2015-11-16T12:57:28-06:00 2014-12-31 135665207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2014-01-01 390908320 AMERY REGIONAL MEDICAL CENTER INC AMER 7152688000 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DEBRA RUDQUIST PRESIDENT & CEO 7152688000 2015-11-16 1 ANN LAMOUREUX P00691316 6123055000 2014 2016-02-25 16:41:14Z X DEBRA RUDQUIST 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 52649688 0 X WWW.AMERYMEDICALCENTER.ORG X 1954 WI SEE PART III, LINE 1 - "ORGANIZATION'S MISSION" 13 6 504 46 0 0 1218419 79333 33484207 50935728 24371 90732 700380 1413667 35427377 52519460 43574 23373 0 0 14262126 30803652 0 0 0 22127508 20765682 36433208 51592707 -1005831 926753 60296588 62494933 41739669 42425170 18556919 20069763 X AMERY REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDEACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THEHEALTH AND WELLNESS OF ITS COMMUNITY. 0 0 45079685 23373 52061777 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 45079685 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 504 1 0 0 0 0 0 0 0 0 0 0 X 13 6 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X JASON LUHRS - CFO 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 DANIEL LIEN DIRECTOR & CHAIR 2.00 1.00 X 1200 0 0 JAMES A LEADHOLM JR DIRECTOR & VICE CHAIR 1.50 1.00 X 1200 0 0 DAN DRAXLER DIRECTOR 1.50 0.50 X 1200 0 0 ROSS R BULLARD DIRECTOR & TREASURER 1.50 43.50 X 0 199103 60564 J DANIEL NELSON MD DIRECTOR 1.00 49.00 X 0 554102 112665 JEFFREY J ROBERTSON DIRECTOR 1.50 48.50 X 0 761012 39693 HEIDI ERSPAMER DIRECTOR 1.00 0.50 X 1200 0 0 JOAN BYRNES DIRECTOR & SECRETARY 1.00 0.50 X 1200 0 0 KATHRYN ISAKSON DIRECTOR 24.00 0.50 X 27903 0 232 RANAE NYGAARD DIRECTOR 1.00 0.50 X 1200 0 0 ANN SEAGREN MD DIRECTOR 1.00 39.00 X 0 206459 37093 NANCY MAGNINE PAC DIRECTOR 1.00 39.00 X 0 109872 24555 DYLAN COE MD DIRECTOR 1.00 39.00 X 0 225283 29396 DEBRA RUDQUIST PRESIDENT & CHIEF EXECUTIVE OFFICER 49.50 0.50 X 0 92591 10284 JAMES QUENAN MD CHIEF MEDICAL OFFICER 0.50 39.50 X 0 258811 81260 JOYCE SCHAEFER ADMINISTRATOR-PATIENT CARE 40.00 X 135908 0 30871 SANDRA REED ADMINISTRATOR-CLINICAL SERVICES 45.00 X 125145 0 30681 JOANNE JACKSON DIRECTOR-HR,PR & MKTG 40.00 X 113455 0 18650 MARK MOIOFFER PHARMACIST 40.00 X 119697 0 8531 MARK TRYGGESTAD DIRECTOR OF PHARMACY 40.00 X 156015 0 9747 685323 2407233 494222 8 0 1 0 GROUP HEALTH PLAN INC PO BOX 64059 ST PAUL MN 551640059 PHYSICIAN SERVICES 4666964 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 370271018 MANAGEMENT SERVICES 852784 ANESTHETISTS INC 130 S KNOWLES AVE PO BOX 376 NEW RICHMOND WI 54017 NURSE ANESTHITISTS 808494 HEALOGICS WOUND CARE 3087 MOMENTUM PLACE CHICAGO IL 606895330 WOUND HEALING MANAGEMENT 429431 DIAMOND HEALTHCARE CORP PO BOX 85050 RICHMOND VA 23285 BEHAVIORAL HEALTH MANAGEMENT 420302 12 5017 9365 64951 79333 NET PATIENT SERVICE RE 621110 49640058 49640058 OTHER OPERATING REVENU 900099 598639 598639 SUBSIDIARY REVENUE 900099 346051 346051 CONTRACT SERVICE REVEN 900099 183594 183594 FITNESS CENTER REVENUE 624110 167386 167386 50935728 217914 217914 92595 0 92595 92595 92595 3046 130228 -127182 -127182 -127182 EHR INCENTIVE REVENUE 900099 1126049 1126049 CAFETERIA AND OTHER SE 900099 195023 195023 1321072 52519460 52061777 0 378350 23373 23373 22800 22800 26865085 23910741 2954344 441526 371553 69973 2188035 1841277 346758 1286206 1082369 203837 32921 32921 67693 67693 4636836 3058117 1578719 311492 39294 272198 593356 472607 120749 958447 948226 10221 1012464 965260 47204 180124 121036 59088 6632 1556 5076 1344147 1344147 4266964 4161197 105767 155443 155443 MEDICAL SUPPLY & EQUIPM 2837899 2835824 2075 DRUG EXPENSE 2225350 2225350 EQUIPMENT RENT, REPAIR 1150612 1144128 6484 OTHER MISCELLANEOUS EXP 608632 412244 196388 376670 121386 255284 51592707 45079685 6513022 0 47900 27014 12930302 15059580 7097727 7267788 671808 711373 15255 544341 53925392 25259624 31374354 28665768 5662905 8176152 1967746 2025673 28142 17244 500449 60296588 62494933 5048954 8046688 1299935 35390780 34378482 41739669 42425170 X 17580403 18969763 976516 1100000 18556919 20069763 60296588 62494933 X 926753 586091 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 0 0 PART II-B, LINE 1: AMERY REGIONAL MEDICAL CENTER, INC. PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 1072735 1072735 26369041 9952217 16416824 20591882 11104457 9487425 5891734 4202950 1688784 28665768 X 52649688 0 52649688 -130228 -130228 52519460 51722935 130228 130228 51592707 0 51592707 PART X, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2014 OR 2013 FOR UNRECOGNIZED TAX BENEFITS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS -130,228. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 130,228. 1 1 X 1 X 1 X 1 1 1 0 1 1 424820 424820 0.00820 6345712 5684705 661007 0.01280 6770532 5684705 1085827 0.02100 468389 198661 269728 0.00520 15672 15672 0.00030 136116 136116 0.00260 620177 198661 421516 0.00810 7390709 5883366 1507343 0.02910 0 1079899 809924 16725345 16985527 -260182 X 1 1 2 1 AMERY REGIONAL MEDICAL CENTER 265 GRIFFIN STREET EAST AMERY WI 54001 X X X X A 2 AMERY REGIONAL MEDICAL CENTER WEST 230 DERONDA STREET AMERY WI 54001 X X X 10 BED INPATIENT BEHAVIORAL HEALTH DPU OF AMERY REGIONAL MEDICAL CENTER CAH A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 13 1 1 1 1 X WWW.AMERYMEDICALCENTER.ORG/ X HTTP://HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 13 1 HTTP://WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX 0 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: AMERY REGIONAL MEDICAL CENTER, - FACILITY 2: AMERY REGIONAL MEDICAL CENTER WEST GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: THE CHNA USED A COMBINATION OF SURVEY'S TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THE ASSESSMENT INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT AT MEDICAL CENTERS, THROUGH THE MEDICAL CENTERS WEB SITES, AND SURVEYS MAILED DIRECT TO COMMUNITY MEMBERS. IN TOTAL, THE ASSESSMENT RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP 10 AREAS OF FOCUS.THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE 10 AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDANCE PLACED VOTES ON THE TOP 5 AREAS.FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH 2. OBESITY 3. ALCOHOL USE GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: THE FOLLOWING HOSPITALS PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): - AMERY REGIONAL MEDICAL CENTER - OSCEOLA MEDICAL CENTER - ST. CROIX REGIONAL MEDICAL CENTER GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B: THE POLK COUNTY HEALTH DEPARTMENT PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT. GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: AMERY REGIONAL MEDICAL CENTER (ARMC) COULD NOT ADDRESS ALL OF THE NEEDS AS THE ALLOCATION OF ARMC'S RESOURCES ALONE WOULD NOT BE ENOUGH TO PROPERLY ADDRESS ALL OF THEM. IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT AND PARTNER HOSPITALS IN POLK COUNTY (OSCEOLA MEDICAL CENTER AND ST. CROIX REGIONAL MEDICAL CENTER), ARMC HAS IDENTIFIED THREE TOP PRIORITY AREAS BASED UPON THE CHNA. AN EXTENSIVE COMMUNITY HEALTHIMPROVEMENT PLAN (CHIP) IS IN PLACE AND ARMC HAS COMMITTED TO WORKING TO IMPROVE THE TOP THREE HEALTH FOCUS AREAS OF OBESITY, MENTAL HEALTH, AND UNHEALTHY ALCOHOL USE. ARMC HAS SET GOALS ALONG WITH WORK PLANS TO ACHIEVE THE GOALS; ACTIVE COMMITTEES ARE WORKING TOWARD ACHIEVING THE COMMUNITY INITIATIVES IN ALL THREE FOCUS AREAS. GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 5: THE CHNA USED A COMBINATION OF SURVEY'S TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THE ASSESSMENT INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT AT MEDICAL CENTERS, THROUGH THE MEDICAL CENTERS WEB SITES, AND SURVEYS MAILED DIRECT TO COMMUNITY MEMBERS. IN TOTAL, THE ASSESSMENT RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP 10 AREAS OF FOCUS.THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE 10 AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDANCE PLACED VOTES ON THE TOP 5 AREAS.FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH 2. OBESITY 3. ALCOHOL USE GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 6A: THE FOLLOWING HOSPITALS PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): - AMERY REGIONAL MEDICAL CENTER - OSCEOLA MEDICAL CENTER - ST. CROIX REGIONAL MEDICAL CENTER GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 6B: THE POLK COUNTY HEALTH DEPARTMENT PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT. GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 11: AMERY REGIONAL MEDICAL CENTER (ARMC) COULD NOT ADDRESS ALL OF THE NEEDS AS THE ALLOCATION OF ARMC'S RESOURCES ALONE WOULD NOT BE ENOUGH TO PROPERLY ADDRESS ALL OF THEM. IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT AND PARTNER HOSPITALS IN POLK COUNTY (OSCEOLA MEDICAL CENTER AND ST. CROIX REGIONAL MEDICAL CENTER), ARMC HAS IDENTIFIED THREE TOP PRIORITY AREAS BASED UPON THE CHNA. AN EXTENSIVE COMMUNITY HEALTHIMPROVEMENT PLAN (CHIP) IS IN PLACE AND ARMC HAS COMMITTED TO WORKING TO IMPROVE THE TOP THREE HEALTH FOCUS AREAS OF OBESITY, MENTAL HEALTH, AND UNHEALTHY ALCOHOL USE. ARMC HAS SET GOALS ALONG WITH WORK PLANS TO ACHIEVE THE GOALS; ACTIVE COMMITTEES ARE WORKING TOWARD ACHIEVING THE COMMUNITY INITIATIVES IN ALL THREE FOCUS AREAS. 5 ARMC REHAB SERVICES 220 N KELLER AVENUE AMERY WI 54001 REHABILITATION LUCK MEDICAL CLINIC 137 FIRST AVENUE LUCK WI 54853 RURAL HEALTH CLINIC TURTLE LAKE MEDICAL CLINIC 550 MARTIN AVENUE TURTLE LAKE WI 54889 RURAL HEALTH CLINIC CLEAR LAKE CLINIC 357 THIRD AVENUE CLEAR LAKE WI 54005 RURAL HEALTH CLINIC LUCK PT & FITNESS 2547 STATE ROAD 35 SUITE 5 LUCK WI 54853 PHYSICAL THERAPY PART III, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) USES A COST TO CHARGE METHODOLOGY. PART III, LINE 3: ARMC USES THE COST TO CHARGE COST METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. ARMC IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN ITS SERVICE AREA WHO ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH ARMC ALSO INCLUDES AS A COMMUNITY BENEFIT. PART III, LINE 4: ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE:THE FINANCIAL STATEMENTS DO NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOLLOWING IS PART OF THE ARMC'S PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS OR CHARITY CARE, BASED ON ESTABLISHED GUIDELINES FOR IDENTIFYING UNCOLLECTIBLE PATIENT ACCOUNTS AND CLASSIFYING THESE ACCOUNTS AS EITHER DOUBTFUL ACCOUNTS OR CHARITY CARE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ARMC'S MANAGEMENT PERIODICALLY ASSESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE BY TAKING INTO CONSIDERATION, BY PAYER CATEGORY, THE EXPECTED NET COLLECTIONS, ACCOUNTS RECEIVABLE AGING, HISTORICAL COLLECTIONS EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS THE PATIENT RESPONSIBILITY PORTION OF COMMERCIAL ACCOUNTS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR CHARITY CARE IS CHARGES FOR UNINSURED PATIENTS. PATIENTS WHO ARE INSURED ARE ASSESSED SEPARATELY FOR COLLECTABILITY FROM UNINSURED PATIENTS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO ESTABLISH THE NET REALIZABLE VALUE OF PATIENT ACCOUNTS RECEIVABLE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE.ARMC PROVIDED MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COST TO PATIENTS WHO WERE DETERMINED TO BE UNABLE TO PAY (CHARITY CARE) OF $778,638 AND $1,153,581 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY, AND PROVIDED MEDICAL CARE TO PATIENTS WHO WERE DETERMINED TO BE ABLE, BUT UNWILLING, TO PAY (DOUBTFUL ACCOUNTS) OF $2,289,688 AND $2,315,465 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. ACCORDINGLY, ARMC DOES NOT SEPARATE ALLOWANCE ACCOUNTS FOR DOUBTFUL ACCOUNTS AND CHARITY CARE. PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE ARMC IS INCURRING THE COST OF PROVIDING SERVICES TO MEDICARE PATIENTS AND NOT GETTING PAID COMPLETELY BY MEDICARE FOR THE COST OF PROVIDING THESE SERVICES. PART III, LINE 9B: ARMC IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. AS PART OF THIS MISSION, ARMC ADMINISTERS A FINANCIAL ASSISTANCE PROGRAM TO HELP PATIENTS WHO NEED MEDICAL CARE BUT HAVE DIFFICULTY WITH RELATED MEDICAL EXPENSES. IN ARMC FACILITIES, NON-ELECTIVE PROFESSIONAL MEDICAL SERVICES WILL BE PROVIDED WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY AND FINANCIAL ASSISTANCE WILL BE MADE AVAILABLE. PROGRAM ELIGIBILITY IS BASED ON INCOME, ASSETS, LIABILITIES AND FAMILY SIZE UTILIZING A SLIDING DISCOUNT BASED ON THE LATEST HEALTH AND HUMAN/SERVICES (HHS) FEDERAL POVERTY GUIDELINES. PATIENTS IN NEED OF FINANCIAL ASSISTANCE ARE SENT AN APPLICATION AND FOLLOWED UP IN COORDINATION WITH THE HEALTH BENEFITS COUNSELOR. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. PART VI, LINE 7, REPORTS FILED WITH STATES WI PART VI, LINE 2 ARMC COMPLETED A CHNA IN COORDINATION WITH THE POLK COUNTY HEALTH DEPARTMENT, OSCEOLA MEDICAL CENTER, AND ST. CROIX REGIONAL MEDICAL CENTER IN FISCAL YEAR 2013.THIS CHNA IDENTIFIED THE TOP TEN COMMUNITY NEEDS AND PROVIDES DETAILED STATISTICS BREAKING DOWN THOSE NEEDS AND THEIR EFFECT ON THE COMMUNITY IN RELATION WITH THE ARMC'S ROLE IN ADDRESSING THOSE NEEDS. PART VI, LINE 3 ARMC'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS WHO ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE, ARE REFERRED TO ARMC'S HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH ARMC AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON THE ARMC'S INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION. PART VI, LINE 4 ARMC'S SERVICE AREA INCLUDES FIFTEEN DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES THREE RURAL HEALTH CLINICS IN LUCK, TURTLE LAKE, & CLEAR LAKE WHICH ARE ALL MEDICALLY UNDERSERVED AREAS. THE ARMC COMMUNITY IS ALSO CONSIDERED A MENTAL HEALTH MEDICALLY UNDERSERVED AREA. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS PATIENTS FROM OUTSIDE ARMC'S NORMAL SERVICE AREA. PART VI, LINE 5 TEN OF ARMC'S THIRTEEN BOARD MEMBERS LIVE IN ARMC'S SERVICE AREA. ARMC HAS AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, AND OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN ARMC'S COMMUNITY. PART VI, LINE 6 HEALTHPARTNERS AND ARMC HAVE HAD A LONG-STANDING RELATIONSHIP, WITH HEALTHPARTNERS EMPLOYING AND SOURCING PHYSICIANS AND MID-LEVEL PRACTITIONERS TO ARMC FOR ARMC'S PRIMARY CARE CLINICS. AS OF 2014, ARMC BECAME PART OF THE HEALTHPARTNERS FAMILY OF MISSION-DRIVEN NON-PROFIT ORGANIZATIONS. AS PART OF THE HEALTHPARTNERS FAMILY, ARMC USES HEALTHPARTNERS' INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM, PARTICIPATES IN COORDINATED CHNA PROCESSES AND IMPLEMENTATION STRATEGIES, ACCESSES CENTRALIZED SUPPORT SERVICES IN FINANCE, LEGAL, IS AND T, AND QUALITY. THE FOUR HEALTHPARTNERS HOSPITALS IN THE ST. CROIX VALLEY - STILLWATER MN AND HUDSON, NEW RICHMOND, AND AMERY WI - WORK TOGETHER TO ESTABLISH ACCESSIBLE AND COORDINATED SPECIALTY SERVICES IN THE VALLEY FOR THE BENEFIT OF VALLEY RESIDENTS. EXAMPLES OF THESE SERVICES INCLUDE RADIATION THERAPY ON THE NEW RICHMOND CAMPUS, BREAST DIAGNOSTICS ON THE LAKEVIEW CAMPUS, AND GERIATRIC BEHAVIORAL HEALTH SERVICES ON THE AMERY CAMPUS. HEALTHPARTNERS INCLUDES INSURANCE AND HMO (HEALTH MAINTENANCE ORGANIZATION) ENTITIES THAT PROVIDE CARE COORDINATION, DISEASE MANAGEMENT, ON-LINE CARE FOR BASIC CONDITIONS, A 24 HOUR/7 DAY PER WEEK NURSE LINE, AND OTHER SERVICES THAT ENHANCE CARE FOR MEMBERS, PATIENTS AND THE COMMUNITY. 1 WISCONSIN MEDICAL SOCIETY INC 330 E LAKESIDE ST PO BOX 1109 MADISON WI 537011109 8000 PROGRAM SUPPORT 1 0 PART I, LINE 2: AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH ARMC'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO ARMC'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. X X 0 0 0 0 0 0 0 0 0 ROSS R BULLARD DIRECTOR & TREASURER 0 173194 0 25909 0 0 0 27860 0 32704 0 259667 0 0 J DANIEL NELSON MD DIRECTOR 0 473107 0 80000 0 995 0 70120 0 42545 0 666767 0 995 JEFFREY J ROBERTSON DIRECTOR 0 416986 0 299000 0 45026 0 5100 0 34593 0 800705 0 0 ANN SEAGREN MD DIRECTOR 0 206459 0 0 0 0 0 19208 0 17885 0 243552 0 0 DYLAN COE MD DIRECTOR 0 225283 0 0 0 0 0 21890 0 7506 0 254679 0 0 JAMES QUENAN MD CHIEF MEDICAL OFFICER 0 242405 0 10640 0 5766 0 46288 0 34972 0 340071 0 999 JOYCE SCHAEFER ADMINISTRATOR-PATIENT CARE 135908 0 0 0 0 0 4319 0 26552 0 166779 0 0 0 SANDRA REED ADMINISTRATOR-CLINICAL SERVICES 125145 0 0 0 0 0 3954 0 26727 0 155826 0 0 0 MARK TRYGGESTAD DIRECTOR OF PHARMACY 155381 0 0 0 634 0 4486 0 5261 0 165762 0 0 0 SCHEDULE J, PART II - PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS AND OFFICERS: J. DANIEL NELSON, MD $ 995 JAMES QUENAN, MD $ 999 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. A VILLAGE OF LUCK WISCONSIN 396006307 2011-04-28 8500000 REFINANCE EXISTING DEBT 0 0 0 B CITY OF AMERY WISCONSIN 396005378 2011-04-13 8500000 REFINANCE EXISTING DEBT 0 0 0 C VILLAGE OF CLEAR LAKE WISCONSIN 396006238 2011-03-29 8500000 REFINANCE EXISTING DEBT 0 0 0 D TOWN OF BLACK BROOK POLK COUNTY WISCONSIN 391169876 2011-05-13 6150000 REFINANCE EXISTING DEBT 0 0 0 A 769121 8500000 170000 8330000 2007 1 0 1 1 B 769121 8500000 170000 8330000 2007 1 0 1 1 C 769121 8500000 170000 8330000 2007 1 0 1 1 D 557077 6150000 123000 6027000 2007 1 0 1 1 A 0 0 0 0 1 0 0 B 0 0 0 0 1 0 0 C 0 0 0 0 1 0 0 D 0 0 0 0 1 0 0 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 C 0 1 0 0 1 0 0 0 0 D 0 1 0 0 1 0 0 0 0 FORM 990, SCHEDULE K, PART IV, LINE 2A THRU 2C REBATE CALCULATION IS NOT DUE BUT EVERY 5 YEARS. THERE IS NO REBATE CACLULATION DUE FOR ANY BONDS LISTED IN SCHEDULE K, PART I. A TOWN OF LINCOLN POLK COUNTY WISCONSIN 391406159 2011-05-31 6150000 REFINANCE EXISTING DEBT 0 0 0 A 557077 6150000 123000 1709792 4317208 2007 1 0 1 1 A 0 0 0 0 1 0 0 A 0 1 0 0 1 0 0 0 0 FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER (ARMC), A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS "HEALTHPARTNERS". FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED SYSTEM OF HEALTH CARE DELIVERY AND HEALTH CARE FINANCING ORGANIZATIONS, AND IS ONE OF THE LARGEST CONSUMER-GOVERNED ORGANIZATIONS IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY, ALL AT THE SAME TIME. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS PROVIDES A FULL-RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLAN'S SERVE MORE THAN 1.5 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE, AND IS THE TOP-RANKED COMMERCIAL PLAN IN MINNESOTA. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,700 PHYSICIANS, SIX HOSPITALS, 55 PRIMARY CARE CLINICS, 22 URGENT CARE LOCATIONS AND NUMEROUS SPECIALTY PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. IN ADDITION, HEALTHPARTNERS DENTAL CARE SYSTEM HAS MORE THAN 60 DENTISTS AND 22 DENTAL CLINICS. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN THE HEALTHPARTNERS FAMILY, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2014 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF ARMC. GHI IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) A WISCONSIN NON-STOCK CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). BENEFIT TO THE COMMUNITY: 1. COMMUNITY HEALTH SERVICES: $269,728 - COMMUNITY HEALTH EDUCATION - ARMC HELPS EDUCATE THE LOCAL COMMUNITIES IN REGARDS TO HEALTH ISSUES BY PROVIDING THE FOLLOWING TYPES OF COMMUNITY EDUCATION: ASTHMA, BREASTFEEDING, CPR, CARDIAC SUPPORT, DIABETES, EXPECTANT PARENTS/PRE-NATAL, HEALTH FAIRS, NUTRITION COUNSELING, SMOKING CESSATION, AND SPORTS MEDICINE. THE FACILITY ALSO WORKS CLOSELY WITH LOCAL AND COUNTY REPRESENTATIVES TO INFORM THE COMMUNITY ABOUT GOVERNMENTAL BENEFITS AND PROGRAMS AVAILABLE. ARMC PROVIDES EDUCATION AT OUR SCHOOLS BY HOLDING A 3RD GRADE HEALTH FAIR REACHING 206 STUDENTS FROM AMERY, CLEAR LAKE, CLAYTON, AND TURTLE LAKE. THE FACILITY ALSO PROVIDED EDUCATION FOR EARLY CHILDHOOD DEVELOPMENT TARGETING PRE-K, ADOLESCENT SEXUALITY CLASSES AT AMERY SCHOOLS, SEX-EDUCATION CLASSES WERE OFFERED TO AMERY 8TH GRADE GIRLS AND MEDICAL PROFESSIONAL SPEAKERS AT CAREER DAY FOR HIGH SCHOOL STUDENTS. ARMC ALSO PARTICIPATED IN SHADOW TRAINING FOR HIGH SCHOOL STUDENTS WHO ARE INTERESTED IN PURSUING HEALTH CARE AS A CAREER. - COMMUNITY-BASED CLINICAL SERVICES - $2,911 ARMC HOSTED TWO BLOOD DRIVES COLLECTING A TOTAL OF 69 PINTS IN SUPPORT OF THE AMERICAN RED CROSS. BEHAVIORAL HEALTH SCREENED TEENS FOR DEPRESSION AT THE AMERY HIGH SCHOOL REACHING APPROXIMATELY 200 STUDENTS FROM THE 9TH AND 10TH GRADE. ARMC CONDUCTED FREE BLOOD PRESSURE CHECKS FOR 2014 AT A COST OF $379 (3 HEALTH FAIRS TOTALING 16 HRS OF STAFF TIME). INFLUENZA VACCINATIONS WERE ADMINISTERED TO STAFF MEMBERS AT VARIOUS EMPLOYER SITES AT A COST OF $1,165. - HEALTH CARE SUPPORT SERVICES - $255,423 ARMC'S PATIENT EMERGENCY FUND, SUPPORTED BY EMPLOYEES AND STAFF, DONATED $407 TO HELP 20 INDIVIDUALS RECEIVING CARE AT THE FACILITY IN 2014. FUNDS PROVIDED TO INDIVIDUALS WERE FOR EMERGENT NEEDS RELATED TO THEIR HEALTH INCLUDING EMERGENCY MEDICATIONS AND GAS CARDS. ARMC OPERATES A FITNESS CENTER IN AMERY AND LUCK TO MEET THE WELLNESS NEEDS OF THE COMMUNITIES. THIS SERVICE OPERATES AT A LOSS OF $96,386. SOCIAL WORKER, HEALTH BENEFIT COUNSELORS, AND PATIENT FINANCIAL SERVICES REPRESENTATIVES PROVIDE HEALTH CARE SUPPORT SERVICES TO INDIVIDUALS ON A ONE-ON-ONE BASIS. THESE STAFF MEMBERS HELP EDUCATE AND ASSIST INDIVIDUALS WITH ADVANCE DIRECTIVE SUPPORT, INFORMATION AND REFERRAL SERVICES, ENROLLMENT ASSISTANCE IN GOVERNMENT PROGRAMS, FINDING OTHER SOURCES OF PAYMENT, AND ACCESSING SERVICES BEYOND MEDICAL CARE. ARMC SPENT $99,848 IN STAFF TIME TO ASSIST 227 PATIENTS TO ENROLL IN PUBLIC MEDICAL PROGRAMS, REFER INDIVIDUALS TO COMMUNITY SERVICES/PUBLIC HEALTH ASSISTANCE AND HELP 165 PATIENTS WITH FINANCIAL ASSISTANCE. ARMC OPERATES A VAN TRANSPORTATION SERVICE FOR ITS RURAL PATIENT POPULATION. PATIENTS WHO ARE UNABLE TO ARRANGE THEIR OWN TRANSPORTATION TO ARMC FOR CARE AND TREATMENT MAY SCHEDULE A TRANSPORT. PERSONS WHO USE THE SERVICE ARE ASKED TO PAY $2.00 PER RIDE. OVER 1,200 PATIENTS USED THIS SERVICE IN 2014, WITH REVENUE JUST UNDER $4,000 AND OPERATING COST OF $62,000. FORM 990, PART III, LINE 4A 2. HEALTH PROFESSIONAL EDUCATION: $15,672 STUDENTS IN NURSING, PHYSICIAN ASSISTANT PROGRAMS, PHYSICAL THERAPY, MEDICAL RECORDS, MEDICAL ASSISTANT, LAB TECHNICIAN, NURSE PRACTITIONERS, AND MEDICAL ADMINISTRATIVE ASSISTANTS STUDY AT ARMC. WEEKLY MEDICAL CONFERENCES ARE OFFERED BY ARMC MEDICAL STAFF PRESENTING CASES AND EDUCATIONAL TOPICS TO VARIOUS STAFF. ARMC ALSO HAS AN AGREEMENT WITH UW MADISON FOR 4TH YEAR MEDICAL STUDENTS AND UM-DULUTH FOR FIRST YEAR AND SECOND YEAR MEDICAL STUDENT ROTATIONS. IN ADDITION, ARMC ACTIVELY COLLABORATES WITH THE WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) TO HELP EDUCATE AND TRAIN YOUNG NURSES. FOR THE YEAR 2014, ARMC PROVIDED CLINICAL TRAINING FOR 39 NURSES, 9 MED STUDENTS, 2 LAB TECHNICIANS AND 2 DIAGNOSTIC TECHNICIANS TOTALING 4,362 HOURS. EACH YEAR ARMC AND THE FOUNDATION PROVIDE SEVEN $1,000 SCHOLARSHIPS TO LOCAL HIGH SCHOOL SENIORS PURSUING A CAREER IN A HEALTH-RELATED FIELD. 3. SUBSIDIZED HEALTH SERVICES: ARMC IS COMMITTED TO SERVING OUR COMMUNITIES AND PROVIDING NEEDED SERVICES EVEN IF A FINANCIAL LOSS IS REALIZED. 4. FINANCIAL CONTRIBUTIONS: $45,008 - CASH DONATIONS - ARMC HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS TOTALING $26,223. - IN-KIND DONATIONS - IN-KIND SERVICES DONATED INCLUDED STAFF HOURS (112 HOURS $7,704) SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK (UNITED WAY OF ST. CROIX VALLEY), WITC HEALTH INFORMATION TECHNOLOGY, NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) AND MENTAL HEALTH TASK FORCE, AMERY COMMUNITY CLUB, POLK COUNTY CRIMINAL JUSTICE COLLABORATING COUNSEL , AMERY SCHOOL DISTRICT STRATEGIC PLANNING COMMITTEE, AMERY ECONOMIC DEVELOPMENT, LAKE WAPO/ BT SANITARY DISTRICT COMMISSIONER, AMERICAN CANCER SOCIETY, ST. CROIX VALLEY FAMILY RESOURCE CENTER, WITC PROGRAM REVIEW COMMITTEE AND ADVISORY COMMITTEE FOR MEDICAL ASSISTANTS). ARMC IS ALSO A STRONG ADVOCATE AND MEMBER OF THE ST. CROIX VALLEY SART (SEXUAL ASSAULT RESPONSE TEAM), WHICH FORMED IN ORDER TO HELP THOSE WHO HAVE EXPERIENCED ACUTE RAPE TRAUMA OR DOMESTIC ABUSE. MEDICAL EQUIPMENT AND PHARMACEUTICAL SUPPLIES TOTALING $66 WERE DONATED TO MEDICAL MISSION TRIPS IN HAITI. EXPENSES ABSORBED BY ARMC WHEN PROVIDING MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS LIKE THE AMERICAN CANCER SOCIETY-AMERY, CAREGIVERS SUPPORT GROUP OF POLK COUNTY, GIRL SCOUT LEADERSHIP, BABY & ME-FAMILY RESOURCE CENTER OF ST. CROIX VALLEY, AND CLAYTON AREA 4H CLUB TOTALED $1,015. - SPONSORSHIP ACTIVITIES/EVENTS - ARMC SPONSORS EVENTS SUCH AS THE AMERICAN CANCER SOCIETY WALK/RUN ($5000) IN AMERY, LUCK AND FREDERIC; ALZHEIMER'S GREAT WALK IN AMERY ($2500); AMERY FALL FESTIVAL ($2000) AND AMERY AREA COMMUNITY CENTER EVENTS ($500) TOTALING $10,000. 5. COMMUNITY BUILDING ACTIVITIES: $88,854 ARMC REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT POLK COUNTY, PARTS OF BARRON, BURNETT, AND ST. CROIX COUNTIES AND IS AN INVOLVED MEMBER IN LOCAL AND STATE COMMUNITIES. ARMC'S CONCERN FOR THE GROWTH AND DEVELOPMENT OF THE SURROUNDING COMMUNITIES AS WELL AS INDIVIDUAL WELFARE IS DEMONSTRATED BY PROVIDING EDUCATION AND RESOURCES TO ENCOURAGE POSITIVE COMMUNITY RELATIONS AND IMPROVE THE HEALTH OF ITS LOCAL COMMUNITIES. IMPLEMENTATION OF VARIOUS PROGRAMS IS SPECIFICALLY INTENDED TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. ARMC PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED CHILDREN'S SAFETY, DRUG AWARENESS, ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, WORK-FORCE DEVELOPMENT, LOCAL ARTISTS (COMMUNITY ART WALL/ART CASE), FITNESS AND HEALTH IN SCHOOLS, RADIO HEALTH EDUCATION PROGRAMS, HEALTH FAIRS, LOCAL FOOD SHELF, AND ADOPT-A-FAMILY PROGRAM FOR FAMILIES IN NEED. PARTNERSHIPS WITH SCHOOLS, CHURCHES AND OTHER ORGANIZATIONS MAKE MANY OF THESE PROGRAMS POSSIBLE. IN ORDER TO HELP COMBAT POVERTY, ARMC PROVIDES THE LOCAL FOOD SHELF, AMERY AREA FOOD SHELF, WITH FREE RENT, HEAT AND SHELVING FOR FOOD ITEMS. IN 2014, A TOTAL OF $26,919 WAS PROVIDED TO THIS LOCAL PROGRAM. ARMC CONTINUES TO BE ECO-FRIENDLY AND ENVIRONMENTALLY CONSCIOUS USING SUSTAINABLE INITIATIVES THAT ENSURE THE COMMUNITY'S HEALTH AND WELL-BEING. FROM RECYCLING PROGRAMS TO SUPPORT OF LOCAL GROWN ORGANIC PRODUCE TO THE DESIGN OF ARMC, ARMC EFFORTS ENCOURAGE HEALTHY LIFE CHOICES THROUGHOUT THE COMMUNITY. ENVIRONMENTAL-FRIENDLY ELEMENTS FOUND ON THE GROUNDS OF ARMC INCLUDE LANDSCAPING FOR WILDLIFE AND WATER QUALITY, RAIN GARDENS, GREEN ROOFS, PERVIOUS SURFACES, AND A COMMUNITY WALKING PATH WHICH ENHANCE THE VALUE OF THE NATURAL RESOURCES AND CONTRIBUTES TO THE HEALTH OF THE COMMUNITY. 6. COMMUNITY BENEFIT OPERATIONS: $2,253 ARMC HAS WORKED CLOSELY WITH POLK COUNTY AND OTHER AREA MEDICAL FACILITIES TO GATHER DATA AND COSTS ASSOCIATED WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT, AS WELL AS OTHER COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGY AND OPERATIONS. DEDICATED STAFF TIME, RESOURCES, AND OTHER COSTS INVOLVED IN THE REPORTING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR 2014 TOTAL $2,253. THE CHNA CONDUCTED IN 2013 INCLUDED AMRC, OSCEOLA MEDICAL CENTER, ST. CROIX REGIONAL MEDICAL CENTER AND POLK COUNTY HEALTH DEPARTMENT. THE CHNA USED A COMBINATION OF SURVEYS TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY WHICH INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT BY THE PARTICIPATING ORGANIZATIONS, THROUGH PARTICIPATING ORGANIZATION WEBSITES, AND SURVEYS MAILED DIRECTLY TO COMMUNITY MEMBERS. IN TOTAL, THE CHNA RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP TEN AREAS OF FOCUS. A FULL REPORT OF THE CHNA IS AVAILABLE AT WWW.POLKCOUNTYHEALTHDEPT.COM AND WWW.AMERYMEDICALCENTER.ORG. THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE TEN AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDANCE PLACED VOTES ON THE TOP FIVE AREAS. FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH 2. OBESITY 3. ALCOHOL USE IMPLEMENTATION ACTIVITIES IN 2014 INCLUDED THE FOLLOWING: MENTAL HEALTH: - MENTAL HEALTH TASK FORCE COMPLETED FINAL YEAR OF A 3 YEAR SUICIDE PREVENTION GRANT TARGETING QUESTION, PERSUADE, REFER TRAININGS IN COUNTY SCHOOL DISTRICTS, COMMUNITY, AND OTHER SERVICE ORGANIZATIONS - MENTAL HEALTH TASK FORCE UPDATED BROCHURE OF LOCAL MENTAL HEALTH RESOURCES AND DISTRIBUTED WIDELY IN COMMUNITY - HEALTHY BEGINNINGS PROJECT OFFERED IN POLK COUNTY OFFERING STUDENT THERAPY SERVICES ONSITE IN OSCEOLA SCHOOL DISTRICT AS WELL AS HOME VISITS - MENTAL HEALTH TASK FORCE OBTAINED OTTO BREMER FOUNDATION GRAND FUNDING FOR DEPRESSION SCREENING PROGRAM TO BE IMPLEMENTED 2015-2016 - ARMC OFFERS MONTHLY SEMINARS FOR COMMUNITY AND STAFF SPONSORED BY BEHAVIORAL HEALTH AT AHC OBESITY PREVENTION: - ENVIRONMENTAL SCAN OF SCHOOL POLICIES AND OBESITY PREVENTION INITIATIVES CONDUCTED - RESOURCE BROCHURE DETAILING SCHOOL OBESITY PREVENTION PROGRAMS CREATED AND DISTRIBUTED - WORKSITE WELLNESS TOOLKIT TRAINING SCHEDULED IN 2015 FOR BUSINESSES IN POLK COUNTY - COMMUNITY HARVEST OF THE MONTH PROJECT DRAFTED AND APPLIED FOR GRANT FUNDING TO IMPLEMENT COUNTY WIDE - BABY BEHAVIOR VIDEO PRODUCED BY HEALTH DEPARTMENT TO PREVENT INFANT OVERFEEDING- UNDERSTANDING YOUR BABY'S CUES UNHEALTHY ALCOHOL USE: - ENVIRONMENTAL SCAN OF CITY/TOWN CLERKS CONDUCTED ON EXISTENCE OF LOCAL ALCOHOL POLICIES - DATA COLLECTION OF OPERATING WHILE INTOXICATED ON UNDERAGE DRINKING CITATIONS GATHERED FROM SHERIFF'S DEPARTMENT AND LOCAL MUNICIPALITIES. DATA WILL BE USED TO CREATE A PUBLIC INFORMATION CAMPAIGN - HEALTH DEPARTMENT SECURED WI RURAL HEALTH GRANT TO PLAN FOR AND CONDUCT UNDERAGE ALCOHOL COMPLIANCE CHECKS - POLK COUNTY GUIDE TO ALCOHOL COMPLIANCE CHECKS COMPLETED - HEALTH DEPARTMENT SECURED PARENTS WHO HOST CAMPAIGN GRANT - COMMUNITY HEALTH IN ACTION GRANT SECURED FOCUSING ON BEST PRACTICES FOR CHANGING UNHEALTHY ALCOHOL PRACTICES IN COMMUNITIES 7. ORGANIZATION AWARDS AND ACHIEVEMENTS $30,000 INFECTION PREVENTION COORDINATOR LYNN GAFFNEY, RN, WAS AWARDED A FELLOWSHIP FOR $30,000 IN PARTNERSHIP WITH THE ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY, EMERGENCY NURSES ASSOCIATION, SOCIETY FOR HEALTHCARE EPIDEMIOLOGY OF AMERICA AND SOCIETY OF HOSPITAL MEDICINE. HEALTH RESEARCH AND EDUCATION TRUST (HRET) IS AN AMERICAN HOSPITAL ASSOCIATION (AHA) AFFILIATE. THIS FELLOWSHIP WAS GRANTED TO HELP REDUCE CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) AT FACILITY. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S NAME WAS CHANGED FROM APPLE RIVER HOSPITAL, INC., TO AMERY REGIONAL MEDICAL CENTER, INC. (ARMC), AND THE CORPORATE MEMBERS OF ARMC WERE DEFINED AS GROUP HEALTH PLAN, INC. (GHI) AND RH-WISCONSIN, INC., WHEN ARTICLES OF INCORPORATION AND BYLAWS OF ARMC WERE AMENDED 1/1/14. FORM 990, PART VI, SECTION A, LINE 6 RH WISCONSIN, INC. IS THE CLASS A MEMBER AND GHI IS THE CLASS B MEMBER OF ARMC. FORM 990, PART VI, SECTION A, LINE 7A ARMC'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN 13 PERSONS APPOINTED AS FOLLOWS: - 7 COMMUNITY REPRESENTATIVES APPOINTED BY THE CLASS A MEMBER (RH-WISCONSIN), FROM RECOMMENDATIONS BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. - 3 REPRESENTATIVES APPOINTED BY THE CLASS B MEMBER (GHI). - 3 HEALTH CARE PROVIDERS NOMINATED BY THE PHYSICIAN GROUP STAFFING ARMC'S PRIMARY CARE CLINIC, AND APPOINTED BY THE CLASS B MEMBER (GHI). - THE PRESIDENT AND CHIEF MEDICAL OFFICER OF ARMC SIT IN EX-OFFICIO CAPACITIES, WITHOUT THE RIGHT TO VOTE. FORM 990, PART VI, SECTION A, LINE 7B THE CLASS A AND CLASS B MEMBERS (RH WISCONSIN, INC. AND GHI RESPECTIVELY) BOTH MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS IMPACTING MEMBERSHIP - RESIGNATION OF A MEMBER - DISSOLUTION - ANY CHANGE IN THE FUNDAMENTAL NATURE OR PURPOSE - MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION - DISPOSITION OF SUBSTANTIALLY ALL ASSETS. ONLY THE CLASS A MEMBER MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS NOT IMPACTING MEMBERSHIP - ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS - ESTABLISHMENT OF NEW ENTITIES OR SIGNIFICANT RELATIONSHIPS WITH OTHER ENTITIES - UNBUDGETED EXPENDITURES IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - GUARANTEEING THE DEBT OF ANY OTHER PERSON OR ENTITY - A LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - TRANSFER OF ASSETS TO ANOTHER ENTITY - APPOINTMENT OF THE PRESIDENT AND THE BOARD CHAIR. FORM 990, PART VI, SECTION B, LINE 11 ARMC'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF ARMC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF ARMC, GHI'S INTERNAL LEGAL DEPARTMENT AND ARMC'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF ARMC. ARMC MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY WILL BE PROVIDED IN A MAILING TO THE BOARD MEMBERS PRIOR TO THE FILING OF THE 990. EACH BOARD MEMBER WILL HAVE AN OPPORTUNITY TO COMMENT OR ASK QUESTIONS ABOUT THE 990 BEFORE IT IS FILED. THIS PROCESS WILL BE NOTED AND DOCUMENTED IN A WRITTEN MEMO IN THE FILES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE ARMC BOARD OF DIRECTORS MONITORS POTENTIAL CONFLICTS OF INTEREST OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES, BY MAINTAINING A CONFLICT OF INTEREST POLICY. ANNUALLY, UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. A REPORT OF THESE POTENTIAL CONFLICTS IS SHARED WITH THE CHAIR AND THE CEO. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES OF ARMC ARE PAID BY ARMC, GHI, LAKEVIEW HEALTH RHSC AND REGIONS, ALL RELATED ORGANIZATIONS WHICH HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE FOUNDATION'S PRESIDENT AND ITS OTHER OFFICERS. EVERY THREE YEARS, UNDER THE DIRECTION OF THE GHI BOARD OF DIRECTORS' COMPENSATION COMMITTEE (COMPENSATION COMMITTEE), A TOTAL COMPENSATION MARKET REVIEW IS COMPLETED. THE REVIEW INCLUDES ALL COMPONENTS OF COMPENSATION; BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE DIRECTION OF THE COMPENSATION COMMITTEE, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION COMMITTEE. FOR THE PRESIDENT AND CERTAIN OTHER POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED. IN ALL CASES, COMMITTEE MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMPENSATION COMMITTEE MEMBERS' INDEPENDENCE, STAFF IS NOT IN ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. THE BOARD OF DIRECTORS HAS DELEGATED TO THE COMPENSATION COMMITTEE THE ACCOUNTABILITY TO CONDUCT AN ANNUAL PERFORMANCE EVALUATION AND TO DETERMINE THE COMPENSATION OF THE PRESIDENT BASED ON THE PERFORMANCE REVIEW AND THE MARKET COMPARABILITY DATA, APPROVED BY THE COMPENSATION COMMITTEE. THE BOARD HAD DELEGATED TO THE PRESIDENT (WITH AUTHORITY TO FURTHER DELEGATE) THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL OTHER OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMPENSATION COMMITTEE. ANY EXCEPTIONS NEED TO BE APPROVED BY THE COMPENSATION COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND W2 STATEMENTS. FORM 990, PART VI, SECTION C, LINE 18 ARMC 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM ARMC OR HEALTHPARTNERS, INC. FORM 990, PART VI, SECTION C, LINE 19 ARMC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: FIXED ASSET VALUATION ADJUSTMENT 584,020. OTHER BALANCE SHEET VALUATION ADJUSTMENTS 2,071. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 1 HPI - RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 1 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 1 HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411670163 HEALTHCARE EDUCATION & RESEARCH MN 501(C)(3) 509(A)(3) TYPE I GROUP HEALTH PLAN INC 1 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 412011453 POST HOSPITALIZATION PATIENT CARE MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 1 REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410956618 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 1 REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411888902 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY 1 RHSC INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411891928 HEALTHCARE STAFFING MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC 1 RH-WISCONSIN 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 1 PHYSICIANS NECK AND BACK CLINICS 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 270684883 SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC 1 HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390804125 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN & GROUP HEALTH PLAN INC 1 HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391279567 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC 1 WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 263616590 PROVIDE MEDICAL TRANSPORT SERVICES WI 501(C)(3) 509(A)(3) TYPE II RH-WISCONSIN 1 LAKEVIEW MEMORIAL HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411386635 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 509(A)(3) TYPE II STILLWATER HEALTH SYSTEM 1 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410811697 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) STILLWATER HEALTH SYSTEM 1 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 830379473 PHYSICIANS GROUP MN 501(C)(3) 509(A)(2) STILLWATER HEALTH SYSTEM 1 STILLWATER HEALTH SYSTEM 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 300221189 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 1 WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390808442 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN & GROUP HEALTH PLAN INC 1 WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391770913 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 509(A)(3) TYPE I WESTFIELDS HOSPITAL INC 1 RAMSEY INTEGRATED HEALTH SERVICES 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411503090 IN-HOME PATIENT CARE MN 501(C)(3) 509(A)(2) HPI - RAMSEY 1 PARK NICOLLET HEALTH SERVICES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 363465840 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) TYPE III HEALTHPARTNERS INC 1 PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 237346465 GRANTS TO SERVE THE COMMUNITY MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410132080 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET INSTITUTE 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410961862 HEALTHCARE RESEARCH MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET HEALTH CARE PRODUCTS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 010638901 HEALTHCARE PRODUCTS MN 501(C)(3) 509(A)(3) TYPE II PARK NICOLLET HEALTH SERVICES 1 PARK NICOLLET CLINIC 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410834920 HEALTHCARE MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 1 PNMC HOLDINGS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411741792 HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET CLINIC 1 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391726539 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 170(B)(1) (A)(VI) AMERY REGIONAL MEDICAL CENTER INC 1 AMERY REGIONAL MEDICAL CENTER PHARMACY LLC 265 GRIFFIN STREET E AMERY WI 54001 390908320 PHARMACEUTICAL WI AMERY REGIONAL MEDICAL CENTER -2253 83092 0 1 0.50000 HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411629390 THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC C 0 HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 522365151 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683568 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683523 MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC C 0 DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 451297583 PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411236798 MEDICAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC C 0 PARK NICOLLET ENTERPRISES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411656735 REAL ESTATE FOR RELATED ORGANIZATIONS MN PARK NICOLLET HEALTH SERVICES C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION C 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION N 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION O 0 HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES L 223371