2014-05-13T16:20:45-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-07-01 331007002 TRINITY HEALTH & AFFILIATES TRIN 7018575160 PO BOX 5020 MINOT ND 58702 DENNIS C EMPEY 7018575160 2014-05-13 1 KOREY BOELTER P00775161 6123764500 2012 2015-11-30 17:44:51Z JOHN M KUTCH PO BOX 5020 MINOT ND 58702 289148158 1 0 3904 X WWW.TRINITYHEALTH.ORG X MEETING THE NEEDS OF THE WHOLE PERSON THROUGH QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 11 5 0 342 1743235 0 2311018 973398 289982315 285352213 1021896 2149764 6040222 541161 299355451 289016536 574174 109150 0 0 119323020 121387830 0 0 932422 153472521 149797985 273369715 271294965 25985736 17721571 569541785 655440720 309204107 376839020 260337678 278601700 X TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 182724467 109150 122979923 TRINITY HEALTH & AFFILIATES PROVIDES HOSPITAL SERVICES TO CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. TRINITY HOSPITALS IS THE LARGEST HOSPITAL PROVIDER IN NORTHWEST NORTH DAKOTA, WITH AN ACUTE CARE FACILITY THAT IS VERIFIED BY THE AMERICAN COLLEGE OF SURGEONS AS A LEVEL 2 TRAUMA CENTER. THE FACILITY ALSO INCLUDES A NEONATAL INTENSIVE CARE UNIT, A KIDNEY DIALYSIS UNIT, AN INPATIENT REHABILITATION CENTER, AN INPATIENT PSYCHIATRIC UNIT, AND A COMPREHENSIVE COMPLEMENT OF BOTH ACUTE CARE AND OUTPATIENT SERVICES, ALONG WITH A SKILLED NURSING HOME FACILITY AND A CRITICAL ACCESS HOSPITAL IN KENMARE. TRINITY PROVIDED COMMUNITY EDUCATION PROGRAMS AND EVENTS, SCREENINGS AND SUPPORT OF UND FAMILY MEDICINE. 27389266 0 86379487 TRINITY HOSPITALS PHARMACY DEPARTMENT PROVIDES COMPREHENSIVE PHARMACEUTICAL SERVICES 24 HOURS PER DAY TO PROVIDERS AND PATIENTS. THROUGH INVESTMENTS IN TECHNOLOGY, OUR MEDICATION MANAGEMENT PROCESS ENSURES THE SAFE AND EFFECTIVE ADMINISTRATION AND MONITORING OF ALL MEDICATIONS. IN ADDITION TO PROVIDING MEDICATIONS AND RELATED SUPPLIES, THE PHARMACY PROVIDES DRUG INFORMATION TO PATIENTS AND HEALTHCARE PROVIDERS, DOSING AND PHARMACOKENETIC SERVICES, ADVERSE DRUG REACTION MONITORING ,DRUG-DRUG AND DRUG-FOOD INTERACTION INFORMATION, DRUG COMPATABILITIES, TOXICOLOGY AND ANTURAL PRODUCT INFORMATION. SERVICES RANGE FROM MEDICATION DISPENSING TO PERFORMING COMPLEX PHARMACOKENETIC CALCULATIONS AND COMPOUDNING SPECIALIZED NUTRITION SOLUTIONS, CHEMOTHERAPY AND BIOLOGICAL REGIMENS. THE PHARMACY DEPARTMENT ALSO PARTICIPATED IN FMEA (FAILURE MODE EFFECT ANALYSIS) AND ROOT CAUSE ANALYSIS IN COOPERATION WITH OTHER DEPARTMENTS. RETROSPECTIVE AND CONCURRENT CHART REVIEWS ARE CONDUCTED TO ASSESS TIMELINESS AND APPROPRIATENESS OF THERAPY, AS WELL AS HOW WELL THE PATIENTS' NEEDS ARE BEING MET. 19992813 0 18443698 TRINITY HOMES IS A 292-BED HOSPITAL-BASED SKILLED NURSING FACILITY PARTICIPATING IN THE MEDICARE AND MEDICAID PROGRAMS. RESIDENTS OF TRINITY HOMES, UNDER THE DIRECTION OF THEIR PHYSICIAN, ARE ABLE TO RECEIVE SKILLED NURSING CARE, PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, DIETETIC SERVICES, SOCIAL SERVICES, AND ACTIVITIES OF DAILY LIVING ASSISTANCE, SPIRITUAL CARE AND RECREATIONAL ACTIVITIES. 10067171 0 57549105 TRINITY HOSPITALS LABORATORY IS STAFFED 24/7, 365 DAYS A YEAR, TO SERVE HOSPITAL, CLINIC AND OUTREACH PATIENTS. OUR PURPOSE IS TO PROVIDE LABORATORY TESTING TO AID THE PROVIDER IN DIAGNOSIS, TREATMENT, AND FOLLOW-UP OF DISEASE AND WELLNESS. WE PROVIDE ROUTINE TESTING FREE OF CHARGE TO THE COMMUNITY "FREE CLINIC", HAVE DONE PSA SCREENINGS AT THE NORTH DAKOTA STATE FAIR; AND DO SOME SCREENING TESTS FOR COMPANIES IN TOWN. WE HAVE A PHLEBOTOMIST WHO GOES TO ASSISTED LIVING FACILITIES, NURSING HOMES, AND PRIVATE HOMES TO DRAW BLOOD. 10067171 57549105 240173717 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 0 0 1 2 0 0 1 1 0 0 0 0 1 1 0 0 0 0 X 11 5 0 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 X DENNIS EMPEY 7018575160 PO BOX 5020 MINOT ND 58702 PATRICK HOLIEN 2.00 2.00 X X 0 0 0 STEVE LYNSE 2.00 2.00 X X 0 0 0 KAREN KREBSBACH 2.00 2.00 X X 0 0 0 DAVID FULLER 2.00 2.00 X 0 0 0 CLARA SUE PRICE 2.00 2.00 X 0 0 0 MARTIN ROTHBERG MD 20.00 20.00 X 0 113199 12332 KEVIN COLLINS MD 20.00 20.00 X 0 801483 22362 BORGI BEELER 2.00 2.00 X 0 0 0 JOHN COUGHLIN 2.00 2.00 X 0 0 0 DARYL SOMERVILLE 2.00 2.00 X 0 0 0 BLAINE DESLAURIERS 2.00 0.00 X 0 0 0 JOHN KUTCH 20.00 20.00 X X 0 471119 17862 ALISON FRYE 0.00 40.00 X 0 44921 505 MAX OWENS 20.00 20.00 X 0 0 0 RANDY SCHWAN 32.00 8.00 X 0 176059 10830 PAUL SIMONSON 32.00 8.00 X 0 238621 17329 THOMAS WARSOCKI 0.00 40.00 X 0 158819 14816 DAVE KOHLMAN 28.00 12.00 X 0 180794 15271 BARBARA BROWN 40.00 0.00 X 0 205737 10291 JEFFREY VERHEY MD 15.00 25.00 X 0 525060 22362 0 2915812 143960 0 1 1 0 0 18626 954772 44756 973398 NET PATIENT REVENUE 621110 280402259 280402259 DIETARY SERVICES 722320 1820705 144912 1675793 OTHER PATIENT SERVICES 621110 1530926 1530926 ADMINISTRATIVE SERVICES 561000 845200 845200 OTHER UBIT SERVICES 900099 380278 380278 372845 372845 285352213 801032 801032 69732 44436 25296 25296 25296 1420406 71674 1348732 1348732 1348732 12950 18626 15512 -2562 -2562 VENDOR REBATES 900099 518427 518427 518427 289016536 281933185 1743235 4366718 X 90500 90500 18650 18650 103300808 93782885 9399836 118087 1309100 1185180 123920 9626220 8345695 1271660 8865 7151702 6530879 612312 8511 1312007 5848 1306159 152740 20000 132740 31739600 25874620 5825659 39321 2200719 106843 2093876 7205900 6379488 822726 3686 1303996 789861 514135 9505321 8660655 844666 198521 189483 8910 128 344478 226454 117775 249 4155179 4117711 37468 11741109 7233821 4505325 1963 612494 138420 474074 MEDICAL SUPPLIES / DRUG 48695035 48692661 2374 BAD DEBT EXPENSE 24248765 24163692 72117 12956 MISCELLANEOUS EXPENSES 2909229 2122404 94373 692452 BOOKS & SUBSCRIPTIONS 2040725 1105342 935255 128 1432167 392625 1030934 8608 271294965 240173717 30188826 932422 6811547 23805256 4921844 1445948 4420 1475 77468571 72395292 662488 477490 7105650 7544457 2099290 3027121 230929800 158643178 71620661 72286622 12138104 13228893 50000 50000 386659210 461178166 569541785 655440720 50504887 58004855 144000 180000 29574 28832 4200846 16777832 58607 254266193 301847501 309204107 376839020 X 252711681 274476511 7515013 4024881 110984 100308 260337678 278601700 569541785 655440720 17721571 542451 0 X 0 1 X 1 1 1 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE PUBLIC CHARITY STATUS AS IDENTIFIED IN EACH OF THE CORPORATION'S DETERMINATION LETTER ARE AS FOLLOWS: TRINITY HOSPITALS - LINE 3, SECTION 170(B)(1)(A)(III) TRINITY KENMARE HOSPITAL - LINE 3, SECTION 170(B)(1)(A)(III) TRINITY HOMES - LINE 9, 509(A)(2) TRINITY HEALTH FOUNDATION - LINE 11, 509(A)(3), TYPE II PART I, LINE 11E TRINITY HEALTH FOUNDATION CERTIFIES THAT THE ORGANIZATION IS NOT CONTROLLED DIRECTLY OR INDIRECTLY BY ONE OR MORE DISQUALIFIED PERSONS OTHER THAN FOUNDATION MANAGERS AND OTHER THAN ONE OR MORE PUBLICLY SUPPORTED ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR SECTION 509(A)(2). PART 1, LINE 11F TRINITY HEALTH FOUNDATION HAS NOT RECEIVED A WRITTEN DETERMINATION FROM THE IRS. PART 1, LINE 11G TRINITY HEALTH FOUNDATION HAS NOT ACCEPTED ANY GIFT OR CONTRIBUTION FROM A PERSON WHO DIRECTLY OR INDIRECTLY CONTROLS, EITHER ALONE OR TOGETHER, THE GOVERNING BODY OF THE SUPPORTED ORGANIZATION, A FAMILY MEMBER OF SUCH A PERSON, OR A 35% CONTROLLED ENTITY OF SUCH A PERSON. PART 1, LINE 11H TRINITY HEALTH FOUNDATION SUPPORTS TRINITY HOSPITALS, TRINITY KENMARE HOSPITAL, AND TRINITY HOMES, THE OTHER ORGANIZATIONS REPORTED IN THIS GROUP RETURN. TRINITY HOSPITALS AND TRINITY HOMES ARE LISTED IN THE TRINITY HEALTH FOUNDATION'S GOVERNING DOCUMENTS, BUT TRINITY KENMARE HOSPITAL IS NOT. TRINITY HEALTH FOUNDATION NOTIFIED THE ORGANIZATIONS OF SUPPORT. EACH SUPPORTED ORGANIZATION IS ORGANIZED IN THE U.S. THE AMOUNT OF MONETARY SUPPORT FOR EACH SUPPORTED ORGANIZATION IS $0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 39844 39844 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING ACTIVITIES CONSIST OF A PORTION OF OUR ANNUAL MEMBERSHIP DUES IDENTIFIED UPON RENEWAL AS ASSOCIATED WITH LOBBYING ACTIVITY. ASSOCIATIONS INCLUDE NORTH DAKOTA HEALTHCARE ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, NORTH DAKOTA LONG TERM CARE ASSOCIATION, NATIONAL HOSPICE ASSOCATION, HEALTH POLICY CONSORTIUM, AND SECTION 508 HOSPITAL COALITION. 1 270849 16123 286972 1 X 102253 14163 116416 95051 7202 102253 95145 3902 3693 303 95051 305323 -214179 4001 95145 313288 -5031 2934 305232 0.00000 0.86160 0.13840 0 0 2155215 2155215 44222151 24713545 19508606 19447 19447 0 179272951 133910186 45362765 5260036 5260036 72286622 DUE FROM AFFILIATES 461178166 461178166 DUE TO AFFILIATES 299244937 ESTIMATED 3RD PARTY SETTLEMENTS 2602564 301847501 X PART IV, LINE 1B: TO PROVIDE PUBLIC EDUCATION FOR HOSPICE CARE. PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE HELD BY TRINITY HOMES. THESE FUNDS ARE TRACKED SEPARATELY FROM THE ORGANIZATIONS AND ARE HELD IN A SEPARATE BANK ACCOUNT. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE PURPOSE OF THE ENDOWMENT FUNDS IS TO SUPPORT STAFF EDUCATION AND SCHOLARSHIPS AND THE PURCHASE OF NEW EQUIPMENT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: TRINITY HOSPITALS, TRINITY HOMES, TRINITY HEALTH FOUNDATION, AND TRINITY KENMARE HOSPITAL HAVE ALL BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. ALL UNRELATED BUSINESS INCOME GENERATED BY TRINITY IS SUBJECT TO FEDERAL INCOME TAX UNDER 511 OF THE IRC. TRINITY'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS, AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. TRINITY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. NORTH AMERICA 0 0 OTHER - MINERAL RIGHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FOREIGN ACTIVITIES SCHEDULE F, PART I, LINE 3 THE ORGANIZATION'S FOREIGN ACTIVITIES ARE LIMITED TO THE RECEIPT OF MINERAL RIGHTS FROM PROPERTY IN CANADA. GOLF - BUILDING HOPE 23976 17026 6950 1461 2366 4500 5432 GOLF FOR LIFE 7600 1600 6000 1568 185 31576 18626 12950 3029 2366 4500 5617 15512 -2562 1 1 X 1 X 1 X 1 1 1 0 1 0 3393792 3393792 0.01250 15746885 15369210 377675 0.00140 19140677 15369210 3771467 0.01390 19140677 15369210 3771467 0.01390 25 3065 40087 40087 0.00010 25 3065 40087 40087 0.00010 1 24248765 0 72770994 66909719 5861275 X 1 1 3 1 TRINITY HOSPITAL

ONE BURDICK EXPRESSWAY WEST MINOT ND 58701

X X X X 2 TRINITY HOSPITAL ST JOSEPH'S

407 3RD STREET SE MINOT ND 58701

X X 3 TRINITY KENMARE HOSPITAL

PO BOX 697 KENMARE ND 587460697

X X X TRINITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 150.000000000000 1 250.000000000000 1 X X X X 1 1 X X X X X 1 0 X X X 1 X 0 0 TRINITY HOSPITAL ST JOSEPH'S 2 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 150.000000000000 1 250.000000000000 1 X X X X 1 1 X X X X X 1 0 X X X 1 X 0 0 TRINITY KENMARE HOSPITAL 3 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 150.000000000000 1 250.000000000000 1 X X X X 1 1 X X X X X 1 0 X X X 1 X 0 0 28 TRINITY HOMES

305 8TH AVENUE NE MINOT ND 58701

SKILLED NURSING HOME TRINITY HOSPITALS HOME HEALTHHOSPICE

1015 SOUTH BROADWAY SUITE 306 MINOT ND 58701

HOME HEALTH & HOSPICE TRINITY HOSPITALS

HOSPITAL ROAD BELCOURT ND 58316

DIALYSIS SERVICES TCC-BELCOURT (KDU)

1310 HOSPITAL LOOP ROAD BELCOURT ND 58316

DIALYSIS SERVICES ORAL & FACIAL SURGERY CENTER-PLAZA 16

2815 16TH STREET SW MINOT ND 58702

ORAL & FACIAL SURGICAL SERVICES ORAL & FACIAL SURGERY CENTER-WILLISTON

2224 1ST AVE W WILLISTON ND 58801

ORAL & FACIAL SURGICAL SERVICES TRINITY REGIONAL EYECARE-WILLISTON

1321 W DAKOTA PARKWAY WILLISTON ND 55801

EYE HEALTH SERVICES TRINITY REGIONAL EYECARE-DEVIL'S LAKE

404 HWY 2 EAST DEVILS LAKE ND 58301

EYE HEALTH SERVICES VISION GALLERIA AT TRINITY - PLAZA 16

2815 16TH STREET SW MINOT ND 58702

OPTICAL AND CONTACT LENS DISPENSARY SAME DAY SURGERY CENTER

407 3RD ST SE MINOT ND 58701

SURGICAL SERVICES WESTERN DAKOTA SURGERY

1102 MAIN ST WILLISTON ND 58801

SURGICAL SERVICES TRINITY HEALTH CENTER MEDICAL ARTS

400 BURDICK EXPRESSWAY EAST MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY HEALTH CENTER-EAST

20 BURDICK EXPRESSWAY WEST MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY HEALTH CENTER-WEST

101 ERD AVENUE SW MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY REGIONAL EYECARE-MINOT CENTER

120 BURDICK EXPRESSWAY EAST MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY HEALTH CENTER-RIVERSIDE

1900 8TH AVENUE SE MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY HEALTH CENTER-TOWN & COUNTRY

831 SOUTH BROADWAY MINOT ND 58701

PROVIDER-BASED CLINIC MAIN MEDICAL BUILDING

315 SOUTH MAIN MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY HEALTH SOUTH RIDGE

1500 24TH AVENUE SW MINOT ND 58701

PROVIDER-BASED CLINIC TCC-WESTERN DAKOTA

1321 WEST DAKOTA PARKWAY WILLISTON ND 58801

PROVIDER-BASED CLINIC TRINITY HEALTH CENTER-3RD STREET

420 3RD ST SE MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY HEALTH CENTER-5TH AVE

307 5TH AVE SE MINOT ND 58701

PROVIDER-BASED CLINIC TRINITY COMMUNITY CLINIC KENMARE

307 1ST AVENUE NW KENMARE ND 58746

RURAL HEALTH CLINIC TCC-GARRISON

PO BOX 1179 GARRISION ND 585401179

RURAL HEALTH CLINIC TCC-MOHALL

504 1ST ST SW MOHALL ND 58760

RURAL HEALTH CLINIC TCC-NEW TOWN

PO BOX 1029 NEW TOWN ND 587631029

RURAL HEALTH CLINIC TCC-VELVA

PO BOX 70 VELVA ND 587900070

RURAL HEALTH CLINIC TCC-WESTHOPE

PO BOX 383 WESTHOPE ND 587930383

RURAL HEALTH CLINIC PART I, LINE 7: TRINITY'S COMMUNITY BENEFIT EXPENSES AND REVENUES WERE CALCULATED USING THE IRS WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO THE 2012 FORM 990, SCHEDULE H. PART I, L7 COL(F): THE PERCENTAGES WERE CALCULATED EXCLUDING $24,248,765 OF BAD DEBT EXPENSE.IN FURTHERANCE OF ITS CHARITABLE PURPOSE, TRINITY PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY-BASED SERVICE PROGRAMS SUCH AS FREE CLINICS, HEALTH SCREENINGS, IN-HOME CAREGIVER SERVICES, SOCIAL SERVICE AND SUPPORT COUNSELING FOR PATIENTS 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, TELEPHONE INFORMATION SERVICES, AND COSTS RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. THE COST OF PROVIDING THE ABOVE SERVICES IS NOT INCLUDED IN TRINITY'S CHARITY CARE AMOUNT. PART III, LINE 2: TRINITY PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED CHARGE TO RESIDENTS OF ITS COMMUNITY THROUGH THE PROVISION OF CHARITY CARE. INCLUDED IN TRINITY'S DEFINITION OF CHARITY CARE ARE THE FOLLOWING: (A) SERVICES PROVIDED TO THE UNINSURED OR UNDERINSURED AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED TO BE UNABLE TO PAY BECAUSE OF SOCIOECONOMIC FACTORS. TRINITY MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE THE AMONT OF CHARGES FOREGONE FOR CHARITY CARE.AMOUNTS DO NOT INCLUDE THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS OR THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES. TRINITY USES THE MEDICARE COST-TO-CHARGE RATIO TO DETERMINE THE AMOUNTS REPORTED ON LINE 2. PART III, LINE 3: TRINITY IS REPORTING $0 ON LINE 3 BECAUSE THE ORGANIZATION DOES NOT HAVE A RELIABLE ESTIMATE OF THE PORTION OF BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO INDIVIDUALS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. PART III, LINE 4: SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, NET" NOTE ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 9B: IT IS THE POLICY OF TRINITY TO PROVIDE MEDICAL SERVICES TO THE COMMUNITY AND REGION REGARDLESS OF THE CUSTOMER'S ABILITY TO PAY THROUGH CONSISTENT BILLING PRACTICES. ACCOUNTS WILL BE MONITORED TO ENSURE THAT CUSTOMERS ARE BILLED FOR ONLY THOSE SERVICES PROVIDED. TRINITY, THROUGH VERIFICATION OF INFORMATION, IS REQUIRED TO PROVIDE TIMELY AND ACCURATE BILLING, COLLECTION, AND PATIENT ACCOUNT MAINTENANCE. INFORMATION REGARDING TRINITY'S BILLING AND PAYMENT GUIDELINES, WHICH INCLUDES FINANCIAL ASSISTANCE PROGRAMS, ARE AVAILABLE AT REGISTRATION AND BUSINESS SERVICES LOCATIONS. THIS INFORMATION IS COMMUNICATED VERBALLY OR THROUGH THE USE OF THE TRINITY BILLING & PAYMENT GUIDELINES BROCHURE. TO ENHANCE VERBAL COMMUNICATIONS, INTERPRETERS ARE PROVIDED AS NECESSARY. TRINITY HOSPITAL PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") PROCESS PRIMARILY INVOLVED INTERVIEWS AND COMMUNITY SURVEYS. INTERVIEWS WERE CONDUCTED IN EARLY 2013 WITH VARIOUS COMMUNITY LEADERS, MEDICAL PROFESSIONALS, AND CITY AND COUNTY GOVERNMENT OFFICIALS. THIS PROCESS INCLUDED THE COUNTY HEALTH OFFICER, SOCIAL SERVICE WORKERS, SCHOOL DISTRICT REPRESENTATIVES, AND MILITARY REPRESENTATIVES OF THE NEARBY MINOT AIR FORCE BASE. COMMUNITY SURVEYS WERE DISTRIBUTED THROUGH THE LOCAL NEWSPAPER, OUR WEBSITE, FACEBOOK, AND OUR HEALTH CARE FACILITIES. TRINITY HOSPITAL ST. JOSEPH'S PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") PROCESS PRIMARILY INVOLVED INTERVIEWS AND COMMUNITY SURVEYS. INTERVIEWS WERE CONDUCTED IN EARLY 2013 WITH VARIOUS COMMUNITY LEADERS, MEDICAL PROFESSIONALS, AND CITY AND COUNTY GOVERNMENT OFFICIALS. THIS PROCESS INCLUDED THE COUNTY HEALTH OFFICER, SOCIAL SERVICE WORKERS, SCHOOL DISTRICT REPRESENTATIVES, AND MILITARY REPRESENTATIVES OF THE NEARBY MINOT AIR FORCE BASE. COMMUNITY SURVEYS WERE DISTRIBUTED THROUGH THE LOCAL NEWSPAPER, OUR WEBSITE, FACEBOOK, AND OUR HEALTH CARE FACILITIES. TRINITY KENMARE HOSPITAL PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") PROCESS PRIMARILY INVOLVED INTERVIEWS AND COMMUNITY SURVEYS. INTERVIEWS WERE CONDUCTED IN EARLY 2013 WITH VARIOUS COMMUNITY LEADERS, MEDICAL PROFESSIONALS, AND CITY AND COUNTY GOVERNMENT OFFICIALS. THIS PROCESS INCLUDED THE COUNTY HEALTH OFFICER, SOCIAL SERVICE WORKERS, SCHOOL DISTRICT REPRESENTATIVES, AND MILITARY REPRESENTATIVES OF THE NEARBY MINOT AIR FORCE BASE. COMMUNITY SURVEYS WERE DISTRIBUTED THROUGH THE LOCAL NEWSPAPER, OUR WEBSITE, FACEBOOK, AND OUR HEALTH CARE FACILITIES. TRINITY HOSPITAL PART V, SECTION B, LINE 4: TRINITY HOSPITAL CONDUCTED ITS CHNA IN COLLABORATION WITH TRINITY HOSPITAL-ST. JOSEPH'S AND TRINITY KENMARE HOSPITAL. BECAUSE OF THEIR IDENTICAL COMMUNITIES AND RELATIONSHIP WITHIN TRINITY HEALTH, TRINITY HOSPITAL AND TRINITY HOSPITAL-ST. JOSEPH'S PRODUCED A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. TRINITY HOSPITAL ST. JOSEPH'S PART V, SECTION B, LINE 4: TRINITY HOSPITAL-ST. JOSEPH'S CONDUCTED ITS CHNA IN COLLABORATION WITH TRINITY HOSPITAL AND TRINITY KENMARE HOSPITAL. BECAUSE OF THEIR IDENTICAL COMMUNITIES AND RELATIONSHIP WITHIN TRINITY HEALTH, TRINITY HOSPITAL AND TRINITY HOSPITAL-ST. JOSEPH'S PRODUCED A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. TRINITY KENMARE HOSPITAL PART V, SECTION B, LINE 4: TRINITY KENMARE HOSPITAL CONDUCTED ITS CHNA IN COLLABORATION WITH TRINITY HOSPITAL AND TRINITY HOSPITAL-ST. JOSEPH'S. TRINITY HOSPITAL PART V, SECTION B, LINE 7: BECAUSE OF LIMITED RESOURCES, WE CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED HEALTH NEED. WE HAVE CHOSEN OUR RESPONSES BASED ON ANALYSIS OF OUR RESOURCES, OUR MISSION, OUR EXISTING SPECIALTIES, COMMUNITY PRIORITIES, AND EXISTING COMMUNITY RESOURCES. WE HAVE CHOSEN TO FOCUS OUR RESOURCES ON ACCESS TO HEALTHCARE AND ARE NOT ACTIVELY PLANNING TO RESPOND TO ANY OTHER IDENTIFIED HEALTH NEEDS. TRINITY HOSPITAL ST. JOSEPH'S PART V, SECTION B, LINE 7: BECAUSE OF LIMITED RESOURCES, WE CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED HEALTH NEED. WE HAVE CHOSEN OUR RESPONSES BASED ON ANALYSIS OF OUR RESOURCES, OUR MISSION, OUR EXISTING SPECIALTIES, COMMUNITY PRIORITIES, AND EXISTING COMMUNITY RESOURCES. WE HAVE CHOSEN TO FOCUS OUR RESOURCES ON ACCESS TO HEALTHCARE AND ARE NOT ACTIVELY PLANNING TO RESPOND TO ANY OTHER IDENTIFIED HEALTH NEEDS. TRINITY KENMARE HOSPITAL PART V, SECTION B, LINE 7: BECAUSE OF LIMITED RESOURCES, WE CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED HEALTH NEED. WE HAVE CHOSEN OUR RESPONSES BASED ON ANALYSIS OF OUR RESOURCES, OUR MISSION, OUR EXISTING SPECIALTIES, COMMUNITY PRIORITIES, AND EXISTING COMMUNITY RESOURCES. WE HAVE CHOSEN TO FOCUS OUR RESOURCES ON ACCESS TO HEALTHCARE AND ARE NOT ACTIVELY PLANNING TO RESPOND TO ANY OTHER IDENTIFIED HEALTH NEEDS. TRINITY HOSPITAL PART V, SECTION B, LINE 14G: PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO BE COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR. TRINITY HOSPITAL ST. JOSEPH'S PART V, SECTION B, LINE 14G: PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO BE COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR. TRINITY KENMARE HOSPITAL PART V, SECTION B, LINE 14G: PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO BE COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR. TRINITY HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE OF ALL COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNT THAT CAN BE CHARGED. TRINITY HOSPITAL ST. JOSEPH'S PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE OF ALL COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNT THAT CAN BE CHARGED. TRINITY KENMARE HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE OF ALL COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNT THAT CAN BE CHARGED. PART VI, LINE 2: TRINITY HEALTH COMPLETES A THOROUGH COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS, IN COMPLIANCE WITH SECTION 501(R). TRINITY'S FIRST COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE YEAR ENDED JUNE 30, 2013. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IS AVAILABLE ONLINE AT HTTP://WWW.TRINITYHEALTH.ORG/COMMUNITY. PART VI, LINE 3: TRINITY POSTS NOTICE OF ITS FINANCIAL ASSISTANCE PROGRAM AND HOW A PATIENT MAY APPLY. PATIENT ACCESS AND BUSINESS OFFICE STAFF ATTEMPT TO IDENTIFY ALL CASES THAT WILL QUALIFY FOR FINANCIAL ASSISTANCE AT THE TIME OF ADMISSION. PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR. PART VI, LINE 4: ALTHOUGH TRINITY HOSPITAL AND TRINITY HOSPITAL - ST. JOSEPH'S ARE LOCATED IN MINOT, NORTH DAKOTA, WE HAVE HISTORICALLY DEFINED OUR "COMMUNITY" AS A BROADER AREA THAT INCLUDES NORTHWESTERN NORTH DAKOTA AS WELL AS A PORTION OF NORTHEASTERN MONTANA. WITHIN THIS BROADER COMMUNITY, APPROXIMATELY TWO-THIRDS OF OUR INPATIENTS AND OUTPATIENTS RESIDE WITHIN IN AND IMMEDIATELY AROUND THE CITY OF MINOT AND WARD COUNTY.UNDERSTANDING OUR COMMUNITY REQUIRES AN UNDERSTANDING OF NORTH DAKOTA'S OIL BOOM. ON MARCH 13, 2013, THE ATLANTIC PUBLISHED A SHORT ARTICLE EXPLAINING THE SITUATION:"UNDERLYING NORTHWESTERN NORTH DAKOTA IS A MASSIVE ROCK FORMATION, REFERRED TO AS THE BAKKEN SHALE, WHICH HOLDS AN ESTIMATED 18 BILLION BARRELS OF CRUDE OIL. WHEN THIS RESOURCE WAS FIRST DISCOVERED IN 1951, RECOVERING IT WAS FINANCIALLY UNFEASIBLE BECAUSE THE OIL WAS EMBEDDED IN THE STONE. THEN, AROUND 2008, EVERYTHING CHANGED, AND NORTH DAKOTA BOOMED. NEW DRILLING TECHNOLOGY CALLED HYDRAULIC FRACTURING, OR 'FRACKING,' BECAME WIDESPREAD, AND OIL PRODUCTION TOOK OFF. AS OF 2013, THERE ARE MORE THAN 200 ACTIVE OIL RIGS IN NORTH DAKOTA, PRODUCING ABOUT 20 MILLION BARRELS OF OIL EVERY MONTH-NEARLY 60 PERCENT OF IT SHIPPED BY RAIL, RATHER THAN PIPELINE. THE RIGS AND SUPPORT SYSTEMS HAVE RESCULPTED THE LANDSCAPE, MILLIONS ARE DOLLARS ARE BEING SPENT ON INFRASTRUCTURE UPGRADES ACROSS THE AREA, AND THOUSANDS OF OIL FIELD WORKERS HAVE ARRIVED, LIVING IN NEW OR TEMPORARY HOUSING."ALTHOUGH MUCH OF THE OIL FIELD ACTIVITY OCCURS TO THE WEST OF MINOT, OUR COMMUNITY HAS BEEN SIGNIFICANTLY IMPACTED BY THE INFLUX OF PEOPLE INTO OUR COMMUNITY. DEMAND FOR ALMOST EVERY GOOD, FROM HOUSING TO CLOTHING TO FOOD, HAS INCREASED. WHILE THE INCREASE IN JOBS AND THE INFLOW OF MONEY HAS BEEN BENEFICIAL, OUR COMMUNITY ALSO STRUGGLES WITH INCREASING COST-OF-LIVING AND A HOUSING SHORTAGE. PART VI, LINE 5: IN FURTHERANCE OF ITS CHARITABLE PURPOSE, TRINITY PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY-BASED SERVICE PROGRAMS SUCH AS FREE CLINICS, HEALTH SCREENINGS, IN-HOME CAREGIVER SERVICES, SOCIAL SERVICE AND SUPPORT COUNSELING FOR PATIENTS 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, TELEPHONE INFORMATION SERVICES, AND COSTS RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: THIS FORM 990 INCLUDES TRINITY HOSPITAL, TRINITY HOSPITAL-ST. JOSEPH'S, AND TRINITY KENMARE HOSPITAL. THESE THREE HOSPITALS ARE PART OF TRINITY HEALTH SYSTEM. TRINITY HEALTH IS THE PARENT ORGANIZATION. THE SYSTEM ALSO INCLUDES TRINITY HEALTH FOUNDATION, TRINITY HOMES, AND COMMUNITY AMBULANCE SERVICE OF MINOT, ALL OF WHICH ARE TAX-EXEMPT 501(C)(3) ORGANIZATIONS, AS WELL AS MEDICAL ARTS OUTPATIENT SERVICES INC. AND B&B DRUG INC., BOTH OF WHICH ARE FOR-PROFIT C CORPORATIONS. 0 MINOT FAMILY YMCA PO BOX 69 MINOT ND 58702 450237612 501(C)(3) 50000 FACILITY EXPANSION NORSK HOSTFEST ASSOCIATION PO BOX 1347 MINOT ND 58702 450353644 501(C)(3) 24000 SPONSORSHIP NORTH DAKOTA STATE FAIR PO BOX 1796 MINOT ND 58702 450215346 501(C)(3) 8500 SPONSORSHIP MINOT POLICE DEPARTMENT 515 2ND AVE SW MINOT ND 58701 456002126 501(C)(3) 8000 SPONSORSHIP 4 0 INDIVIDUAL GRANTS WERE GIVEN FOR HARDSHIPS AND FLOOD RELIEF. 78 18650 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TRINITY HEALTH & AFFILIATES DOES NOT HAVE A PROCEDURE FOR MONITORING USE OF GRANT FUNDS. 0 0 0 0 0 0 0 0 0 KEVIN COLLINS MD 0 588810 0 203000 0 9673 0 8350 0 14012 0 823845 0 0 JOHN KUTCH 0 470543 0 0 0 576 0 8350 0 9512 0 488981 0 0 RANDY SCHWAN 0 176059 0 0 0 0 0 6204 0 4626 0 186889 0 0 PAUL SIMONSON 0 236191 0 0 0 2430 0 8195 0 9134 0 255950 0 0 THOMAS WARSOCKI 0 158819 0 0 0 0 0 5803 0 9013 0 173635 0 0 DAVE KOHLMAN 0 180128 0 0 0 666 0 6517 0 8754 0 196065 0 0 BARBARA BROWN 0 205071 0 0 0 666 0 5946 0 4345 0 216028 0 0 JEFFREY VERHEY MD 0 292813 0 130000 0 102247 0 8350 0 14012 0 547422 0 0 SUPPLEMENTAL INFORMATION PART III JOHN KUTCH, PRESIDENT/CEO, IS COMPENSATED BY TRINITY HEALTH, A RELATED ORGANIZATION. TRINITY HEALTH USES THE FOLLOWING METHODS TO DETERMINE THE COMPENSATION FOR JOHN: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE KALIX BORGI BEELER, A BOARD MEMBER, IS KALIX'S PRESIDENT & CEO 1472709 LAUNDRY SERVICES FOR HOSPITALS 0 DAVE KOHLMAN BOARD MEMBER 45119 REAL ESTATE RENTAL 0 X MINERAL RIGHTS 1 44756 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD OF DIRECTORS' CHAIR, VICE CHAIR, PRESIDENT, SECRETARY, TREASURER AND ONE ADDITIONAL MEMBER OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD OF DIRECTORS AT ITS FIRST MEETING AFTER ITS ELECTION. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 TRINITY HEALTH CONTRACTED WITH A MANAGEMENT COMPANY TO PROVIDE FINANCIAL MANAGEMENT SERVICES, INCLUDING A CONTRACTED CFO, DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 TRINITY HEALTH IS THE SOLE MEMBER OF EACH CORPORATION INCLUDED IN THIS GROUP RETURN. FORM 990, PART VI, SECTION A, LINE 7A AT EACH ANNUAL MEETING, THE SOLE MEMBER TRINITY HEALTH, APPOINTS THE BOARD OF DIRECTORS. AT LEAST SEVEN OF THE BOARD OF DIRECTORS ALSO SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF TRINITY HEALTH. IN THE BYLAWS OF TRINITY HEALTH FOUNDATION, THIS OVERLAP ONLY NEEDS TO BE THREE. ANY DIRECTOR WHO CEASES TO BE A MEMBER OF THE TRINITY HEALTH BOARD OF DIRECTORS AUTOMATICALLY BECOMES DISQUALIFIED FROM SERVING AS A DIRECTOR OF THE AFFILIATES' BOARD AND IS REPLACED WITH ANOTHER BOARD MEMBER CURRENTLY SERVING ON THE BOARD OF TRINITY HEALTH, UNLESS THERE ARE AT LEAST A MINIMUM OF SEVEN (OR THREE IN THE CASE OF TRINITY HEALTH FOUNDATION) OTHER BOARD MEMBERS CURRENTLY SERVING AS A DIRECTOR OF TRINITY HEALTH. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE SOLE MEMBER, TRINITY HEALTH: (A) APPROVE THE APPOINTMENT OF OFFICERS OF CORPORATION; (B) APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OF CORPORATION OR THESE BYLAWS; (C) APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF CORPORATION; (D) APPROVE THE SELECTION OF AUDITORS AND LEGAL COUNSEL FOR CORPORATION; (E) APPROVE ANY STRATEGIC PLANS ADOPTED BY CORPORATION; (F) APPROVE ANY UNBUDGETED BORROWING, ANY ENCUMBRANCE OF ASSETS, AND ANY EXPENDITURES FOR CAPITAL IMPROVEMENTS WHERE THE AMOUNT EXCEEDS FIVE PERCENT OF THE CAPITAL BUDGET PREVIOUSLY APPROVED BY MEMBER; (G) CHANGE THE NUMBER OF DIRECTORS OF THE BOARD OF DIRECTORS OF CORPORATION; AND (H) APPROVE ANY ACTION OF CORPORATION THAT IS NOT IN THE ORDINARY COURSE OF THE CORPORATION'S BUSINESS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE FORM 990 IS GIVEN TO THE GOVERNING BODY OF TRINITY HEALTH & AFFILIATES FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL SALARIED EMPLOYEES (AT MANAGER LEVEL AND ABOVE AS DETERMINED BY TRINITY) AND SUCH OTHER EMPLOYEES AS FROM TIME TO TIME MAY BE DIRECTED TO DO SO, ARE REQUIRED TO COMPLETE TRINITY HEALTH'S CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. ANY EMPLOYEE WHO HAS ASSUMED, OR IS ABOUT TO ASSUME, A FINANCIAL OR OTHER INTEREST OR RELATIONSHIP THAT MIGHT INVOLVE A CONFLICT OF INTEREST MUST IMMEDIATELY INFORM HIS/HER SUPERVISOR, A MEMBER OF THE COMPLIANCE COMMITTEE, OR THE COMPLIANCE OFFICER. ISSUES INVOLVING CONFLICT OF INTEREST SHALL BE REVIEWED AND A DETERMINATION OF EACH SHALL BE MADE BY THE TRINITY COMPLIANCE COMMITTEE. IF A CONFLICT EXISTS, THE CONFLICTED PERSON MUST ABSTAIN FROM DISCUSSION OF AND VOTING ON THE CONFLICTED TOPIC. FORM 990, PART VI, SECTION C, LINE 19 ON OUR WEBSITE WWW.TRINITYHEALTH.ORG WE LIST OUR BOARD OF DIRECTORS, MISSION, VISION, VALUES AND OUR ANNUAL REPORT WHICH INCLUDES FINANCIAL INFORMATION. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G MEDICAL PROFESSIONALS: PROGRAM SERVICE EXPENSES 25,874,620. MANAGEMENT AND GENERAL EXPENSES 5,825,659. FUNDRAISING EXPENSES 39,321. TOTAL EXPENSES 31,739,600. COMMUNITY AMBULANCE SERVICE OF MINOT INC 305 11TH AVENUE SW MINOT ND 58701 450363593 AMBULANCE SERVICES ND 501(C)(3) LINE 11A, I TRINITY HEALTH 0 TRINITY HEALTH PO BOX 5020 MINOT ND 58702 450226558 HEALTHCARE ND 501(C)(3) LINE 11A, I N/A 0 MEDICAL ARTS OUTPATIENT SERVICES INC 400 BURDICK EXPRESSWAY EAST MINOT ND 58701 450278212 RETAIL PHARMACY & DURABLE MEDICAL EQUIPMENT ND TRINITY HOSPITALS C 13120922 16500051 1.00000 1 B&B DRUG INC 20 BURDICK EXPRESSWAY EAST MINOT ND 58701 450260565 RETAIL DRUG STORE ND N/A C 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 0 0 MEDICAL ARTS OUTPATIENT SERVICES INC A 72000 FMV TRINITY HOSPITALS PO BOX 5020 MINOT ND 58702 412002771 TRIN TRINITY KENMARE HOSPITAL PO BOX 697 KENMARE ND 58746 412002769 TRIN TRINITY HOMES PO BOX 5020 MINOT ND 58702 450404412 TRIN TRINITY HEALTH FOUNDATION PO BOX 5020 MINOT ND 58702 450215346 TRIN