2015-05-08T07:43:23-05:00 2014-06-30 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2013-07-01 411924645 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE CENT 3207322141 20 SE NINTH STREET LONG PRAIRIE MN 56347 CRAIG BROMAN PRESIDENT 3207322141 2015-04-21 1 TODD A JACKSON P00092672 6123324300 2013 2016-02-25 16:41:14Z CENTRACARE HEALTH - LONG PRAIRIE DR TERENCE PLADSON 20 SE NINTH STREET LONG PRAIRIE MN 56347 25286979 0 X WWW.CENTRACARE.COM X 1999 MN CENTRACARE HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 5 0 293 68 0 0 13191 111872 24088775 24688944 449291 425144 1456815 45033 26008072 25270993 50365 50225 0 0 15476487 14587433 0 0 0 8573673 9465013 24100525 24102671 1907547 1168322 20945664 21581313 5416061 5248437 15529603 16332876 CENTRACARE HEALTH WORKS TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. 0 0 7013120 50225 15587648 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, REHABILITIATION, AND CHEMOTHERAPY TO THE COMMUNITY OF LONG PRAIRIE AND THE SURROUNDING AREA. THERE WERE 535 ADMITS, 2,096 INPATIENT DAYS, AND 23,382 OUTPATIENT VISITS DURING FISCAL YEAR 2014. 5281794 3885050 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 19,063 CLINIC VISITS DURING FISCAL YEAR 2014. 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 PHSYCIANS FROM THE LONG PRAIRIE CLINIC. THERE WERE 1,205 CLINIC VISITS DURING FISCAL YEAR 2014. 5838397 5200260 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 23,902 RESIDENT DAYS DURING FISCAL YEAR 2014. 18133311 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 35 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 43.00 X X 0 1357426 251323 JAMES R DAVIS VICE PRESIDENT 1.00 39.00 X X 0 386595 26537 DAVID TILSTRA MD VICE PRESIDENT 1.00 39.00 X X 0 463047 92387 PAUL R HARRIS CORPORATE SECRETARY 2.00 39.00 X X 0 434166 77979 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 1.00 40.00 X X 0 628226 126100 CRAIG J BROMAN PRESIDENT 5.00 40.00 X X 0 692452 148606 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 39.50 0.50 X 0 240472 50658 ERIC M LOHN REGIONAL CFO 9.00 31.00 X 0 161181 14414 JAMES M BERGMANN PA PHYSICIAN ASSISTANT 40.00 X 156467 0 24616 THOMAS J HOCK PA PHYSICIAN ASSISTANT 40.00 X 145676 0 33656 CHRISTOPHER A HAGEN PHARMACIST 40.00 X 136204 0 21855 MARK A CHRISTIANSEN PA PHYSICIAN ASSISTANT 40.00 X 150795 0 19181 LARRY KNUTSON DIRECTOR OF FINANCE 40.00 X 122374 0 32963 711516 4363565 920275 7 0 1 0 CENTRACARE CLINIC 1200 6TH AVENUE NORTH ST CLOUD MN 56303 PHYSICIAN SERVICES 1826245 CENTRAL MINNESOTA DIAGNOSTIC INC 150 TENTH ST NW PO BOX 158 MILACA MN 56353 MOBILE MRI & CT SERVICES 319265 WEST CENTRAL ANESTESIA 10382 AUGUSTA DRIVE SAUK CENTRE MN 56378 CRNA SERVICES 257177 3 21227 90645 111872 PATIENT AND RESIDENT SERVICE REVE 900099 23427578 23427578 SUPPLIES/DRUGS/FOOD SALES 900099 697596 697596 OTHER PROGRAM REVENUE 900099 295158 295158 QUALITY & TECH INITIATIVES 900099 268612 268612 24688944 441130 441130 45033 0 45033 45033 45033 15986 -15986 -15986 -15986 25270993 24672958 0 486163 X 50225 50225 10919274 8508773 2410501 551281 428101 123180 2341243 1773268 567975 775635 593728 181907 75524 10 75514 31497 31497 2729410 2302565 426845 47829 276 47553 211463 111812 99651 285559 74243 211316 651176 324164 327012 31349 16919 14430 89584 67772 21812 145103 2327 142776 115703 115703 840983 840983 124955 31521 93434 MEDICAL SUPPLIES 2090211 2048034 42177 BAD DEBT 778825 778825 MEDICAID SURCHARGE/MN C 543471 543471 MINOR EQUIPMENT 284914 240963 43951 387457 236314 151143 24102671 18133311 5969360 0 3281076 3688787 3527708 3876477 300224 273713 168171 175897 16045258 8566342 7630294 7478916 5255135 5200144 496856 434229 286200 453150 20945664 21581313 2497266 2472143 15559 18403 2461890 2384274 441346 373617 5416061 5248437 X 15502347 16299828 27256 33048 15529603 16332876 20945664 21581313 X 1168322 273451 -638500 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 312427 312427 8781901 3988886 4793015 447775 119972 327803 6503155 4457484 2045671 7478916 ASSETS INTERNALLY DESIGNATED FOR CAPITAL ACQUISITIONS 5200144 F 5200144 THIRD PARTY PAYOR SETTLEMENTS 175000 ASSET RETIREMENT OBLIGATION 113336 CAPITAL LEASES 85281 373617 PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE HELD BY THE ORGANIZATION ON BEHALF OF THE RESIDENTS IN A SEPARATE BANK ACCOUNT. 1 1 1 X 175.000000000000 1 X 1 1 1 0 1 1 179222 0 179222 0.00770 3409916 1911997 1497919 0.06420 3589138 1911997 1677141 0.07190 1291595 0 1291595 0.05540 380 0 380 0.00000 1291975 1291975 0.05540 4881113 1911997 2969116 0.12730 1 778825 0 5895974 6056678 -160704 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 1 X X X X X X X X X X 12 1 1 1 X WWW.CENTRACARE.COM X X X 0 0 1 1 175.000000000000 1 250.000000000000 1 X 1 1 X 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 1J: 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 - LONG PRAIRIE PART V, SECTION B, LINE 3: 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 4: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE BEGINNING 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 5D: 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 6I: THE NEEDS IDENTIFIED BY THE CHNA ARE CURRENTLY IN ORGANIZATIONAL WORK PLANS AND ARE UNDER IMPLEMENTATION. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 7: 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 14G: 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 16E: 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 17E: THE ORGANIZATION CONTRACTS WITH SEVERAL COLLECTION AGENCIES TO ATTEMPT TO COLLECT PATIENT BALANCES. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 18E: 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 20D: 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. 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 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 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 $160,704 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 CENTRA 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 1 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE NORTH ST CLOUD MN 56203 411855173 501(C)(3) 50000 PROGRAM SUPPORT 1 PART I, LINE 2: CENTRACARE HEALTH SYSTEM, INCLUDING LONG PRAIRIE, HAS THE FOLLOWING POLICY REGARDING CHARITABLE CONTRIBUTIONS: CONTRIBUTIONS MUST BE IN KEEPING WITH THE MISSION OF CENTRACARE HEALTH, WHICH IS TO WORK TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. CONTRIBUTIONS WILL BE MADE TO ORGANIZATIONS RATHER THAN TO INDIVIDUALS WITHIN THE CENTRAL MINNESOTA REGION. CENTRACARE'S CHARITABLE FUNDS MAY NOT BE USED TO SUPPORT ANY ORGANIZATION OR EVENT THAT WOULD RESULT IN BENEFITS OF ANY KIND TO AN EMPLOYEE OF THE HEALTH SYSTEM OR A MEMBER OF THE VARIOUS BOARDS OF DIRECTORS, EITHER DIRECTLY OR INDIRECTLY. ONE EXCEPTION EXISTS TO THE GUIDELINE REGARDING BENEFIT TO EMPLOYEES: WE WILL SUPPORT, VIA SCHOLARSHIPS AND THE PURCHASE OF SUPPLIES, THE MEDICAL MISSION WORK OF OUR STAFF AND PHYSICIANS. THE CENTRACARE HEALTH CONTRIBUTIONS COMMITTEE IS MADE UP OF : ONE REPRESENTATIVE FROM CENTRACARE HEALTH FOUNDATION; ONE REPRESENTATIVE FROM ST. CLOUD HOSPITAL HUMAN RESOURCES/DIVERSITY COMMITTEE; THE DIRECTOR OF CENTRACARE HEALTH'S COMMUNICATION DEPARTMENT AND THE COMMUNICATIONS/MARKETING FOR ST. BENEDICT'S SENIOR COMMUNITY; THE DIRECTOR OF CENTRACARE HEALTH'S MARKETING DEPARTMENT; THE DIRECTOR OF ST. CLOUD HOSPITAL VOLUNTEER SERVICES; AND ST. CLOUD HOSPITAL'S DIRECTOR OF MISSION & SPIRITUAL CARE. THE COMMITTEE MEETS MONTHLY TO ENSURE A STREAMLINED, COORDINATED PROCESS OF REVIEWING REQUESTS AND DETERMINING FUNDING. THE COMMITTEE MAINTAINS A DATABASE TO TRACK ALL CONTRIBUTIONS. OTHER CENTRACARE ENTITIES, INCLUDING CENTRACARE HEALTH - LONG PRAIRIE, MELROSE, MONTICELLO, PAYNESVILLE AND SAUK CENTRE, MAY DEVELOP A BUDGET FOR APPROVAL AND IMPLEMENT THEIR OWN CONTRIBUTIONS DECISIONS WITHIN THE GUIDELINES OF THIS DOCUMENT. CONTRIBUTIONS MAY NOT EXCEED THE STATED BUDGET AND NO MULTI-YEAR COMMITMENTS TO ORGANIZATIONS MAY BE MADE WITHOUT APPROVAL FORM THE CENTRACARE HEALTH EXECUTIVE COUNCIL. INDIVIDUALS AND DEPARTMENTS FORM THROUGHOUT ST. CLOUD HOSPITAL AND CENTRACARE CLINIC SHOULD FORWARD ALL OUTSIDE FUNDING REQUESTS TO A MEMBER OF THE COMMITTEE FOR THE FULL GROUP'S CONSIDERATION. THOSE REQUESTING FUNDS SHOULD BE ASKED TO SUBMIT REQUESTS IN WRITING. 0 1 0 0 0 0 1 0 0 TERENCE R PLADSON MD CEO 0 852388 0 268267 0 236771 0 235050 0 20959 0 1613435 0 225588 JAMES R DAVIS VICE PRESIDENT 0 284429 0 48737 0 53429 0 12764 0 20148 0 419507 0 45254 DAVID TILSTRA MD VICE PRESIDENT 0 321776 0 101769 0 39502 0 71513 0 25691 0 560251 0 18818 PAUL R HARRIS CORPORATE SECRETARY 0 300778 0 63000 0 70388 0 52913 0 33817 0 520896 0 67504 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 0 422200 0 96448 0 109578 0 110826 0 19039 0 758091 0 84515 CRAIG J BROMAN PRESIDENT 0 537979 0 148309 0 6164 0 127476 0 34691 0 854619 0 0 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 0 182093 0 42165 0 16214 0 28825 0 23623 0 292920 0 14312 ERIC M LOHN REGIONAL CFO 0 84493 0 18463 0 58225 0 10285 0 4372 0 175838 0 0 JAMES M BERGMANN PA PHYSICIAN ASSISTANT 150323 0 5490 0 654 0 11781 0 13295 0 181543 0 0 0 THOMAS J HOCK PA PHYSICIAN ASSISTANT 138610 0 6653 0 413 0 11090 0 23037 0 179803 0 0 0 CHRISTOPHER A HAGEN PHARMACIST 131572 0 4056 0 576 0 7020 0 17113 0 160337 0 0 0 MARK A CHRISTIANSEN PA PHYSICIAN ASSISTANT 138076 0 12644 0 75 0 9253 0 10393 0 170441 0 0 0 LARRY KNUTSON DIRECTOR OF FINANCE 109603 0 8060 0 4711 0 9488 0 23936 0 155798 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 - PAID $225,588; ACCRUED $215,925 JAMES R DAVIS - PAID $45,254; ACCRUED $0 DANIEL J SWENSON - PAID $14,312; ACCRUED $18,188 PAUL R HARRIS - PAID $67,504; ACCRUED $42,880 GREGORY R KLUGHERZ - PAID $84,515; ACCRUED $98,076 CRAIG BROMAN - PAID $0; ACCRUED $108,351 DAVID TILSTRA, MD - PAID $18,818; ACCRUED $51,203 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 COMPENSATION OF THE PRESIDENT/CEO IS PAID BY A RELATED ORGANIZATION AND IS SUBJECT TO BI-ANNUAL FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES BY AN OUTSIDE, INDEPENDENT CONSULTANT. THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMMITTEE AND BOARD REVIEW FOR PHYSICIANS. THE LAST FULL REVIEW WAS DONE IN MAY 2013. THE LAST COMPENSATION REVIEW WAS DONE IN MARCH 2013. THE COMPENSATION AND BENEFITS OF THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE ALSO PAID BY A RELATED ORGANIZATION AND 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 IN MAY 2013. 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 879,275. MANAGEMENT AND GENERAL EXPENSES 417,693. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,296,968. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,190,748. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,190,748. FOOD SERVICES: PROGRAM SERVICE EXPENSES 232,542. MANAGEMENT AND GENERAL EXPENSES 9,152. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 241,694. FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS TO AFFILIATED ORGANIZATIONS -754,000. CAPITAL CONTRIBUTION 115,500. FORM 990, PART I, LINE 6 - TOTAL NUMBER OF VOLUNTEERS: CENTRACARE HEALTH - LONG PRAIRIE HAD 68 VOLUNTEERS IN FY14 WHO DONATED A TOTAL OF APPROXIMATLEY 2,191 HOURS TO VARIOUS DEPARTMENTS. FORM 990, PAGE 1, LINE 11 "OTHER REVENUE" THE AMOUNT REPORTED ON LINE 11 OF PAGE 1, "OTHER REVENUE" IS $45,033 FOR THE CURRENT YEAR AND $1,456,815 FOR THE PRIOR YEAR. THE REASON FOR THE DIFFERENCE IS DUE TO A CHANGE IN REPORTING PRESENTATION. THE QUALITY & TECH INITIATIVES INCOME REPORTED ON LINE 2D OF THE STATEMENT OF REVENUE WAS REPORTED ON LINE 11 AS MISCELLANEOUS INCOME ON THE 2012 (FY13) FORM 990. THE INCOME OF THESE ACTIVITIES RELATES TO THE MISSION OF THE HOSPITAL AND IS THE REASON FOR THE CHANGE IN PRESENTATION. CENTRACARE HEALTH SYSTEM 1406 6TH AVE NORTH ST CLOUD MN 56303 411813221 HEALTHCARE HOLDING COMPANY MN 501(C)(3) LINE 11C, III-FI N/A 0 CENTRACARE HEALTH SYSTEM-MELROSE 11 NORTH 5TH AVENUE WEST MELROSE MN 56352 411865315 ACUTE & LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1406 6TH AVE NORTH ST CLOUD MN 56303 411708142 EMERGENCY PHYSICIANS MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 411806657 MULTI-SPECIAL CLINIC MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE NORTH ST CLOUD MN 56303 411855173 FUNDRAISING MN 501(C)(3) LINE 7 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH-SAUK CENTRE 425 ELM STREET NORTH SAUK CENTRE MN 56378 452438973 ACUTE CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 ST CLOUD HOSPITAL 1406 6TH AVE NORTH ST CLOUD MN 56303 410695596 ACUTE & LONG TERM CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE PHARMACY SERVICES INC 1406 6TH AVE NORTH ST CLOUD MN 56303 411620618 RETAIL PHARMACY MN CENTRACARE HEALTH SYSTEM C 0 0 1 1 1 1 0 0 0 0 0 1 0 1 0 1 1 1 1 0 SAUK CENTRE O 52548 ACTUAL AMOUNT