2015-08-06T14:50:27-05:00 2014-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-10-01 411804205 LifeCare Medical Center LIFE 2184632500 715 Delmore Drive Roseau MN 56751 Keith Okeson CEO/President 2184632500 2015-07-29 1 Kim Hunwardsen CPA P00484560 6122536500 2015-07-29 2013 2016-03-07 17:11:31Z Keith Okeson 715 Delmore Drive Roseau MN 56751 40348291 0 X www.lifecaremedicalcenter.org X 1995 MN Promotion of Health 13 13 547 360 4270 1403 208904 206584 39656659 39542916 235227 259218 -50354 91262 40050436 40099980 24794 15832 0 0 20433065 20949331 0 0 0 15556487 16542492 36014346 37507655 4036090 2592325 60958197 62510226 10766478 9670854 50191719 52839372 X To provide care for a healthy life. 0 0 32736424 15832 39538646 LifeCare Medical Center operates a 25-bed acute care hospital, including a 60-bed nursing facility, home health, hospice, and public health in Roseau, Minnesota. The organization also operates a 40-bed nursing home and 12 apartments of assisted living in Greenbush, Minnesota. The purpose of the organization is to own, maintain, and operate a hospital, nursing homes, furnish medical and surgical care to the sick, infirmed, or injured.Acute Care Hospital (Inpatient and Outpatient)Inpatient days: 1,939Outpatient visits: 38,669Long Term CareLifeCare Roseau Manor Resident Days: 19,113LifeCare Greenbush Manor Resident Days: 14,415Home Health/Public Health Visits: 10,546Hospice Clients Served: 18To fulfill its mission of community service, LifeCare Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The amount of charges foregone, based on established rates, was $604,201 for the year ended September 30, 2014. 32736424 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 71 0 1 547 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Cathy Huss 2184634763 715 Delmore Drive Roseau MN 56751 Corwin Vatnsdal Chair 1.00 X X 1950 0 0 Carolyn Eeg Vice Chair 1.00 X X 1350 0 0 Carmen Przekwas Secretary 1.00 X X 1650 0 0 Therese McBride Treasurer 1.00 X X 1200 0 0 Brenda Sather Trustee 1.00 X 900 0 0 Ralph Herseth MD Trustee 1.00 X 975 0 0 Paul Everson Trustee 1.00 X 525 0 0 Mark Wilson Trustee 1.00 X 900 0 0 Pete Granger Trustee (Oct-Nov) 1.00 X 525 0 0 Steve Haugen Trustee 1.00 X 450 0 0 Pete Helgeson Trustee 1.00 X 525 0 0 Chuck Lindner Trustee 1.00 X 1050 0 0 Shayne Isane Trustee 1.00 X 600 0 0 Matthew Ulwelling Trustee (Nov-Sept) 1.00 X 0 0 0 Keith Okeson CEO/President 40.00 X 238607 0 39314 Cathy Huss CFO 40.00 X 173233 0 30850 Gordon Streiff Pharmacy Director 40.00 X 134607 0 32338 Susan Lisell Senior Leader 40.00 X 149668 0 21942 Shannon D Carlson Senior Leader 40.00 X 118224 0 26151 Judy K Mattson Pharmacist 40.00 X 124016 0 30160 Patricia A Berger Registered Nurse 40.00 X 107346 0 16427 1058301 0 197182 9 0 1 0 Comstock Construction Inc of Minnesota PO Box 396 Fergus Falls MN 565380396 Construction 2186525 Wapiti Medical Group 107 Flynn Drive Suite 600 Milbank SD 57252 ER Physician Service 1244897 Central Minnesota Diagnostic PO Box 158 Milaca MN 563531221 Imaging CT SCAN Service 494500 R C Shefland Anesthesia Ltd 27040 COUNTY 9 Bemidji MN 566019005 Anesthesia Service 457902 DMS Technologies Inc 26273 Network Place Chicago IL 606731262 Imaging MRI Service 337013 10 79275 127309 206584 Net Patient Service Revenue 622110 38172847 38172847 Other Revenue 621500 1370069 1365799 4270 39542916 297101 297101 301690 210428 91262 91262 91262 37883 -37883 -37883 -37883 40099980 39538646 4270 350480 X 13332 13332 2500 2500 519989 519989 15967302 13862762 2104540 552161 504642 47519 2729411 2397143 332268 1180468 996225 184243 73757 73757 4238098 4038425 199673 134277 134277 2028789 1175138 853651 878543 870390 8153 399650 377448 22202 37633 6602 31031 105320 105320 2815006 2815006 155859 155859 Medical Supplies 3330074 3330074 Bad Debt Expense 1092047 1092047 Surcharge Fees 600982 600982 MN Care Tax 341006 341006 311451 51523 259928 37507655 32736424 4771231 0 5434503 6343798 5812017 5359787 780947 795630 162034 177475 46525397 23022208 24138081 23503189 22844729 25577617 856473 625488 929413 127242 60958197 62510226 4591350 4172661 501000 268317 5440000 4945000 234128 233350 0 51526 10766478 9670854 X 50191719 52839372 50191719 52839372 60958197 62510226 2592325 55328 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 15740 15740 31901581 13991438 17910143 12733838 8623399 4110439 1874238 407371 1466867 23503189 Estimated Third Party 51526 51526 X 39260357 55328 -1105379 -1050051 40310408 -210428 -210428 40099980 36612704 210428 210428 36402276 1105379 1105379 37507655 Part IV, Line 2b: The Medical Center acts as custodian for the funds of the residents, holds resident security deposits, and holds employee voluntary withholdings. Funds for residents and others totaled $233,350 and $234,128 at September 30, 2014 and 2013. Part X, Line 2: The Medical Center is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. The Medical Center files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Medical Center believes that is has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Medical Center's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2010. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Recorded in Revenue for Financial Statements -1,092,047. Contribution Expense Recorded in Revenue for Financial Statements -13,332. Part XI, Line 4b - Other Adjustments: Rental Expense Recorded in Expense for Financial Statements -210,428. Part XII, Line 2d - Other Adjustments: Rental Expense Recorded in Expense for Financial Statements 210,428. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Recorded in Revenue for Financial Statements 1,092,047. Contribution Expense Recorded in Revenue for Financial Statements 13,332. 1 1 X 1 X 1 X 1 1 1 0 1 1 393000 393000 0.01080 7344528 5636435 1708093 0.04690 7737528 5636435 2101093 0.05770 176933 12740 164193 0.00450 210733 210733 0.00580 3386189 2331274 1054915 0.02900 56010 56010 0.00150 3829865 2344014 1485851 0.04080 11567393 7980449 3586944 0.09850 2354 2354 0.00010 7403 7403 0.00020 6990 6990 0.00020 90653 90653 0.00250 98820 98820 0.00270 206220 206220 0.00570 0 1092047 14185 6688301 6744337 -56036 X 1 1 1 1 LifeCare Medical Center 715 Delmore Drive Roseau MN 56751 www.lifecaremedicalcenter.org 00579 X X X X X Urgent Care LifeCare Medical Center 1 1 X X X X X X X X X 12 1 0 1 X www.lifecaremedicalcenter.org/about X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X 1 1 X X X 1 0 X X X 1 X 0 0 LifeCare Medical Center Part V, Section B, Line 3: Representatives from both LifeCare Medical Center and LifeCare Public Health conducted 13 individual meetings with organizations and individuals who represent all geographic and age levels in our service area. These included: Roseau Ministerial Association, Warroad School District, Roseau School District, Badger/Greenbush School District, Warroad Chamber of Commerce, Altru Physicians, Marvin Windows and Doors, Central Boiler and Polaris Industries (3 largest employers in service area). In addition, those who serve low-income and minority populations were represented by Roseau County Social Services, LifeCare Public Health, Northwest Community Action and HeadStart. LifeCare Medical Center Part V, Section B, Line 5d: The CHNA was mailed to all city offices, county leadership and those who participated in the needs assessment. LifeCare Medical Center Part V, Section B, Line 6i: The Implementation Strategy was made available upon request. It is also posted on the Organization's website at www.lifecaremedicalcenter.org/about. LifeCare Medical Center Part V, Section B, Line 7: We did not address the need for positive parenting. LifeCare Medical Center does not have the expertise to implement strategies for this area of concern, but we do have related programs to help new parents navigate the first few years of their baby's life through services offered in our LifeCare Public Health department. Additionally, we will support those organizations who can make an impact by offering education in topics such as exercise, nutrition, and health overall well-being. LifeCare Medical Center Part V, Section B, Line 14g: In addition to providing the full policy upon request, the Hospital also summarizes the policy on its website, billing invoices, as well as brochures summarizing the policy in the emergency rooms and admissions office. 3 LifeCare Roseau Manor 715 Delmore Drive Roseau MN 56751 Skilled Nursing Facility LifeCare Greenbush Manor 19120 290th Street Greenbush MN 56726 Skilled Nursing Facility and Assisted Living Facility LifeCare Home Care and Hospice 715 Delmore Drive Roseau MN 56751 Home Health and Hospice Part I, Line 3c: Part I, Line 6b: The organization's community benefit report can be found on its website at lifecaremedicalcenter.org and is shared with service area residents in an annual newsletter that focuses on community benefit. Part I, Line 7: Charity care was converted to cost by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients. Community health improvements and cash and in-kind contributions are calculated at actual costs recorded in the general ledger. Education costs are based on estimated time and wages to manage students and interns at the facilities. Medicaid is calculated based on gross charges and estimated payments from the internal revenue system. Subsidized health services is converted to cost according to costs allocated to the relevant cost centers on the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $1,092,047. Part II, Community Building Activities: Economic development and community support includes donations to local community organizations and employee staff time donated to local community committees. Community support includes employee staff time spent on disaster preparedness beyond legal requirements.Environmental improvements include the time employees have been involved in a Healing Garden Team that has developed a tranquil park area for use by our patients, families, employees and community. We also had an asbestos removal project.Coalition building includes EMT and CPR training for area First Responders and Fire Departments, as well as time donated to the Roseau Area Diabetes Center.Community health improvement advocacy includes staff time on healthcare related boards that advocate for healthcare, as well as time spent on discussions on proper prescription drug disposals, med alerts, chronic disease management, time spent in local correctional facilities on prescription drug abuse and on the Roseau County Committee on Aging. By being involved in the community through the above activities, we are able to increase health awareness.Roseau County is considered a Health Professional Shortage Area and therefore is including the costs of recruitment in workforce development. This promotes better care for our patients. The costs include physician recruitment, career fairs and workforce development committees. Part III, Line 2: Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is calculated by using gross charity care at charges as a percentage of total gross hospital revenue. It is reasonable to assume that charity care as a percentage of gross revenue can also be applied to bad debt. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expense can be found on page eight and nine of the audited financial statement. Part III, Line 8: Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If a patient is known to qualify for financial assistance, or if the patient begins the financial assistance process, all collection actions cease until the application is completed. Part VI, Line 2: LifeCare provides the Public Health functions for the Roseau County. Through this role, we participated in a community needs assessment through Quinn County to assess the needs of our service area. Part VI, Line 3: We have financial counselors who have phone conversations with patients during our collections process. We guide patients to other financial programs as well as our own charity care program. Brochures are available in the admitting area which is in the same location as the Emergency Room. Information is also sent to our patients via patient bills. Our website has the charity care application and brochure, as well as the contact information for our financial counselors, available to patients. Part VI, Line 4: Roseau County is a rural area with a population of approximately 17,000 people. We are the sole hospital located in Roseau County and the nearest tertiary hospital is two hours away. We are a federally-designated medically underserved area. In 2009, approximately 12.7% of the population was age 65 or older. The average per capita income is 23,061 and approximately 9.7% of the population is below the federal poverty level. Part VI, Line 5: The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay.As a not-for-profit organization, LifeCare Medical Center has made a promise to give back to its community. As a regional healthcare leader, LifeCare strives to respond to healthcare needs by partnering with local leaders, educators, government officials and others.The community benefit report summarizes how this leadership role has made a difference to the people of the area. Included are highlights describing how LifeCare has played an integral role in enhancing the health and overall well being of the community.Trusted PartnershipsLifeCare's commitment to quality care extends beyond its walls and into the community where strong partnerships have been built to maintain and improve the health and overall well-being of its neighbors. LifeCare EMS personnel are proud of their trusted relationships with regional emergency response groups. Area fire fighters, police, and others participate in disaster training sessions where a disaster is staged and responded to as if it were a real life situation. This type of training helps prepare all groups involved.Education for a Healthy FuturePart of LifeCare's mission is to help educate the next generation of health care professionals. LifeCare Directors work closely with many regional high school and post-secondary educational facilities to bring students into our organization through job shadowing, internships, rural scholar and other programs. Through these programs, students get a firsthand look at specific health care careers as they learn from our staff for a day, week, month or several months based on their program. Students often times focus on rural healthcare employment opportunities that may be available to them once they have completed their education.Community CareLifeCare recognizes that circumstances arise where a patient is simply unable to pay a hospital bill. In these situations, LifeCare offers a program called Community Care, in which LifeCare forgives the bills of deserving families and individuals who meet set income guidelines. Great appreciation has been voiced by many who received a helping hand from this program. In fiscal year 2014, LifeCare granted over $600,000 in Community Care based on charges foregone.A Healthy Awareness and Community OutreachLifeCare employees know the importance of educating the public about a healthy lifestyle. And sometimes the best way to provide awareness is to venture outside the facility. That's why LifeCare is involved with many initiatives throughout our communities. By reaching out to the public through parish nursing, nutrition and exercise programs, civic projects, health and safety awareness, health fairs, and other methods, they are able to educate and strengthen the community.Fifth grade tours have become a favorite for students throughout Roseau County. A hospital tour is coupled with a mini health fair where students learn their blood type. The goal of this program is to influence young students into making healthy lifestyle decisions, in addition to introducing them to careers in healthcare.A partnership with area law enforcement has allowed LifeCare to initiate the POLST program, which assists local and county law enforcement officers and other first responders in helping patients in a medical emergency.Funding Essential ServicesLifeCare's commitment to community needs is exemplified by its contribution to subsidized services. In fiscal year 2014, LifeCare absorbed approximately $1,000,000 in costs in order to sustain services that rely on funding from other sources, in particular the Medicaid program. These departments include Home Health Care, Hospice, Public Health, and LifeCare's two nursing homes (Roseau Manor and Greenbush Manor).LifeCare Medical Center distributed over $4 million in Community Benefits in fiscal year 2014. Part VI, Line 7, Reports Filed With States MN X X X 0 0 0 0 0 0 0 0 0 Keith Okeson CEO/President 220987 0 16000 0 1620 0 16131 0 24953 0 279691 0 0 0 Cathy Huss CFO 165797 0 6000 0 1436 0 11462 0 20974 0 205669 0 0 0 Gordon Streiff Pharmacy Director 133104 0 250 0 1253 0 9100 0 24641 0 168348 0 0 0 Susan Lisell Senior Leader 146147 0 1000 0 2521 0 9659 0 13730 0 173057 0 0 0 Judy K Mattson Pharmacist 122760 0 50 0 1206 0 8177 0 23057 0 155250 0 0 0 A Roseau Area Hospital District 410785143 777187CW3 2012-11-15 5860000 Refund Series 1998 Bonds Issued 12/01/1998 0 0 0 A 915000 5860000 586000 117200 5156800 2012 1 0 1 1 A 0 0 0 0 0 0 0 0 1 A 1 Schedule K, Part II, Line 4, Gross Proceeds in Reserve Fund The filing organization does not report the $586,000 reserve funds on the their audited financials due to the issuer of the tax exempt bonds holding these funds. The issuer of the tax exempt bonds has included this amount on their financial statements. Form 990, Part VI, Section A, line 1 The Executive Committee consists of the Chair, Vice-Chair, Treasurer, Secretary, and at least one other director (who shall be selected annually.) The President/CEO will be a non-voting member of the committee. The President/CEO will be excused for matters relating to compensation and evaluation. The Executive Committee shall meet as often as necessary at the call of the Chair, Vice-Chair, or at the request of any two of its members. A majority of the Executive Committee shall constitute a quorum. The Executive Committee's specific responsibilities are to: * Exercise the authority of the board in the management of the business of the corporation between regularly scheduled meetings. * Report to the board any official actions it has taken at the next board meeting. * Review and approve the compensation program for the senior leaders of the organization that is designed to allow the organization to recruit and retain superior talent. * Responsible for conducting on an annual basis the process of establishing goals, evaluating the performance and establishing the compensation of the President/CEO. Form 990, Part VI, Section B, line 11 The return is reviewed initially by the CFO. The return is made available to the Board of Trustees before it is filed. Form 990, Part VI, Section B, line 12c All officers, trustees, and key employees are required to complete a conflict of interest form annually. The form is reviewed by the Board of Trustees to determine if any conflicts exist. If there are any conflicts, the Board of Trustees will discuss the restrictions that should be placed on the person with the conflict. Restrictions are typically related to voting and discussion of matters related to the conflict. Form 990, Part VI, Section B, line 15 The compensation for the CEO and CFO is approved by the Executive Committee based on comparability data. The CEO and CFO both have employment contracts. The deliberation and discussion of compensation is documented in the board meeting minutes. This process takes place on an annual basis. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part IX, line 11g Physician Fees: Program service expenses 1,610,295. Management and general expenses 11,360. Fundraising expenses 0. Total expenses 1,621,655. Service Related Fees: Program service expenses 2,208,590. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,208,590. Other Professional Fees: Program service expenses 219,540. Management and general expenses 188,313. Fundraising expenses 0. Total expenses 407,853.