOLDINGS 3800 PARK NICOLLET BLVD ST LOUIS PARK MN 55416 101741792 HEALTH CARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE II PARK NICOLLET HEALTH SERVICES 1 TRIA ORTHOPEADIC CENTER RESEARCH INSTITUTE 8100 NOIRTHLAND DRIVE BLOOMINGTON MN 55431 200033919 HEALTH CARE RESEARCH AND EDUCATION MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 1 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 - 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