2014-11-07T08:48:49-06:00 2013-12-31 450310328 BRADY MARTZ & ASSOCIATES PC PO BOX 1297 BISMARCK ND 585021297 990 2013-01-01 450358986 WISHEK HOSPITAL CLINIC ASSOCIATION WISH 7014522326 PO BOX 647 WISHEK ND 584950647 MARK RINEHARDT CEO 7014522326 2014-10-31 1 PATRICK J BROWN P00149579 7012231717 2014-10-31 2013 2015-11-30 17:44:51Z MARK RINEHARDT 1007 4TH AVE S WISHEK ND 58495 6605914 0 X WWW.WISHEKHOSPITAL.COM X 1949 ND THE MISSION OF WISHEK HOSPTIAL CLINIC ASSOCIATION IS TO PROVIDE THE HIGHEST POSSIBLE STANDARD OF HEALTH CARE IN A COMPASSIONATE AND PROFESSIONAL MANNER FOR THE PEOPLE IN OUR REGION. 9 9 115 21 0 0 208034 126120 5937353 6271561 -6710 8056 406796 188341 6545473 6594078 0 0 0 0 3270117 3375794 0 0 4598 2783926 3363239 6054043 6739033 491430 -144955 3755538 3530130 1630238 1557096 2125300 1973034 WISHEK HOSPITAL CLINIC ASSOCIATION IS A PROGRESSIVE AND INNOVATIVE HEALTHCARE LEADER PROVIDING PERSONALIZED SERVICES PROMOTING THE CREATION OF HEALTHIER COMMUNITIES. 0 0 4012122 4458094 ACUTE HEALTHCARE/OUTPATIENT SERVICES/EMERGENCY DEPARTMENT. 918800 1677897 HEALTHCARE SERVICES PROVIDED TO FOUR COMMUNITIES WITHIN OUR SERVICE AREA OF RURAL ND. FOUR RURAL HEALTH CLINICS. 177789 135570 HOME HEALTH/HOSPICE/EXTENDED CARE HEALTHCARE SERVICES PROVIDED TO HOME BOUND PATIENTS. 805429 118626 805429 118626 5914140 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 1 115 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BEV VILHAUER CFO 7014522326 1007 4TH AVE S WISHEK ND 58495 NATHAN PINKE PRESIDENT 1.00 X X 0 0 0 TODD SCHNABEL VICE PRESIDENT 1.00 X X 0 0 0 GREG SALWEI EXECUTIVE SECRETARY 1.00 X X 0 0 0 CRIS TURMAN DIRECTOR 1.00 X 0 0 0 REBECCA SCHNABEL DIRECTOR 1.00 X 0 0 0 MARLA BERNTSON DIRECTOR 1.00 X 0 0 0 LEE AIPPERSPACH DIRECTOR 1.00 X 0 0 0 CARMEN RATH-WALD DIRECTOR 1.00 X 0 0 0 BRYAN SCHUMACHER DIRECTOR 1.00 X 0 0 0 MARK RINEHARDT CEO-CONTRACTED 40.00 X 0 0 0 SAHLENIA BRAUN CFO 40.00 X 57720 0 3405 KAY RAU PA 40.00 X 119840 0 5855 PAULETTE BENSON-EISEMAN PA 40.00 X 109512 0 15678 287072 0 24938 2 0 0 1 BLUE CROSS BLUE SHIELD 1415 MAPLETON AVE BISMARCK ND 58501 HEALTH INSURANCE 567887 ST ALEXIUS MEDICAL CENTER 900 E BROADWAY BISMARCK ND 58501 HEALTHCARE EQUIPMENT/CONTRACT LABOR 404115 HEALTHLAND INC 1600 UTICA AVE S SUITE 300 MINNEAPOLIS MN 55416 HEATHCARE SUPPLIES 326261 DAKOTA DRUG INC 1101 LUND BOULEVARD ANOKA MN 55303 PHARMACY 208017 AMERICAN UNITED LIFE INSURANCE 2110 E THAYER AVE BISMARCK ND 58501 INSURANCE 202543 5 106665 19455 126120 HOSPITAL PATIENT REV 624100 4458094 4458094 CLINIC PATIENT REV 621400 1677897 1677897 HOME HEALTH PATIENT RE 621610 135570 135570 6271561 3149 3149 10255 0 10255 10255 10255 7510 2603 4907 4907 4907 73600 9233 64367 64367 ACTIVITIES/MISC 624200 113719 113719 113719 6594078 6390187 0 77771 287072 229352 57720 2363319 2238926 124393 89909 83731 6178 635494 592180 43314 3315 3315 27206 27206 16410 16410 16731 1014 14781 936 167364 24678 142686 123978 123978 577720 548730 28990 53315 48621 4694 8884 8884 282408 277056 5352 36588 36588 CONTRACT SERVICES 1150926 973591 173673 3662 SUPPLIES 740688 740688 PROVISION FOR BAD DEBTS 71356 71356 PATIENT FOOD/LAUNDRY 57515 57515 28835 26702 2133 6739033 5914140 820295 4598 223714 14753 960316 822058 1190198 1240116 53102 63754 68355 95830 4321716 3241254 972295 1080462 287558 213157 3755538 3530130 765832 812909 780660 684067 83746 60120 1630238 1557096 X 2041641 1838444 83659 134590 2125300 1973034 3755538 3530130 -144955 -7311 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 69975 69975 2469003 2161361 307642 1782738 1079893 702845 1080462 DEPOSIT ON EQUIPMENT 92345 RENTAL PROPERTY 120812 213157 CAPITAL LEASE PAYABLE 60120 60120 X 6603311 0 6603311 -9233 -9233 6594078 6748268 0 6748268 -9235 -9235 6739033 PART X, LINE 2: INCOME TAXES THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, THE ASSOCIATION IS NOT SUBJECT TO INCOME TAX. THE ASSOCIATION'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. ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES IT IS THE OPINION OF MANAGEMENT THAT THE ASSOCIATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURNS OF THE ASSOCIATION ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -9,233. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -9,233. ROUNDING -2. NAPOLEON CLINIC FUNDRAISER 27765 27765 101 TACO FEED & BIKE-A-THON 27723 27723 1401 2 18112 18112 7731 73600 73600 9233 9233 64367 1 1 X 1 X 1 X 100.000000000000 1 1 1 0 1 0 21866 21866 0.00320 177046 24034 153012 0.02270 198912 24034 174878 0.02590 198912 24034 174878 0.02590 1 71356 17839 2739053 2923579 -184526 X 1 1 1 NONE 5 1 WISHEK HOSPITAL 1007 4TH AVE S WISHEK ND 58495 X X X HOME HEALTH AND HOSPICE 2 WISHEK CLINIC 1015 4TH AVE S WISHEK ND 58495 RURAL HEALTH CLINIC 3 NAPOLEON CLINIC 420 MAIN STREET NAPOLEON ND 58561 RURAL HEALTH CLINIC 4 KULM COMMUNITY CLINIC 4TH 1ST AVE SE KULM ND 58456 CLINIC 5 GACKLE CLINIC 321 MAIN STREET GACKLE ND 58442 CLINIC WISHEK HOSPITAL 1 1 X X X X X X X X X 11 1 0 1 X X X X X X X X X 1 0 1 1 100.000000000000 1 200.000000000000 1 X X 1 1 X X X 1 X 0 X X 1 X 0 1 WISHEK HOSPITAL PART V, SECTION B, LINE 3: A TOTAL OF 24 COMMUNITY LEADERS WERE IDENTIFIED AND CONTACTED BY THE UND CENTER FOR RURAL HEALTH. EACH WAS ASKED TO PARTICIPATE IN AN INDIVIDUAL INTERVIEW AND/OR TO COMPLETE THE SURVEY. FOURTEEN PARTICIPANTS (58%) WERE AVAILABLE AND PARTICIPATED IN KEY INFORMANT INTERVIEWS WHICH WERE COMPLETED ON JUNE 13, 14 AND 15 IN NAPOLEON, WISHEK, KULM AND GACKLE. WISHEK HOSPITAL PART V, SECTION B, LINE 14G: ON THE BACK OF THE PATIENT'S STATEMENTS, UNCOMPENSATED CARE IS OFFERED. THE BACK OF THE PATIENT'S STATEMENTS IS AS FOLLOWS "WISHEK HOSPITAL CLINIC ASSOCIATION OFFERS AN UNCOMPENSATED CARE PROGRAM FOR ANYONE UNABLE TO MEET OUR PAYMENT POLICY. IF YOU FEEL YOU WOULD QUALIFY FOR THIS PROGRAM, PLEASE CALL FOR THE NECESSARY PAPERS." WISHEK HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL USES THE SAME CHARGING METHOD AS THEY DO ALL OUR CLIENTS. CHARGES ARE ESTABLISHED WHEN WE GET THE BLUE CROSS BLUE SHIELD FEE SCHEDULE AT THE END OF THE END FOR UPCOMING YEAR AND OUR CHARGEMASTER IS CHANGED AT THAT TIME. ALL PAYERS ARE CHARGED THE SAME. WISHEK HOSPITAL PART V, SECTION B, LINE 22: ALL CHARGES ARE CHARGED AT GROSS BASED ON THE CHARGEMASTER RATES THAT WERE ESTABLISHED. PART I, LINE 3C: WISHEK HOSPITAL CLINIC ASSOCIATION (WHCA) USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. WHCA USES 100% AS THE FAMILY INCOME LIMIT. PART I, LINE 7: A COST TO CHARGE RATIO WAS USED FOR THE FIGURES REPORTED IN THE TABLE USING WORKSHEET 2. PART I, LINE 6A WCHA COMPLETED A COMMUNITY BENEFIT REPORT AND MADE IT AVAILABLE TO PUBLIC UPON REQUEST. PART III, LINE 4: THE AMOUNTS WERE DETERMINED BASED UPON THE COST TO CHARGE RATIO USING WORKSHEET A. THE HOSPITAL ALSO HAS A POLICY FOR COLLECTIONS AND BAD DEBTS.WHCA FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. A PORTION CAN BE LOCATED IN PATIENT RECEIVABLES SECTION ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE AMOUNTS WERE DETERMINED BASED UPON THE COST TO CHARGE RATIO FROM THE COST REPORT THAT WAS FILED FOR THE YEAR. PART III, LINE 9B: ALL PATIENTS ARE NOTIFIED ON THEIR MONTHLY STATEMENT THAT THE ORGANIZATION OFFERS AN UNCOMPENSATED CARE PROGRAM FOR ANYONE UNABLE TO MEET THEIR PRIVATE PAY POLICY AND THAT THEY ARE TO CONTACT THE ACCOUNTS RECEIVABLE DEPARTMENT. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING WITH THE ORGANIZATION IN GOOD FAITH TO RESOLVE THEIR BILLS, THE ORGANIZATION WILL OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS, REDUCE THE BILL BY THE APPROPRIATE AMOUNTS, WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION EFFORTS. PART VI, LINE 2: THE MEDICAL STAFF TEAM MEETS MONTHLY TO DISCUSS CURRENT OR MOST RECENT CASES THAT THEY HAVE ENCOUNTERED. UNIQUE CASES, AS WELL AS THE ROUTINE CASES ARE DISCUSSED. EVERY OTHER MONTH, SUPPORT STAFF, WHICH INCLUDE THE DIRECTORS OF NURSING, HEALTH INFORMATION MANAGEMENT, LABORATORY/RADIOLOGY, PHARMACY, HOME HEALTH/HOSPICE, DISCHARGE PLANNING AND ADMINISTRATION, ARE INVITED TO THESE MEETINGS FOR SIMILAR DISCUSSIONS, IN ADDITION TO UNIFYING THE APPROACH IN VARIOUS MATTERS SUCH AS STANDARDS OF CARE, QUALITY ASSURANCE STUDY REVIEW, MEDICARE/MEDICAID OR 3RD PARTY GUIDELINES ON STANDARDS OF CARE AND/OR REIMBURSEMENT. THE ORGANIZATION HAS ALSO ESTABLISHED A CALL-BACK SYSTEM. ALL PATIENT DISCHARGED FROM THE HOSPITAL OR HOME HEALTH/HOSPICE PROGRAMS ARE FOLLOWED UP WITH A CALL AND/QUESTIONNAIRES ASKING ABOUT HOW THEY ARE DOING, IF THERE ARE ANY QUESTIONS, ADDITIONAL AREAS OF NEED OR SERVICES THAT WE MAY NEED TO GET IN PLACE FOR THEM. WE HAVE A SYSTEM IN OUR ORGANIZATION THAT ALSO ALLOWS FOR OUR STAFF TO REVIEW THE PATIENTS CHART PRIOR TO A CLINIC VISIT TO IDENTIFY ANY NEEDS SUCH AS MAMMOGRAMS, BONE DENSITY, PSA, CHOLESTEROL, PAP, COLONOSCOPE OR ANY OTHER IDENTIFIED FOLLOW-UP SCREENING OR TEST. A SHEET IS PLACED ON THE FRONT OF THE CHART TO ASSIST THE MEDICAL STAFF IN CUEING INTO THESE NEEDS. ONCE THE VISIT IS COMPLETE THE CHART IS THEN RE-ROUTED BACK INTO THE CALL-BACK OFFICE FOR PLACING INTO THE SYSTEM THE NEXT DATE OF SCREENING SERVICES OR TO SCHEDULE FOLLOW-UP OR REFERRAL APPOINTMENTS FOR THAT PATIENT NEEDS. MESSAGES ARE ALSO SENT TO PATIENTS IN RELATION TO THE ROUTINE FOLLOW-UPS FOR MEDICATION REFILLS OR MONITORING OF CHRONIC MEDICAL CONDITIONS SUCH AS DIABETES, HEART DISEASE, KIDNEY OR LIVER DISEASE PROCESS, OSTEOPOROSIS OR ANY OTHER IDENTIFIED DISEASE PROCESS/ABNORMALITY.THE MANAGEMENT TEAM AND THE BOARD OF DIRECTORS ALSO MEETS MONTHLY TO BRING TO THE TABLE THE CURRENT OPERATIONS AND DISCUSSION OF CURRENT HAPPENINGS AND FEEDBACK. DUE TO THE FACT WE REPRESENT DIFFERENT AREAS THAT COME TOGETHER AS A TEAM TO ENSURE ACCESS TO HEALTHCARE AT A LOW COST HIGH QUALITY MANNER IS IN PLACE - THIS OPPORTUNITY ALLOWS VARIABLE DISCUSSION TO COMMUNITY NEEDS AND HOW WE CAN ADDRESS THEM IN AN INTERDISCIPLINARY TEAM APPROACH.UTILIZATION IS MONITORED IN RELATION TO THE CURRENT PROGRAMS IN PLACE. SUCH PROGRAMS INCLUDE THE CARDIAC REHAB PROGRAM, WOMENS WAY PROGRAM, CHARITY CARE OR UNCOMPENSATED CARE PROGRAM, HOME HEALTH AND EXTENDED CARE PROGRAMS.TO EXPAND A BIT ON HOW FAR OUR COMMUNITY REACHES AND ITS REPRESENTATION - WE HAVE ESTABLISHED FOUR RURAL HEALTH CLINICS IN SURROUNDING COMMUNITIES WHICH REACH AS FAR OUT AS 45 MILES FOR THE CLINIC LOCATION, HOWEVER COMMUNITY CITIZEN EXPANSION REACHES BEYOND THE 45 MILE RADIUS. REPRESENTATION ON THE MEDICAL STAFF AND BOARD OF DIRECTORS REACHES INTO THESE AREAS, AS WE HAVE BOTH DESIGNATED PROFESSIONALS FROM THOSE AREAS ON OUR TEAMS FOR ENSURING ACCESS TO HEALTHCARE AND ADDRESSING THOSE NEEDS OF THE POPULATION IN THE AREA. PART VI, LINE 3: AS PATIENTS ENTER INTO THE HOSPITAL THE SOCIAL WORKER PAYS CLOSE ATTENTION TO THE PATIENTS FINANCIAL CLASS (TYPE OF PAYOR). IF PATIENTS ARE PRIVATE PAY, WE GO EDUCATE AND SPEAK TO THAT PATIENT ABOUT PROGRAMS THEY WOULD BE ELIGIBLE FOR. IF PATIENTS HAVE LOW ASSETS/LOW INCOME, THEY COULD BE ELIGIBLE FOR MEDICAID THROUGH THE COUNTY SOCIAL SERVICES OR THEY ARE ELIGIBLE FOR THE HOSPITALS UNCOMPENSATED CARE. THE UNCOMPENSATED CARE (CHARITY CARE) FOLLOWS THE FEDERAL GUIDELINES REGARDING INCOME ASSET LEVELS. IF PATIENTS NEED ASSISTANCE WITH THE APPLICATION, WE WOULD ASSIST THEM. THE CHARITY CARE GUIDELINES ARE PRINTED ON THE BACK OF EVERY PATIENTS MONTHLY STATEMENT. THE SOCIAL WORKER AT OUR FACILITY IS THE RESPONSIBLE PARTY OF INFORMING PATIENTS WITH EDUCATION ABOUT PROGRAMS THEY MAY BE ELIGIBLE FOR WHETHER IT IS THE HOSPITALS CHARITY CARE OR OTHER STATE/FEDERAL FUNDED PROGRAMS. PART VI, LINE 4: WISHEK HOSPITAL CLINIC ASSOCIATION (WHCA) IS A 24-BED NON-PROFIT CRITICAL ACCESS HOSPITAL (CAH) LOCATED IN SOUTH CENTRAL NORTH DAKOTA. OUR ORGANIZATION PROVIDES SUCH SERVICES AS 24-HOUR EMERGENCY CARE, CLINIC, AMBULANCE, OUTPATIENT HOSPITAL AND ANCILLARY SERVICES, INPATIENT AND SWINGBED, OUTPATIENT SURGERY, HOME HEALTH, AND HOSPICE SERVICES. WHCA HAS FOUR RURAL HEALTH CLINICS LOCATED IN WISHEK, KULM, NAPOLEON, AND GACKLE AND OF THE FOUR; THREE ARE LOCATED MORE THAN 30 MILES AWAY. OUR AMBULANCE PROVIDES CPR TRAINING TO THOSE INTERESTED AND IS ON STANDBY CALL AT LOCAL FOOTBALL GAMES AS A COURTESY TO THE COMMUNITY. WHCA SERVES THE COUNTIES OF MCINTOSH, LOGAN, AND WESTERN LAMOURE, WHICH INCLUDES A GEOGRAPHIC AREA OF OVER 2,000 SQUARE MILES AND APPROXIMATELY 6,800 RESIDENTS ACCORDING TO THE U.S. CENSUS BUREAU, CENSUS 2010 REPORT. STATISTICS IN RELATION TO THIS POPULATION INCLUDE A MAJORITY OF THE POPULATION OF AGE 65 OR OLDER WITH MCINTOSH AT 37.2%, LOGAN 28.2%, AND LAMOURE 24.6%. THE CASE MIX FOR THE HOSPITAL IS 71% MEDICARE, 19% BCBS, 3% MEDICAID AND 7% OTHER. THE CASE MIX FOR OUR FOUR CLINICS IS 50% MEDICARE, 35% BCBS, 3% MEDICAID, AND 12% OTHER. THE MEDIAN AGE OF RESIDENTS OF MCINTOSH COUNTY IS 51 YEARS OF AGE. WITH THIS STATISTIC, THE MAIN AREA WHICH WHCA SERVES INDICATES MCINTOSH COUNTY IS THE OLDEST COUNTY OF THE 53 COUNTIES IN NORTH DAKOTA. FURTHERMORE, MCINTOSH COUNTY IS THE FIFTH OLDEST MEDIAN AGE OF ALL COUNTIES IN THE NATION. THE STATE MEDIAN AGE IS 37 YEARS AND THE NATIONAL MEDIAN AGE IS 37.2. FIGURES ARE ACCORDING TO THE 2010 CENSUS. THE PERCENT OF NORTH DAKOTA RESIDENTS LIVING IN POVERTY WAS ESTIMATED IN 2009 TO BE 11.7%. MCINTOSH COUNTY WAS ESTIMATED TO BE 14%, LOGAN COUNTY 13.2%, AND LAMOURE COUNTY 10.9%.THE COMMUNITY OF WISHEK POSSESSES AN 86-BED NURSING HOME (WISHEK HOME FOR THE AGED), WHICH IS INDEPENDENT OF THE HOSPITAL. THE COMMUNITY OF NAPOLEON, WHICH IS LOCATED IN LOGAN COUNTY, HAS A 44-BED NURSING HOME (NAPOLEON CARE CENTER) AND WE PROVIDE THE MAJORITY OF HEALTH CARE IN THESE TWO SKILLED FACILITIES. WE ALSO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS OF THE GACKLE CARE CENTERS BASIC CARE RESIDENTS IN GACKLE, ND.WHCA IS LOCATED IN A DESIGNATED MEDICALLY UNDERSERVED AREA AND IN A HEALTH PROFESSIONAL SHORTAGE AREA IN NORTH DAKOTA. PART VI, LINE 5: THE WHCA GOVERNING BOARD IS COMPOSED OF MEMBERS FROM THE COMMUNITIES IT SERVES AND ARE NOT EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS. THE SURPLUS OF FUNDS IS USED TO UPDATE THE AGING FACILITY AS WELL AS UPDATED TECHNOLOGICALLY MEDICAL EQUIPMENT TO SERVICE OUR PATIENT POPULATION. HAVING UPDATED MEDICAL EQUIPMENT NOT ONLY KEEPS THE SERVICES IN TO OUR RURAL AREA, BUT ALSO ALLOWS US TO PROVIDE FOR OUR PATIENTS PART VI, LINE 7, REPORTS FILED WITH STATES ND,ND X X X 0 0 0 0 0 0 0 0 0 MARK RINEHARDT CEO-CONTRACTED 0 0 0 0 0 0 0 0 0 0 0 0 PART I, LINE 3 MARK RINEHARDT IS AN EMPLOYEE OF ST. ALEXIUS MEDICAL CENTER, WHO THE ASSOCIATION HAS CONTRACTED WITH FOR MANAGEMENT SERVICES. ST. ALEXIUS IS AN UNRELATED ORGANIZATION. HIS COMPENSATION IS PAID DIRECTLY BY ST. ALEXIUS MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT SERVICES ARE PROVIDED BY A MANAGEMENT SERVICES AGREEMENT WITH ST. ALEXIUS MEDICAL CENTER. ST. ALEXIUS PROVIDES CEO SERVICES TO THE ASSOCIATION. THESE SERVICES INCLUDE HIRING EMPLOYEES, FIRING EMPLOYEES, SUPERVISING PERSONNEL AND SUPERVISING EXEMPT OPERATIONS. ALL DECISIONS OF THE CONTRACTED CEO ARE SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IS OPEN TO ANY INDIVIDUAL IN THE SERVICE AREA WHO CONTRIBUTES $10.00 TO THE ASSOCIATION AND REQUESTS MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A ALL ELIGIBLE MEMBERS MAY VOTE AT THE ANNUAL MEETING FOR THE ELECTION OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B AT THE ANNUAL MEETING THE MEMBERS MAY DISCUSS THE BUSINESS OF THE ASSOCIATION AND MAKE AND APPROVE MOTIONS CONCERNING THAT BUSINESS OR THE ACTIONS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER PRIOR TO THE FILING OF THE RETURN WITH THE IRS. ALL BOARD MEMBERS ARE GIVEN AN OPPORTUNITY TO REVIEW AND ASK ANY QUESTIONS CONCERNING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE BOARD MEMBERS MUST DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST TO THE BOARD AND MANAGEMENT AND MUST NOT PARTICIPATE IN ANY VOTE THAT INVOLVES A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD RECEIVES AND REVIEWS A COPY OF THE ND HOSPITAL ASSOCIATION SALARY SURVEY, COMPARES THE SURVEY AMOUNTS TO THE SALARIES BEING PAID TO THE CEO, OTHER OFFICERS AND KEY EMPLOYEES, REVIEWS THE EVALUATION RESULTS FOR EACH INDIVIDUAL AND APPROVES APPROPRIATES SALARIES AND RAISES. FORM 990, PART VI, SECTION C, LINE 19 AUDITED FINANCIAL STATEMENTS ARE PRESENTED TO THE MEMBERS AT THE ANNUAL MEETING AND ARE AVAILABLE UPON REQUEST BY A MEMBER OF THE PUBLIC FOR REVIEW. FORM 990, PART XI, LINE 2C: THE FULL BOARD OF DIRECTORS APPROVE THE SELECTION OF THE AUDITORS AND MEET WITH THE AUDITORS TO REVIEW AND APPROVE THE AUDITED FINANCIAL STATEMENTS.