2016-08-11T10:20:16-05:00 2015-09-30 420714325 RSM US LLP 227 W FIRST ST STE 700 DULUTH MN 558021926 990 2014-10-01 410745522 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE CENTER AITK 2189272121 200 BUNKER HILL DRIVE AITKIN MN 56431 CASEY JOHNSON CFO 2189272121 2016-08-08 1 MARY BETH SANTORI P00023783 2187275025 2014 2016-12-15 16:53:06Z CHAD COOPER 200 BUNKER HILL DRIVE AITKIN MN 56431 74556190 0 X WWW.RIVERWOODHEALTHCARE.COM X 1948 MN INPATIENT AND OUTPATIENT MEDICAL CARE AND THREE PRIMARY CARE CLINICS. 11 10 427 120 1673317 0 728571 723951 54971487 58026714 1117684 2103456 487405 325324 57305147 61179445 0 0 0 0 25613279 26390232 24817 22204 120529 28334271 29366673 53972367 55779109 3332780 5400336 81626274 84910661 47474845 47771545 34151429 37139116 X PROVIDE HIGH QUALITY INPATIENT AND OUTPATIENT CARE AND THREE PRIMARY CLINICS CARE TO THE RESIDENTS OF AITKIN AND THE SURROUNDING AREA. 0 0 46243686 56678973 RIVERWOOD HAS A STRONG FOCUS ON HEALTH AND WELLNESS AND STRIVES TO EDUCATE AND INFORM THE COMMUNITY ON HEALTH ISSUES. THE HEALTHCARE CENTER ALSO LISTENS TO AND INCORPORATES THE NEEDS OF THE COMMUNITY AND PATIENTS. RIVERWOOD OFFERS COMMUNITY HEALTH EDUCATION SEMINARS, SUPPORT GROUPS AND CLASSES AS WELL AS HEALTH AND WELLNESS TIPS IN THE "HEALTHY LIVING NEWSLETTER". IN 2015 RIVERWOOD CONTINUED IT'S MISSION TO PROVIDE HIGH QUALITY, COMPASSIONATE AND PERSONALIZED CARE TO ITS PATIENTS. AS PART OF RIVERWOOD'S STRATEGIC PLAN FOR 2015-18, THE ORGANIZATION COMMITTED TO TRANSITIONING TO A NEW ELECTRONIC HEALTH RECORD (EHR), WHICH WILL HAVE LONG-TERM BENEFITS FOR PATIENTS IN TERMS OF PROVIDING THE SAFEST AND HIGHEST QUALITY CARE. IN JULY 2015, RIVERWOOD BEGAN TRANSITIONING TO ALLINA HEALTH'S VERSION OF EPIC, WHICH IS CALLED EXCELLIAN, WITH A GO-LIVE DATE OF MARCH 31, 2016. AMONG OTHER THINGS, THE EXCELLIAN PLATFORM ALLOWED RIVERWOOD TO INTEGRATE BOTH ITS HOSPITAL AND CLINIC ELECTRONIC RECORDS INTO A SINGLE, INTEGRATED SYSTEM. ADDITIONALLY, THE ABILITY TO SEAMLESSLY SHARE INFORMATION WITH OTHER HEALTH CARE PROVIDERS WITH WHOM THE HEALTH SYSTEM PARTNERS HAS BEEN GREATLY ENHANCED. RIVERWOOD INSTALLED AN 80-SLICE CT SCANNER IN THE RADIOLOGY DEPARTMENT. THIS CT TECHNOLOGY ALLOWS FOR IMPROVED IMAGE QUALITY AND SPEED, REDUCING TOTAL TIME-TO-DIAGNOSIS FOR ENHANCED PATIENT CARE. WITH A GRANT FROM THE MINNESOTA DEPARTMENT OF HEALTH, RIVERWOOD IS MOVING FORWARD WITH ENHANCING PRIMARY CARE WITH THE DEVELOPMENT OF A NEW MODEL OF CARE CALLED PATIENT CENTERED MEDICAL HOME. THIS MODEL USES TEAM-BASED CARE THAT FOCUSES ON WELLNESS AND DISEASE PREVENTION WHILE PLACING CONTROL OF HEALTHCARE CHOICES IN THE HANDS OF THE PATIENT. TWO NEW PHYSICIANS WERE ADDED DURING THE YEAR AND A PHYSICIAN ASSISTANT FOR SPECIALTY CARE AS WELL AS A NEW NURSE PRACTITIONER FOR FAMILY MEDICINE.RIVERWOOD MOVED ITS URGENT CARE SERVICE FROM THE EMERGENCY DEPARTMENT TO ITS CLINIC IN AITKIN. RIVERWOOD NURSE PRACTITIONERS NOW STAFF URGENT CARE, SEEING PATIENTS FROM 10 A.M. TO 7 P.M., MONDAY THROUGH FRIDAY. THE TRANSITION OF URGENT CARE FROM THE ER TO THE CLINIC BENEFITS PATIENTS IN SEVERAL WAYS: THE COST OF CARE IS LESS EXPENSIVE IN THE CLINIC SETTING THAN THE ER SO PATIENTS CAN SAVE MONEY ON THEIR INSURANCE DEDUCTIBLES AND COPAYMENTS. IN ADDITION, PATIENT WAIT TIMES ARE NOT IMPACTED BY HOW BUSY THE EMERGENCY ROOM IS. 46243686 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 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 65 0 1 427 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 MN X JUDY TURNER 2189272121 200 BUNKER HILL DRIVE AITKIN MN 56431 X THOMAS RIKALA DIRECTOR 1.00 X 0 0 0 JEFF EHNSTROM MD DIRECTOR/PHYSICIAN 41.00 X 306531 0 27788 STEVE WILSON DIRECTOR 1.00 X 0 0 0 ALISON MATALAMAKI TREASURER 1.00 X X 0 0 0 MIKE PAULBECK CHAIRMAN 1.00 X X 0 0 0 JARED LUNDGREN DIRECTOR 1.00 X 0 0 0 TOM LUNDBERG DIRECTOR 1.00 X 0 0 0 TIMOTHY DIRKS MD DIRECTOR 1.00 X 0 0 0 DAVID MEYER SECRETARY 1.00 X X 0 0 0 KATHLEEN RYAN DIRECTOR 1.00 X 0 0 0 CHAD GROSS VICE CHAIRMAN 1.00 X X 0 0 0 CHRISTINE BRIGHT DIRECTOR 1.00 X 0 0 0 CHAD COOPER CEO 39.90 0.10 X 338873 0 26761 CASEY JOHNSON CFO 39.90 0.10 X 77536 0 9385 MARK HEGGEM MD CMO 40.00 X 278286 0 27788 JEFFREY RAPP MD PHYSICIAN 40.00 X 322378 0 27788 JIM HARRIS MD ER MEDICAL DIRECTOR 40.00 X 339832 0 27788 DAVID TAYLOR MD PHYSICIAN 40.00 X 286904 0 18125 THOMAS OSBORNE MD PHYSICIAN 40.00 X 329031 0 27788 DONALD HUGHES MD PHYSICIAN 40.00 X 248083 0 27661 2527454 0 220872 35 0 1 0 CUYUNA REGIONAL MEDICAL CENTER 320 E MAIN CROSBY MN 56441 PROF MEDICAL SERVICES 2366998 CENTRAL MINNESOTA DIAGNOSTICS INC 150 10TH STREET NW MILACA MN 56353 PROF IMAGING SERVICES 1356973 LIFE GUARD ANESTHESIA SERVICES INC 29561 395TH PLACE AITKIN MN 56431 PROF ANESTHESIA SERVICES 1201652 TECHNICAL LIFE CARE 2720 HWY 10 NE MOUNDS VIEW MN 55112 EQUIPMENT MAINT SERVICES 752051 PREMIER SURGICAL ASSOCIATES PA 318 E MAIN CROSBY MN 56441 PROF SURGICAL SVCS 537726 11 238719 348913 136319 723951 NET PATIENT SERVICE REVENUE 621500 55857475 55857475 GARRISON PHARMACY 446110 1690780 1690780 EQUITY IN EARNINGS OF AFFILIATES 900099 367748 385211 -17463 ELECTRONIC HEALTH RECORD INCENTIV 621500 110711 110711 58026714 846863 846863 14597862 35476 13363751 12994 1234111 22482 1256593 1256593 OTHER REVENUE 900099 325324 325324 325324 61179445 56678721 1673317 2103456 1173760 321120 852640 20209655 17217327 2900893 91435 730042 648573 81469 2903540 2536995 366545 1373235 1179583 193652 60063 60063 88203 88203 22204 22204 2200173 2193283 6890 1926227 1592261 333966 3343245 2763599 579646 231934 231934 HOSPITAL SUPPLIES & OTH 10534594 10534594 NURSING SUPPLIES & OTHE 7222225 7222225 OTHER GENERAL SERVICE S 1338885 1338885 PROVISION FOR DOUBTFUL 888524 888524 1532600 1532600 55779109 46243686 9414894 120529 908036 1757467 4382348 4892346 8221832 7868756 1264754 1439531 532051 543421 60739021 31573026 30702633 29165995 25325579 29391966 10289041 9851179 81626274 84910661 7967580 9441384 21630000 20895000 17877265 17435161 47474845 47771545 X 33182185 36261600 969244 877516 34151429 37139116 81626274 84910661 X 5400336 -2320921 -91728 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2158 2158 0 PART II-B, LINE 1: RIVERWOOD HEALTHCARE CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 558330 -22684 535646 406564 134710 27056 2000 8000 558330 380978 15063 26281 15758 406564 330207 1250 52521 3000 380978 331439 1590 -1822 1000 330207 0.36940 0.22680 0.40380 0 1 1 1213670 1213670 31811263 12481166 19330097 22607223 17003671 5603552 5106865 2088189 3018676 29165995 ASSETS LIMITED FOR RESERVE ACCOUNTS 2626080 ASSETS LIMITED FOR PRINCIPAL & INTEREST PAYMENTS 731191 BENEFICIAL INTEREST IN NET ASSETS-HOSPITAL FOUNDATION 877516 BOND ISSUE COSTS, NET OF ACCUMULATED AMORTIZATION 584672 INVESTMENT IN CENTRAL MINNESOTA DIAGNOSTICS, INC. 1126485 INVESTMENT IN SISU MEDICAL SYSTEMS 1685 INVESTMENT IN SISU MEDICAL SOLUTIONS, LLC -401 ASSETS LIMITED BY AGREEMENT FOR DEFERRED COMPENSATION 907295 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 40000 ASSETS LIMITED FOR CONSTRUCTION 22397 ASSETS LIMITED BY AGREEMENT FOR WORKER'S COMPENSATION 238000 ASSETS LIMITED BY BOARD FOR FUNDED DEPRECIATION 2696259 9851179 BOND PREMIUM 41413 REVENUE NOTE PAYABLE 17393748 17435161 X 57855790 -2320921 -980252 -3301173 61156963 22482 22482 61179445 54868103 -22482 -22482 54890585 888524 888524 55779109 PART V, LINE 4: TO BE USED AND DISTRIBUTED AS A SCHOLARSHIP OR EDUCATIONAL FUND TO AID IN THE EDUCATION AND RECRUITMENT OF HEALTH CARE PROFESSIONALS FOR RIVERWOOD HEALTHCARE CENTER. PART X, LINE 2: NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE CENTER HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES -888,524. DECREASE IN INTEREST IN NET ASSETS - AITKIN COMMUNITY HOPSITAL FOUNDATION -91,728. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT 22,482. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT -22,482. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 888,524. 1 HBH ASSOCIATES LLC 340 10TH STREET NW MILACA MN 56353 GRANT WRITING 0 126868 6204 120664 VELA STRATEGY 611 SUMMIT AVE SOUTH SAUK RAPIDS MN 56379 GRANT WRITING 0 8224 16000 -7776 135092 22204 112888 MN PART I, LINE 1 RIVERWOOD HEALTHCARE CENTER PAYS FOR EXPENSE FOR THE PROFESSIONAL FUNDRAISERS, BUT THE FUNDRAISING ACTIVITIES ARE DONE THROUGH THE RIVERWOOD HEALTHCARE CENTER FOUNDATION. THE FOUNDATION RAISED FUNDS THROUGH THE FOLLOWING ACTIVITIES: MAIL SOLICITATIONS, EMAIL SOLICITATIONS, IN-PERSON SOLICITATIONS, PHONE SOLICITATIONS, AND SPECIAL FUNDRAISING EVENTS. PART I, LINE 2 RIVERWOOD HEALTHCARE CENTER PAYS FOR EXPENSE FOR THE PROFESSIONAL FUNDRAISERS (COLUMN V), BUT THE GROSS RECEIPTS ARE RECEIVED BY THE RIVERWOOD HEALTHCARE CENTER FOUNDATION (COLUMN IV). 1 1 1 X 1 X 1 1 0 0 944097 944097 0.01720 8496930 6659235 1837695 0.03350 9441027 6659235 2781792 0.05070 540705 540705 0.00990 28440 28440 0.00050 15163734 12723535 2440199 0.04450 15732879 12723535 3009344 0.05490 25173906 19382770 5791136 0.10560 1 888524 177522 19318605 19353345 -34740 X 1 1 1 1 RIVERWOOD HEALTHCARE CENTER 200 BUNKER HILL DRIVE AITKIN MN 56431 X X X X AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.RIVERWOODHEALTHCARE.COM X 1 13 1 HTTP://RIVERWOODHEALTHCARE.ORG 0 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X HTTP://RIVERWOODHEALTHCARE.ORG/PATIENTS/POLICIES/ X HTTP://RIVERWOODHEALTHCARE.ORG/PATIENTS/POLICIES/ X HTTP://RIVERWOODHEALTHCARE.ORG/PATIENTS/POLICIES/ X X X X X 1 X 0 X X X X 1 X 0 0 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 5: RIVERWOOD HEALTHCARE CENTER UTILIZED AND ENGAGED MANY INDIVIDUALS AND ORGANIZATIONS TO COMPLETE ITS CHNA. A PROJECT CORE TEAM PROVIDED INPUT AND GUIDANCE IN THIS PROJECT. THE TEAM CONSISTED OF INDIVIDUALS FROM AITKIN COUNTY PUBLIC HEALTH, AITKIN AND MCGREGOR SCHOOL DISTRICTS, AICOTA HEALTHCARE CENTER AND RIVERWOOD HEALTHCARE CENTER ALONG WITH CONSULTING FROM HBH ASSOCIATES, SHELLI URNESS CONSULTING AND HEALTH PLANNING AND MANAGEMENT RESOURCES. FEEDBACK WAS GATHERED FROM COMMUNITY MEMBER'S FROM RIVERWOOD'S PRIMARY SERVICE COMMUNITIES OF AITKIN, GARRISON AND MCGREGOR. COMMUNITY FEEDBACK SESSIONS, TELEPHONE INTERVIEWS AND EMAIL QUESTIONNAIRES WERE USED TO OBTAIN INPUT. AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 11: THE MISSION OF RIVERWOOD HEALTHCARE CENTER IS TO PROVIDE QUALITY INPATIENT AND OUTPATIENT CARE. THE IMPLEMENTATION STRATEGY IS DESIGNED TO ADDRESS THE HEALTH CARE NEEDS OF THE PEOPLE OF AITKIN COUNTY, AND THEIR UNIQUE CHARACTERISTICS AND HEALTHCARE NEEDS. THE IMPLEMENTATION STRATEGIES ARE BASED ON RIVERWOOD'S CURRENT PROGRAMMING, SURVEY DATA, AND COMMUNITY INPUT. RIVERWOOD'S STRATEGIC PLAN IS DEVELOPED BY ITS LEADERSHIP TEAM AND REVIEWED ANNUALLY. THE IMPLEMENTATION STRATEGY ALSO IDENTIFIES HOW EXISTING AND PLANNED RIVERWOOD SERVICES, PARTNERSHIPS AND PROGRAMS WILL BE UTILIZED TO HELP ADDRESS COMMUNITY HEALTH NEEDS. THE IMPLEMENTATION STRATEGY FOR THE HEALTH OF AITKIN COUNTY CHNA IS THE HOSPITAL/COMMUNITY PLAN FOR ADDRESSING THE COMMUNITY HEALTH NEEDS. IRS NOTICE 2011-52 DICTATES THE CONTENTS OF AN IMPLEMENTATION STRATEGY, AND STATES THAT THE HOSPITAL MUST ADDRESS HOW IT BOTH INTENDS AND DOES NOT INTEND TO ADDRESS THE IDENTIFIED COMMUNITY HEALTH NEEDS. RIVERWOOD HEALTHCARE CENTER'S IMPLEMENTATION STRATEGY IS DESCRIBED IN THIS SECTION OF THE REPORT. WE WILL CONTINUE TO STAY THE COURSE AND FOLLOW OUR STRATEGIC PLAN. WE WILL CREATE THE FUTURE WE SEEK BY FOCUSING ON SIX CRITICAL STRATEGIC GOALS:(1) QUALITY: OUR CUSTOMERS ARE DEMANDING MORE EFFICIENCY, BETTER QUALITY, AND SUPERIOR SAFETY. WE WILL LEAD IN DELIVERING ON THESE REQUIREMENTS THROUGH IMPROVED DATA, REPORTING AND PROCESS IMPROVEMENTS.(2) PEOPLE: OUR PEOPLE ARE KEY. WE WILL INSPIRE THEIR TRUST, IMPROVE THEIR SKILLS, AND DEVELOP LEADERSHIP AND ENGAGEMENT THAT LEADS US INTO A STRONGER FUTURE.(3) CARE DELIVERY MODEL: REDESIGNING FOR THE CARE MODEL OF THE FUTURE WILL ENSURE READINESS IN A POST REFORM WORLD.(4) GROWTH: WE WILL GROW OUR PRIMARY CARE SERVICES AND SHARE OF OUR MARKET. WE INTEND TO BUILD THE CONFIDENCE OF OUR COMMUNITY IN THEIR ABILITY AND DESIRE TO STAY LOCAL FOR CARE AND KNOW THAT WHEN THEY NEED SPECIALIZED OR TERTIARY CARE WE WILL MAKE THE TRANSITION EASY.(5) TECHNOLOGY: WE WILL INSTALL PLATFORMS AND SYSTEMS THAT ENSURE WE MAXIMIZE EFFICIENCY, PRODUCTIVITY AND SUPPORT THE IMPROVEMENT OF QUALITY.(6) FINANCE: WE WILL ACHIEVE OPERATING MARGINS THAT ENSURE LONG TERM FINANCIAL STRENGTH AND THE CAPACITY TO CONTINUE TO INVEST FOR THE BENEFIT OF PATIENTS AND FAMILIES.RIVERWOOD'S ADDRESSING OF NEEDSRIVERWOOD'S IMPLEMENTATION STRATEGY WILL ADDRESS ALL THE IDENTIFIED PRIORITIES. EXCEPT ON A LIMITED SCALE, THE STRATEGY WILL NOT ADDRESS THE PROVISION OF DIALYSIS SERVICES DUE TO COST-EFFECTIVENESS, TOO FEW LOCAL PATIENTS TO COST JUSTIFY THE PROGRAM, AND INABILITY TO EXPAND THAT SERVICE LINE VIA EQUIPMENT AND STAFFING. CONCLUSION IN ADDITION TO SPECIFIC STRATEGIES AND MISSION DRIVEN PROGRAMS, RIVERWOOD HEALTHCARE CENTER WILL CONTINUE TO BUILD ITS PATIENT-CENTERED MEDICAL HOME (PCMH) AS IT ADDRESSES COMMUNITY NEEDS. IT IS WHAT ALIGNS WITH THE HOSPITAL STRATEGIC PLAN AND WITH THE CHNA. WE KNOW THAT THE PCMH IS NOT ONLY THE WAVE OF THE FUTURE, BUT WILL POSITIVELY IMPACT THE HEALTH OF THE PEOPLE OF AITKIN COUNTY. RHCC BUILDS EVALUATIVE MEASURES AND GOALS INTO ALL OF ITS PROGRAMS AND SERVICES. IN ADDITION, THE CHNA PLAN WILL BE REVIEWED AND REWRITTEN EVERY 3 YEARS. RHCC'S MANAGEMENT TEAM WILL CONTINUE TO PLAY A LEADERSHIP ROLE IN THE IMPLEMENTATION STRATEGIES AND MONITOR ITS PROGRESS, AND MAKE ADJUSTMENTS TO STRATEGIES AS NEEDED. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD PART V, SECTION B, LINE 16A WEBSITE: HTTP://RIVERWOODHEALTHCARE.ORG/PATIENTS/POLICIES/ AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD PART V, SECTION B, LINE 16B WEBSITE: HTTP://RIVERWOODHEALTHCARE.ORG/PATIENTS/POLICIES/ AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD PART V, SECTION B, LINE 16C WEBSITE: HTTP://RIVERWOODHEALTHCARE.ORG/PATIENTS/POLICIES/ 3 RIVERWOOD AITKIN CLINIC 200 BUNKER HILL DRIVE AITKIN MN 56431 CLINIC RIVERWOOD MCGREGOR CLINIC 2 E CENTRAL AVENUE AITKIN MN 56431 CLINIC RIVERWOOD GARRISON CLINIC 27278 STATE HWY 18 GARRISON MN 56450 CLINIC PART I, LINE 3C: IN ADDITION TO INCOME BASED TESTING, OUR CHARITY CARE POLICY REQUIRES THAT AN APPLICANT MUST HAVE RECEIVED A DENIAL FROM EITHER MEDICAID (MINNESOTA ASSISTANCE) OR OTHER STATE SUBSIDIZED HEALTHCARE PROGRAMS (MINNESOTA CARE OR GMAC). PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2015 MEDICARE COST REPORT. PART I, LINE 7G: THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES INCLUDE SPEECH PATHOLOGY, CHEMOTHERAPY, CARDIAC REHABILITATION, DIABETES EDUCATION, NUTRITION SERVICE, WOUND CARE, EMERGENCY, OBSERVATION BEDS, AND RURAL HEALTH CLINIC/RETAIL PHARMACY. PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $888,524. PART I LINE 6A THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH MINNESOTA. THIS INFORMATION IS AVAILABLE ON THE MINNESOTA HOSPITAL ASSOCIATION WEBSITE. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: MANAGEMENT DETERMINES ALLOWANCES FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND THEN USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PART III, LINE 3: LOOKED AT THE NUMBER OF CHARITY CARE APPLICATIONS SENT TO POTENTIAL APPLICANTS ALONG WITH THE TOTAL DOLLAR AMOUNT OF THEIR ACCOUNTS. DIVIDED TOTAL OF THEIR ACCOUNTS OF $310,716 BY THE 62 TOTAL POTENTIAL APPLICANTS FOR AN AVERAGE BALANCE PER APPLICANT OF $4,932. THEN TOOK UNRETURNED APPLICATIONS OF 36, TIMES THE AVERAGE OF $4,932 WHICH EQUALS $177,552, WHICH REPRESENTS THE DOLLAR AMOUNT OF BAD DEBT THAT LIKELY COULD HAVE BEEN COMMUNITY BENEFIT. PART III, LINE 4: FROM FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS - "ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE VALUE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ONGOING ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY INSURANCE COVERAGE (INCLUDING COPAYMENT AND DEDUCTIBLE AMOUNTS FROM PATIENTS), THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH PRIVATE-PAY PATIENTS, THE CENTER RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS HISTORICAL EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.THE CENTER FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE REVISED AS NEEDED IN FUTURE PERIODS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF PRIVATE-PAY RECEIVABLE HAS DECREASED FROM 52.7 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2014, TO 48.4 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2015.THE CENTER HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2015 OR 2014. THE CENTER DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD PARTY PAYORS." PART III, LINE 8: THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND THUS IS REIMBURSED AT 101% OF COST. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $790,123 AND ALLOWABLE COSTS OF $1,115,559 RESULTING IN A SHORTFALL OF $325,436. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE. THE MEDICARE ADVANTAGE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $4,122,055 AND ALLOWABLE COSTS OF $4,164,534 RESULTING IN A SHORTFALL OF $42,479.THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: AITKIN COMMUNITY HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY TO THE UNINSURED AND TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. THE HOSPITAL EMPLOYS A FULL TIME FINANCIAL COUNSELOR WHO WORKS WITH PATIENTS TO EVALUATE ELIGIBILITY AND REDIRECT THEM AS NEEDED TO LOCAL STATE OR COUNTY STAFF FOR ASSISTANCE WITH APPLICATIONS FOR GOVERNMENTAL ASSISTANCE PROGRAMS. UPON RECEIPT OF DENIAL, PATIENT WILL BE PROVIDED A CHARITY CARE APPLICATION OR SLIDING FEE SCALE APPLICATION. DEPENDING ON THE PATIENT'S INCOME AND THE GUIDELINES, THEY WILL BE PROVIDED A WAIVER OF ALL CHARGES OR A REDUCTION IN THEIR MEDICAL CHARGES. THE HOSPITAL'S BILLING STAFF, PATIENT ACCESS STAFF AND OUTSIDE COLLECTION AGENCIES ARE ALL EDUCATED AND AWARE OF THE CHARITY CARE ASSISTANCE PROGRAM AND SLIDING FEE SCALE AND IN THE COURSE OF THEIR EVERYDAY WORK WILL OFFER PATIENTS THIS INFORMATION IF THEY EXPRESS A NEED FOR FINANCIAL ASSISTANCE. PART III, LINE 2 MANAGEMENT DETERMINES THE ALLOWANCES FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND THEN USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PART III, LINE 3 THE HOSPITAL LOOKS AT THE NUMBER OF CHARITY CARE APPLICATIONS SENT TO POTENTIAL APPLICANTS AND COMES UP WITH AN APPROVAL RATIO BASED ON RETURNED APPLICATIONS. THE PERCENTAGE OF UNRETURNED APPLICATIONS IS THEN MULTIPLIED BY THE TOTAL DOLLAR AMOUNT OF BAD DEBT EXPENSE. PART VI, LINE 2: AITKIN COMMUNITY HOSPITAL PERFORMS A COMMUNITY NEEDS ASSESSMENT TO EVALUATE THE HEALTH CARE NEEDS OF THE COMMUNITY EVERY 3 YEARS WITH AN OUTSIDE CONSULTING FIRM. ADDITIONALLY, WE PERFORM A COMMUNITY PERCEPTION ASSESSMENT AND HEALTH ASSESSMENT OF OUR SERVICE AREA EVERY 3 YEARS. PART VI, LINE 3: AITKIN COMMUNITY HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY TO THE UNINSURED AND TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. THE HOSPITAL EMPLOYS A FULL TIME FINANCIAL COUNSELOR WHO WORKS WITH PATIENTS TO EVALUATE ELIGIBILITY AND REDIRECT THEM AS NEEDED TO LOCAL STATE OR COUNTY STAFF FOR ASSISTANCE WITH APPLICATIONS FOR GOVERNMENTAL ASSISTANCE PROGRAMS. UPON RECEIPT OF DENIAL, PATIENT WILL BE PROVIDED A CHARITY CARE APPLICATION OR SLIDING FEE SCALE APPLICATION. DEPENDING ON THE PATIENT'S INCOME AND THE GUIDELINES, THEY WILL BE PROVIDED A WAIVER OF ALL CHARGES OR A REDUCTION IN THEIR MEDICAL CHARGES. RIVERWOOD'S EMPLOYED FINANCIAL COUNSELOR IS A MNSURE NAVIGATOR, TRAINED AND CERTIFED BY THE STATE OF MINNESOTA.THE HOSPITAL'S BILLING STAFF, PATIENT ACCESS STAFF AND OUTSIDE COLLECTION AGENCIES ARE ALL EDUCATED AND AWARE OF THE CHARITY CARE ASSISTANCE PROGRAM AND SLIDING FEE SCALE AND IN THE COURSE OF THEIR EVERYDAY WORK WILL OFFER PATIENTS THIS INFORMATION IF THEY EXPRESS A NEED FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: AITKIN COMMUNITY HOSPITAL, INC. D.B.A. RIVERWOOD HEALTHCARE CENTER (RIVERWOOD), A 501(C)3 NON-PROFIT CORPORATION, IS SITUATED IN THE CENTER OF AITKIN COUNTY. IT WAS FOUNDED IN 1948 AND IS LOCATED AT 200 BUNKER HILL DRIVE IN AITKIN, MN (POP. 1984). RIVERWOOD IS A 25 BED ACUTE-CARE CRITICAL ACCESS HOSPITAL AND HAS THREE RURAL HEALTH CLINICS IN AITKIN, MCGREGOR AND GARRISON. ALL THREE CLINICS ARE LOCATED IN A MEDICALLY UNDERSERVED AREA (MUA). RIVERWOOD OFFERS PATIENTS A CONTINUUM OF CARE INCLUDING INPATIENT, OUTPATIENT, SPECIALTY, SURGICAL AND EMERGENCY SERVICES. THE DISTANCE TO THE NEXT HOSPITAL IS 17 MILES. DULUTH AND ST. CLOUD ARE THE TWO CLOSEST CITIES WITH TERTIARY CARE CENTERS BOTH APPROXIMATELY 90 MILES FROM AITKIN.RIVERWOOD SERVES THE RESIDENTS OF AITKIN COUNTY (POP. 16,149) THE EAST SIDE OF CROW WING COUNTY (POP. 61,009) AND MILLE LACS COUNTY (POP. 26,169). THE GEOGRAPHIC AREA OF THESE COUNTIES IS RURAL.SPECIAL POPULATIONS SERVED INCLUDE THOSE WITH A HIGH RATE OF POVERTY AND UNEMPLOYMENT WITH AITKIN, CROW WING AND MILLE LACS COUNTIES. IN 2007, THE ESTIMATED PERCENTAGES OF THESE THREE COUNTIES WITH POPULATIONS BELOW POVERTY LEVEL WERE RESPECTIVELY: AITKIN - 13.4%, CROW WING - 9.3%, MILLE LACS - 9.5%. ADDITIONALLY, ACCORDING TO THE MINNESOTA DEPARTMENT OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, THE UNEMPLOYMENT RATE IN AITKIN COUNTY SKYROCKETED TO 10.5% IN JANUARY 2009, WHICH IS NEARLY 4 PERCENTAGE POINTS OVER THE STATE AVERAGE OF 6.9%. THE DEPARTMENT OF LABOR AND INDUSTRY CONSIDERS AITKIN COUNTY TO BE A "LABOR SURPLUS AREA". OTHER SPECIAL POPULATIONS SERVED ALSO INCLUDE THE ELDERLY. THE LARGEST PERCENTAGE OF RIVERWOOD'S CURRENT PATIENT BASE CONSISTS OF PATIENTS OVER THE AGE OF 65. POPULATION PROJECTIONS INDICATE THAT BETWEEN THE YEARS OF 2005-2030, A 50% OVERALL INCREASE IS EXPECTED IN AITKIN COUNTY WITH THE 65+ AGE GROUP BY 120%. AITKIN COUNTY IS SECOND ONLY TO TRAVERSE COUNTY FOR HAVING THE OLDEST MEDIAN POPULATION IN MINNESOTA. PART VI, LINE 5: IN FURTHERANCE OF ITS CHARITABLE PURPOSE, THE CENTER PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED SERVICE PROGRAMS AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY, A LARGE NUMBER OF HEALTH RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 X X X X X X 0 0 0 0 0 0 0 0 0 JEFF EHNSTROM MD DIRECTOR/PHYSICIAN 306531 0 0 0 0 0 10400 0 17388 0 334319 0 0 0 CHAD COOPER CEO 309373 0 29500 0 0 0 9373 0 17388 0 365634 0 0 0 MARK HEGGEM MD CMO 260786 0 17500 0 0 0 10400 0 17388 0 306074 0 0 0 JEFFREY RAPP MD PHYSICIAN 310279 0 12099 0 0 0 10400 0 17388 0 350166 0 0 0 JIM HARRIS MD ER MEDICAL DIRECTOR 339832 0 0 0 0 0 10400 0 17388 0 367620 0 0 0 DAVID TAYLOR MD PHYSICIAN 286904 0 0 0 0 0 10400 0 7725 0 305029 0 0 0 THOMAS OSBORNE MD PHYSICIAN 329031 0 0 0 0 0 10400 0 17388 0 356819 0 0 0 DONALD HUGHES MD PHYSICIAN 248083 0 0 0 0 0 10273 0 17388 0 275744 0 0 0 A CITY OF AITKIN 416004918 00958PAP1 2006-08-10 24350057 REFINANCE 2011 BONDS THAT WERE USED TO BUILD NEW HOSPITAL 0 0 0 A 24350057 487001 24350057 2006 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF AITKIN DATE THE REBATE COMPUTATION WAS PERFORMED: 08/10/2011 FORM 990, PART VI, SECTION A, LINE 6 RIVERWOOD HEALTHCARE CENTER HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A RIVERWOOD HEALTHCARE CENTER HAS MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS AND APPROVES THE 990 AFTER PREPARATION AND RECOMMENDS APPROVAL TO THE BOARD. AFTER APPROVAL BY THE BOARD, THE 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. CONFLICTS ARE DISCUSSED, REVIEWED, A FORMS IS SIGNED ANNUALLY BY EACH BOARD MEMBER. THIS IS DONE AT THE HOSPITAL'S ANNUAL REORGANIZATIONAL MEETING. SECTION 1. PURPOSE THE PURPOSE OF THIS POLICY IS TO PROVIDE A MEANS BY WHICH TO ADDRESS ANY CONFLICT OF INTEREST INVOLVING THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, AND EMPLOYEES THAT AFFECT OR HAVE THE POTENTIAL TO AFFECT THE SAFETY OR QUALITY OF CARE, TREATMENT, AND SERVICES. SECTION 2. PERSONS CONCERNED THIS STATEMENT IS DIRECTED NOT ONLY TO BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, BUT TO ALL EMPLOYEES OR NON-EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF RHCC FOR EXAMPLE, THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL, AND ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING RHCC. SECTION 3. AREAS IN WHICH CONFLICT MAY ARISE CONFLICTS OF INTEREST MAY ARISE IN THE RELATIONS OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WITH ANY OF THE FOLLOWING THIRD PARTIES: 1. PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO RHCC. 2. PERSONS AND FIRMS FROM WHOM RHCC LEASES PROPERTY AND EQUIPMENT. 3. PERSONS AND FIRMS WITH WHOM RHCC IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES, OR OTHER PROPERTY. 4. COMPETING OR AFFINITY ORGANIZATIONS. 5. DONORS AND OTHERS SUPPORTING RHCC. 6. AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF RHCC. 7. FAMILY MEMBERS, FRIENDS, AND OTHER EMPLOYEES. SECTION 4. NATURE OF CONFLICTING INTEREST A CONFLICTING INTEREST MAY BE DEFINED AS AN INTEREST, DIRECT OR INDIRECT, WITH ANY PERSONS OR FIRMS MENTIONED IN SECTION 3. SUCH AN INTEREST MIGHT ARISE THROUGH: SECTION 5. INTERPRETATION OF THIS STATEMENT OF POLICY THE AREAS OF CONFLICTING INTEREST LISTED IN SECTION 3, AND THE RELATIONS IN THOSE AREAS WHICH MAY GIVE RISE TO CONFLICT, AS LISTED IN SECTION 4, ARE NOT EXHAUSTIVE. CONFLICTS MIGHT ARISE IN OTHER AREAS OR THROUGH OTHER RELATIONS. IT IS ASSUMED THAT THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. THE FACT THAT ONE OF THE INTERESTS DESCRIBED IN SECTION 4 EXISTS DOES NOT NECESSARILY MEAN THAT A CONFLICT EXISTS, OR THAT THE CONFLICT, IF IT EXISTS, IS MATERIAL ENOUGH TO BE OF PRACTICAL IMPORTANCE, OR IF MATERIAL, THAT UPON FULL DISCLOSURE OF ALL RELEVANT FACTS AND CIRCUMSTANCES IT IS NECESSARILY ADVERSE TO THE INTERESTS OF RHCC. HOWEVER, IT IS THE POLICY OF THE GOVERNING BOARD THAT THE EXISTENCE OF ANY OF THE INTERESTS DESCRIBED IN SECTION 4 SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. SECTION 6. DISCLOSURE POLICY AND PROCEDURE PROCEDURES FOR ADDRESSING CONFLICTS OF INTEREST TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: 1. THE CONFLICTING INTEREST AND ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE GOVERNING BOARD OF DIRECTORS OR TO A COMMITTEE WITH BOARD-DELEGATED POWERS; 2. THE PERSON WITH THE CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL BE EXCLUDED FROM THE DISCUSSION AND VOTE ON APPROVAL OF SUCH TRANSACTION; 3. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 4. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER RHCC CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST; 5. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN RHCC'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO RHCC, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. DISCLOSURE DISCLOSURE IN RHCC SHOULD BE MADE TO THE CHIEF EXECUTIVE OFFICER (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE GOVERNING BOARD OF DIRECTORS. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE GOVERNING BOARD CHAIR (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE GOVERNING BOARD VICE-CHAIR) WHO SHALL BRING THESE MATTERS TO THE GOVERNING BOARD. DECISION THE GOVERNING BOARD OF DIRECTORS OR A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO RHCC. IN THE CASE OF A CONFLICT INVOLVING A MEMBER OF THE GOVERNING BOARD OF DIRECTORS, THE GOVERNING BOARD OR COMMITTEE REVIEWING THE MATTER SHALL CONSIDER THE DISABLING GUIDELINES ATTACHED HERETO. THE DECISION OF THE GOVERNING BOARD OR COMMITTEE ON THESE MATTERS WILL REST IN ITS SOLE DISCRETION, AND ITS CONCERN MUST BE THE WELFARE OF RHCC AND THE ADVANCEMENT OF RHCC'S PURPOSE. SECTION 7. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY 1. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. 2. IF, AFTER HEARING THE RESPONSE OF THE PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THAT THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH MAY INCLUDE NO ACTION, REPRIMAND, REQUEST FOR RESIGNATION OR REMOVAL FROM THE BOARD OF DIRECTORS AS THE FACTS AND CIRCUMSTANCES MAY WARRANT. SECTION 9. COMPENSATION 1. A VOTING MEMBER OF THE BOARD OF DIRECTORS WHO RECEIVES COMPENSATION FOR PROVISION OF SERVICES AS AN EMPLOYEE OR CONTRACTOR, DIRECTLY OR INDIRECTLY, FROM RHCC IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO MEMBER OF THE BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. 4. PHYSICIANS WHO RECEIVE COMPENSATION FROM RHCC, WHETHER DIRECTLY OR INDIRECTLY OR AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS. NO PHYSICIAN, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING PHYSICIAN COMPENSATION. SECTION 10. ANNUAL STATEMENTS EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING OR FOUNDATION BOARD DELEGATED POWERS, AND ALL LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON-- 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2. HAS READ AND UNDERSTANDS THE POLICY; 3. HAS AGREED TO COMPLY WITH THE POLICY; AND 4. UNDERSTANDS THAT RHCC IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 INDEPENDENT EXECUTIVE COMPENSATION STUDY WAS CONDUCTED AND YIELDED BASE PAY RANGES BASED ON VARIOUS REGIONAL MARKET AND NATIONAL SALARY SURVEYS. THE BOARD'S EVALUATION AND COMPENSATION COMMITTEE REVIEWED THE FULL SURVEY ALONG WITH PROPOSED SALARY RANGES AND CURRENT PAY. BOARD DISCUSSION TOOK PLACE AND MOTIONS AND APPROVALS OCCURRED REGARDING COMPENSATION CHANGES. DOCUMENTATION OF THIS IS WITHIN MEETING MINUTES. CEO AND BOARD CHAIR SIGN A SUMMARY SHEET FOR EACH EXECUTIVE. UPON COMPLETION OF ALL THIS, COMPENSATION CHANGES ARE THEN IMPLEMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT, WHICH PROVIDES AN OVERVIEW OF THE ORGANIZATION'S FINANCIAL STATUS, IS MADE AVAILABLE TO THE PUBLIC FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). IT IS MAILED TO MEMBERS OF THE ORGANIZATION, ORGANIZATIONS THAT WE HAVE FINANCING WITH, AND IS AVAILABLE ON OUR WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART VII, SECTION A JEFF EHNSTROM, MD: RIVERWOOD HEALTHCARE CENTER TIME ALLOCATION: EMPLOYMENT AS A DOCTOR: 40 HOURS PER WEEK BOARD OF DIRECTORS: 1 HOURS PER WEEK RIVERWOOD HEALTHCARE ASSOCIATION COMPENSATION: DOCTOR REPORTABLE COMPENSATION: $ 306,531 DOCTOR OTHER COMPENSATION: $ 27,788 BOARD REPORTABLE COMPENSATION: $ 0 BOARD OTHER COMPENSATION: $ 0 CHAD COOPER HOURS PER WEEK DEVOTED TO THE HOSPITAL = 39.9 HOURS PER WEEK DEVOTED TO THE FOUNDATION (RELATED ORGANIZATION) = 0.1 ALL COMPENSATION RECEIVED IS FOR CHAD'S POSITION AS THE HOSPITAL CEO. CASEY JOHNSON HOURS PER WEEK DEVOTED TO THE HOSPITAL = 39.9 HOURS PER WEEK DEVOTED TO THE FOUNDATION(RELATED ORGANIZATION) = 0.1 ALL COMPENSATION RECEIVED IS FOR CASEY'S POSITION AS THE HOSPITAL CFO. FORM 990, PART XI, LINE 9: DECREASE IN INTEREST IN NET ASSETS OF AITKIN COMMUNITY HOSPITAL FOUNDATION -91,728. RIVERWOOD HEALTH CARE CENTER FOUNDATION 200 BUNKER HILL DRIVE AITKIN MN 56431 411738787 SUPPORT MN 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0