2014-11-17T13:56:03-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-01-01 311667875 RIDGEVIEW MEDICAL CENTER RIDG 9524422191 500 SOUTH MAPLE STREET WACONIA MN 553871791 GORDON GABLENZ VICE PRESIDENT & CFO 9524422191 2014-11-17 1 DARRYN MCGARVEY P00958683 6123764500 2013 2015-11-30 17:44:51Z ROBERT STEVENS 500 SOUTH MAPLE STREET WACONIA MN 553871791 231092179 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1999 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 9 9 1804 500 2023712 -177319 2087639 1528584 162082431 175106504 2895409 2734884 5724336 28569091 172789815 207939063 0 3057283 0 0 96162707 104902026 0 0 57381 75786006 81733608 171948713 189692917 841102 18246146 186542662 232830682 76740588 96041207 109802074 136789475 X RIDGEVIEW MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF PEOPLE IT SERVES WITH A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. 0 0 136973213 3057283 175106504 RIDGEVIEW MEDICAL CENTER ENHANCED AND PROVIDED QUALITY HEALTHCARE SERVICES FOR THE COMMUNITY OF WACONIA AND SURROUNDING AREAS. THE HOSPITAL PROVIDED CHARITY CARE AND OTHER UNCOMPENSATED CARE IN THE AMOUNT OF $507,149 DURING 2013. THE UNPAID COST FOR SERVICES PROVIDED TO MEDICAID AND MEDICARE PATIENTS WAS $2,344,008 AND $11,838,696 IN 2013. UNREIMBURSED COSTS ASSOCIATED WITH THE TRAINING OF HEALTHCARE PROFESSIONALS SUCH AS HIGH SCHOOL STUDENTS SHADOWING FOR INTERNSHIPS FOR PHARMACY, IMAGING, DIETARY, AND MORE TOTALED $309,635. IN 2013 THE HOSPITAL SPENT $4,375,309 ON OTHER UNCOMPENSATED COMMUNITY SERVICES INCLUDING TAXES AND FEES. THE HOSPITAL SERVED 5,926 INPATIENTS, 26,118 EMERGENCY CARE VISITS, 26,972 HOME HEALTH VISITS, 5,731 SURGERIES, 1,468 BIRTHS, 8,360 AMBULANCE CALLS, AND 160,902 OUTPATIENT VISITS IN 2013. RIDGEVIEW MEDICAL CENTER SERVES MORE THAN 100,000 PEOPLE, OPERATES ONE HOSPITAL, ONE FREE-STANDING EMERGENCY AND URGENT CARE FACILITY CENTER AND SEVEN MULTI-SPECIALTY CLINIC LOCATIONS. 136973213 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 72 0 1804 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MN X GORDON GABLENZ 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 MITCHELL KILIAN CHAIR 0.80 X X 2000 0 0 WAYNE HUBIN VICE CHAIR 0.80 X X 1600 0 0 JULIE HERMAN SECRETARY 0.80 X X 1600 0 0 MARIA GLYNN TREASURER 0.80 X X 1600 0 0 MIKE WERNER BOARD MEMBER 0.80 X 1600 0 0 JEFF NELSON BOARD MEMBER 0.80 1.00 X 1600 0 0 DEL PLOEN BOARD MEMBER (THRU FEB 2013) 0.80 X 267 0 0 SHARON COOK BOARD MEMBER 0.80 X 1600 0 0 STAN BANDUR BOARD MEMBER 0.80 X 1600 0 0 KATE ROEHL BOARD MEMBER 0.80 0.50 X 1600 0 0 ROBERT STEVENS PRESIDENT / CEO 44.00 6.00 X 343711 0 329451 PATRICIA MICHAELSON VICE PRESIDENT 50.00 X 229874 0 17714 JOHN PRONDZINSKI VICE PRESIDENT 50.00 X 203874 0 22656 GORDON GABLENZ VICE PRESIDENT / CFO 48.50 1.50 X 211128 0 27773 MICHAEL PHELPS CAO 40.00 10.00 X 226247 0 25948 DOUGLAS STASEK VICE PRESIDENT 2.50 47.50 X 186146 0 25503 SARAH HASTINGS VICE PRESIDENT 49.00 1.00 X 171478 0 26152 BERNARD BUCKLAND DIRECTOR OF SURGERY 40.00 X 184421 0 14779 KRISTI WIDSETH CRNA 40.00 X 168131 0 6322 CYNTHIA BRICK CRNA 40.00 X 179096 0 18311 ARLIEN CORTLAND CRNA 40.00 X 169222 0 6359 TINA KIRSCH CRNA 40.00 X 168673 0 6097 2457068 0 527065 67 0 1 1 EMPAC 500 SOUTH MAPLE STREET WACONIA MN 55387 ED PHYSICIAN SERVICES 7515755 MINNEAPOLIS HEART INSTITUTE 500 SOUTH MAPLE STREET WACONIA MN 55387 CARDIOLOGY SERVICES 3739967 CHILDRENS HEALTHCARE 2525 CHICAGO AVE SOUTH MINNEAPOLIS MN 55404 CHILDREN'S NCU CONTRACT & MEDICAL DIRECT 1265546 EMERGENT NETWORKS 768 SOUTHCROSS DRIVE WEST STE 201 BURNSVILLE MN 55306 MIS SERVICES 1078492 CHUTE AND DREW PA 111 HUNDERTMARK ROAD CHASKA MN 55318 BARIATRIC SERVICES 871311 20 1510190 18394 1528584 NET PATIENT REVENUE 621610 175106504 175106504 175106504 906758 906758 3932730 3143971 788759 788759 788759 20642918 19390 18792732 41450 1850186 -22060 1828126 1828126 2874523 1174963 1699560 1669440 30120 MISCELLANEOUS 621610 24723795 354272 24369523 CAFETERIA REVENUE 722210 543203 543203 ALL OTHER REVENUE 900099 456939 456939 356835 356835 26080772 207939063 175106504 2023712 29280263 3057283 3057283 2062723 2062723 86707479 65339600 21367879 2093290 1749032 344258 8513362 6258168 2255194 5525172 4017518 1507654 668047 668047 75331 75331 18254535 5863754 12390781 263716 228582 35134 5296822 3112457 2184365 1575885 280153 1295732 11197940 7910700 3287240 571232 295554 275678 543814 201531 342283 1952614 1952614 10370843 7728118 2642725 758340 171211 587129 MEDICAL SUPPLIES 21790145 21790145 BAD DEBT EXPENSE 3931696 3931696 MINNESOTA CARE TAX 2450472 2450472 MISCELLANEOUS 507796 -12689 463104 57381 1524380 647314 877066 189692917 136973213 52662323 57381 5618420 7338294 25992834 48380985 316666 158333 21286825 23972512 3065570 3165299 3282707 2843339 209610209 113522305 84265572 96087904 10304064 13823442 32410004 37060574 186542662 232830682 19668507 24885517 112715 6868358 42694761 52801631 8559871 3248550 5704734 8237151 76740588 96041207 X 103090394 130032089 5639401 5194016 1072279 1563370 109802074 136789475 186542662 232830682 X 18246146 5148792 3592463 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9760 9760 0 PART II-B, LINE 1: RIDGEVIEW MEDICAL CENTER PAYS DUES TO MHA AND AHA, OF WHICH A PORTION ARE LOBBYING EXPENSES. 8643504 8643504 77201247 38759970 38441277 7201445 4774838 2426607 95507732 69987497 25520235 21056281 21056281 96087904 INVESTMENT IN CHASKA PLAZA SURGERY CENTER 676731 F INVESTMENT IN JOINT VENTURES 703996 F INVESTMENT IN RIDGEVIEW INSURANCE 563767 F INVESTMENT IN FOUNDATION 11811421 F INVESTMENT IN MN OTOLARYNGOLOGY 67527 F 13823442 UNAMORTIZED FINANCING COSTS 1127895 AMOUNTS HELD UNDER SECURITY AGREEMENT 5203549 DUE FROM MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW MEDICAL CENTER 119284 SELF INSURANCE RESERVES 2672917 DEFERRED COMPENSATION PLAN 6724869 DUE FROM RIDGEVIEW CLINICS 18045646 DUE FROM FOUNDATION 2000 DUE FROM CHASKA PLAZA SURGERY CENTER 2995575 DUE FROM 212 1961 DUE FROM NORTHLAND COUNSELING 175 STEP LEASE ASSET 155766 DUE FROM RIDGEVIEW REAL ESTATE, LLC 4166 INVESTMENT IN AFFILIATE 10000 DUE FROM CREATE HEALTH -3229 37060574 DEFERRED COMPENSATION 2036631 THIRD PARTY PAYABLE 1101010 WORKERS COMPENSATION 1500000 ASSET RETIREMENT OBLIGATION 12224 BRIDGE LOAN FROM RIDGEVIEW FOUNDATION 3000147 DUE TO CARDIOLOGY JOINT VENTURE 587139 8237151 X 205725742 -3931696 -3931696 209657438 -1718375 -1718375 207939063 186587692 4318934 4318934 182268758 7424159 7424159 189692917 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. GENERALLY, THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2008. THE ORGANIZATION IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSES -3,931,696. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 906,758. REALIZED GAINS ON INVESTMENTS 1,850,186. RENTAL EXPENSES -3,143,971. HOME MEDICAL EQUIPMENT COST OF GOODS SOLD -1,069,898. GIFT SHOP EXPENSES -105,065. NET ASSETS RELEASED FROM RESTRICTIONS -156,385. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 3,143,971. HOME MEDICAL EQUIPMENT COST OF GOODS SOLD 1,069,898. GIFT SHOP EXPENSES 105,065. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,931,696. EQUITY TRANSFER 3,000,000. LOSS ON REFINANCING OF DEBT 142,463. DISTRIBUTION EXPENSE 350,000. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 505552 505552 0.00270 5642801 3298793 2344008 0.01260 1604883 1604883 0.00860 7753236 3298793 4454443 0.02390 14284 312631 2996 309635 0.00170 307 339033 339033 0.00180 182 136949 19603 117346 0.00060 151 61506 61506 0.00030 306 97392 97392 0.00050 15230 947511 22599 924912 0.00490 15230 8700747 3321392 5379355 0.02880 12400 63207 63207 0.00030 12400 63207 63207 0.00030 1 3931696 437000 33339688 48315365 -14975677 X 1 1 1 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 X X X RIDGEVIEW MEDICAL CENTER 1 1 X X X X X X X X X 13 1 0 1 X HTTP://WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ X X X X X X X X X 0 0 1 1 250.000000000000 1 250.000000000000 1 X X X X X X X 1 0 1 0 X X X 1 X 0 0 RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 3: A THREE-PHASE PROCESS WAS USED TO GATHER COMMUNITY INPUT. FIRST, KEY INFORMANTS, DESCRIBED BELOW, WERE INTERVIEWED IN OCTOBER 2013 TO PROVIDE BROAD-BASED INPUT ON PRIORITY HEALTH NEEDS WITHIN RIDGEVIEW'S SERVICE AREAS. THE KEY INFORMANTS INCLUDED: PERSONS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, REPRESENTATIVES FROM HEALTH DEPARTMENTS OR GOVERNMENTAL AGENCIES SERVING COMMUNITY HEALTH, AND LEADERS OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND/OR POPULATIONS WITH CHRONIC DISEASE. IN ADDITION TO KEY INFORMANT INTERVIEWS, TWO FOCUS GROUPS, DESCRIBED BELOW, WERE CONVENED TO DISCUSS AND IDENTIFY COMMUNITY HEALTH NEEDS RELATED TO CITY LEADERSHIP AND SENIOR CARE FACILITIES.RIDGEVIEW ALSO CONDUCTED AN ONLINE SURVEY OF COMMUNITY RESIDENTS IN OCTOBER 2013. THE SURVEY INSTRUMENT WAS DEVELPED TO GAIN INFORMATION FROM RESPONDENTS ABOUT THEIR PERCEPTIONS OF HEALTH CONCERNS IN THE COMMUNITY. THE ONLINE SUREVEY WAS ISSUED TO MORE THAN 9,000 PERSONS IN RIDGEVIEW'S EMAIL DATABASE; RESPONSES WERE RECEIVED FROM 432 PARTICIPANTS, REPRESENTATIVE OF RIDGEVIEW'S SERVICE AREA. KEY STAKEHOLDER INTERVIEWEES: BELLE PLAINE FIRE DEPARTMENT, THE CAP AGENCY, CARVER COUNTY LAW ENFORCEMENT, CARVER COUNTY OFFICE OF AGING, CARVER COUNTY PUBLIC HEALTH AND ENVIRONMENT DIVISION, DELANO PUBLIC SCHOOLS, MCLEOD COUNTY LAW ENFORCEMENT, MCLEOD COUNTY PUBLIC HEALTH, MCLEOD COUNTY SOCIAL SERVICES, MENTAL HEALTH CONSORTIUM OF CARVER COUNTY, SOUTHERN VALLEY ALLIANCE FOR BATTERED WOMEN, WACONIA FIRE DEPARTMENT, WACONIA PUBLIC SCHOOLS, WRIGHT COUNTY HUMAN SERVICES, WRIGHT COUNTY LAW ENFORCEMENT, AND WRIGHT COUNTY PUBLIC HEALTH. FOCUS GROUPS: 40 CITY OFFICIALS, 20 NURSING HOME PERSONNEL, AND 50 PEOPLE REPRESENTING SCHOOLS FROM THROUGHOUT RIDGEVIEW'S SERVICE AREA WERE INVITED TO PARTICIPATE IN FOCUS GROUPS. 12 PERSONNEL FROM THE FOLLOWING ORGANIZATIONS PARTICIPATED: AURBURN HOMES, BENEDICTINE HEALTH SYSTEM, CITY OF CHASKA, CITY OF MOUND, CITY OF WINSTED, ELIM CARE, GOLDEN LIVING, AND THE LUTHERAN HOME ASSOCIATION. RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 7: DUE TO LIMITED FINANCIAL RESOURCES, RMC WILL FOCUS ON THE TOP FOUR HEALTH NEEDS IDENTIFIED IN THEIR COMMUNITY HEALTH NEEDS ASSESSMENT AND WILL NOT TO ADDRESS THE FOLLOWING NEEDS AT THIS TIME: SUBSTANCE ABUSE, MALTREATMENT, AND DENTAL HEALTH. RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 20D: RIDGEVIEW MEDICAL CENTER USES ITS LARGEST NON-GOVERNMENTAL PAYOR'S DISCOUNT PERCENTAGE WHEN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED. THE DISCOUNT GIVEN TO ALL FAP ELIGIBLE PATIENTS IS EQUAL TO THE DISCOUNT GIVEN TO THE ORGANIZATION'S LARGEST NON-GOVERNMENTAL PAYOR IN ACCORDANCE WITH THEIR AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL. 10 CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 GENERAL MEDICAL CLINIC SAME DAY SURGERY 3000 HUNDERTMARK ROAD CHASKA MN 55318 GENERAL MEDCIAL & SURGICAL CLINIC SPECIALTY CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 SEE PART V, SECTION C FOR DESCRIPTION HOME HEALTH HOSPICE 500 SOUTH MAPLE STREET STE 1 WACONIA MN 55387 HOME HEALTH & HOSPICE REHAB SPECIALTIES 560 SOUTH MAPLE STREET WACONIA MN 55387 REHABILITATION SERVICES HOME MEDICAL EQUIPMENT 500 SOUTH MAPLE STREET STE 2 WACONIA MN 55387 MEDICAL EQUIPMENT SUPPLIER RIDGEVIEW SLEEP CENTER 560 SOUTH MAPLE STREET STE 103 WACONIA MN 55387 SLEEP DISORDER SERVICES PEDIATRIC REHAB 490 SOUTH MAPLE STREET STE 125 WACONIA MN 55387 PEDIATRIC SERVICES RIDGEVIEW RESEARCH 3000 HUNDERTMARK ROAD STE 8 CHASKA MN 55318 RESERACH FACILITY WESTERN OBGYN 560 SOUTH MAPLE STREET WACONIA MN 55387 OBESTRIC AND GYNECOLOGY SERVICES PART I, LINE 7: THE COSTING METHODOLOGY USED BY RMC TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON RMC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. PART I, LINE 7G: THE AMOUNT REPORTED AS SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G IS MADE UP OF AMBULANCE/ON-SITE EMERGENCY CARE ($13,214) AND REDUCED COST MAMMOGRAMS ($123,735). PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS CALCULATED BY RIDGEVIEW AS FOLLOWS: PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF THE INVOICE OR CLAIM SUBMITTED. PATIENT ACCOUNTS THAT ARE MORE THAN 90 DAYS PAST DUE ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE ORGANIZATION. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE. PART V, SECTION C, LINE 3 - SPECIALTY CLINICS ENDOCRINOLOGY, PEDIATRIC INTEGRATIVE MEDICINE, DERMATOLOGY, PODIATRY, PULMONOLOGY, RHEUMATOLOGY, OTOLARYNGOLOGY, GASTROENTEROLOGY, AND BARIATRIC PART II, COMMUNITY BUILDING ACTIVITIES: RIDGEVIEW OFFERS REDUCED-COST MAMMOGRAMS TO ELIGIBLE WOMEN, FREE HEALTH SCREENINGS, SUPPORT GROUP SESSIONS, HEALTH EDUCATION SEMINARS, AND COMMUNITY HEALTH INFORMATION RESOURCES.IN ADDITION, RIDGEVIEW PROVIDES FREE BIOMETRIC SCREENINGS TO AREA EMPLOYERS, BLOOD PRESSURE CHECKS AT COMMUNITY EVENTS, HAND-ONLY CPR TRAINING IN SCHOOLS, AND STAFFS COMMUNITY EVENTS WITH ITS AMBULANCE/PARAMEDIC SUPPORT AND ATHLETIC TRAINER/SPORTS MEDICINE SERVICES. PART III, LINE 4: RIDGEVIEW ESTIMATES THE BAD DEBT AMOUNT INCLUDED IN PART III, LINE 3 RELATED TO PATIENTS UNDER THEIR FINANCIAL ASSISTANCE POLICY WOULD BE ABOUT 25% OF THE TOTAL COST OF CHARITY CARE. FOR 2013, THIS AMOUNT IS ESTIMATED TO BE $437,000.THE FOOTNOTE OF RIDGEVIEW'S 2013 FINANCIAL STATEMENTS THAT INCLUDES THE EXPLANATION OF BAD DEBT EXPENSE IS THE "PATIENT RECEIVABLES, NET" FOOTNOTE INCLUDED ON PAGE 10. PART III, LINE 8: RIDGEVIEW USED THE 2013 FILED MEDICARE COST REPORT TO CALCULATE THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6. APPLIED AGAINST ACTUAL RECEIPTS RIDGEVIEW EXPERIENCED COSTS NOT COVERED BY MEDICARE IN THE AMOUNT OF $14,975,677 IN 2013. THIS IS A DIRECT BENEFIT TO THE MEDICARE POPULATION IN OUR COMMUNITY. PART III, LINE 9B: RIDGEVIEW'S CHARITY PROGRAM ALLOWS FOR ACCOUNTS IN BAD DEBT STATUS TO COMPLETE A CHARITY CARE APPLICATION. IF APPROVED, THE ACCOUNT WILL BE RETURNED FROM BAD DEBT AND APPLIED TO OUR CHARITY CARE PROGRAM. ALL PATIENTS ARE ADVISED OF OUR CHARITY CARE PROGRAM THROUGH OUR MONTHLY BILLING PROCESS. RIDGEVIEW MEDICAL CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING PATIENT ACCOUNT BALANCES. PART VI, LINE 2: RIDGEVIEW MEDICAL CENTER ASSESSES THE CURRENT HEALTH STATUS, HEALTH OUTCOMES, AND UNMET NEEDS IN THE 46+ COMMUNITIES IT SERVES THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS. COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND PUBLIC REPORTING ENSURES THAT RIDGEVIEW HEALTH IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH COMMUNITY HEALTH PRIORITIES.RIDGEVIEW HAS AND WILL CONTINUE TO USE A CHNA AND OTHER INTERNAL, EXTERNAL (INCLUDING DISCHARGE, QUALITY MEASURES, PREDICTIVE, AND POPULATION DATA) TO AID STRATEGIC PLANNING PROCESSES AND ALIGN ORGANIZATIONAL SERVICES/RESOURCES ACCORDINGLY. PART VI, LINE 3: AT THE TIME OF SCHEDULING, PRE-REGISTRATION, REGISTRATION, OR DISCHARGE (WHICHEVER ARE APPLICABLE), THE PATIENT WILL BE ASKED FOR INSURANCE COVERAGE, AND THE PATIENT WILL BE INFORMED OF ANY CO-PAYMENTS THAT WILL BE EXPECTED AT THE TIME OF PAYMENT. IF THE PATIENT WISHES TO APPLY FOR COMMUNITY CARE, HE OR SHE WILL BE GIVEN OR MAILED AN APPLICATION; THE APPLICATION IS ALSO AVAILABLE FOR DOWNLOAD FROM THE RMC WEBSITE. A PATIENT MAY NOT QUALIFY FOR COMMUNITY CARE UNTIL HE OR SHE HAS COMPLETED THE COMMUNITY CARE APPLICATION. AFTER COMPLETING THE COMMUNITY CARE APPLICATION (INCLUDING SUPPORTING DOCUMENTATION), THE ACCOUNT REPRESENTATIVE WILL ASSESS THE APPLICATION AND DETERMINE WHETHER THE PATIENT QUALIFIES FOR COMMUNITY CARE OR ANY OTHER GOVERNMENTAL HEALTH CARE COVERAGE. IF THE PATIENT IS LIKELY TO QUALIFY FOR THE HOSPITAL PRESUMPTIVE ELIGIBILITY PROGRAM OTHER GOVERNMENTAL HEALTH CARE COVERAGE, THE ACCOUNT REPRESENTATIVE WILL DETERMINE APPROPRIATE COVERAGE AND REFER THE PATIENT AS APPROPRIATE. IF AN UNINSURED PATIENT IS UNLIKELY TO QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE, OR DENIED HOSPITAL PRESUMPTIVE ELIGIBILITY, AND THE PATIENT DOES NOT QUALIFY FOR COMMUNITY CARE, APPROPRIATE PAYMENT ARRANGEMENTS MUST BE MADE WITH THE ACCOUNT REPRESENTATIVE BASED UPON RMC'S UNINSURED PAYMENT POLICY. SHOULD THE PATIENT SUBSEQUENTLY QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE OR ANY OTHER HEALTH INSURANCE, ANY PAYMENTS RECEIVED WILL BE REFUNDED LESS ANY CO-PAYMENTS DUE. PART VI, LINE 4: RIDGEVIEW SERVES A POPULATION OF APPROXIMATELY 300,000 PEOPLE, PRIMARILY FROM ITS FIVE-COUNTY SERVICE AREA OF CARVER, NORTHERN SIBLEY, SOUTHERN WRIGHT, WESTERN HENNEPIN, AND EASTERN MCLEOD.AS OF THE 2010 CENSUS, THE SERVICE AREA POPULATION DISTRIBUTION BY AGE COHORT WAS 10% ARE 65+, 28% ARE 45-64, 35% ARE 18-44, AND 27% ARE 0-17. ACCORDING TO CARVER COUNTY DATA (PRIMARY SERVICE AREA), FAMILY HOUSEHOLDS MAKE UP 42% OF THE SERVICE AREA, 90% OF THE TOTAL POPULATION ARE OF CAUCASIAN DESCENT, 4% ARE OF HISPANIC DESCENT, AND 3% ARE OF ASIAN DESCENT. CARVER COUNTY MEDIAN HOUSEHOLD INCOME IS $82,710 AND 5% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PART VI, LINE 5: RIDGEVIEW MEDICAL CENTER'S PHYSICIANS, AND MEDICAL AND SUPPORT STAFF, PROVIDE SERVICES AND IN-KIND CONTRIBUTIONS TO THE COMMUNITIES IT SERVES IN A FIVE-COUNTY AREA. EXAMPLE OF RIDGEVIEW'S COMMUNITY BENEFIT CONTRIBUTIONS INCLUDE UNDERFUNDING OF MEDICARE AND MEDICAID AND CHARITY CARE, FREE LACTATION CONSULTATIONS TO NEW MOTHERS, JOB SHADOWS FOR HIGH SCHOOL AND COLLEGE STUDENTS, INTERNSHIP OPPORTUNITIES FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS(BOTH CLINICAL AND NON-CLINICAL), AND DISCOUNTS TO THE UNINSURED. RIDGEVIEW ALSO PROVIDES IN-KIND AND FINANCIAL DONATIONS TO OTHER NON-PROFITS' COMMUNITY HEALTH INITIATIVES (INCLUDING WESTONKA WECAB TRANSPORTATION SERVICE, PAY IT FORWARD FUND, AND COMMUNITY HEALTH AND WELLNESS EVENTS). PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 RIDGEVIEW FOUNDATION 500 SOUTH MAPLE STREET WACONIA MN 55387 411328097 3000000 EQUITY TO RELATED ORGANIZATION CARVER COUNTY HEALTH PARTNERSHIP 600 EAST 4TH STREET CHASKA MN 55318 320182075 501(C)(3) 57283 TO SUPPORT GENERAL OPERATIONS. 2 0 X X 0 1 0 0 0 0 0 0 0 ROBERT STEVENS PRESIDENT / CEO 343711 0 0 0 0 0 317391 0 12060 0 673162 0 0 0 PATRICIA MICHAELSON VICE PRESIDENT 229874 0 0 0 0 0 16288 0 1426 0 247588 0 0 0 JOHN PRONDZINSKI VICE PRESIDENT 203874 0 0 0 0 0 15049 0 7607 0 226530 0 0 0 GORDON GABLENZ VICE PRESIDENT / CFO 211128 0 0 0 0 0 15713 0 12060 0 238901 0 0 0 MICHAEL PHELPS CAO 226247 0 0 0 0 0 14477 0 11471 0 252195 0 0 0 DOUGLAS STASEK VICE PRESIDENT 186146 0 0 0 0 0 14038 0 11465 0 211649 0 0 0 SARAH HASTINGS VICE PRESIDENT 171478 0 0 0 0 0 14092 0 12060 0 197630 0 0 0 BERNARD BUCKLAND DIRECTOR OF SURGERY 184421 0 0 0 0 0 7172 0 7607 0 199200 0 0 0 KRISTI WIDSETH CRNA 168131 0 0 0 0 0 6292 0 30 0 174453 0 0 0 CYNTHIA BRICK CRNA 179096 0 0 0 0 0 6957 0 11354 0 197407 0 0 0 ARLIEN CORTLAND CRNA 169222 0 0 0 0 0 6329 0 30 0 175581 0 0 0 TINA KIRSCH CRNA 168673 0 0 0 0 0 6067 0 30 0 174770 0 0 0 PART I, LINE 4B ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN ACCRUED $317,391 DURING 2013. ROBERT STEVEN'S DEFERRED COMPENSATION IS REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO HIS VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF MR. STEVEN'S DEFERRED COMPENSATION PACKAGE IS NOT VESTED. IN ADDITION TO SCHEDULE J, PART II, LINE 1, COLUMN C, THIS AMOUNT IS ALSO INCLUDED IN PART VII, SECTION A, LINE 11, COLUMN F. A CITY OF WINSTED MINNESOTA 416005652 2007-04-27 5000000 BUILDING ADDITION TO HOSPITAL 0 0 0 B CITY OF DELANO MINNESOTA 416005093 2007-05-14 4337423 BUILDING ADDITION TO HOSPITAL 0 0 0 C CITY OF COLOGNE MINNESOTA 416005068 2007-03-13 9000000 DEFEASE 1999 BONDS 0 0 0 D CITY OF CARVER MINNESOTA 416005037 2007-03-28 7000000 DEFEASE 1999 BONDS 0 0 0 A 98644 5000000 100000 4900000 2007 0 0 1 1 B 85573 4337423 85000 4252423 2007 0 0 1 1 C 177777 9000000 8950000 50000 2000 0 1 1 1 D 141050 7000000 6950000 50000 2000 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A CITY OF HAMBURG MINNESOTA 410941733 2007-04-12 7000000 DEFEASE 1999 BONDS 0 0 0 B CITY OF HAMBURG MINNESOTA 410941733 2013-09-17 8912500 DEFEASE 2005, 2002A, 2003 BONDS, EQUIP PURCHASE, RMC BUILDING REMODEL 0 0 0 C CITY OF WINSTED MINNESOTA 416005652 2013-09-17 8912500 DEFEASE 2005, 2002A, 2003 BONDS, EQUIPMENT PURCHASE, RMC BUILDING REMODEL 0 0 0 D CITY OF HOWARD LAKE MINNESOTA 416005249 2013-12-30 7000000 212 NORTH PROJECT 0 0 0 A 138102 7000000 6102423 50000 847577 2000 0 1 1 1 B 266478 8912500 3607744 178250 5126506 2013 1 0 1 1 C 266468 8912500 3607744 178250 5126506 2013 1 0 1 1 D 7000000 181568 3713300 3105132 2002 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 0 A 1 B 1 C 1 D 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON, THE VICE CHAIRPERSON, THE SECRETARY, AND THE TREASURER AS EX OFFICIO VOTING MEMBERS THEREOF. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE FULL AUTHORITY OF THE BOARD EXCEPT AS OTHERWISE LIMITED BY LAW, BY THE BOARD, OR BY THESE BYLAWS. THE EXECUTIVE COMMITTEE SHALL TRANSACT THE BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL CONDUCT AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND REPORT THE FINDINGS AND RECOMMENDED COMPENSATION AND BENEFITS TO THE BOARD OF DIRECTORS. AFTER RECEIVING THE EXECUTIVE COMMITTEE'S REPORT, THE ENTIRE BOARD SHALL THEN SET THE COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AS THE BOARD DEEMS APPROPRIATE. THE EXECUTIVE COMMITTEE SHALL ESTABLISH A PROCESS FOR STRATEGIC PLANNING WHICH SHALL ALSO ENCOMPASS BOARD RETREATS. FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S HEALTH CARE, D/B/A CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA, IS A MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE MAYOR OF WACONIA SERVES AS AN EX-OFFICIO NON-VOTING MEMBER OF THE BOARD. CERTAIN RIGHTS, LIKE AUTHORITY OVER CAPITAL EXPANDITURES, ARE RESERVED BY THE CITY OF WACONIA. AS A CORPORATE MEMBER OF RIDGEVIEW MEDICAL CENTER, CHILDREN'S HOSPITAL AND CLINICS SHALL HAVE THE RIGHT TO APPROVE ANY AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS TO THE EXTENT SUCH AMENDMENT WOULD MATERIALLY ADVERSELY AFFECT THE RIGHTS OR OBLIGATIONS OF CHILDREN'S AS A MEMBER OF RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWS THE FORM 990. THE BOARD OF DIRECTORS ARE PROVIDED A COPY OF THE FORM AFTER THE CFO'S REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION. THE BOARD USES COMPARABILITY DATA FROM A COMPENSATION SURVEY AND VOTES ON HIS COMPENSATION. HOWEVER, ONE BOARD MEMBER, A PHYSICIAN WHO IS EMPLOYED BY RIDGEVIEW CLINICS, DOES NOT VOTE ON THE CEO'S COMPENSATION. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2013. THE CEO DETERMINES THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES. HIS DUE DILIGENCE PROCEDURES INCLUDE REVIEWING COMPENSATION SURVEYS AND PRESENTING HIS CONCLUSIONS TO THE BOARD OF DIRECTORS FOR APPROVAL. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2013. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW MEDICAL CENTER HOLDS A PUBLIC MEETING ANNUALLY, AT WHICH THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PRESENTED. OTHERWISE THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INVESTMENT IN FOUNDATION 3,592,463. RIDGEVIEW REAL ESTATE LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 LAND LESSOR MN 49992 4166 RIDGEVIEW MEDICAL CENTER RIDGEVIEW REAL ESTATE II LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 LAND LESSOR MN 0 0 RIDGEVIEW MEDICAL CENTER RIDGEVIEW FOUNDATION 500 SOUTH MAPLE STREET WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 1 RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 1 RIDGEVIEW INSURANCE CO 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 11A, I RIDGEVIEW MEDICAL CENTER 1 MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN RELATED -37502 531594 0 1 0.50000 CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD CHASKA MN 55318 450975783 SURGERY SERVICES MN RELATED 995376 676731 0 1 0.51000 EXECUTIVE HEALTH MANAGEMENT SERVICES INC 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN RIDGEVIEW MEDICAL CENTER C 1.00000 1 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN N/A T 0 0 0 1 0 1 0 0 0 0 1 0 0 1 1 1 1 0 0 0 RIDGEVIEW FOUNDATION B 3000000 FAIR MARKET VALUE RIDGEVIEW FOUNDATION O 455381 FAIR MARKET VALUE RIDGEVIEW FOUNDATION C 1510190 CASH VALUE RIDGEVIEW CLINCS P 9559451 FAIR MARKET VALUE