2016-05-12T08:27:37-05:00 2015-06-30 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2014-07-01 411924645 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE CENT 3207322141 20 SE NINTH STREET LONG PRAIRIE MN 56347 CRAIG BROMAN PRESIDENT 3207322141 2016-04-29 1 TODD A JACKSON P00092672 6123324300 2016-04-29 2014 2016-08-17 19:52:53Z CENTRACARE HEALTH - LONG PRAIRIE DR TERENCE PLADSON 20 SE NINTH STREET LONG PRAIRIE MN 56347 28644796 0 X WWW.CENTRACARE.COM X 1999 MN CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 5 0 293 200 0 0 111872 88063 24688944 28003915 425144 511383 45033 41435 25270993 28644796 50225 0 0 0 14587433 15421598 0 0 0 9465013 10785483 24102671 26207081 1168322 2437715 21581313 23824284 5248437 6018151 16332876 17806133 X CENTRACARE HEALTH WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 0 0 13788487 20440027 CCH - LONG PRAIRIE IS PART OF A LARGER INTEGRATED HEALTH CARE DELIVERY SYSTEM KNOWN AS CENTRACARE HEALTH, A SYSTEM RECOGNIZED FOR BEING A LEADER IN PROVIDING HIGH-QUALITY, COMPREHENSIVE CARE THROUGHOUT THE REGION. CCH - LONG PRAIRIE IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE SERVICES IN THE AREAS OF MEDICAL, SURGICAL, DIAGNOSTIC, AND OBSTETRICS ALONG WITH OTHER SERVICES OF 24 HOUR EMERGENCY ROOM, IMAGING, LABORATORY, REHABILITATION, AND CHEMOTHERAPY TO THE COMMUNITY OF LONG PRAIRIE AND THE SURROUNDING AREA. THERE WERE 600 ADMITS, 2,389 INPATIENT DAYS, AND 27,422 OUTPATIENT VISITS DURING FISCAL YEAR 2015. 4056394 3535069 CCH - LONG PRAIRIE OPERATES THE LONG PRAIRIE CLINIC WHICH IS CONVENIENTLY CONNECTED TO THE LONG PRAIRIE HOSPITAL FOR THE HEALTH CARE NEEDS OF THE COMMUNITY. LONG PRAIRIE CLINIC PROVIDES HEALTH CARE THROUGH A MIXTURE OF PHYSICIANS AND MIDLEVEL PROVIDERS. THERE WERE 20,895 CLINIC VISITS AND 865 SURGEON CLINIC VISITS DURING FISCAL YEAR 2015.CCH - LONG PRAIRIE ALSO OPERATES THE EAGLE VALLEY CLINIC IN EAGLE BEND, MN WHICH PROVIDES HEALTH CARE FOR BOTH THE CLARISSA AND EAGLE BEND COMMUNITIES AND SURROUNDING AREAS. THE EAGLE VALLEY CLINIC PROVIDES HEALTH CARE THROUGH THE USE OF MIDLEVEL PROVIDERS WITH OVERSIGHT OF THE PHYSICIANS FROM THE LONG PRAIRIE CLINIC. THERE WERE 1,400 CLINIC VISITS DURING FISCAL YEAR 2015. 4453627 4028819 THE CCH - LONG PRAIRIE CARE CENTER IS AN ATTACHED 70 BED SKILLED NURSING FACILITY THAT PROVIDES QUALITY, COMPASSIONATE CARE WITH AN EMPHASIS ON ENHANCING EACH RESIDENT'S PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL WELL-BEING. THERE WERE 24,473 RESIDENT DAYS DURING FISCAL YEAR 2015. 22298508 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 293 1 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X LARRY KNUTSON 3207327240 20 SOUTHEAST NINTH STREET LONG PRAIRIE MN 56347 TERENCE R PLADSON MD CEO 1.00 39.00 X X 0 1248123 260124 CRAIG J BROMAN PRESIDENT 1.00 39.00 X X 0 739657 164742 JAMES R DAVIS VICE PRESIDENT 0.00 0.00 X X 0 0 0 DAVID TILSTRA MD VICE PRESIDENT 1.00 39.00 X X 0 467937 90976 PAUL R HARRIS CORPORATE SECRETARY 2.00 38.00 X X 0 431612 93139 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 1.00 39.00 X X 0 642402 136804 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 39.50 0.50 X 0 243186 55657 JAMES M BERGMANN PHYSICIAN ASSISTANT 40.00 X 151261 0 25193 CHRISTOPHER A HAGEN PHARMACIST 40.00 X 139287 0 23283 ELIZABETH R CLARK PHYSICIAN ASSISTANT 40.00 X 138333 0 7396 THOMAS J HOCK PHYSICIAN ASSISTANT 40.00 X 138260 0 34761 LARRY KNUTSON DIRECTOR OF FINANCE 40.00 X 137603 0 35755 704744 3772917 927830 9 0 1 0 CENTRACARE CLINIC 1200 6TH AVENUE NORTH ST CLOUD MN 56303 PHYSICIAN SERVICES 1750389 CENTRAL MINNESOTA DIAGNOSTIC INC 150 TENTH ST NW PO BOX 158 MILACA MN 56353 MRI & CT SERVICES 341390 WEST CENTRAL ANESTESIA 520 COUNTRY OAK DRIVE SAUK CENTRE MN 56370 CRNA SERVICES 301443 WHITESELL MEDICAL STAFFING 1630 ANDERSON AVE SUITE 100 BUFFALO MN 55313 PHYSICIAN SERVICES 248393 NORTH CENTRAL AMBULANCE 18448 COUNTY ROAD 9 LESTER PRAIRIE MN 55354 AMBULANCE SERVICES 158922 5 88063 88063 PATIENT AND RESIDENT SERVICE REVE 900099 26779148 26779148 SUPPLIES/DRUGS/FOOD SALES 900099 863381 863381 OTHER PROGRAM REVENUE 900099 337736 337736 QUALITY & TECH INITIATIVES 900099 23650 23650 28003915 499883 499883 41435 0 41435 41435 41435 11500 0 11500 11500 11500 28644796 28003915 0 552818 X 11967006 10725805 1241201 553475 495678 57797 2161756 1923433 238323 739361 672278 67083 43453 43453 25275 25275 2962090 2344982 617108 92921 32194 60727 476436 476436 72513 52489 20024 69043 60881 8162 1395 1395 867187 867187 SUPPLIES 3591409 3425131 166278 EQIUPMENT RENT-MAINT 911634 710209 201425 MISCELLANEOUS 909451 224170 685281 BAD DEBT 762676 762676 26207081 22298508 3908573 0 3688787 6161808 3876477 4254079 273713 381009 175897 156331 17043243 9378915 7478916 7664328 5200144 4703779 434229 407550 453150 95400 21581313 23824284 2472143 3095026 18403 16108 2384274 2302148 373617 604869 5248437 6018151 X 16299828 17765160 33048 40973 16332876 17806133 21581313 23824284 X 2437715 -354822 -609636 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 312427 312427 8856341 4319590 4536751 1010528 152932 857596 6863947 4906393 1957554 7664328 ASSETS INTERNALLY DESIGNATED FOR CAPITAL ACQUISITIONS 4703779 F 4703779 THIRD PARTY PAYOR SETTLEMENTS 444642 ASSET RETIREMENT OBLIGATION 119004 CAPITAL LEASES 41223 604869 1 1 1 X 175.000000000000 1 X 1 1 1 0 1 1 204820 0 204820 0.00800 7799028 5576041 2222987 0.08740 8003848 5576041 2427807 0.09540 14268 0 14268 0.00060 205543 0 205543 0.00810 358 0 358 0.00000 220169 220169 0.00870 8224017 5576041 2647976 0.10410 1 762676 0 7364184 7568362 -204178 X 1 1 1 1 CENTRACARE HEALTH - LONG PRAIRIE 20 NINTH STRET SOUTHEAST LONG PRAIRIE MN 56347 X X X X RURAL HEALTH CLINIC, NURSING HOME CENTRACARE HEALTH - LONG PRAIRIE 1 0 0 1 X X X X X X X X X X 13 1 1 0 1 X WWW.CENTRACARE.COM X X 1 13 1 WWW.CENTRACARE.COM 0 0 1 X 175.000000000000 250.000000000000 X 1 1 X X X X 1 X WWW.CENTRACARE.COM X X X X X 1 X X 1 X X X X X X 1 X 0 0 CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 3J: CCH'S CHNA PROCESS ALSO CONSIDERED SECONDARY DATA FROM THE DARTMOUTH ATLAS, ROBERT WOOD JOHNSON, MINNESOTA DEPARTMENT OF HEALTH, US CENSUS BUREAU, MINNESOTA HOSPITAL ASSOCIATION, ST. CLOUD AREA UNITED WAY, CATHOLIC CHARITIES OF THE DIOCESE OF ST. CLOUD, MINNESOTA SENIOR FEDERATION, PUBLIC HEALTH DEPARTMENTS FROM APPROPRIATE COUNTIES AND ADDITIONAL FEDERAL AND STATE ENTITIES.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 SURVEYS 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 - LONG PRAIRIE 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 - LONG PRAIRIE PART V, SECTION B, LINE 6A: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE END OF ITS FISCAL 2013. THOSE FACILITIES INCLUDED ST. CLOUD HOSPITAL, CENTRACARE HEALTH MELROSE, CENTRACARE HEALTH LONG PRAIRIE, CENTRACARE HEALTH SAUK CENTRE AND CENTRACARE HEALTH - MONTICELLO.EACH HOSPITAL PREPARED INDIVIDUAL ACTION PLANS TO THE CHNA BASED ON SPECIFIC INPUT FROM THOSE COMMUNITIES. CENTRACARE HEALTH - LONG PRAIRIE 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 - LONG PRAIRIE 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 THE FOLLOWING SIX, BROAD COMMUNITY HEALTH ISSUES:1 - ACCESS TO PRIMARY CARE2 - CULTURALLY COMPETENT CARE3 - HEART DISEASE MORBIDITY AND MORTALITY (PRIMARILY IN BENTON COUNTY)4 - LINGUISTICALLY COMPETENT CARE5 - MENTAL HEALTH SERVICES6 - STROKE MORBIDITY AND MORTALITY (PRIMARILY BENSON COUNTY) ST. CLOUD HOPSITAL WILL MAITAIN 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 ORGANIZATIONS 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 2013 - 2015 LOCATED ON THE WEBSITE AT WWW.CENTRACARE.COM/APP/FILES/PUBLIC/1547/IMPLEMENTATION-STRATEGY.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 - LONG PRAIRIE 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 - LONG PRAIRIE 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 AS WELL. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 19D: THE ORGANIZATION CONTRACTS WITH SEVERAL COLLECTION AGENCIES TO ATTEMPT TO COLLECT PATIENT BALANCES. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST THE PATIENT. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 22D: 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 16B WEBSITE: WWW.CENTRACARE.COM 3 LONG PRAIRIE CARE CENTER 20 NINTH STREET SE LONG PRAIRIE MN 56347 NURSING HOME LONG PRAIRIE CLINIC 20 NINTH STREET SE LONG PRAIRIE MN 56347 CLINIC EAGLE VALLEY CLINIC 815 HWY 71 SOUTH EAGLE BEND MN 56446 CLINIC PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE ORGANIZATIONS' TOTAL EXPENSES WERE REDUCED BY THEIR NON-OPERATING REVENUE, MEDICAID SURCHARGE AND MN CARE TAX, AND THEIR COMMUNITY BENEFIT EXPENSE. THE NET TOTAL EXPENSES WERE THEN DIVIDED BY GROSS CHARGES TO DETERMINE THE 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 FOLLOWING IS FROM THE "ACCOUNTS RECEIVABLE" PARAGRAPH INCLUDED IN NOTE 2 OF THE ORGANIZATION'S AUDITED FINANCIALS."PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS, CONSIDERING HISTORICAL NET COLLECTION, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUECY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON 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 RESTRICITONS ON COLLECTION EFFORTS AS DETERMINED BY CENTRACARE." PART III, LINE 8: THE SHORTFALL OF $204,178 OF TREATING MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT IN ITS ENTIRETY. THE HOSPITAL PROVIDES AN EXCELLENT LEVEL OF CARE TO THE PEOPLE IN THE COMMUNITY. DESPITE THE SHORTFALL IN REIMBURSEMENT FROM MEDICARE, THE HOSPITAL 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 SECTION OF THAT REPORT, PRIMARILY THE D SERIES AND E SERIES. PART III, LINE 9B: THE COLLECTION POLICIES AT THE ORGANIZATION 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 REPORTING 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 THE ORGANIZATION'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: LONG PRAIRIE IS LOCATED IN TODD COUNTY, MN AND IS PREDOMINANTLY AN AGRICULTURAL COMMUNITY WITH A TOTAL POPULATION OF APPROXIMATELY 2,400 PEOPLE. TODD COUNTY HAS A TOTAL POPULATION OF 24,895 AND HAS WITNESSED A STEADY DECLINE OVER THE PAST DECADE, WITH A TOTAL PERCENT CHANGE IN POPULATION OF -22.2% FROM 2000 TO 2010. DURING THIS SAME TIME FRAME, THE STATE OF MINNESOTA EXPERIENCED A POPULATION GROWTH OF 7.45%. THE PER CAPITA INCOME OF THE RESIDENTS IN OUR AREA IS EXTREMELY DEPRESSED AT $19,530 COMPARED TO A STATE AVERAGE OF $30,858. PART VI, LINE 5: THE ORGANIZATION HAS A COMMUNITY BASED OPERATING COMMITTEE THAT MEETS ON A MONTHLY BASIS TO REVIEW VARIOUS ASPECTS OF THE FACILITY AND PROVIDE INPUT ON THOSE ASPECTS FROM A COMMUNITY PERSPECTIVE. THE ORGANIZATION PARTICIPATES IN THE COMMUNITY BLOOD DRIVES BY PROVIDING FOOD AND SUPPLIES FOR BOTH THE WORKERS AND BLOOD DONORS. THE FACILITY ALSO SPONSORS A HEALTH FAIR ON AN ANNUAL BASIS FOR THE LOCAL AND SURROUNDING COMMUNITIES. 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 0 1 0 0 0 0 1 0 0 TERENCE R PLADSON MD CEO 0 876657 0 199174 0 172292 0 242933 0 20998 0 1512054 0 151734 CRAIG J BROMAN PRESIDENT 0 592132 0 140893 0 6632 0 148251 0 30405 0 918313 0 0 DAVID TILSTRA MD VICE PRESIDENT 0 335222 0 92200 0 40515 0 68505 0 25541 0 561983 0 19605 PAUL R HARRIS CORPORATE SECRETARY 0 331254 0 62700 0 37658 0 66572 0 35552 0 533736 0 34588 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 0 442053 0 87461 0 112888 0 120553 0 20175 0 783130 0 87558 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 0 190266 0 36574 0 16346 0 32336 0 25182 0 300704 0 14331 JAMES M BERGMANN PHYSICIAN ASSISTANT 148866 0 1515 0 880 0 11476 0 14178 0 176915 0 0 0 CHRISTOPHER A HAGEN PHARMACIST 137258 0 1398 0 631 0 7116 0 17648 0 164051 0 0 0 THOMAS J HOCK PHYSICIAN ASSISTANT 135381 0 1443 0 1436 0 10644 0 24589 0 173493 0 0 0 LARRY KNUTSON DIRECTOR OF FINANCE 118829 0 13822 0 4952 0 10702 0 25521 0 173826 0 0 0 PART I, LINE 3 THE COMPENSATION PAID TO THE PRESIDENT AND VICE-PRESIDENTS (NON-MEDICAL PROVIDERS) IS DETERMINED BY CENTRACARE HEALTH SYSTEM, A RELATED ORGANIZATION. CENTRACARE HEALTH SYSTEM USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED 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 FORM 990, THE AMOUNTS LISTED IN PART VII AND SCHEDULE J, PART II, COLUMN C, REFLECT TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON FORM 990 - ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF AND WHEN IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: TERENCE R PLADSON, MD - PAID $151,734; ACCRUED $223,433 DANIEL J SWENSON - PAID $14,331; ACCRUED $21,593 GREGORY R KLUGHERZ - PAID $87,558; ACCRUED $104,953 PAUL R HARRIS - PAID $34,588; ACCRUED $52,699 DAVID TILSTRA, MD - PAID $19,605; ACCRUED $49,005 CRAIG J BROMAN - PAID $0; ACCRUED $128,751 PART I, LINE 6 THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR CENTRACARE CLINIC OR CENTRACARE HEALTH SYSTEM; ACHIEVEMENT OF IMPROVEMENT IN PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; ACHIEVEMENT OF IMPROVEMENT IN OVERALL EMPLOYMENT ENGAGEMENT SCORES; AND ACHIEVEMENT OF UP TO THREE INDIVIDUAL GOALS WHICH ARE TIED TO THE CENTRACARE SYSTEM'S STRATEGIC PLAN. 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 INCENTIVE COMPENSATION IS PAID. FORM 990, PART VI, SECTION A, LINE 6 CENTRACARE HEALTH SYSTEM, A MINNESOTA NONPROFIT ASSOCIATION, IS THE SOLE MEMBER OF CENTRACARE HEALTH SYSTEM - LONG PRAIRIE. FORM 990, PART VI, SECTION A, LINE 7A ALL BOARD MEMBERS ARE APPOINTED BY CENTRACARE HEALTH SYSTEM, THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS ARE RESERVED FOR ACTION BY CENTRACARE HEALTH SYSTEM, THE SOLE MEMBER: 1. ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. 2. APPOINTMENT OF DIRECTORS AND OFFICERS. 3. APPROVAL OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY DEBTS TO BE INCURRED. 4. APPROVAL OF ALL STRATEGIC PLANS. 5. DETERMINATION OF THE DISSOLUTION OF OR THE DISCONTINUATION OF THE BUSINESS OF THE CORPORATION. 6. APPROVAL OF ANY TRANSACTION WHICH MAY AFFECT THE CORPORATION'S STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXATION. FORM 990, PART VI, SECTION B, LINE 11 ANNUALLY, AT THE BOARD OF DIRECTORS' MEETING, PRIOR TO FILING WITH THE IRS, THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW THE FORM 990 WITH 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 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. THE MOST RECENT FULL REVIEW WAS DONE MAY 2015. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. COULD HOSPITAL TO PERFORM SERVICES. FORM 990, PART VI, QUESTION 15B: THE COMPENSATION AND BENEFITS OF 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. THE MOST RECENT FULL REVIEW WAS COMPLETED IN MAY 2015. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. CLOUD HOSPITAL TO PERFORM THESE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES DO AN ANNUAL REPORT TO THE COMMUNITY IN WHICH FINANCIAL RESULTS ARE REPORTED TO AND DISCUSSED WITH THE PUBLIC. THIS REPORT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 2,344,982. MANAGEMENT AND GENERAL EXPENSES 617,108. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,962,090. FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS TO AFFILIATED ORGANIZATIONS -621,886. CAPITAL CONTRIBUTIONS FROM CENTRACARE FOUNDATION 12,250. 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