2015-05-12T09:28:35-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 450226558 TRINITY HEALTH TRIN 7018575160 PO BOX 5020 MINOT ND 58702 DENNIS C EMPEY CHIEF FINANCIAL OFFICER 7018575160 2015-05-07 1 KOREY BOELTER P00775161 6123764500 2013 2016-03-07 17:11:31Z JOHN M KUTCH PO BOX 5020 MINOT ND 58702 101234849 0 X WWW.TRINITYHEALTH.ORG X 1929 ND PROVIDE HEALTH EDUCATION & HEALTHCARE SERVICES TO RESIDENTS OF CENTRAL & NORTHWEST NORTH DAKOTA 11 5 3700 347 66135 -38745 0 0 94432927 99005556 1382177 1532043 -293919 -429543 95521185 100108056 0 0 0 0 82816590 94854677 0 0 0 26831657 34857376 109648247 129712053 -14127062 -29603997 373375142 80825122 557136062 99900869 -183760920 -19075747 X TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 87226934 0 73042092 TRINITY HEALTH PROVIDES EDUCATION AND HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 8471887 0 7972139 TRINITY HEALTH RADIOLOGISTS ARE HIGHLY TRAINED AND SKILLED AT ASSESSING AND INTERPRETING X-RAYS, CT, NUCLEAR MEDICINE, ULTRASOUND, MRI SCANS, AND MAMMOGRAPHY IMAGES. 10510304 0 12645900 TRINITY HEALTH PROVIDES OPTOMETRY SERVICES FOR GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS; OPHTHALMOLOGY WHO PROVIDE COMPREHENSIVE EYE AND VISION CARE, INCLUDING SURGERY TO REPAIR AND ENHANCE VISION; OPTOMETRY WHO PROVIDES GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS AND OPTICAL SALE OF CONTACT LENS AND EYEGLASSES. 6156883 0 1944972 TRINITY HEALTH HOSPITALISTS PROVIDE AND COORDINATE ALL ASPECTS OF INPATIENT AND OBSERVATION CARE FOR TRINITY HOSPITALS. 3439995 0 3400453 TRINITY HEALTH'S ORAL AND MAXILLOFACIAL SURGERY PROGRAM TREATS MANY DISEASES, INJURIES AND DEFECTS IN THE HEAD, NECK, FACE, JAWS AND THE HARD AND SOFT TISSUES OF THE ORAL (MOUTH) AND CRANIO-MAXILLOFACIAL (JAWS AND FACE) REGION. IT IS AN INTERNATIONALLY RECOGNIZED SURGICAL SPECIALTY. IN MOST COUNTRIES AROUND THE WORLD, INCLUDING THE UNITED STATES, CANADA AND AUSTRALIA, IT IS A RECOGNIZED SPECIALTY OF DENTISTRY; IN OTHERS, SUCH AS THE UK, IT IS RECOGNIZED AS A MEDICAL SPECIALTY. 9596878 0 5345425 115806003 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 221 0 3700 1 1 1 0 0 0 0 0 0 0 0 0 0 X 11 5 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X DENNIS EMPEY 7018575160 PO BOX 5020 MINOT ND 58702 PATRICK HOLIEN CHAIRMAN 2.00 2.00 X X 0 0 0 STEVE LYSNE VICE CHAIRMAN 2.00 2.00 X X 0 0 0 KAREN KREBSBACH SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 BORGI BEELER DIRECTOR 2.00 2.00 X 0 0 0 KEVIN COLLINS MD DIRECTOR 20.00 20.00 X 738588 0 14760 JOHN COUGHLIN DIRECTOR 2.00 2.00 X 0 0 0 DR DAVID FULLER DIRECTOR 2.00 2.00 X 0 0 0 SCOTT KNUTSON MD DIRECTOR 2.00 2.00 X 0 0 0 BRENT MATTSON DIRECTOR 2.00 2.00 X 0 0 0 CLARA SUE PRICE DIRECTOR 2.00 2.00 X 0 0 0 MARTIN ROTHBERG MD DIRECTOR 20.00 20.00 X 1071625 0 14760 DARYL SOMERVILLE DIRECTOR 2.00 2.00 X 0 0 0 JOHN KUTCH PRESIDENT & CEO 12.00 28.00 X X 542170 0 14760 ALISON FRYE ASSISTANT SECRETARY 40.00 0.00 X 50378 0 1460 DENNIS EMPEY VICE PRESIDENT & CFO 12.00 28.00 X 80246 0 291 RANDY SCHWAN VICE PRES. - MISSION INTEGRATION 4.00 36.00 X 171295 0 7367 PAUL SIMONSON VICE PRES. - HUMAN RESOURCES 4.00 36.00 X 240131 0 14228 THOMAS WARSOCKI VICE PRES. - PHYSICIAN OPERATIONS 40.00 0.00 X 159298 0 7093 DAVE KOHLMAN VICE PRES. - FACILITIES MANAGEMENT 8.00 32.00 X 174477 0 7689 BARBRA BROWN RN BSN MA VICE PRES. & CNO 0.00 40.00 X 201184 0 8210 JUAN ULLOA MD PHYSICIAN 25.00 15.00 X 1053392 0 14760 MICHAEL MCMAHON MD PHYSICIAN 25.00 15.00 X 1073328 0 14760 MARC EICHLER MD PHYSICIAN 25.00 15.00 X 1091711 0 14760 RAVINDRA JOSHI MD PHYSICIAN 25.00 15.00 X 1606679 0 14760 SAMIR TURK MD PHYSICIAN 25.00 15.00 X 1297790 0 14760 9552292 0 164418 260 0 1 0 AUREUS NURSING LLC PO BOX 3037 OMAHA NE 68103 LOCUM NURSING SERVICES 4259132 COMMUNITY AMBULANCE SERVICE OF MINOT PO BOX 2195 MINOT ND 58702 AMBULANCE SERVICES 3120716 B E SMITH INTERIM SERVICES PO BOX 219241 DEPT 300 KANSAS CITY MO 64121 INTERIM SERVICES 2727856 ROI HEALTHCARE SOLUTIONS LLC 1595 PEACHTREE PKWY STE 204 CUMMING GA 30041 IT PROJECT MANAGEMENT SERVICES 1635130 UNITED BLOOD SERVICES PO BOX 53022 PHOENIX AZ 85072 COMMUNITY BLOOD CENTER 1284312 56 NET PATIENT REVENUE 621110 98762794 98762794 OTHER PATIENT REVENUE 621110 154356 154356 OPTICAL SALES 446199 88406 88406 99005556 709431 709431 394482 394482 773841 1126793 -352952 -352952 -22271 -330681 428130 0 428130 428130 428130 JOINT VENTURE REVENUE 900099 -76591 -76591 -76591 100108056 98917150 66135 1124771 3522702 1532251 1990451 81478589 79934398 1544191 2513860 2445140 68720 3782559 3341587 440972 3556967 3302513 254454 2334 29 2305 26 26 10232951 9352869 880082 673754 22787 650967 544058 365451 178607 5335 5335 4632703 1461997 3170706 42347 36839 5508 86846 52533 34313 384785 200445 184340 2784602 1373735 1410867 719142 717420 1722 UBI TAXES 7782 7782 BAD DEBT EXPENSE 9754704 7193637 2561067 MED. SUPPLIES & DRUGS 3762597 3749784 12813 CONT. MEDICAL EDUCATION 619085 619085 604325 98168 506157 129712053 115806003 13906050 0 1042276 1191482 797160 685452 8137926 12785294 13286 2652875 2220841 683452 748553 13807 13653 64026951 29394371 33245692 34632580 12029277 13996066 171848 142082 830095 770967 313757448 13638152 373375142 80825122 13699467 15455689 79484970 75707440 463951625 8737740 557136062 99900869 X -183760920 -19075747 -183760920 -19075747 373375142 80825122 X -29603997 1117826 193171344 X 0 1 X 1 0 X X X 0 0 0 TRINITY HOSPITALS 412002771 3 1 1 1 0 TRINITY KENMARE HOSPITAL 412002769 3 1 1 1 0 TRINITY HOMES 450404412 9 1 1 1 0 3 0 0 0 0 0 305323 305323 0.00000 0.00000 0.00000 6770229 6770229 12119956 4703906 7416050 5528437 2444844 3083593 38300020 22245621 16054399 1308309 1308309 34632580 ASSETS HELD BY TRUSTEE UNDER BOND RESERVE FUND 7873036 ASSETS HELD BY TRUSTEE FOR DEBT SERVICE 5765116 13638152 ASSET RETIREMENT OBLIGATION 8737740 8737740 X 90024693 1117826 1203384 2321210 87703483 12404573 12404573 100108056 121084142 1126793 1126793 119957349 9754704 9754704 129712053 PART X, LINE 2: TRINITY HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. ALL UNRELATED BUSINESS INCOME GENERATED BY TRINITY IS SUBJECT TO FEDERAL INCOME TAX UNDER 511 OF THE IRC. TRINITY'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS, AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. TRINITY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,126,793. LOSS ON JOINT VENTURE 76,591. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 9,754,704. INVESTMENT INCOME 2,649,869. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,126,793. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 9,754,704. X X 1 1 X X X X 0 0 0 1 1 0 0 0 0 KEVIN COLLINS MD DIRECTOR 633810 0 11161 0 93617 0 13800 0 960 0 753348 0 0 0 MARTIN ROTHBERG MD DIRECTOR 120074 0 0 0 951551 0 13800 0 960 0 1086385 0 0 0 JOHN KUTCH PRESIDENT & CEO 541234 0 0 0 936 0 13800 0 960 0 556930 0 0 0 RANDY SCHWAN VICE PRES. - MISSION INTEGRATION 160490 0 3110 0 7695 0 6900 0 467 0 178662 0 0 0 PAUL SIMONSON VICE PRES. - HUMAN RESOURCES 224216 0 4393 0 11522 0 13800 0 428 0 254359 0 0 0 THOMAS WARSOCKI VICE PRES. - PHYSICIAN OPERATIONS 153158 0 0 0 6140 0 6632 0 461 0 166391 0 0 0 DAVE KOHLMAN VICE PRES. - FACILITIES MANAGEMENT 166915 0 3313 0 4249 0 7192 0 497 0 182166 0 0 0 BARBRA BROWN RN BSN MA VICE PRES. & CNO 200248 0 0 0 936 0 8037 0 173 0 209394 0 0 0 JUAN ULLOA MD PHYSICIAN 496314 0 552581 0 4497 0 13800 0 960 0 1068152 0 0 0 MICHAEL MCMAHON MD PHYSICIAN 498161 0 570670 0 4497 0 13800 0 960 0 1088088 0 0 0 MARC EICHLER MD PHYSICIAN 746746 0 0 0 344965 0 13800 0 960 0 1106471 0 0 0 RAVINDRA JOSHI MD PHYSICIAN 844246 0 591653 0 170780 0 13800 0 960 0 1621439 0 0 0 SAMIR TURK MD PHYSICIAN 1095328 0 25402 0 177060 0 13800 0 960 0 1312550 0 0 0 PART I, LINE 1A TRINITY HEALTH HAS A PRIVATE AIRPLANE AND DURING FY 2014 OFFICERS USED THIS PLANE FOR BUSINESS USE TRAVEL. BECAUSE THE USE WAS RESTRICTED FOR BUSINESS THIS DID NOT EFFECT THE OFFICER'S COMPENSATION. TEMPORARY HOUSING WAS PROVIDED TO DENNIS EMPEY UPON HIS HIRE AS CFO UNTIL HE COULD FIND A PERMANENT RESIDENCE. THIS WAS NOT INCLUDED IN HIS TAXABLE COMPENSATION. PART I, LINE 5 PHYSICIANS RECEIVE INCENTIVE COMPENSATION BASED ON MULTIPLE FACTORS INCLUDING THE NUMBER OF PATIENTS SERVED, WHICH IS CLOSELY CONNECTED TO REVENUES. A COUNTY OF WARD 456002248 934023EMO 2006-11-01 88455263 SEE PART VI 0 0 0 A 19357342 88455263 7873036 1077014 10000000 70839643 2006 1 1 0 1 A 0 1 1 0 0 0.01810 0.01810 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 SCHEDULE K, PART I, COLUMN F DESCRIPTION OF PURPOSE OF BONDS PROCEEDS OF THE SERIES 2006 BONDS WERE USED (I) TO CURRENTLY REFUND THE COUNTY OF WARD, NORTH DAKOTA, ADJUSTABLE RATE DEMAND HEALTH CARE REVENUE BONDS (TRINITY OBLIGATED GROUP) TAX-EXEMPT SERIES 2002A (THE "SERIES 2002 BONDS"), OUTSTANDING IN THE AMOUNT OF $58,615,000, (II) TO FUND A TERMINATION PAYMENT FOR THE INTEREST RATE SWAP ASSOCIATED WITH THE SERIES 2002 BONDS, (III) TO ADVANCE REFUND THE COUNTY OF WARD, NORTH DAKOTA HEALTH CARE FACILITIES REVENUE REFUNDING BONDS (TRINITY OBLIGATED GROUP) SERIES 1996A (THE "SERIES 1996A BONDS"), OUTSTANDING IN THE AMOUNT OF $9,400,000, (IV) TO FINANCE OR REIMBURSE THE CORPORATION FOR THE COSTS OF CERTAIN RENOVATION, REMODELING, AND EQUIPPING OF ITS HEALTH CARE FACILITIES (THE "PROJECT"), (V) TO FUND A DEPOSIT TO A DEBT SERVICE RESERVE FUND, AND (VI) TO PAY CERTAIN EXPENSES RELATING TO THE ISSUANCE OF THE SERIES 2006 BONDS AND THE REFUNDING OF THE SERIES 2002 BONDS AND THE SERIES 1996A BONDS. DARYL SOMERVILLE OWNER OF MINOT TOWN AND COUNTRY INVESTORS, LLC 262836 TRINITY HEALTH PAID RENT TO MINOT TOWN AND COUNTRY INVESTORS, LLC 0 NICOLE KUTCH SPOUSE OF CEO 23764 THERAPIST 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD OF DIRECTORS' CHAIR, VICE CHAIR, PRESIDENT, SECRETARY, TREASURER AND ONE ADDITIONAL MEMBER OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD OF DIRECTORS AT ITS FIRST MEETING AFTER ITS ELECTION. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 TRINITY HEALTH CONTRACTED WITH A MANAGEMENT COMPANY TO PROVIDE FINANCIAL MANAGEMENT SERVICES, INCLUDING A CONTRACTED CFO, DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE FORM 990 WAS GIVEN TO THE GOVERNING BODY OF TRINITY HEALTH FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL SALARIED EMPLOYEES (AT MANAGER LEVEL AND ABOVE AS DETERMINED BY TRINITY) AND SUCH OTHER EMPLOYEES AS FROM TIME TO TIME MAY BE DIRECTED TO DO SO, ARE REQUIRED TO COMPLETE TRINITY HEALTH'S CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. ANY EMPLOYEE WHO HAS ASSUMED, OR IS ABOUT TO ASSUME, A FINANCIAL OR OTHER INTEREST OR RELATIONSHIP THAT MIGHT INVOLVE A CONFLICT OF INTEREST MUST IMMEDIATELY INFORM HIS/HER SUPERVISOR, A MEMBER OF THE COMPLIANCE COMMITTEE, OR THE COMPLIANCE OFFICER. ISSUES INVOLVING CONFLICT OF INTEREST SHALL BE REVIEWED AND A DETERMINATION OF EACH SHALL BE MADE BY THE TRINITY COMPLIANCE COMMITTEE. IF A CONFLICT EXISTS, THE CONFLICTED PERSON MUST ABSTAIN FROM DISCUSSION OF AND VOTING ON THE CONFLICTED TOPIC. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE REVIEWED COMPENSATION INFORMATION FOR THE CEO PREPARED BY DELOITTE & TOUCHE. DELOITTE & TOUCHE ANALYZED FOUR COMPENSATION SURVEYS OF HEALTH CARE EMPLOYERS AND REVIEWED FORM 990 FILINGS FOR A PEER GROUP ANALYSIS. THIS PROCESS WAS LAST PERFORMED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 ON OUR WEBSITE, WWW.TRINITYHEALTH.ORG, WE LIST OUR BOARD OF DIRECTORS, MISSION, VISION, VALUES, AND OUR ANNUAL REPORT WHICH INCLUDES FINANCIAL INFORMATION. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS 193,171,344. COMMUNITY AMBULANCE SERVICE OF MINOT INC PO BOX 2195 MINOT ND 58702 450363593 AMBULANCE SERVICES ND 501(C)(3) LINE 11A, I TRINITY HEALTH 0 TRINITY HOSPITALS PO BOX 5020 MINOT ND 58702 412002771 MEDICAL SERVICES ND 501(C)(3) LINE 3 TRINITY HEALTH 0 TRINITY KENMARE HOSPITAL PO BOX 5020 MINOT ND 58702 412002769 MEDICAL SERVICES ND 501(C)(3) LINE 3 TRINITY HEALTH 0 TRINITY HOMES PO BOX 5020 MINOT ND 58702 450404412 SKILLED NURSING FACILITY ND 501(C)(3) LINE 9 TRINITY HEALTH 0 TRINITY HEALTH FOUNDATION PO BOX 5020 MINOT ND 58702 450215346 FUNDRAISING ND 501(C)(3) LINE 11B, II TRINITY HEALTH 0 B&B DRUG INC 20 BURDICK EXPRESSWAY WEST MINOT ND 58701 450260565 RETAIL DRUG STORE ND TRINITY HEALTH C 5717784 2983983 1.00000 1 MEDICAL ARTS OUTPATIENT SERVICES INC 400 BURDICK EXPRESSWAY EAST MINOT ND 58701 450278212 RETAIL PHARMACY & DURABLE MEDICAL EQUIPMENT ND N/A C 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 0 1 B&B DRUG A 28000 FMV