2015-08-10T16:36:20-05:00 2014-09-30 420714325 MCGLADREY LLP 227 W FIRST ST STE 700 DULUTH MN 558021926 990 2013-10-01 410745522 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE CENTER AITK 2189272121 200 BUNKER HILL DRIVE AITKIN MN 56431 CASEY JOHNSON CFO 2189272121 2015-08-06 1 MARY BETH SANTORI P00023783 2187275025 2013 2016-04-25 22:37:26Z CHAD COOPER 200 BUNKER HILL DRIVE AITKIN MN 56431 66750347 0 X WWW.RIVERWOODHEALTHCARE.COM X 1948 MN INPATIENT AND OUTPATIENT MEDICAL CARE AND THREE PRIMARY CARE CLINICS. 11 10 419 125 1291491 0 671522 728571 51932652 54971487 945158 1117684 358544 487405 53907876 57305147 0 0 0 0 25370019 25613279 38801 24817 556195 26570151 28334271 51978971 53972367 1928905 3332780 75825894 81626274 45417709 47474845 30408185 34151429 X PROVIDE HIGH QUALITY INPATIENT AND OUTPATIENT CARE AND THREE PRIMARY CLINICS CARE TO THE RESIDENTS OF AITKIN AND THE SURROUNDING AREA. 0 0 44980531 54167401 RIVERWOOD HEALTHCARE CENTER EXISTS TO ENHANCE AND IMPROVE THE HEALTH AND WELLBEING OF RESIDENTS OF AITKIN COUNTY AND THE SURROUNDING AREA BY PROVIDING A COMPREHENSIVE ARRAY OF MEDICAL SERVICES CLOSE TO HOME. RIVERWOOD HEALTHCARE CENTER OPERATES A CRITICAL ACCESS, 25-BED HOSPITAL LOCATED IN AITKIN, MINN. SERVICES INCLUDE 24-HOUR EMERGENCY CARE WITH COMPREHENSIVE ADVANCED LIFE SUPPORT (CALS) HOSPITAL, LEVEL I HEART ATTACK PROGRAM AND LEVEL III TRAUMA DESIGNATIONS, INTENSIVE/CORONARY CARE, URGENT CARE, INPATIENT AND OUTPATIENT SURGERY WITH MANY MINIMALLY INVASIVE PROCEDURES, BIRTHING SUITES, A WIDE RANGE OF SPECIALTY CARE, REHABILITATION SERVICES AND MORE. RIVERWOOD OFFERS OUTPATIENT CARE AT CLINICS IN AITKIN, GARRISON AND MCGREGOR. RIVERWOOD IS STAFFED BY APPROXIMATELY 350 HEALTHCARE PROFESSIONALS. RIVERWOOD ALSO HAS A STRONG FOCUS ON HEALTH AND WELLNESS AND STRIVES TO EDUCATE AND INFORM THE COMMUNITY ON HEALTH ISSUES. RIVERWOOD OFFERS COMMUNITY HEALTH EDUCATION SEMINARS, SUPPORT GROUPS AND CLASSES AS WELL AS HEALTH AND WELLNESS TIPS IN OUR HEALTHY LIVING NEWSLETTER.DURING 2014, RIVERWOOD HEALTHCARE CONTINUED TO PARTNER WITH THE COMMUNITIES SERVED IN AITKIN, GARRISON AND MCGREGOR ON VARIOUS WELLNESS PROGRAMS AND INITIATIVES. IN 2014, TWO NEW PHYSICIANS JOINED RIVERWOOD'S MEDICAL STAFF. DR. AUSTIN KROHN, A FAMILY PRACTICE PHYSICIAN, HAS A SPECIAL INTERESTED IN PEDIATRICS, ADOLESCENT HEALTH AND SPORTS MEDICINE. DR. CHRISTINA KRAMER, OBSTETRICIAN AND GYNECOLOGIST, JOINED DRS. MICHAEL AND RACHEL CADY IN SERVING WOMEN'S HEALTH NEEDS. RIVERWOOD OBTAINED A GRANT FROM THE MINNESOTA DEPARTMENT OF HEALTH TO MOVE AHEAD IN 2015 WITH IMPLEMENTING A PATIENT CENTERED MEDICAL HOME MODEL OF CARE IN IT'S CLINICS IN AITKIN, GARRISON AND MCGREGOR, MINNESOTA. 44980531 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 61 0 1 419 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X JUDY TURNER 2189272121 200 BUNKER HILL DRIVE AITKIN MN 56431 X THOMAS RIKALA CHAIRMAN 1.00 X X 0 0 0 JOHN W NEWSTROM DIRECTOR 1.00 X 0 0 0 DR SANDRA KILDE DIRECTOR 1.00 X 0 0 0 JEFF EHNSTROM MD DIRECTOR/PHYSICIAN 41.00 X 294362 0 28011 STEVE WILSON FORMER SECRETARY 1.00 X 0 0 0 ALISON MATALAMAKI TREASURER 1.00 X X 0 0 0 MIKE PAULBECK VICE CHAIR 1.00 X X 0 0 0 MARK HEGGEM MD CMO 41.00 X 284549 0 28011 JARED LUNDGREN DIRECTOR 1.00 X 0 0 0 TOM LUNDBERG DIRECTOR 1.00 X 0 0 0 TIM DIRKS DIRECTOR 1.00 X 0 0 0 DAVID MEYER DIRECTOR 1.00 X 0 0 0 KATHLEEN RYAN DIRECTOR 1.00 X 0 0 0 CHAD GROSS SECRETARY 1.00 X X 0 0 0 MICHAEL HAGEN CEO - FORMER 39.90 0.10 X 235444 0 19679 KENT DUMONSEAU CFO - FORMER 39.90 0.10 X 122229 0 15824 CHAD COOPER CEO 39.90 0.10 X 137009 0 8819 GORDY FORBORT FORMER - INTERIM CFO 19.90 0.10 X 49000 0 0 CASEY JOHNSON CFO 39.90 0.10 X 0 0 0 STEVEN PITSCHKA MD PHYSICIAN 40.00 X 336578 0 18384 JEFFREY RAPP MD PHYSICIAN 40.00 X 325479 0 28011 JIM HARRIS MD ER MEDICAL DIRECTOR 40.00 X 320685 0 28011 DAVID TAYLOR MD PHYSICIAN 40.00 X 298499 0 18348 THOMAS OSBORNE MD PHYSICIAN 40.00 X 340967 0 28011 2744801 0 221109 31 0 1 0 CUYUNA REGIONAL MEDICAL CENTER 320 E MAIN CROSBY MN 56441 PROF MEDICAL SERVICES 1578961 CENTRAL MINNESOTA DIAGNOSTICS INC 150 10TH STREET NW MILACA MN 56353 RADIOLOGY SERVICES 1225018 LIFE GUARD ANESTHESIA SERVICES INC 29561 395TH PLACE AITKIN MN 56431 PROF ANESTHESIA SERVICES 964387 PREMIER SURGICAL ASSOCIATES PA 320 E MAIN CROSBY MN 56441 PROF SURGICAL SVCS 426558 TECHNISCRIBE 7734 EXCELSIOR RD 102 BAXTER MN 56425 TRANSCRIPTION SVCS 224301 11 325278 403293 26598 728571 NET PATIENT SERVICE REVENUE 621500 52912346 52912346 GARRISON PHARMACY 446110 1296287 1296287 ELECTRONIC HEALTH RECORD INCENTIV 621500 519429 519429 EQUITY IN EARNINGS OF AFFILIATES 900099 243425 248221 -4796 54971487 663107 663107 9844086 55691 9396768 48432 447318 7259 454577 454577 OTHER REVENUE 900099 487405 487405 487405 57305147 54167401 1291491 1117684 1176087 659629 516458 19371138 16407178 2727424 236536 667814 617581 41347 8886 3090678 2790970 261422 38286 1307562 1177795 113729 16038 81231 81208 23 82697 82697 24817 24817 2284599 2108589 176010 1989567 1652429 316267 20871 3310552 2749569 526255 34728 266516 266516 HOSPITAL SUPPLIES & OTH 10104212 10104212 NURSING SUPPLIES & OTHE 6538587 6538587 OTHER GENERAL SERVICE S 1338518 1338518 PROVISION FOR DOUBTFUL 944063 944063 1393729 1393729 53972367 44980531 8435641 556195 234391 908036 3151342 4382348 6761690 8221832 1309694 1264754 697070 532051 59107740 28405107 32910122 30702633 23676675 25325579 7084910 10289041 75825894 81626274 4822644 7967580 24562176 23721090 16032889 15786175 45417709 47474845 X 29503404 33182185 904781 969244 30408185 34151429 75825894 81626274 X 3332780 319404 91061 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2088 2088 0 PART II-B, LINE 1: RIVERWOOD HEALTHCARE CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 406564 134710 27056 2000 8000 558330 380978 15063 26281 15758 406564 330207 1250 52521 3000 380978 331439 1590 -1822 1000 330207 203149 17190 22131 -90969 2000 331439 0.36850 0.21760 0.41390 0 1 1 1213670 1213670 31769102 10823361 20945741 22161166 15717417 6443749 3963802 1864329 2099473 30702633 ASSETS LIMITED FOR RESERVE ACCOUNTS 2626080 ASSETS LIMITED FOR PRINCIPAL & INTEREST PAYMENTS 700326 BENEFICIAL INTEREST IN NET ASSETS-HOSPITAL FOUNDATION 969244 BOND ISSUE COSTS, NET OF ACCUMULATED AMORTIZATION 634541 INVESTMENT IN CENTRAL MINNESOTA DIAGNOSTICS, INC. 1172406 INVESTMENT IN SISU MEDICAL SYSTEMS 3306 INVESTMENT IN SISU MEDICAL SOLUTIONS, LLC -4530 ASSETS LIMITED BY AGREEMENT FOR DEFERRED COMPENSATION 900566 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1012411 ASSETS LIMITED FOR CONSTRUCTION 22388 ASSETS LIMITED BY AGREEMENT FOR WORKER'S COMPENSATION 238000 ASSETS LIMITED BY BOARD FOR FUNDED DEPRECIATION 2014303 10289041 BOND PREMIUM 45901 REVENUE NOTE PAYABLE 15740274 15786175 X 56764290 319404 -853002 -533598 57297888 7259 7259 57305147 53021046 -7259 -7259 53028305 944063 944063 53972368 PART V, LINE 4: TO BE USED AND DISTRIBUTED AS A SCHOLARSHIP OR EDUCATIONAL FUND TO AID IN THE EDUCATION AND RECRUITMENT OF HEALTH CARE PROFESSIONALS FOR RIVERWOOD HEALTHCARE CENTER. PART X, LINE 2: NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NOT-FOR-PROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE CENTER HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES -944,063. INCREASE IN INTEREST IN NET ASSETS - AITKIN COMMUNITY HOPSITAL FOUNDATION 64,463. GRANT USED FOR PURCHASE OF EQUIPMENT 26,598. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT 7,259. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT -7,259. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 944,063. X X X X X X X 1 HBH ASSOCIATES LLC 340 10TH STREET NW MILACA MN 56353 CONSULTING 0 177527 24817 152710 177527 24817 152710 MN 1 1 1 X 1 X 1 1 0 0 971221 971221 0.01830 6669574 4184385 2485189 0.04690 7640795 4184385 3456410 0.06520 524097 524097 0.00990 13440 13440 0.00030 14710463 11858643 2851820 0.05380 15248000 11858643 3389357 0.06400 22888795 16043028 6845767 0.12920 1 944063 141609 18520183 18633750 -113567 X 1 1 1 1 RIVERWOOD HEALTHCARE CENTER 200 BUNKER HILL DRIVE AITKIN MN 56431 X X X X AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD 1 1 X X X X X X X X X 12 1 0 1 X WWW.RIVERWOODHEALTHCARE.COM X X X X X X X X X 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 3: RIVERWOOD HEALTHCARE CENTER UTILIZED AND ENGAGED MANY INDIVIDUALS AND ORGANIZATIONS TO COMPLETE ITS CHNA. A PROJECT CORE TEAM PROVIDED INPUT AND GUIDANCE IN THIS PROJECT. THE TEAM CONSISTED OF INDIVIDUALS FROM AITKIN COUNTY PUBLIC HEALTH, AITKIN AND MCGREGOR SCHOOL DISTRICTS, AICOTA HEALTHCARE CENTER AND RIVERWOOD HEALTHCARE CENTER ALONG WITH CONSULTING FROM HBH ASSOCIATES, SHELLI URNESS CONSULTING AND HEALTH PLANNING AND MANAGEMENT RESOURCES. FEEDBACK WAS GATHERED FROM COMMUNITY MEMBER'S FROM RIVERWOOD'S PRIMARY SERVICE COMMUNITIES OF AITKIN, GARRISON AND MCGREGOR. COMMUNITY FEEDBACK SESSIONS, TELEPHONE INTERVIEWS AND EMAIL QUESTIONNAIRES WERE USED TO OBTAIN INPUT. AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE LOBBY, ADVERTISED IN THE LOCAL NEWSPAPER AND ADVERTISED ON THE RADIO STATION. 3 RIVERWOOD AITKIN CLINIC 200 BUNKER HILL DRIVE AITKIN MN 56431 CLINIC RIVERWOOD MCGREGOR CLINIC 2 E CENTRAL AVENUE AITKIN MN 56431 CLINIC RIVERWOOD GARRISON CLINIC 27278 STATE HWY 18 GARRISON MN 56450 CLINIC PART I, LINE 3C: IN ADDITION TO INCOME BASED TESTING, OUR CHARITY CARE POLICY REQUIRES THAT AN APPLICANT MUST HAVE RECEIVED A DENIAL FROM EITHER MEDICAID (MINNESOTA ASSISTANCE) OR OTHER STATE SUBSIDIZED HEALTHCARE PROGRAMS (MINNESOTA CARE OR GMAC). PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2014 MEDICARE COST REPORT. PART I, LINE 7G: THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES INCLUDE SPEECH PATHOLOGY, IMPLANTABLE DEVICES, CHEMOTHERAPY, CARDIAC REHABILITATION, DIABETES EDUCATION, NUTRITION SERVICE, WOUND CARE, EMERGENCY, OBSERVATION BEDS, AND RURAL HEALTH CLINIC/RETAIL PHARMACY. PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $944,063. PART I LINE 6A THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH MINNESOTA. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 4: FROM FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS - "ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS."THE TAXPAYER LOOKED AT THE NUMBER OF CHARITY CARE APPLICATIONS SENT TO POTENTIAL APPLICANTS AND CAME UP WITH AN APPROVAL RATIO BASED ON RETURNED APPLICATIONS. THEN THE RATIO WAS MULTIPLIED BY THE APPLICATIONS THAT WERE NOT RETURNED TO DETERMINE AN ESTIMATED AMOUNT OF ADDITIONAL APPROVALS. AN AVERAGE CHARITY CARE AMOUNT PER PATIENT WAS THEN ESTIMATED. THAT ESTIMATE MULTIPLIED BY THE NUMBER OF APPLICATIONS WAS USED TO DETERMINE THE BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER THE CHARITY CARE POLICY. PART III, LINE 8: THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND THUS IS REIMBURSED AT 101% OF COST. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $600,473 AND ALLOWABLE COSTS OF $1,070,893 RESULTING IN A SHORTFALL OF $470,420. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE. THE MEDICARE ADVANTAGE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $4,658,902 AND ALLOWABLE COSTS OF $4,706,913 RESULTING IN A SHORTFALL OF $48,011.THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: AITKIN COMMUNITY HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY TO THE UNINSURED AND TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. THE HOSPITAL EMPLOYS A FULL TIME FINANCIAL COUNSELOR WHO WORKS WITH PATIENTS TO EVALUATE ELIGIBILITY AND REDIRECT THEM AS NEEDED TO LOCAL STATE OR COUNTY STAFF FOR ASSISTANCE WITH APPLICATIONS FOR GOVERNMENTAL ASSISTANCE PROGRAMS. UPON RECEIPT OF DENIAL, PATIENT WILL BE PROVIDED A CHARITY CARE APPLICATION OR SLIDING FEE SCALE APPLICATION. DEPENDING ON THE PATIENT'S INCOME AND THE GUIDELINES, THEY WILL BE PROVIDED A WAIVER OF ALL CHARGES OR A REDUCTION IN THEIR MEDICAL CHARGES. THE HOSPITAL'S BILLING STAFF, PATIENT ACCESS STAFF AND OUTSIDE COLLECTION AGENCIES ARE ALL EDUCATED AND AWARE OF THE CHARITY CARE ASSISTANCE PROGRAM AND SLIDING FEE SCALE AND IN THE COURSE OF THEIR EVERYDAY WORK WILL OFFER PATIENTS THIS INFORMATION IF THEY EXPRESS A NEED FOR FINANCIAL ASSISTANCE. PART III, LINE 2 MANAGEMENT DETERMINES THE ALLOWANCES FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND THEN USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PART III, LINE 3 THE HOSPITAL LOOKS AT THE NUMBER OF CHARITY CARE APPLICATIONS SENT TO POTENTIAL APPLICANTS AND COMES UP WITH AN APPROVAL RATIO BASED ON RETURNED APPLICATIONS. THE PERCENTAGE OF UNRETURNED APPLICATIONS IS THEN MULTIPLIED BY THE TOTAL DOLLAR AMOUNT OF BAD DEBT EXPENSE. PART VI, LINE 2: AITKIN COMMUNITY HOSPITAL PERFORMS A COMMUNITY NEEDS ASSESSMENT TO EVALUATE THE HEALTH CARE NEEDS OF THE COMMUNITY EVERY 3 YEARS WITH AN OUTSIDE CONSULTING FIRM. ADDITIONALLY, WE PERFORM A COMMUNITY PERCEPTION ASSESSMENT AND HEALTH ASSESSMENT OF OUR SERVICE AREA EVERY 3 YEARS. PART VI, LINE 3: AITKIN COMMUNITY HOSPITAL PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY TO THE UNINSURED AND TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. THE HOSPITAL EMPLOYS A FULL TIME FINANCIAL COUNSELOR WHO WORKS WITH PATIENTS TO EVALUATE ELIGIBILITY AND REDIRECT THEM AS NEEDED TO LOCAL STATE OR COUNTY STAFF FOR ASSISTANCE WITH APPLICATIONS FOR GOVERNMENTAL ASSISTANCE PROGRAMS. UPON RECEIPT OF DENIAL, PATIENT WILL BE PROVIDED A CHARITY CARE APPLICATION OR SLIDING FEE SCALE APPLICATION. DEPENDING ON THE PATIENT'S INCOME AND THE GUIDELINES, THEY WILL BE PROVIDED A WAIVER OF ALL CHARGES OR A REDUCTION IN THEIR MEDICAL CHARGES. RIVERWOOD'S EMPLOYED FINANCIAL COUNSELOR IS A MNSURE NAVIGATOR, TRAINED AND CERTIFED BY THE STATE OF MINNESOTA.THE HOSPITAL'S BILLING STAFF, PATIENT ACCESS STAFF AND OUTSIDE COLLECTION AGENCIES ARE ALL EDUCATED AND AWARE OF THE CHARITY CARE ASSISTANCE PROGRAM AND SLIDING FEE SCALE AND IN THE COURSE OF THEIR EVERYDAY WORK WILL OFFER PATIENTS THIS INFORMATION IF THEY EXPRESS A NEED FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: AITKIN COMMUNITY HOSPITAL, INC. D.B.A. RIVERWOOD HEALTHCARE CENTER (RIVERWOOD), A 501(C)3 NON-PROFIT CORPORATION, IS SITUATED IN THE CENTER OF AITKIN COUNTY. IT WAS FOUNDED IN 1948 AND IS LOCATED AT 200 BUNKER HILL DRIVE IN AITKIN, MN (POP. 1984). RIVERWOOD IS A 25 BED ACUTE-CARE CRITICAL ACCESS HOSPITAL AND HAS THREE RURAL HEALTH CLINICS IN AITKIN, MCGREGOR AND GARRISON. ALL THREE CLINICS ARE LOCATED IN A MEDICALLY UNDERSERVED AREA (MUA). RIVERWOOD OFFERS PATIENTS A CONTINUUM OF CARE INCLUDING INPATIENT, OUTPATIENT, SPECIALTY, SURGICAL AND EMERGENCY SERVICES. THE DISTANCE TO THE NEXT HOSPITAL IS 17 MILES. DULUTH AND ST. CLOUD ARE THE TWO CLOSEST CITIES WITH TERTIARY CARE CENTERS BOTH APPROXIMATELY 90 MILES FROM AITKIN.RIVERWOOD SERVES THE RESIDENTS OF AITKIN COUNTY (POP. 16,149) THE EAST SIDE OF CROW WING COUNTY (POP. 61,009) AND MILLE LACS COUNTY (POP. 26,169). THE GEOGRAPHIC AREA OF THESE COUNTIES IS RURAL.SPECIAL POPULATIONS SERVED INCLUDE THOSE WITH A HIGH RATE OF POVERTY AND UNEMPLOYMENT WITH AITKIN, CROW WING AND MILLE LACS COUNTIES. IN 2007, THE ESTIMATED PERCENTAGES OF THESE THREE COUNTIES WITH POPULATIONS BELOW POVERTY LEVEL WERE RESPECTIVELY: AITKIN - 13.4%, CROW WING - 9.3%, MILLE LACS - 9.5%. ADDITIONALLY, ACCORDING TO THE MINNESOTA DEPARTMENT OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, THE UNEMPLOYMENT RATE IN AITKIN COUNTY SKYROCKETED TO 10.5% IN JANUARY 2009, WHICH IS NEARLY 4 PERCENTAGE POINTS OVER THE STATE AVERAGE OF 6.9%. THE DEPARTMENT OF LABOR AND INDUSTRY CONSIDERS AITKIN COUNTY TO BE A "LABOR SURPLUS AREA". OTHER SPECIAL POPULATIONS SERVED ALSO INCLUDE THE ELDERLY. THE LARGEST PERCENTAGE OF RIVERWOOD'S CURRENT PATIENT BASE CONSISTS OF PATIENTS OVER THE AGE OF 65. POPULATION PROJECTIONS INDICATE THAT BETWEEN THE YEARS OF 2005-2030, A 50% OVERALL INCREASE IS EXPECTED IN AITKIN COUNTY WITH THE 65+ AGE GROUP BY 120%. AITKIN COUNTY IS SECOND ONLY TO TRAVERSE COUNTY FOR HAVING THE OLDEST MEDIAN POPULATION IN MINNESOTA. PART VI, LINE 5: IN FURTHERANCE OF ITS CHARITABLE PURPOSE, THE CENTER PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED SERVICE PROGRAMS 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 AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X X X X 0 0 0 0 0 0 0 0 0 JEFF EHNSTROM MD DIRECTOR/PHYSICIAN 287654 0 6708 0 0 0 10200 0 17811 0 322373 0 0 0 MARK HEGGEM MD CMO 257049 0 10000 0 17500 0 10200 0 17811 0 312560 0 0 0 MICHAEL HAGEN CEO - FORMER 204734 0 20000 0 10710 0 9289 0 10390 0 255123 0 0 0 STEVEN PITSCHKA MD PHYSICIAN 312156 0 0 0 24422 0 10200 0 8184 0 354962 0 0 0 JEFFREY RAPP MD PHYSICIAN 325479 0 0 0 0 0 10200 0 17811 0 353490 0 0 0 JIM HARRIS MD ER MEDICAL DIRECTOR 320685 0 0 0 0 0 10200 0 17811 0 348696 0 0 0 DAVID TAYLOR MD PHYSICIAN 298499 0 0 0 0 0 10200 0 8148 0 316847 0 0 0 THOMAS OSBORNE MD PHYSICIAN 340967 0 0 0 0 0 10200 0 17811 0 368978 0 0 0 A CITY OF AITKIN 416004918 00958PAP1 2006-08-10 24350057 REFINANCE 2011 BONDS THAT WERE USED TO BUILD NEW HOSPITAL 0 0 0 A 24350057 487001 24350057 2006 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF AITKIN DATE THE REBATE COMPUTATION WAS PERFORMED: 08/10/2011 X VIDEO CONFERE 1 26598 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 RIVERWOOD HEALTHCARE CENTER HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A RIVERWOOD HEALTHCARE CENTER HAS MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS AND APPROVES THE 990 AFTER PREPARATION AND RECOMMENDS APPROVAL TO THE BOARD. AFTER APPROVAL BY THE BOARD, THE 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SECTION 1. PURPOSE THE PURPOSE OF THIS POLICY IS TO PROVIDE A MEANS BY WHICH TO ADDRESS ANY CONFLICT OF INTEREST INVOLVING THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, AND EMPLOYEES THAT AFFECT OR HAVE THE POTENTIAL TO AFFECT THE SAFETY OR QUALITY OF CARE, TREATMENT, AND SERVICES. SECTION 2. PERSONS CONCERNED THIS STATEMENT IS DIRECTED NOT ONLY TO BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, BUT TO ALL EMPLOYEES OR NON-EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF RHCC FOR EXAMPLE, THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL," AND ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING RHCC. SECTION 3. AREAS IN WHICH CONFLICT MAY ARISE CONFLICTS OF INTEREST MAY ARISE IN THE RELATIONS OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WITH ANY OF THE FOLLOWING THIRD PARTIES: 1. PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO RHCC. 2. PERSONS AND FIRMS FROM WHOM RHCC LEASES PROPERTY AND EQUIPMENT. 3. PERSONS AND FIRMS WITH WHOM RHCC IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES, OR OTHER PROPERTY. 4. COMPETING OR AFFINITY ORGANIZATIONS. 5. DONORS AND OTHERS SUPPORTING RHCC. 6. AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF RHCC. 7. FAMILY MEMBERS, FRIENDS, AND OTHER EMPLOYEES. SECTION 4. NATURE OF CONFLICTING INTEREST A CONFLICTING INTEREST MAY BE DEFINED AS AN INTEREST, DIRECT OR INDIRECT, WITH ANY PERSONS OR FIRMS MENTIONED IN SECTION 3. SUCH AN INTEREST MIGHT ARISE THROUGH: SECTION 5. INTERPRETATION OF THIS STATEMENT OF POLICY THE AREAS OF CONFLICTING INTEREST LISTED IN SECTION 3, AND THE RELATIONS IN THOSE AREAS WHICH MAY GIVE RISE TO CONFLICT, AS LISTED IN SECTION 4, ARE NOT EXHAUSTIVE. CONFLICTS MIGHT ARISE IN OTHER AREAS OR THROUGH OTHER RELATIONS. IT IS ASSUMED THAT THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. THE FACT THAT ONE OF THE INTERESTS DESCRIBED IN SECTION 4 EXISTS DOES NOT NECESSARILY MEAN THAT A CONFLICT EXISTS, OR THAT THE CONFLICT, IF IT EXISTS, IS MATERIAL ENOUGH TO BE OF PRACTICAL IMPORTANCE, OR IF MATERIAL, THAT UPON FULL DISCLOSURE OF ALL RELEVANT FACTS AND CIRCUMSTANCES IT IS NECESSARILY ADVERSE TO THE INTERESTS OF RHCC. HOWEVER, IT IS THE POLICY OF THE GOVERNING BOARD THAT THE EXISTENCE OF ANY OF THE INTERESTS DESCRIBED IN SECTION 4 SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. SECTION 6. DISCLOSURE POLICY AND PROCEDURE PROCEDURES FOR ADDRESSING CONFLICTS OF INTEREST TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: 1. THE CONFLICTING INTEREST AND ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE GOVERNING BOARD OF DIRECTORS OR TO A COMMITTEE WITH BOARD-DELEGATED POWERS; 2. THE PERSON WITH THE CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL BE EXCLUDED FROM THE DISCUSSION AND VOTE ON APPROVAL OF SUCH TRANSACTION; 3. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 4. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER RHCC CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST; 5. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN RHCC'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO RHCC, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. DISCLOSURE DISCLOSURE IN RHCC SHOULD BE MADE TO THE CHIEF EXECUTIVE OFFICER (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE GOVERNING BOARD OF DIRECTORS. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE GOVERNING BOARD CHAIR (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE GOVERNING BOARD VICE-CHAIR) WHO SHALL BRING THESE MATTERS TO THE GOVERNING BOARD. DECISION THE GOVERNING BOARD OF DIRECTORS OR A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO RHCC. IN THE CASE OF A CONFLICT INVOLVING A MEMBER OF THE GOVERNING BOARD OF DIRECTORS, THE GOVERNING BOARD OR COMMITTEE REVIEWING THE MATTER SHALL CONSIDER THE DISABLING GUIDELINES ATTACHED HERETO. THE DECISION OF THE GOVERNING BOARD OR COMMITTEE ON THESE MATTERS WILL REST IN ITS SOLE DISCRETION, AND ITS CONCERN MUST BE THE WELFARE OF RHCC AND THE ADVANCEMENT OF RHCC'S PURPOSE. SECTION 7. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY 1. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. 2. IF, AFTER HEARING THE RESPONSE OF THE PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THAT THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH MAY INCLUDE NO ACTION, REPRIMAND, REQUEST FOR RESIGNATION OR REMOVAL FROM THE BOARD OF DIRECTORS AS THE FACTS AND CIRCUMSTANCES MAY WARRANT. SECTION 9. COMPENSATION 1. A VOTING MEMBER OF THE BOARD OF DIRECTORS WHO RECEIVES COMPENSATION FOR PROVISION OF SERVICES AS AN EMPLOYEE OR CONTRACTOR, DIRECTLY OR INDIRECTLY, FROM RHCC IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO MEMBER OF THE BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. 4. PHYSICIANS WHO RECEIVE COMPENSATION FROM RHCC, WHETHER DIRECTLY OR INDIRECTLY OR AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS. NO PHYSICIAN, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING PHYSICIAN COMPENSATION. SECTION 10. ANNUAL STATEMENTS EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING OR FOUNDATION BOARD DELEGATED POWERS, AND ALL LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON-- 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2. HAS READ AND UNDERSTANDS THE POLICY; 3. HAS AGREED TO COMPLY WITH THE POLICY; AND 4. UNDERSTANDS THAT RHCC IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 INDEPENDENT EXECUTIVE COMPENSATION STUDY WAS CONDUCTED AND YIELDED BASE PAY RANGES BASED ON VARIOUS REGIONAL MARKET AND NATIONAL SALARY SURVEYS. THE BOARD'S EVALUATION AND COMPENSATION COMMITTEE REVIEWED THE FULL SURVEY ALONG WITH PROPOSED SALARY RANGES AND CURRENT PAY. BOARD DISCUSSION TOOK PLACE AND MOTIONS AND APPROVALS OCCURRED REGARDING COMPENSATION CHANGES. DOCUMENTATION OF THIS IS WITHIN MEETING MINUTES. CEO AND BOARD CHAIR SIGN A SUMMARY SHEET FOR EACH EXECUTIVE. UPON COMPLETION OF ALL THIS, COMPENSATION CHANGES ARE THEN IMPLEMENTED. FORM 990, PART VI, SECTION C, LINE 18 THE 1023, 990, AND 990-T ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT, WHICH PROVIDES AN OVERVIEW OF THE ORGANIZATION'S FINANCIAL STATUS, IS MADE AVAILABLE TO THE PUBLIC FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). IT IS MAILED TO MEMBERS OF THE ORGANIZATION, ORGANIZATIONS THAT WE HAVE FINANCING WITH, AND IS AVAILABLE ON OUR WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART VII, SECTION A JEFF EHNSTROM, MD: RIVERWOOD HEALTHCARE CENTER TIME ALLOCATION: EMPLOYMENT AS A DOCTOR: 40 HOURS PER WEEK BOARD OF DIRECTORS: 1 HOURS PER WEEK RIVERWOOD HEALTHCARE ASSOCIATION COMPENSATION: DOCTOR REPORTABLE COMPENSATION: $ 294,362 DOCTOR OTHER COMPENSATION: $ 28,011 BOARD REPORTABLE COMPENSATION: $ 0 BOARD OTHER COMPENSATION: $ 0 MARK HEGGEM, MD: RIVERWOOD HEALTHCARE CENTER TIME ALLOCATION: EMPLOYMENT AS A DOCTOR: 40 HOURS PER WEEK BOARD OF DIRECTORS: 1 HOURS PER WEEK RIVERWOOD HEALTHCARE ASSOCIATION COMPENSATION: DOCTOR REPORTABLE COMPENSATION: $ 284,549 DOCTOR OTHER COMPENSATION: $ 28,011 BOARD REPORTABLE COMPENSATION: $ 0 BOARD OTHER COMPENSATION: $ 0 CHAD COOPER HOURS PER WEEK DEVOTED TO THE HOSPITAL = 39.9 HOURS PER WEEK DEVOTED TO THE FOUNDATION (RELATED ORGANIZATION) = 0.1 ALL COMPENSATION RECEIVED IS FOR CHAD'S POSITION AS THE HOSPITAL CEO. MICHAEL HAGEN HOURS PER WEEK DEVOTED TO THE HOSPITAL = 39.9 HOURS PER WEEK DEVOTED TO THE FOUNDATION (RELATED ORGANIZATION) = 0.1 ALL COMPENSATION RECEIVED IS FOR MICHAEL'S POSITION AS THE FORMER HOSPITAL CEO. KENT DUMONSEAU HOURS PER WEEK DEVOTED TO THE HOSPITAL = 39.9 HOURS PER WEEK DEVOTED TO THE FOUNDATION(RELATED ORGANIZATION) = 0.1 ALL COMPENSATION RECEIVED IS FOR KENT'S POSITION AS THE FORMER HOSPITAL CFO. GORDY FORBORT HOURS PER WEEK DEVOTED TO THE HOSPITAL = 19.9 HOURS PER WEEK DEVOTED TO THE FOUNDATION (RELATED ORGANIZATION) = 0.1 ALL COMPENSATION RECEIVED IS FOR GORDY'S POSITION AS THE HOSPITAL FORMER INTERIM CFO. FORM 990, PART XI, LINE 9: INCREASE IN INTEREST IN NET ASSETS OF AITKIN COMMUNITY HOSPITAL FOUNDATION 64,463. GRANT USED FOR PURCHASE OF EQUIPMENT 26,598. RIVERWOOD HEALTH CARE CENTER FOUNDATION 200 BUNKER HILL DRIVE AITKIN MN 56431 411738787 SUPPORT MN 501(C)(3) LINE 11A, I 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0