2015-11-12T17:31:33-06:00 2014-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2014-01-01 410729979 NORTH MEMORIAL HEALTH CARE NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 TODD OSTENDORF CHIEF FINANCIAL OFFICER 7635205200 2015-11-11 1 LAWRENCE H MOHR CPA P00447603 6128764500 2014 2016-02-25 16:41:14Z J KEVIN CROSTON MD 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 789488003 0 X WWW.NORTHMEMORIAL.COM X 1954 MN GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. 14 13 5275 669 9540702 0 1250375 755248 631102778 655017004 14778356 18475881 -490606 -1569444 646640903 672678689 0 0 0 0 370462198 405110904 0 0 0 263129622 269506611 633591820 674617515 13049083 -1938826 581188207 598327991 220859367 244073385 360328840 354254606 X INSPIRING EACH OTHER TO GIVE OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. 0 0 592041141 591638698 NORTH MEMORIAL HEALTH CARE (NMHC) IS A GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE, OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL- SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATION, BEHAVIORAL HEALTH, MEDICAL TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NMHC ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST) IN FURTHERANCE OF ITS CHARITABLE PURPOSE. NORTH MEMORIAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED PROGRAMS, SUCH AS HEALTH SCREENINGS, SUPPORT COUNSELING FOR PARENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, UNREIMBURSED COSTS OF MEDICAL EDUCATION, TELEPHONE INFORMATION SERVICES, AND COST RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. NORTH MEMORIAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES, AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, NORTH MEMORIAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE. 592041141 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 505 0 5275 1 1 1 1 BD 0 0 0 0 0 0 0 0 X 14 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X TODD OSTENDORF 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 LOREN TAYLOR CEO NORTH MEMORIAL 50.00 5.00 X X 863098 0 24403 ROBERT POTTS CHAIRMAN OF BOARD 2.00 0.00 X X 3600 0 0 TIMOTHY BAYLOR BOARD MEMBER 2.00 0.00 X 3600 0 0 DANA CARLSON MD BOARD MEMBER 2.00 0.00 X 3600 0 0 JOHN GRAY MD BOARD MEMBER 2.00 0.00 X 0 0 0 SCOTT COLSON MD BOARD MEMBER 2.00 0.00 X 3600 0 0 ROBERT DAHL BOARD MEMBER 2.00 0.00 X 3600 0 0 MATTHIAS FELDKAMP MD BOARD MEMBER 2.00 0.00 X 3600 0 0 WARREN MACK BOARD MEMBER 2.00 0.00 X 3600 0 0 PATRICK MCHALE BOARD MEMBER 2.00 0.00 X 0 0 0 ROBERT N PRENTISS JR BOARD MEMBER 2.00 0.00 X 3600 0 0 MICHAEL STEINHAUSER BOARD MEMBER 2.00 0.00 X 0 0 0 RAHUL TAMHANE MD BOARD MEMBER 2.00 0.00 X 3600 0 0 WILLIAM TOBIN BOARD MEMBER 2.00 0.00 X 1800 0 0 TED FERRARA BOARD MEMBER 2.00 0.00 X 2700 0 0 KEVIN S RAFF MD BOARD MEMBER 2.00 0.00 X 0 0 0 TODD OSTENDORF VP FINANCE, CFO 50.00 2.00 X 428011 0 21773 J KEVIN CROSTON MD CHIEF MEDICAL OFFICER 50.00 2.00 X 511017 0 23841 JEFF WICKLANDER VP OPERATIONS 50.00 0.00 X 294542 0 25605 ANDREW COCHRANE CEO - MAPLE GROVE HOSPITAL 0.00 50.00 X 401997 0 26478 KELLY WHITE VP INPATIENT CARE/CNO 50.00 0.00 X 167595 0 11469 PATRICK TAFFE CHIEF INFORMATION OFFICER 50.00 0.00 X 322074 0 24383 DAVID ABRAMS VP HUMAN RESOURCES 50.00 0.00 X 289700 0 25352 COLLEEN NADEAU VP PATIENT CARE OPERATIONS - MGH 0.00 50.00 X 0 195323 4996 CRAIG MATTICKS STAFF EMERGENCY PHYSICIAN 50.00 0.00 X 531923 0 26591 TIFFANY ZITZEWITZ VP BUSINESS DEVELOPMENT 50.00 2.00 X 308174 0 26708 ANDREW HOULTON VP MEDICAL AFFAIRS 50.00 0.00 X 401662 0 24189 MICHAEL PARRISH VP EMERGENCY & ENTERPRISE OPERATIONS 50.00 0.00 X 332992 0 24135 GAYLE MATTSON PRESIDENT OF NORTH MEMORIAL 50.00 0.00 X 747008 0 18812 TRACY KIRBY VP INPATIENT CARE/CNO 50.00 0.00 X 334774 0 8893 ROBERT KING CARDIAC SURGEON 50.00 0.00 X 732870 0 26724 ALOK MAHESHWARI CARDIOLOGIST 50.00 0.00 X 785062 0 26112 STEVEN ROH CARDIOLOGIST 50.00 0.00 X 779332 0 26654 THOMAS ROSSINI STAFF EMERGENCY PHYSICIAN 50.00 0.00 X 683489 0 26572 JOSEPH VAN CAMP CARDIAC SURGEON 50.00 0.00 X 743693 0 18200 9695913 195323 441890 490 0 1 0 NORTH CLINIC 3366 OAKDALE AVE N 601 ROBBINSDALE MN 55422 PHYSICIAN SERVICES 8359544 DJ KRANZ COMPANY INCORPORATED 725 HIGHWAY 169 NORTH PLYMOUTH MN 554416403 CONSTRUCTION 6183103 RESPIRATORY CONSULTANTS PA 3366 OAKDALE AVE N 605 ROBBINSDALE MN 55422 INTENSIVISTS STAFFING 3164028 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 MANAGEMENT SUPPORT FOR DIETARY 2077378 UNIVERSITY OF MINNESOTA PHYSICIANS 720 WASHINGTON AVE SE STE 200 MINNEAPOLIS MN 55414 PHYSICIAN SERVICES 1801661 40 436289 318959 16817 755248 HOSPITAL PATIENT REVENUE 621500 597482451 587941749 9540702 CONTRACT REVENUE 900099 32604675 32604675 EHR/MEDICARE & OTHER 900099 12291949 12291949 JOINT VENTURE REVENUE 900099 5266393 5266393 PHARMACY 900099 5074380 5074380 2297156 2297156 655017004 5411204 5411204 1627 1627 11064317 12633761 -1569444 -1569444 -1569444 116165691 1072912 103821643 353910 12344048 719002 13063050 13063050 672678689 591638698 9540702 70744041 6702065 6702065 306349510 270182768 36166742 32698401 28838122 3860279 38894035 34302317 4591718 20466893 18050630 2416263 1453478 1281885 171593 325759 287301 38458 103593 103593 793407 793407 57994776 51148079 6846697 2469397 2266061 203336 5854444 5163285 691159 9363789 8258327 1105462 17137735 15114503 2023232 3702440 3265341 437099 30277654 26788045 3489609 5297867 4672416 625451 SUPPLIES 83796953 73904127 9892826 BAD DEBT EXPENSE 21275990 21275990 MAINTENANCE & REPAIR 13011366 11475282 1536084 GOVERNMENT TAXES 9156077 9156077 7491886 6610585 881301 674617515 592041141 82576374 0 18424 12174 8446193 14970298 128351 83422384 97938989 6250000 6582936 6391600 3962207 4505563 610999739 405044943 212607567 205954796 205615544 214845345 38756112 42745377 21776840 4585498 581188207 598327991 62622331 80221606 699070 418209 138985212 131974673 18552754 31458897 220859367 244073385 X 360328840 354254606 360328840 354254606 581188207 598327991 -1938826 -4135408 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 40000 1 80000 0 0 120000 0 PART II-B, LINE 1: CONTACTS AND VISITS WERE MADE WITH STATE LEVEL LEGISLATORS TO PROMOTE HEALTH CARE RELATED ISSUES. 3446092 76703 118858 50230 3591423 2683970 710628 85294 33800 3446092 2382667 270795 92571 62063 2683970 2251229 72500 71751 12813 2382667 1737891 513452 25341 25455 2251229 0.00000 0.94820 0.05180 0 1 1 15494381 15494381 234409773 126192941 108216832 14348364 10679673 3668691 337020134 261872092 75148042 9727087 6300237 3426850 205954796 RREEF AMERICA REIT II 23123885 F MELLON AGGREGATE BOND INDEX FUND 12195817 F CASH ON DEPOSIT WITH BOND TRUSTEE 5726167 F AGENCY ACCOUNT 2508 F CASUALTY INSURANCE SECURITY 1697000 F 42745377 EXECUTIVE PENSION PLAN 3937223 RESTORATION PENSION PLAN 57767 PY PENSION LIABILITY 16755156 POST RETIREMENT HEALTH INSURANCE 1365085 SECURITIES LENDING 3538291 CAA DEPOSIT RESERVE 114747 SETTLEMENTS AND CLAIMS PAYABLE 357295 DEFERRED INCOME LONG TERM 5333333 31458897 X PART V, LINE 4: ALL ENDOWMENT FUNDS ARE HELD BY A RELATED ENTITY: NORTH MEMORIAL FOUNDATION. 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD THE PAY IT FORWARD FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN. MICHELLE RECOGNIZED A NEED TO HELP WOMEN STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, UNITY AND MONTICELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE NORTH MEMORIAL FOUNDATION. 7) MEDICAL STAFF ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. 8) MAPLE GROVE MEDICAL STAFF ENDOWMENT WAS ESTABLISHED IN 2013 BY THE MAPLE GROVE MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND MAPLE GROVE PROGRAMS. PART X, LINE 2: NORTH MEMORIAL EVALUATES ITS UNCERTAIN POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2014 OR 2013. NORTH MEMORIAL IS CURRENTLY UNDER EXAMINATION BY THE STATE OF MINNESOTA FOR A SALES TAX AUDIT FOR THE PERIOD OF SEPTEMBER 2010 THROUGH DECEMBER 2013. 1 1 1 X 1 X 1 1 0 1 1 10052693 10052693 0.01490 85524225 55167688 30356537 0.04500 95576918 55167688 40409230 0.05990 1867151 1867151 0.00280 6424985 736777 5688208 0.00840 54403723 41430918 12972805 0.01920 96815 88398 8417 0.00000 856551 856551 0.00130 63649225 42256093 21393132 0.03170 159226143 97423781 61802362 0.09160 1 7878236 143166758 192948669 -49781911 X 1 1 1 MAPLE GROVE HOSPITAL HOSPITAL 0.75000 0.00000 0.00000 2 NM SURGERY CENTER MAPLE GROVE OUTPATIENT SURG CTR 0.50000 0.00000 0.50000 3 MN DIAGNOSTIC IMAGING PARTNERS OUTPATIENT IMAGING CTR 0.60000 0.00000 0.40000 4 PREFERRED ONE ADMINISTRATIVE SERVICES CLAIMS ADMINISTRATOR 0.25000 0.00000 0.25000 5 PREFERRED ONE COMMUNITY HEALTH PLAN INSURANCE COMPANY 0.50000 0.00000 0.00000 6 INSTITUTE OF ATHLETIC MEDICINE CLINIC 0.37000 0.00000 0.00000 7 MONTICELLO CANCER CENTER OPTNT CANCER CLINIC 0.40000 0.00000 0.00000 8 NORTH RADIATION ONCOLOGY OPTNT RADIATION ONC CLNC 0.50000 0.00000 0.50000 9 BLAINE URGENCY CENTER URGENT CARE 0.50000 0.00000 0.50000 10 PLYMOUTH CITY CENTER MEDICAL BUILDING MEDICAL OFFICE BUILDING 0.50000 0.00000 0.00000 11 MINNETONKA AMBULATORY SURGERY CENTER OUTPATIENT SURGERY CENTER 1.00000 0.00000 0.00000 12 FAIRVIEW HOME INFUSION HOME INFUSION CARE 0.49000 0.00000 0.00000 1 1 NORTH MEMORIAL MEDICAL CENTER 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 WWW.NORTHMEMORIAL.COM X X X X NORTH MEMORIAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.NORTHMEMORIAL.COM X 1 13 1 WWW.NORTHMEMORIAL.COM 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X X 1 0 1 X 0 1 NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 5: ONE OF THE KEY OBJECTIVES IN CONDUCTING THE 2013 CHNA WAS TO IDENTIFY HEALTH ISSUES MOST IMPORTANT TO OUR COMMUNITY MEMBERS. THIS WAS ACCOMPLISHED IN SEVERAL WAYS. NORTH MEMORIAL HEALTH CARE CONVENED 4 FOCUS GROUPS FROM TARGET POPULATIONS FROM THROUGHOUT THE COMMUNITY. WE FURTHER INTERVIEWED COMMUNITY LEADERS REPRESENTING LOCAL GOVERNMENT, LAW ENFORCEMENT, EDUCATION, RELIGIOUS ORGANIZATION, PUBLIC HEALTH AND COMMUNITY-BASED ORGANIZATIONS. LASTLY, WE CONDUCTED AN ONLINE SURVEY FOR COMMUNITY MEMBERS AND NORTH MEMORIAL EMPLOYEES. WE RETAINED AN OUTSIDE CONSULTING FIRM TO LEAD THE FOCUS GROUPS. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 11: PRIORITY AREA 1-ACCESS & AFFORDABILITY1.1-EDUCATION OF COMMUNITY MEMBERS ON HOW TO ENGAGE AND INTERACT WITH HEALTH CARE RESOURCESNORTH MEMORIAL HEALTH CARE HAS HOSTED A NUMBER OF EVENTS TO EDUCATE OUR COMMUNITY MEMBERS ABOUT HOW TO ENGAGE AND INTERACT WITH HEALTH CARE RESOURCES. THESE EVENTS INCLUDED SEMINARS ON: VASCULAR HEALTH AND TREATMENT OPTIONS; TREATMENT OPTIONS FOR ED; AND MINIMALLY INVASIVE SURGERY OPTIONS. 1.2-STRATEGIC PARTNERSHIP WITH COMMUNITY-BASED RESOURCES THAT SUPPORT ACCESS AND ENROLLMENT IN HEALTH INSURANCE PROGRAMS TO ADDRESS THIS PRIORITY WE TRAINED AND CERTIFIED EIGHT NORTH MEMORIAL EMPLOYEES AS MNSURE NAVIGATORS AND EXPANDED ACCESS TO EMERGENCY DEPARTMENT-BASED RESOURCES RELATED TO SUPPORTING PATIENTS' SOCIAL AND FINANCIAL NEEDS. WE ENGAGED PORTICO TO HOST 6 ENROLLMENT SESSIONS AT NORTH MEMORIAL MEDICAL CENTER, MAPLE GROVE HOSPITAL AND SELECT PRIMARY CARE CLINICS. 1.3-DELIVERY OF CARE TO THE COMMUNITY: SCREENINGS, EDUCATION, ETC. NORTH MEMORIAL HEALTH CARE REGULARLY WRITES HEALTH INFORMATION ARTICLES FOR OUR COMMUNITY NEWSPAPERS, OUR ONLINE CONSUMER BLOG AND OUR MONTHLY E-NEWSLETTER. THE CONTENT IS EDUCATIONAL IN NATURE AND THE TOPICS VARY FROM THE IMPORTANCE OF GETTING THE FLU VACCINATION TO HOW TO REDUCE ALLERGY SYMPTOMS AT HOME. THESE HEALTH MESSAGES ARE AUGMENTED WITH HEALTH INFORMATION DISSEMINATED THROUGH DIRECT MAIL NEWSLETTERS REACHING 400,000 HOUSEHOLDS EACH QUARTER, AND LOCAL ADVERTISING IN COMMUNITY NEWSPAPERS. PRIORITY AREA 2-COMMUNITY COLLABORATION & CONNECTING COMMUNITY RESOURCES2.1-QUARTERLY MEETINGS BETWEEN NMMC PRESIDENT AND COMMUNITY LEADERSA COMMUNITY HEALTH STEERING COMMITTEE WAS ESTABLISHED IN SEPTEMBER OF 2014. THE COMMITTEE IS COMPOSED OF COMMUNITY LEADERS WHO REPRESENT VARIOUS AREAS OF THE COMMUNITY. THE MISSION OF THIS COMMUNITY HEALTH STEERING COMMITTEE IS TO PROVIDE GUIDANCE FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, MONITOR THE WORK THAT IS BEING CONDUCTED TO ADDRESS THE IDENTIFIED PRIORITIES AND HELP IDENTIFY POTENTIAL COMMUNITY PARTNERSHIPS. 2.2-LINKING PATIENTS TO COMMUNITY-BASED RESOURCES NORTH MEMORIAL PARTNERED WITH THE METRO AREA AGENCY ON AGING PARTNERSHIP WITH A COMMUNITY ORGANIZATION THAT HAS HAD AN IMPACT ON THE OVERALL HEALTH OF A POPULATION. PROGRAMS INCLUDE COMMUNITY CARE TRANSITIONS PLUS PROGRAM TO REDUCE READMISSIONS, CHRONIC DISEASE SELF-MANAGEMENT PROGRAM, SENIOR FALLS PREVENTION DAY AND DEVELOPMENT OF DIRECT COMMUNICATION CHANNELS BETWEEN SENIOR LINKAGE LINE AND CLINIC CARE COORDINATORS. 2.3-LUTHERAN SOCIAL SERVICES SENIOR CORPS PROGRAMS NORTH MEMORIAL MEDICAL CENTER HAS A DIRECT PARTNERSHIP WITH LUTHERAN SOCIAL SERVICES THAT ALLOWS US TO ACCESS SIX DEDICATED VOLUNTEERS THAT WORK WITH HIGH-RISK SENIORS THAT RECEIVE CARE AT OUR CLINICS. EACH VOLUNTEER IS ABLE TO ENGAGE FIVE OR MORE SENIORS.PRIORITY AREA 3-CULTURAL COMPETENCY IN TREATMENT INTERACTIONS3.1-CLAS ASSESSMENT TO REVIEW ORGANIZATIONAL SYSTEMS, POLICIES AND PRACTICES THAT AFFECT THE CARE OF DIVERSE PATIENTS AN EXTERNAL VENDOR COMPLETED A LANGUAGE PRO PROFICIENCY AND CULTURAL COMPETENCY EVALUATION FOR NMMC. AT THAT TIME THE RECOMMENDATION FROM THE VENDOR AFTER THE ASSESSMENT WAS THAT ALL ED STAFF, INCLUDING PROVIDERS, REGISTRATION, EVS, LEADERSHIP, ATTEND A CULTURAL COMPETENCY TRAINING TO ENHANCE THE UNDERSTANDING AND PARTNERSHIP WITH PATIENTS OF DIFFERENT CULTURAL BACKGROUNDS.3.2-PHASE II: CULTURALLY-COMPETENT NURSE MIDWIFE PROGRAMWE CURRENTLY HAVE FOUR MIDWIVES, WHICH HAVE PROVIDED WELL WOMEN VISITS IN PARTNERSHIP WITH OUR HOPE CHEST BREAST CENTER FOR OUR LAOTIAN POPULATION IN 2014. WE HAVE PARTNERED WITH THE MINNEAPOLIS SCHOOL DISTRICT TO PROVIDE PRENATAL EDUCATION TO THEIR PREGNANT STUDENTS, MANY OF WHICH ARE IN A MINORITY POPULATION. THE MIDWIFE PROGRAM IS PARTNERING WITH EVERYDAY MIRACLES TO PROVIDE DOULA'S TO OUR LABORING PATIENTS STARTING NOVEMBER OF 2015. PRIORITY AREA 4-SOCIAL & EMOTIONAL WELLBEING4.1-POST-INCIDENCE CRISIS RESPONSE PROGRAM THAT ASSISTS IN COMMUNITY RESPONSE AFTER A VIOLENT CRIME OUR POST INCIDENCE CRISIS RESPONSE PROGRAM IS WHERE WE GATHER NECESSARY RESOURCES FROM VARIOUS HOSPITAL DEPARTMENTS AND POOL THOSE RESOURCES TOGETHER TO DEAL WITH A SUDDEN, OFTEN TRAUMATIC SITUATION THAT OCCURS IN OUR COMMUNITY AND ENDS UP AT THE HOSPITAL. MOST LIKELY THIS IS A SITUATION THAT STEMS FROM A VIOLENT INCIDENT. 4.2-PSYCH SERVICES FOR COMMUNITY: PARTIAL HOSPITAL PROGRAM AND PSYCH INTEGRATION IN PRIMARY CARENORTH MEMORIAL MEDICAL CENTER OFFERS THE FOLLOWING PSYCH SERVICES TO THE COMMUNITY WE SERVE: A PARTIAL HOSPITAL PROGRAM; AN INTENSIVE OUTPATIENT PROGRAM; INTEGRATED BEHAVIORAL HEALTH IN PRIMARY CARE; HEALTH PSYCHOLOGIST AVAILABLE TO PAIN, SLEEP AND SPECIALTY CLINICS; PSYCH ASSESSMENTS BY LICENSED MH PROFESSIONALS IN ED; A LIMITED OUTPATIENT PSYCHIATRY CLINIC; AND A KETAMINE CLINIC.4.3-CATHOLIC CHARITIES TRANSITIONAL RECOVERY-CARE: PROGRAM FOR DISCHARGING HOMELESS PATIENTSTHE CATHOLIC CHARITIES TRANSITIONAL RECOVERY-CARE PROGRAM IS A PARTNERSHIP BETWEEN NORTH MEMORIAL MEDICAL CENTER AND CATHOLIC CHARITIES. NORTH MEMORIAL MEDICAL CENTER PAYS FOR TWO STAFFED BEDS AT EXODUS HOUSE TO ENSURE A SAFE DISPOSITION FOR OUR HOMELESS POPULATION WHO ARE MEDICALLY STABLE BUT NEED TIME TO TRANSITION TO PERMANENT HOUSING. 4.4-SAFEJOURNEY PROGRAMSAFEJOURNEY IS AN INNOVATIVE, VOLUNTEER-DRIVEN PROGRAM THAT PROVIDES VICTIMS OF DOMESTIC VIOLENCE WITH SAFETY PLANNING, INJURY DOCUMENTATION, IMMEDIATE EMOTIONAL SUPPORT, LEGAL ADVOCACY, AND OPTIONS FOR LONGER-TERM SUPPORT. TRAINED VOLUNTEER ADVOCATES PROVIDE 24-HOUR ON SITE ADVOCACY TO PATIENTS AT NORTH MEMORIAL AND MAPLE GROVE HOSPITAL AS WELL AS INDIVIDUALS IN OUR COMMUNITIES. ON-GOING SUPPORT IS PROVIDED BY WEEKLY SUPPORT GROUPS, INDIVIDUAL COUNSELING, AND FOLLOW UP CALLS. PRIORITY AREA 5-HEALTH INFORMATION5.1-INJURY PREVENTION: SAFE KIDS NW METRO MINNEAPOLIS COALITION AND THE PARTNERSHIP FOR CHANGE:PARTNERSHIP FOR CHANGE (PFC) IS A COMMUNITY BASED COALITION WHOSE MISSION IS TO LEVERAGE COMMUNITY PARTNERSHIPS TO PREVENT AND REDUCE ALCOHOL AND OTHER DRUG USE AMONG YOUTH AND REDUCE SUBSTANCE ABUSE IN THE COMMUNITY. PFC SERVES THE BROOKLYN CENTER, OSSEO, AND ROBBINSDALE SCHOOL DISTRICTS IN HENNEPIN COUNTY, MN. THE PFC COALITION MET 12 TIMES IN 2014, WITH ADDITIONAL STEERING COMMITTEE MEETINGS AND SUB-COMMITTEE MEETINGS. SOME OF THE MAJOR ACTIVITIES CARRIED OUT INCLUDE: THREE PRESENTATIONS ON THE PLACE OF LAST DRINK INITIATIVE AT NATIONAL CONFERENCES AND OTHERS THROUGHOUT MN. THE HIGH SCHOOL YOUTH LEADERSHIP GROUP MET 10 TIMES AND CARRIED OUT A GREEN BEAN "SOCIAL MARKETING CAMPAIGN" PROMOTING THE MESSAGE THAT MOST STUDENTS DO NOT DRINK ALCOHOL. SOCIAL HOST ORDINANCE REMINDER CARDS WERE DISTRIBUTED TO PARENTS AND CARING ADULTS TO REMIND THEM IT IS ILLEGAL TO PROVIDE A PLACE FOR YOUTH TO DRINK.SAFE KIDS NW METRO MINNEAPOLIS IS A COMMUNITY COALITION THAT WORKS TO PREVENT INJURIES IN CHILDREN. IN 2014 WE HOSTED 4 SAFE KIDS EXECUTIVE MEETINGS AND 6 MN WATER SAFETY COALITION MEETINGS. THROUGH COMMUNITY PARTNERSHIPS WE DISTRIBUTED 1,000 BIKE HELMETS. SAFE KIDS COORDINATED 7 CAR SEAT CLINICS WITH COMMUNITY PARTNERS, TEACHING PARENTS AND GRANDPARENTS TO CORRECTLY INSTALL 142 CAR SEATS5.2-STROKE AWARENESS & PREVENTION:THE NORTH MEMORIAL STROKE PROGRAM PARTICIPATED IN MULTIPLE COMMUNITY EVENTS, SCREENINGS, NEWS REPORTS AND OFFERED TWO STROKE EDUCATION CLASSES FOR STROKE SURVIVORS. WE HAVE AN ACTIVE STOKE SUPPORT GROUP WITH OVER 900 PARTICIPATES IN 2014. IN 2014, 254 STROKE SCREENINGS OCCURRED AT 3 COMMUNITY EVENTS. 33 PEOPLE PARTICIPATED IN 2 STROKE RELATED COMMUNITY OUTREACH PROGRAMS. 5.3-CANCER SCREENING & PREVENTION:MELANOMA SCREENINGS WERE PERFORMED AT NORTH MEMORIAL ON MAY 5, 2014 AND SEPTEMBER 27, 2014 UNDER THE AUSPICES OF THE SPOT SKIN CANCER CAMPAIGN, 150 PERSONS SERVED. THIS PROGRAM STIPULATES THAT SCREENING CLINICIANS SHOULD NOT PREFERENTIALLY FUNNEL REFERRALS TO THEIR OWN PRACTICE. THE PATIENTS WHO PARTICIPATED IN THE MELANOMA SCREENING EVENTS WERE PROVIDED A SHEET LISTING THE NEAREST 5 REPUTABLE DERMATOLOGY GROUPS OF WHICH CLARUS DERMATOLOGY WAS ONE.THERE WAS A BREAST CANCER SCREENING EVENING PROGRAM IN OCTOBER 2014 FOR THE LAO COMMUNITY AT THE BREAST CENTER. SCREENING MAMMOGRAMS WERE COMPLETED AND SOME OF THE WOMEN ALSO UNDERWENT CERVICAL CANCER SCREENING. THERE WERE APPROXIMATELY 10 PATIENTS WHO PARTICIPATED IN THE EVENT. WOMEN'S NIGHT OUT: AN INFORMATIONAL EVENING FOR WOMEN TOOK PLACE IN OCTOBER 2014. THERE WERE THREE SPEAKERS THROUGHOUT THE EVENING, INCLUDING TOPICS ON NUTRITION, GENETIC LINKS AND THE EXPERIENCE OF THE PATIENT. THERE WAS A SCHEDULER AVAILABLE THROUGHOUT THE EVENING TO SCHEDULE PATIENTS FOR THEIR MAMMOGRAMS.5.4-ADVANCE CARE PLANNING (ACP):FROM JANUARY TO NOVEMBER APPROXIMATELY 12 HOURS A WEEK WAS SPENT IN DIRECT PATIENT ACP CONTACT. IN OCTOBER 2014 AN ADVANCE CARE PLANNING FACILITATOR WAS HIRED AND TRAINED IN ACP. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 22D: THE MINNESOTA ATTORNEY GENERAL'S OFFICE REQUIRES HOSPITALS TO RENDER SERVICES TO THOSE PATIENTS WHO DO NOT HAVE INSURANCE AT A REDUCED RATE EQUAL TO THE DISCOUNT INCURRED FROM THE HIGHEST VOLUME MANAGED CARE PLAN. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 24: PER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT, THIRD PARTY LIABILITY AND PROCEDURES THAT ARE NOT MEDICALLY NECESSARY ARE NOT COVERED UNDER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT AND THOSE PATIENTS CAN BE BILLED FULL CHARGES. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: WWW.NORTHMEMORIAL.COM 4 MINNESOTA DIAGNOSTIC IMAGING PARTNERS LL 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 OUTPATIENT RADIOLOGY BLAINE URGENCY CENTER 480 OSBORNE RD NE FRIDLEY MN 55432 URGENT CARE NM SURGERY CENTER MAPLE GROVE 9875 HOSPITAL DRIVE MAPLE GROVE MN 55369 OUTPATIENT SURGERY NORTH RADIATION THERAPY CENTER 6950 FRANCE AVE S SUITE 200 EDINA MN 55435 OUTPATIENT RADIOLOGY PART III, LINE 2: AMOUNT REPRESENTS THE HOSPITAL'S BAD DEBT PROVISION REDUCED BY THE HOSPITAL'S COST TO CHARGE RATIO WHICH REPRESENTS THE BEST ESTIMATE OF COST FOR THE BAD DEBT PROVISION. PART III, LINE 4: NORTH MEMORIAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT. PART III, LINE 8: THE SHORTFALL REPORTED REPRESENTS THE AMOUNT MEDICARE REIMBURSEMENT IS LESS THAN THE ESTIMATED COST OF PROVIDING SERVICES TO THOSE PATIENTS. THE METHOD USED TO ESTIMATE THOSE COSTS IS THE COST TO CHARGE RATIO APPROACH WHICH CALCULATES THE RATIO OF TOTAL HOSPITAL COSTS / TOTAL HOSPITAL GROSS REVENUE AND THEM APPLIES THAT RATIO TO TOTAL MEDICARE GROSS REVENUE. PART III, LINE 9B: NORTH MEMORIAL HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATIONS INTRANET AND PERTAIN TO ALL ENTITIES UNDER THE NORTH MEMORIAL CORPORATE UMBRELLA. PART VI, LINE 2: NORTH MEMORIAL WORKS CLOSELY WITH COMMUNITY MEMBERS TO DETERMINE AREAS OF INTEREST AND NEED IN HEALTHCARE SERVICES. STARTING IN LATE 2012 AND INTO 2013 WE STARTED COMPLETING A FULL COMMUNITY NEEDS ASSESSMENT, INCLUDING COMMUNITY FOCUS GROUPS, TO BETTER UNDERSTAND THE COMMUNITY'S HEALTH NEEDS. WE ARE CURRENTLY ADDRESSING THE NEEDS IDENTIFIED IN OUR 2013 COMMUNITY HEALTH NEEDS ASSESSMENT. A NEW COMMUNITY HEATH NEEDS ASSESSMENT WILL BE CONDUCTED IN 2016. PART VI, LINE 3: NORTH MEMORIAL HEALTH CARE HAS A VERY PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE AN IMMEDIATE DISCOUNT TO UNINSURED MINNESOTA RESIDENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.OUR CHARITY CARE PROGRAM IS PUBLISHED IN THE CORPORATE POLICIES AND PROCEDURES AND PROVIDES FOR 100% COVERAGE OF MEDICAL BILLS FOR ANYONE WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND NEEDS ASSISTANCE IN RESOLVING THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. THERE IS A GRADUAL REDUCTION IN THE CHARITY COVERAGE BETWEEN THE 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES.IF WE ARE UNABLE TO MEET WITH THE PATIENT BEFORE DISCHARGE FROM NORTH MEMORIAL, THE PATIENT IS GIVEN A PAMPHLET THAT LISTS CONTACT NUMBERS TO OUR BUSINESS OFFICE CUSTOMER SERVICE AREA TO DISCUSS OPTIONS FOR ASSISTANCE WITH THEIR MEDICAL BILLS. THIS CONTACT INFORMATION IS ALSO PROVIDED ON EVERY STATEMENT THAT IS SENT TO OUR CUSTOMERS. IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE. PART VI, LINE 4: NORTH MEMORIAL SERVES A GEOGRAPHIC AREA THAT INCLUDES 42 ZIP CODES IN THE NORTHWEST QUADRANT OF THE TWIN CITIES METRO. THIS SERVICE AREA INCLUDES BOTH URBAN, SUBURBAN, EX-URBAN, AND RURAL AREAS. THIS SERVICE AREA INCLUDES A DIVERSE POPULATION OF MORE THAN 900,000 PEOPLE LIVING IN HENNEPIN, WRIGHT, SHERBURNE AND RAMSEY COUNTIES. PART VI, LINE 5: NORTH MEMORIAL MEDICAL CENTER IS A GENERAL ACUTE CARE HOSPITAL PROVIDING SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CARDIOVASULAR AND OPEN HEART SERVICES, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATIVE AND BEHAVIORAL SERVICES. NMHC ALSO PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO OUR COMMUNITY INCLUDING PRIMARY CARE, AMBULANCE TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. NORTH MEMORIAL IS GOVERNED BY A BOARD OF 15 REPRESENTATIVES CONSISTING OF PHYSICIANS AND VARIOUS LEADERS FROM THROUGHOUT THE COMMUNITY. BOARD MEMBERS ARE ELECTED TO SERVE THREE-YEAR TERMS FOR A TOTAL OF FIVE TERMS. THE MEDICAL CENTER ALSO SUPPORTS AN OPEN MEDICAL STAFF ORGANIZATION INCLUDING APPROXIMATELY 900 BOARD CERTIFIED PHYSICIANS AND 300 ALLIED HEALTH PROFESSIONSALS. THE NORTH MEMORIAL BOARD OF TRUSTEES ESTABLISHES AN ANNUAL MARGIN TARGET FOR MANAGEMENT. PER BOARD POLICY 75% OF ANY EXCESS AVAILABLE CASH FLOW IS REINVESTED IN THE FORM OF CAPITAL IMPROVEMENTS TO THE CENTER. THE REMAINING 25% IS REINVESTED TO SUPPORT LONG TERM OPERATIONS. WE PROVIDE EDUCATION TO THE COMMUNITY ON CHILD SAFETY, STROKE RISK FACTORS, HEART DISEASE RISK FACTORS AND OTHER HEALTH PROMOTION INFORMATION. PART VI, LINE 6: NORTH MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. THROUGH TARGETED OUTREACH, EDUCATION AND PARTNERSHIPS, WE IMPROVE THE HEALTH OF OUR COMMUNITIES BY LISTENING TO THEIR NEEDS AND RESPONDING WITH APPROPRIATE PROGRAMS AND SERVICES.OUR PROGRAMS, MANY OF WHICH HAVE BEEN NATIONALLY RECOGNIZED, RANGE FROM HEALTH EDUCATION AND FREE SCREENINGS TO TRAINING HEALTH PROFESSIONALS. PART VI, LINE 7: NORTH MEMORIAL HEALTH CARE FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF MINNESOTA. X 1 1 X X X X 1 0 0 0 0 1 0 0 0 LOREN TAYLOR CEO NORTH MEMORIAL 659362 0 20000 0 183736 0 18200 0 6203 0 887501 0 0 0 TODD OSTENDORF VP FINANCE, CFO 335010 0 20000 0 73001 0 13492 0 8281 0 449784 0 0 0 J KEVIN CROSTON MD CHIEF MEDICAL OFFICER 426538 0 20000 0 64479 0 18200 0 5641 0 534858 0 0 0 JEFF WICKLANDER VP OPERATIONS 244186 0 15000 0 35356 0 17347 0 8258 0 320147 0 0 0 ANDREW COCHRANE CEO - MAPLE GROVE HOSPITAL 330000 0 20000 0 51997 0 18200 0 8278 0 428475 0 0 0 KELLY WHITE VP INPATIENT CARE/CNO 140861 0 7000 0 19734 0 4206 0 7263 0 179064 0 0 0 PATRICK TAFFE CHIEF INFORMATION OFFICER 252261 0 20000 0 49813 0 18460 0 5923 0 346457 0 0 0 DAVID ABRAMS VP HUMAN RESOURCES 225000 0 20000 0 44700 0 17150 0 8202 0 315052 0 40759 0 COLLEEN NADEAU VP PATIENT CARE OPERATIONS - MGH 0 166771 0 28230 0 322 0 4875 0 121 0 200319 0 0 CRAIG MATTICKS STAFF EMERGENCY PHYSICIAN 528089 0 0 0 3834 0 18200 0 8391 0 558514 0 0 0 TIFFANY ZITZEWITZ VP BUSINESS DEVELOPMENT 250000 0 20000 0 38174 0 18488 0 8220 0 334882 0 0 0 ANDREW HOULTON VP MEDICAL AFFAIRS 344856 0 0 0 56806 0 18200 0 5989 0 425851 0 0 0 MICHAEL PARRISH VP EMERGENCY & ENTERPRISE OPERATIONS 272002 0 15000 0 45990 0 18200 0 5935 0 357127 0 0 0 GAYLE MATTSON PRESIDENT OF NORTH MEMORIAL 283256 0 20000 0 443752 0 18552 0 260 0 765820 0 0 0 TRACY KIRBY VP INPATIENT CARE/CNO 62455 0 15000 0 257319 0 5891 0 3002 0 343667 0 0 0 ROBERT KING CARDIAC SURGEON 672400 0 50000 0 10470 0 18200 0 8524 0 759594 0 0 0 ALOK MAHESHWARI CARDIOLOGIST 782416 0 0 0 2646 0 18200 0 7912 0 811174 0 0 0 STEVEN ROH CARDIOLOGIST 776666 0 0 0 2666 0 18200 0 8454 0 805986 0 0 0 THOMAS ROSSINI STAFF EMERGENCY PHYSICIAN 553668 0 127175 0 2646 0 18200 0 8372 0 710061 0 0 0 JOSEPH VAN CAMP CARDIAC SURGEON 672400 0 66774 0 4519 0 18200 0 0 0 761893 0 0 0 PART I, LINE 1A THE ORGANIZATION REIMBURSES ONE OF THE EXECUTIVE MEMBERS FOR THE MONTHLY SOCIAL DUES AT THE GOLDEN VALLEY COUNTRY CLUB. THE DUES FOR 2014 WERE $90 PER MONTH OR $1,080 PER YEAR. THE NORTH MEMORIAL COMMUNITY FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUNDRAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORT VARIOUS ACTIVITIES FOR NORTH MEMORIAL. PART I, LINE 4A A PORTION OF THE AMOUNTS REPORTED IN "OTHER REPORTABLE COMPENSATION" REFLECTS PAYMENTS MADE IN 2014 PURSUANT TO SEVERANCE AGREEMENTS WITH 2 EMPLOYEES AS FOLLOWS: GAYLE MATTSON - $359,840 TRACY KIRBY - $241,434 PART I, LINE 6 NORTH MEMORIAL HEALTH CARE'S ANNUAL INCENTIVE PLAN REQUIRES ACHIEVEMENT OF STATED PERFORMANCE METRICS, WHICH INCLUDE OPERATING CASH FLOW MARGIN. PART III, LINE 2: ALL EXPENSES ARE REVIEWED PRIOR TO REIMBURSEMENT AND APPROVED BY THE CEO. NORTH MEMORIAL REPORTS EXECUTIVE EXPENSE REIMBURSEMENT DATA TO THE BOARD OF TRUSTEES ON A PERIODIC BASIS. A CITY OF MAPLE GROVE 410873250 56516TAD7 2005-09-22 55000000 CONSTRUCTION OF OUTPATIENT CENTER 0 1 0 B CITY OF ROBBINSDALE 716005496 2011-06-07 60000000 REFUND SERIES 2008 BONDS 0 1 0 C CITY OF ROBBINSDALE 716005496 2011-06-07 15000000 REFUND SERIES 2008 BONDS 0 1 0 A 805000 54851782 1083801 49000001 2007 0 0 1 1 B 10806517 60000000 749350 58710650 2011 1 0 1 1 C 2115000 15000000 15000000 2011 1 0 1 1 A 0 1 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MAPLE GROVE DATE THE REBATE COMPUTATION WAS PERFORMED: 08/31/2010 ROBIN DRUG AND MERWIN PHARMACIES BOARD MEMBER IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES 442886 MICHAEL STEINHAUSER, A BOARD MEMBER, IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES, WHICH SUPPLIES DRUGS AND PHARMACEUTICALS TO NORTH MEMORIAL HEALTH CARE. 0 FORM 990, PART VI, SECTION A, LINE 2 LOREN TAYLOR AND BOB POTTS - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE REVIEWS THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEW THE FORM 990 WITH THE FINANCE AND AUDIT COMMITTEE IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE FINANCE AND AUDIT COMMITTEE APPROVES THE FORM 990 AND FORWARDS IT TO THE FULL BOARD FOR ITS REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY POSITIONS IS REVIEWED BY THE COMPENSATION COMMITTEE COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE COMPENSATION COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE ONLINE THROUGH THE OFFICE OF THE ATTORNEY GENERAL VIA THE CHARITY REPORT FILED WITH THE STATE OF MINNESOTA. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT WERE CHANGED DURING THE TAX YEAR. 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