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 411813221 CENTRACARE HEALTH SYSTEM CENT 3202512700 1406 6TH AVENUE NORTH ST CLOUD MN 56303 GREGORY R KLUGHERZ CFO 3202512700 2016-05-03 1 TODD A JACKSON P00092672 6123324300 2016-05-03 2014 2016-08-17 19:52:53Z TERENCE R PLADSON MD 1406 6TH AVENUE NORTH ST CLOUD MN 56303 182914102 0 X WWW.CENTRACARE.COM X 1995 MN THE CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 12 9 1789 349 467332 0 13811966 177151 157331689 176778976 692785 -1028925 733069 665361 172569509 176592563 9751 1049 0 0 70142368 109306522 0 0 791555 93329433 83219962 163481552 192527533 9087957 -15934970 176582230 185298098 90797825 94146535 85784405 91151563 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 48431247 78389219 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 REPROTING, THUS IT IS INCLUDED WITH THIS 990 FILING. MONTICELLO HOSPITAL IS A 25 BED CRITICAL ACCESS HOPSITAL AND ALSO OPERATES A 10 BED ACUTE REHAB UNIT. IN FISCAL YEAR 2015, THEY HAD 4,879 PATIENT DAYS, 26,785 OUTPATIENT VISITS AND 11,862 EMERGENCY ROOM VISITS' WHICH GENERATED $66,511,641 OF PROGRAM REVENUE AND $57,614,435 OF PROGRAM EXPENSES. 30616933 1049 36815507 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 2015, THEY HAD 2,299 PATIENT DAYS, 32,186 OUTPATIENT VISITS AND 3,586 EMERGENCY ROOM VISITS. IN FISCAL YEAR 2015, PAYNESVILLE GENERATED $37,453,716 OF PROGRAM REVENUE AND $30,616,933 OF PROGRAM EXPENSE. 22784542 32226028 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 1.8 MILLION TESTS IN FISCAL YEAR 2015. IN FISCAL YEAR 2015 CENTRACARE LABORATORY GENERATED $32,226,028 IN PROGRAM REVENUE AND INCURRED $22,784,542 OF EXPENSES. 44134378 29541925 THE OTHER MAIN ACTIVITY OF CENTRACARE HEALTH SYSTEM IS THE INFORMATION TECHNOLOGY SERVICES PROVIDED TO ALL ENTITIES WITHIN THE CENTRACARE UMBRELLA. ACTIVITIES INCLUDE FIELDING HELP DESK CALLS, INSTALLING SOFTWARE AND HARDWARE, MAINTAINING THE SERVERS, AND OTHER RELATED INFORMATION SYSTEM TASKS. THE REVENUE GENERATED FROM THIS ACTIVITY IN FISCAL YEAR 2015 WAS $23,465,795 AND GENERATED EXPENSES OF $38,043,127.CENTRACARE SURGICAL CENTER (CCSC) PROVIDES SURGICAL SERVICES TO THE COMMUNITY IT SERVES. IN FISCAL YEAR 2015 THERE WERE 3,519 SURGERIES PERFORMED. CCSC GENERATED $6,063,139 OF REVENUE AND $6,091,215 OF EXPENSE FOR AN OPERATING LOSS OF $28,112. 44134378 29541925 145967100 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 1 209 0 1 1789 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X GREGORY R KLUGHERZ 3202512700 1406 SIXTH AVENUE NORTH ST CLOUD MN 56303 TERENCE R PLADSON MD PRESIDENT/CEO 30.00 10.00 X X 1248123 0 260124 GENE WINDFELDT DIRECTOR, CHAIR 2.00 X X 4500 0 0 ROBERT WHITE DIRECTOR, VICE CHAIR 2.00 X X 1500 0 0 THOMAS W LEITHER MD DIRECTOR & SURGEON 2.00 38.00 X 0 414621 41519 CHRISTOPHER COBORN DIRECTOR 2.00 2.00 X 1500 0 0 DAVID AGERTER MD DIRECTOR 2.00 2.00 X 1000 0 0 DENISE ROSIN DIRECTOR 2.00 2.00 X 1500 0 0 STEVE LARAWAY DIRECTOR 2.00 X 1000 0 0 MIKE BENUSA DIRECTOR 2.00 X 2000 0 0 MOHAMED YASSIN MD DIRECTOR 2.00 X 2000 0 0 MARY JO WILLIAMSON DIRECTOR 2.00 X 1000 0 0 ROBERT STOCKER MD DIRECTOR & OB/GYN 2.00 38.00 X 0 635078 19500 JOSEPH UPHUS DIRECTOR 2.00 X 2000 0 0 GREGORY R KLUGHERZ TREASURER/CFO 16.00 24.00 X 0 642402 136804 PAUL R HARRIS CORPORATE SECRETARY 25.00 15.00 X 431612 0 93140 GERRY G GILBERTSON ADMINISTRATOR-MELROSE 0.50 39.50 X 257415 0 49857 DANIEL J SWENSON ADMINISTRATOR-LONG PRAIRIE 0.50 39.50 X 243186 0 55657 DELANO A CHRISTANSON ADMINISTRATOR - SAUK CENTR 0.50 39.50 X 212170 0 62752 MARY E WELLS ADMINISTRATOR - MONTICELLO 40.00 X 272079 0 53961 JOSEPH D HELLIE VICE PRESIDENT 38.00 2.00 X 221579 0 52790 DENNIS C MILEY ADMINISTRATOR-PAYNESVILLE 40.00 X 232381 0 60237 JOSEPH M BLONSKI MD PHYSICIAN 40.00 0.00 X 299316 0 41468 MARK J LARKIN VICE PRESIDENT OF DEVELOPMENT 40.00 0.00 X 286565 0 68438 MARY V PHIPPS DIRECTOR 40.00 0.00 X 229749 0 42490 ALLEN HORN MD PHYSICIAN RELATIONS 40.00 X 329291 0 3834 MARSHALL SMITH FORMER OFFICER (CEO-MONTICELLO) 0.00 0.00 X 263600 0 0 4545066 1692101 1042571 67 1 1 0 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1406 6TH AVE NORTH ST CLOUD MN 56303 EMERGENCY COVERAGE 4093135 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 PHYSICIAN SERVICES 3799709 MAYO MEDICAL LABORATORIES PO BOX 4100 ROCHESTER MN 559034100 LABORATORY SERVICES 3482355 METRO ANESTHESIA CONSULTANT 9855 AETNA AVE NE MONTICELLO MN 55362 ANESTHESIA SERVICES 2075824 CENTRAL MINNESOTA DIAGNOSTIC INC 150 10TH STREET NW MILACA MN 56353 RADIOLOGY SERVICES 1558968 26 58080 119071 177151 PATIENT & SERVICE REVENUE 900099 136525362 136058030 467332 CORPORATE REVENUE 900099 23465795 23465795 SHARED/LEGAL SYSTEM REVENUE 900099 6226404 6226404 HEALTH INSURANCE PREMIUM CREDIT 900099 6059178 6059178 OTHER REVENUE 900099 3415919 3415919 1086318 1086318 176778976 -472878 -472878 5715657 5699109 16548 16548 16548 21995 578042 -556047 -556047 -556047 32169 44388 -12219 -12219 REVENUE FROM JOINT VENTURES 900099 660907 660907 ALL OTHER REVENUE 900099 125 125 661032 176592563 176972676 467332 -1024596 X 1049 1049 3609114 3609114 89324230 75195891 14099272 29067 3948262 3748893 173010 26359 8621955 8023582 598373 3802961 3407367 314439 81155 666148 13343 652805 129751 5107 124644 19762 11051 8601 110 22193539 19924850 1933551 335138 546822 157514 286710 102598 2676405 1804143 822066 50196 16852354 16852354 417584 14150 403434 108055 69580 25913 12562 465152 361912 80794 22446 2044398 246430 1797968 5266121 3587155 1677030 1936 1428437 272578 1155515 344 DRUGS/MEDICAL SUPPLIES 17141948 17141948 BAD DEBT 2924276 2924276 MEDICAID SURCHARGE/MN C 2443273 2443273 7895937 6613008 1153285 129644 192527533 145967100 45768878 791555 15715128 17126130 496690 0 0 20382978 36583201 1031106 1437263 0 2676939 2960793 1386050 1414651 187948009 103509375 86044616 84438634 31747194 26122345 495149 31821461 176582230 185298098 33618221 38990118 138928 0 42425678 44638396 8903231 6497227 5711767 4020794 90797825 94146535 X 85784405 91151563 85784405 91151563 176582230 185298098 X -15934970 699225 20602903 X 0 1 X 1 0 X X 7 ST CLOUD HOSPITAL 410695596 3 1 38313970 0 CENTRACARE CLINIC 411806657 3 1 10004563 0 CENTRACARE HEALTH SYSTEM - MELROSE 411865315 3 1 1541305 0 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE 411924645 3 1 1441473 0 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 411708142 3 1 705858 0 CENTRACARE HEALTH FOUNDATION 411855173 3 1 124764 0 CENTRACARE HEALTH SYSTEM - SAUK CENTRE 452438973 3 1 1520628 0 7 53652561 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 19386 19386 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 AMERICAN HOSPITAL ASSOCIATION (AHA), A PORTION OF WHICH RELATES TO LOBBYING ACTIVITIES. FOR FY 2015, MHA HAS DETERMINED THAT 3.9% OR $6,662 OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. THE AMERICAN MEDICAL GROUP HAS DETERMINED THAT 20% OR $2,850 OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES. THE AMERICAN HOSPITAL ASSOCIATION HAD DETERMINED 22.80% OR $9,874 OF ITS MEMBERSHIP DUES ARE RELATED TO LOBBYING. THE TOTAL LOBBYING EXPENSES FOR FY15 TOTALED $19,386. 8777911 8777911 125994762 61930108 64064654 52659887 41556410 11103477 515449 22857 492592 84438634 FUNDS HELD BY TRUSTEE UNDER BOND INDENTURES 12874438 C FUNDS HELD BY BOARD FOR FUTURE PROPERTY & EQUIP REPLACEMENT/EXPANSION 13247907 C 26122345 DEFERRED DEBT ACQUISITION COST 226949 DUE FROM AFFILIATED ORGANIZATIONS 19201899 OTHER ASSETS 12392613 31821461 LT SETTLEMENT RESERVES 218014 PENSION ACCRUAL 99167 CONTINGENT CONSIDERATION 1380878 DUE TO AFFILIATES 2322735 4020794 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 330163 0 330163 0.00330 18934456 14891944 4042512 0.04070 19264619 14891944 4372675 0.04400 22224 0 22224 0.00020 12329 12329 0.00010 21351 21351 0.00020 55904 55904 0.00050 19320523 14891944 4428579 0.04450 1 2475646 28370130 28250787 119343 X 1 1 1 MONTICELLO CANCER CENTER RADIATION & ONCOLOGY SERVICES 0.60000 0.00000 0.00000 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 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 X X 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 X 0 0 CENTRACARE HEALTH - PAYNESVILLE 2 0 1 0 0 1 X 175.000000000000 250.000000000000 X X X 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 0 X X 0 0 CENTRACARE HEALTH - MONTICELLO 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 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 - PAYNESVILLE BECAME PART OF THE CENTRACARE HEALTH SYSTEM (CCHS) GROUP ON OCTOBER 1, 2013. CCHS CONDUCTED ITS MOST RECENT CHNA JOINTLHY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE END OF ITS FISCAL YEAR 2013 (6/30/2013). BECAUSE PAYNESVILLE WAS NOT PART OF THE CCH GROUP AS OF 6/30/2013 IT WAS NOT INCLUDED IN THE MOST RECENT CHNA. PAYNESVILLE WILL CONDUCT ITS FIRST COMMUNITY HEALTH NEEDS ASSESSMENT IN FY 2016. CENTRACARE HEALTH - MONTICELLO PART V, SECTION B, LINE 5: 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 - MONTICELLO 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 AND CENTRACARE HEALTH - SAUK CENTRE. EACH HOSPITAL PREPARED INDIVIDUAL ACTION PLANS TO THE CHNA BASED ON SPECIFIC INPUT FROM THOSE COMMUNITIES. 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 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 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 - 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: PER AGREEMENT WITH THE MINNESTOA ATTORNEY GENERAL, THE ORGANIZATION PROVIDES A DISCOUNT TO THE UNINSURED EQUAL TO THE AVERAGE DISCOUNT OF OUR LARGEST (BY VOLUME) NON-GOVERNMENTAL PAYOR. CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 22D: PER AGREEMENT WITH THE MINNESTOA 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 - MONTICELLO PART V, SECTION B, LINE 16B WEBSITE: WWW.CENTRACARE.COM CENTRACARE HEALTH - PAYNESVILLE PART V, SECTION B, LINE 16B WEBSITE: WWW.CENTRACARE.COM 8 MONTICELLO CARE CENTER 1104 EAST RIVER STREET MONTICELLO MN 55362 SKILLED NURSING FACILITY MONTICELLO CLINIC 1001 HART BLVD STE 100 MONTICELLO MN 55362 CLINIC KORONIS MANOR CARE CENTER 200 WEST FIRST STREET PAYNESVILLE MN 56362 SKILLED NURSING FACILITY CCH PAYNESVILLE- BELGRADE CLINIC 505 NELSON AVENUE BELGRADE MN 56312 CLINIC CCH PAYNESVILLE - COLD SPRING CLINIC 308 FIFTH AVENUE SOUTH COLD SPRING MN 56320 CLINIC CCH PAYNESVILLE - EDEN VALLEY CLINIC 405 MEEKER AVENUE EDEN VALLEY MN 56362 CLINIC CCH PAYNESVILLE - PAYNESVILLE CLINIC 200 WEST FIRST STREET PAYNESVILLE MN 56362 CLINIC 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 I, LN 7 COL(F): THE HOSPITALS' BAD DEBT EXPENSE WAS ESTIMATED USING THE COST TO CHARGE RATION DESCRIBED IN PART I, LINE 7 AND MULTIPLYING BY TOTAL BAD DEBTS (WHICH ARE WRITTEN OFF AT GROSS CHARGES UNLESS A SELF PAY DISCOUNT WAS TAKEN ON THE ACCOUNT PRIOR TO BEING WRITTEN OFF). 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 $185,935 IN TREATING MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT IN ITS ENTIRETY. THE HOSPITALS PROVIDE AN EXCELLENT LEVEL OF CARE TO THE PEOPLE IN THE COMMUNITIES SERVED. 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 2010 CENSUS SHOWS A POPULATION OF 11,553 WHICH WAS A 46.84% INCREASE OVER THE 2000 FIGURE OF 7,867. 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: 0-5: 13.34% 6-11: 10.95%, 12 TO 17: 10.01%, 18 TO 24: 9.17%, 25-34: 18.61%, 35-44: 13.77%, 45-54: 10.01%, 55-64: 6.73%, 65-74: 3.38%, 75-84: 2.50%, 85+: 1.54%.THE 2010 CENSUS DATA ETHNICITY BREAKDOWN FOR MONTICELLO, MN WAS AS FOLLOWS: CAUCASIAN: 92.47%, HISPANIC: 3.54%, ASIAN: 1.06%, AFRICAN AMERICAN: 1.03%, OTHER: 3.6%.CENTRACARE HEALTH - PAYNESVILLE IS LOCATED IN CENTRAL MINNESOTA IN STEARNS COUNTY. THE 2010 CENSUS SHOWS A POPULATION OF 2,115 WHICH WAS A 6.70% DECREASE OVER THE 2000 FIGURE OF 2,267. 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: 0-5: 8.04% 6-11: 7.14%, 12 TO 17: 8.89%, 18 TO 24: 7.85%, 25-34: 10.07%, 35-44: 11.49%, 45-54: 13.19%, 55-64: 12.53%, 65-74: 8.18%, 75-84: 3.91%, 85+: 4.87%.THE 2010 CENSUS DATA ETHNICITY BREAKDOWN FOR PAYNESVILLE, MN WAS AS FOLLOWS: CAUCASIAN: 97.21%, HISPANIC: 2.32%, ASIAN: .38%, AND AFRICAN AMERICAN: .09%. 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 1 1 0 0 0 0 1 0 0 TERENCE R PLADSON MD PRESIDENT/CEO 876657 0 199174 0 172292 0 242933 0 20998 0 1512054 0 151734 0 THOMAS W LEITHER MD DIRECTOR & SURGEON 0 355795 0 56285 0 2541 0 19164 0 24978 0 458763 0 0 ROBERT STOCKER MD DIRECTOR & OB/GYN 0 531441 0 100578 0 3059 0 19500 0 754 0 655332 0 0 GREGORY R KLUGHERZ TREASURER/CFO 0 442053 0 87461 0 112888 0 120553 0 20175 0 783130 0 87558 PAUL R HARRIS CORPORATE SECRETARY 331254 0 62700 0 37658 0 66572 0 35552 0 533736 0 34588 0 GERRY G GILBERTSON ADMINISTRATOR-MELROSE 172933 0 30799 0 53683 0 34166 0 24484 0 316065 0 33701 0 DANIEL J SWENSON ADMINISTRATOR-LONG PRAIRIE 190266 0 36574 0 16346 0 32336 0 25182 0 300704 0 14331 0 DELANO A CHRISTANSON ADMINISTRATOR - SAUK CENTR 179415 0 29216 0 3539 0 37440 0 27105 0 276715 0 0 0 MARY E WELLS ADMINISTRATOR - MONTICELLO 225191 0 42750 0 4138 0 46133 0 9669 0 327881 0 0 0 JOSEPH D HELLIE VICE PRESIDENT 197385 0 22167 0 2027 0 28123 0 26589 0 276291 0 0 0 DENNIS C MILEY ADMINISTRATOR-PAYNESVILLE 200163 0 28899 0 3319 0 48004 0 14175 0 294560 0 0 0 JOSEPH M BLONSKI MD PHYSICIAN 285622 0 2816 0 10878 0 19203 0 22751 0 341270 0 0 0 MARK J LARKIN VICE PRESIDENT OF DEVELOPMENT 227329 0 44096 0 15140 0 41871 0 30642 0 359078 0 0 0 MARY V PHIPPS DIRECTOR 202486 0 18208 0 9055 0 16924 0 26053 0 272726 0 0 0 ALLEN HORN MD PHYSICIAN RELATIONS 117775 0 1506 0 210010 0 3708 0 129 0 333128 0 210009 0 MARSHALL SMITH FORMER OFFICER (CEO-MONTICELLO) 0 0 0 0 263600 0 0 0 0 0 263600 0 0 0 PART I, LINES 4A-B MARSHALL SMITH, FORMER CEO OF MONTICELLO HOSPITAL, RECEIVED A $260,000 SEVERANCE PAYMENT IN 2014. 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: TERENCE R PLADSON - PAID $151,734; ACCRUED $223,433 GREGORY R KLUGHERZ - PAID $87,558; ACCRUED $104,953 PAUL R HARRIS - PAID $34,588; ACCRUED $52,699 GERRY G GILBERTSON - PAID $33,701; ACCRUED $22,113 DANIEL J SWENSON - PAID $14,331; ACCRUED $21,593 MARK J LARKIN - PAID $12,867; ACCRUED $23,259 DELANO A CHRISTIANSON - PAID $0; ACCRUED $21,396 MARY ELLEN WELLS - PAID $0; ACCRUED $40,645 DENNIS C MILEY - PAID $0; ACCRUED $42,809 JOSEPH D HELLIE - PAID $0; ACCRUED $18,015 ALLEN HORN, MD - PAID $210,009; ACCRUED $0 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. A THE CITY OF ST CLOUD 416005515 78916VBB5 2009-08-10 201078369 HEALTH CARE REVENUE BONDS 2008D 0 0 0 B THE CITY OF ST CLOUD 416005515 78916VBX7 2010-02-03 187558690 HEALTH CARE REVENUE BONDS 2010AB 0 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 201078369 1408277 1954596 192377062 2013 1 0 1 1 B 47760000 187558690 11776763 2076662 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 0.00000 0.00400 0.00400 0 0 1 B 0 1 0 1 1 0.00000 0.02060 0.02060 0 0 1 C 0 0 0 1 1 0.01470 0.00000 0.01470 0 0 1 D 0 1 0 1 1 0.00630 0.00000 0.00630 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: 07/08/2014 ISSUER NAME: THE CITY OF ST CLOUD DATE THE REBATE COMPUTATION WAS PERFORMED: 06/20/2014 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 2014B 0 0 0 A 48876925 550981 48325944 2010 0 1 1 1 B 128310000 1643396 11331000 13356603 1 0 0 1 A 0 1 0 1 1 0.00000 0.02210 0.02210 0 0 1 B 0 1 0 1 1 0.00000 0.00560 0.00560 0 0 0 A 0 0 0 0 0 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 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 12,917,128. MANAGEMENT AND GENERAL EXPENSES 1,244,174. FUNDRAISING EXPENSES 62,932. TOTAL EXPENSES 14,224,234. CONTRACTED SERVICES/PURCH SVCS: PROGRAM SERVICE EXPENSES 7,007,722. MANAGEMENT AND GENERAL EXPENSES 689,377. FUNDRAISING EXPENSES 272,206. TOTAL EXPENSES 7,969,305. FORM 990, PART XI, LINE 9: PENSION PLAN ADJUSTMENT -9,444. NET EQUITY TRANSFERS BTWN RELATED ORGS 20,289,294. CAPITAL CONTRIBUTION 43,939. NON-CONTROLLING INTEREST DISTRIBUTION -800,000. NON-CONTROLLING INTEREST NET INCOME 1,079,114. 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