2014-05-14T13:04:14-05:00 2013-06-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2012-07-01 450226711 St Alexius Medical Center STAL 7015307000 900 East Broadway Avenue Bismarck ND 585014520 Gary Miller 7015307000 2014-05-13 1 LISA CHAFFEE CPA P00193453 7012398500 2014-05-12 2012 2015-11-30 17:44:51Z Gary Miller 900 East Broadway Avenue Bismarck ND 585014520 294062940 0 0928 X www.st.alexius.org X 1905 ND Providing healthcare 15 8 2830 262 10692101 1589 1197761 1159046 280505258 283731137 -2165730 -2407481 8855053 8936690 288392342 291419392 416797 453859 0 0 111305248 120662800 0 0 780995 166799842 172255586 278521887 293372245 9870455 -1952853 272848189 277166394 112654080 117889411 160194109 159276983 X Based on the Gospel values and our own heritage of healing, the mission of St. Alexius Medical Center is to use our community presence as a means of touching and healing people in a Christ-like manner, and to always exhibit the hospitality as reflected in the rule of St. Benedict: "Let all be received as Christ." 0 0 33482663 147038285 St. Alexius Medical Center began as a 20-bed hospital 128 years ago but has evolved into a 306-bed, full-service, certified Level II Trauma Acute Care Center that provides advanced healthcare services. St Alexius served 12,899 inpatients during the fiscal year ended June 30th, 2013. With over 1,400 births each year, two out of every three babies born in this region are born at St. Alexius Medical Center. Our family-focused care provides a wide range of services for mother and baby, and our specially trained nurses and physicians are prepared to handle every birthing experience with care. St. Alexius' 24-bed Level III NICU has served the region for more than 25 years, which is staffed by neonatal nurses, therapists, board-certified neonatologists, a pediatric neurologist and the region's only pediatric cardiologist. St. Alexius' Heart & Vascular Center provides comprehensive care to patients with cardiovascular, lung, and peripheral artery disease. We are comprised of an interventional radiologist, cardiologists, heart and vascular surgeons as well as other highly trained support personnel. 37649448 37022708 Specialty Clinics: The Clinics of St. Alexius is a unique multi-specialty group practice located mainly inside St. Alexius Medical Center. Over 26 providers in 14 different specialties work together to care for patients. Specialists must complete seven or more years of medical school and post-graduate training and then complete fellowships in their chosen specialties. All physicians are board eligible or board certified in one or more specialties. We provide clinic services in many off site satellite clinics and bring specialty services to the region. The Clinics of St. Alexius include Center for Family Medicine Mandan, Minot Medical Clinic, Infectious Disease, Children's Services, Infusion Center, Nephrology, Neurosurgery, Pain, Neurology, Adult Physical Medicine, Primary Care, Rheumatology, and Urology. 191545743 453859 97325653 Outpatient:1. St. Alexius operates an outpatient family service program called Archway Family Services. This program offers sensitive and responsive services for individual, marital and family problems.This program is keeping with St. Alexius Medical Center's philosophy of being a leader in progressive and quality services to the people of North Dakota. Archway services are also provided in Hazen, Garrison and Linton, ND.2. Great Plains Rehabilitation Services is a division of St. Alexius Medical Center that provides Home Medical Equipment, Orthotic & Prosthetic, Home Respiratory Care, ADA Environmental, and Rehabilitation Technology services. Great Plains provides needed medical equipment and supplies to help individuals lead active and independent lives. Great Plains services all of North Dakota, Central and Eastern Montana, and Northern South Dakota.OTHER:-St. Alexius Medical Center served 12,899 inpatients, 127,087 outpatients, 28,323 emergency patients, and 16,360 Home Health Care patients during the fiscal year ended June 30, 2013.-St. Alexius Medical Center provided community activities and services at reduced or no cost. Those included:1. EMPLOYEE ASSISTANCE - 218 employer contracts servicing 40,338 employees by providing problem assessment, short term counseling and referral to appropriate resources for follow-up care. 2. EMPLOYEE ACTIVITIES - In keeping with the Medical Center's commitment to its employees:-Actively participated in the United Way fund campaign.-Journey Beyond Excellence program - we have seven teams that assist with our journey - behavioral standards, employer of choice, rewards & recognition, communications, patient satisfaction, physician satisfaction, & service recovery. These teams work together with our leadership to resolve challenges & engage all in our mission. -Nursing Education Council develops and implements a preceptor reward and recognition program.-The vacation donation program assisted employees who used 973.75 hours of donated vacation. Employees have donated 238 vacation hours.-The Employee Emergency Fund is for any St. Alexius employee who experiences a crisis or is directly affected by a crisis involving a family member. The funds are available to employees who are facing personal tragedies or hardships for reasons such as a loss of a spouse or child, catastrophic illness, loss of home by fire or flood, or other calamities. 3. ACUTE CARE FACILITY - St. Alexius is a partner with another acute care facility to operate a radiation therapy facility known as The Cancer Center. The Cancer Center helps to ensure that patients with cancer receive quality care and management of their disease without having to drive a long distance to receive the same type of care. 4. AWARDS/ACCOMPLISHMENTS--St. Alexius ranked among the top 5 percent in the nation and #1 in North Dakota for cardiac care. The ranking is based on the Tenth Annual HealthGrades Hospital Quality in America Study. HealthGrades is the leading healthcare ratings organization. Other outcomes from this study:-Ranked among the Top 5% in the Nation for Overall Cardiac Services-Ranked among the Top 5% in the Nation for Cardiac Surgery-Ranked among the Top 5% in the Nation for Coronary Interventional Procedures-Ranked among the Top 10% in the Nation for Cardiology Services-Ranked #1 in ND for Cardiac Care, Cardiac Surgery, Cardiology Services and Coronary Interventional Services-Five-Star Rated for Overall Cardiac Care, Cardiac Surgery, Cardiology Services, Coronary Bypass Surgery, Valve Replacement Surgery, Coronary Interventional Procedure, and Treatment for Heart Attack- "Best Hospital in North Dakota" - U.S. News & World Report Healthcare Data Service- "GWTG Silver Performance Award" - ACTION Registry- Rated "A" in patient safety - The Leapfrog Group- "Blue Distinction Center" designation for cardiac care - BCBS of ND- 5-star rated Transitional Care Unite- 5-diamond status in patient safety Kidney Dialysis units (Bismarck, Dickinson, Williston) - Renal Network of the Upper Midwest- "Blue Distinction Center +" designation for quality and efficiency - BCBS of ND - hip and knee replacement and spine surgery- "100 Greatest Hospitals in the Nation" - Becker's Hospital Review- "Certified Stroke Center" designation - The Joint Commission- "Community Value Five-Star Hospital" and "Community Value 100 Hospital" - Cleverly + Associates -St. Alexius Medical Center has met the criteria necessary to be designated a Blue Distinction Center for bariatric surgery, knee and hip replacement, and spine surgery. This designation means that St. Alexius has met or exceeded certain criteria that demonstrate reliability in delivering bariatric surgical care and better overall outcomes for patients. 262677854 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 1 1 1 0 0 0 0 1 1 1 0 0 0 1 255 0 1 2830 1 1 1 0 0 0 0 0 0 0 0 0 X 15 8 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 X Gary Miller 7015307610 900 East Broadway Avenue Bismarck ND 585014520 John Castleberry 3.00 X X 11300 0 0 Sr Nancy Miller 3.00 X X 0 0 0 Sr Thomas Welder 3.00 X X 0 0 0 Sr Gerard Wald 3.00 X X 0 0 0 Sr Rosanne Zastoupil 3.00 X X 0 0 0 Sr JoAnn Krebsbach 3.00 X 0 0 0 Pamela Schmidt 3.00 X 2750 0 0 Charles Reichert 3.00 X 6100 0 0 Robert Gayton 3.00 X 6100 0 0 Vernon Dosch 3.00 X 4600 0 0 Nicholas Neumann MD 3.00 X 4900 0 0 John Giese 3.00 X 7900 0 0 Ernest Godfread 3.00 X 5800 0 0 Ben Roller 3.00 X 4200 0 0 Michael Brown 3.00 X 0 0 0 Sr Mariah Dietz 3.00 X 0 0 0 Gary Miller 50.00 X X 693754 0 15361 Shiraz Hyder 40.00 X 529530 0 30301 Rosanne Schmidt 40.00 X 275878 0 29897 Duwayne Schlittenhard 40.00 X 254760 0 15920 Wanda Pfaff 40.00 X 247339 0 27926 Frank Kilzer 40.00 X 222376 0 27126 Kurt Waldbillig 40.00 X 205370 0 26306 Susan Sisk 40.00 X 192294 0 26075 Eric Belanger 40.00 X 1960032 0 24897 Steven Kraljic 40.00 X 1575557 0 25301 Leslie Rainwater 40.00 X 975299 0 25960 Brent Herbel 40.00 X 884977 0 25301 Robert Oatfield 40.00 X 746355 0 36741 8817171 0 337112 191 0 1 0 Bismarck Radiology Associates 810 E Rosser Ave Ste 201 Bismarck ND 58501 Radiology Services 5635691 Northern Plains Laboratory LLC PO Box 2036 Bismarck ND 58502 Pathology Services 4343455 DMS Health Technologies PO Box 86 Minneapolis MN 55486 Radiology Services 879986 CHG Companies Inc PO Box 972 G51 Dallas TX 75397 Locum Services 598310 Mayo Collaborative Services Inc PO Box 9146 Minneapolis MN 554809146 Laboratory Services 407218 27 1159046 1159046 Patient Service Revenue 541900 274429228 272084737 2344491 Other Revenue 900099 7795891 7795891 Cafeteria 900099 1314804 1314804 Health and Education 900099 191214 191214 283731137 211849 211849 589080 0 589080 589080 589080 24218 2643548 0 -2643548 24218 -2619330 -2619330 Community Pharmacy 446110 5922033 5922033 Northern Plains Lab 621500 1392769 1392769 Outside Lab 621500 821276 821276 211532 211532 8347610 291419392 281386646 10692101 -1818401 453859 453859 3150886 3150886 93250135 80759371 12328085 162679 3852738 3307356 539402 5980 12367557 10448985 1898392 20180 8041484 7005912 1023761 11811 120592 120592 81308 81308 770162 215841 554321 30259505 21525072 8155910 578523 2665607 2178717 486890 1415762 1202131 213001 630 3385613 3385613 20241553 20146688 94865 1016640 1007842 8798 Medical Supplies 44450115 44450115 Physician Fees 42597635 42140413 457222 Pharmacy 20412047 20412047 Equipment Rental/Mainte 4839047 4037892 799963 1192 293372245 262677854 29913396 780995 33077007 36847848 42277578 43111241 683709 1512528 3899826 4325206 1722864 1616784 331110350 190097267 144839696 141013083 34247461 34595058 10994415 12659380 1105633 1485266 272848189 277166394 35670789 38350428 55739279 54514006 12821943 18427836 8422069 6597141 112654080 117889411 X 158678341 157517051 1515768 1759932 160194109 159276983 272848189 277166394 X -1952853 978704 57023 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3654924 958033 120568 548054 16550 4168921 3639568 494559 137978 601477 15704 3654924 3419691 448744 93749 305526 17090 3639568 3228718 347995 50166 202661 4526 3419692 3007949 415278 -7070 176999 10440 3228718 1.00000 0 0 11924183 11924183 203019851 106794581 96225270 109518242 80123159 29395083 6648074 3179527 3468547 141013083 Capital lease obligations 6437141 Insurance Liability 160000 6597141 X 269054817 978704 -7766732 -6788028 275842845 15576547 15576547 291419392 270471204 0 270471204 22901041 22901041 293372245 Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment is utilized to provide funding to continue to enhance patient care at St. Alexius Medical Center set forth in our mission, "Let all be received as Christ." Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: St. Alexius is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). St. Alexius is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, St. Alexius is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. St. Alexius files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. St. Alexius believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. St. Alexius would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. St. Alexius' federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2008. Part XI, Line 2d - Other Adjustments: Income from subsidiary included in revenue for financial statements -7,466,732. Grant Expense included in income for financial statements -300,000. Part XI, Line 4b - Other Adjustments: Temporily restricted contributions 244,164. Revenues of Disregarded Entity-St. Alexius Heart and Lung 15,134,309. Contribution of Long-Lived Assets 198,074. Part XII, Line 4b - Other Adjustments: Expenses of Disregarded Entity-St. Alexius Heart and Lung 22,601,041. Grant Expense included in income for financials statements 300,000. 1 1 X 1 X 1 X 1 1 0 0 2191000 2191000 0.00750 12837785 10068151 2769634 0.00940 15028785 10068151 4960634 0.01690 176948 176948 0.00060 1945972 1945972 0.00660 57928572 41261562 16667010 0.05680 453859 453859 0.00150 60505351 41261562 19243789 0.06550 75534136 51329713 24204423 0.08240 0 10694538 1283345 79635346 82512534 -2877188 X 1 1 1 Northern Plains Lab Labratory Services 0.50000 0.50000 2 1 St Alexius Medical Center

900 East Broadway Bismarck ND 585065510

X X X X 2 Turtle Lake Community Memorial Hospital

220 5th Ave Turtle Lake ND 58575

X X X St Alexius Medical Center 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X 1 0 X X X 1 X 0 0 Turtle Lake Community Memorial Hospital 2 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X 1 1 X X 1 0 X X X 1 X 0 0 6 St Alexius Mandan Clinic

403 Burlington Street SE Mandan ND 58554

Family Medicine Clinic St Alexius Minot Clinic

1600 2nd Ave SW Ste 19 Minot ND 58701

Family Medicine Clinic Great Plains Rehabilitation Services

1212 East Main Bismarck ND 58501

Provide Home Medical Products to General Public Medical Arts Surgery Center

810 East Rosser Ave Bismarck ND 58501

Ambulatory Surgery Center for Individuals Who Require Overnight Stay St Alexius Heart & Lung Clinic

310 North 10th Street Bismarck ND 58501

Heart, Lung & Peripheral Vascular Disease Clinic Mandan Clinic-East

2008 Twin City Drive Mandan ND 58554

Family Medicine Clinic Part I, Line 7: The charity care included in Part I, Line 7a is based on the average cost to gross charges calculated from internal cost system.The unreimbursed Medicaid in Part I, Line 7b is based on gross charges and claims from the Medicaid cost report.The community health services and education in Part I, Lines 7e and f are estimates.The contributions in Part I, line 71 are based on actual expenses.The subsidized health services in Part I, Line 7g are based on estimated costs from the internal cost accounting general ledger systems. Part I, Line 7g: Subsidized health services includes $56,351,415 in costs attributable to physician clinics. Part I, L7 Col(f): The amount of bad debt expense included in Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $10,694,538. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses is located in Footnote 1 on page 12 of the attached financial statements. The estimated amount of the organization's bad debt expense that is attributable to patients eligible under the organization's charity care policy is approximately $1,283,345. This was based off the most recent community needs assessment reported in March 2011, which indicated that 12% of the population is below the Federal Poverty Guidelines. The 12% was applied to the amount of bad debt expense.Discounts and payments on accounts are applied directly to the principal of the account. The Hospital does not charge interest or fees related to the use of a collection agency to collect these payments. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by the Centers for Medicare and Medicaid Services.St. Alexius Medical Center provides medically necessary care to all regardless of the ability to pay. Therefore the shortfall should be treated as a community benefit. Part III, Line 9b: Reasonable efforts are taken for patients qualifying under financial assistance policy before turning over the account to a third party collector.Any individual who indicates the financial inability to pay a bill for a medically necessary service shall be evaluated for Charity Care assistance. The Financial Counselor along with the Social Work Department staff attempt to identify all inpatients prior to discharge and begin the discussion of available programs including, but not limited to, the charity care program. Determination of eligibility should be made prior to discharge or as close to the date of service as possible. However, retroactive determinations are also eligible. The Customer Service staff in Patient Financial Services discusses Charity Care options with patients after services are rendered, usually, after the patient has received their first statement and provided the necessary documentation. St. Alexius Medical Center Part V, Section B, Line 4: www.st.alexius.org Turtle Lake Community Memorial Hospital Part V, Section B, Line 4: www.communitymh.com St. Alexius Medical Center Part V, Section B, Line 7: 1. It was noted in the community health needs assessment that Alzheimer's disease in North Dakota had the 2nd highest per capita number of deaths related to Alzheimer's. Although we have offered education, memory screenings and support groups for Alzheimer's, the availability of medical specialists that treat Alzheimer's and other mental health issues is still a need. Recruitment efforts have not been completed thus far to meet the need, due to diminished availability of psychiatrists and/or neuropsychologists.2. Although Diabetes and Obesity associated issues were identified as being prevalent in our minority Native American population, we continue to see a lack of participation by Native Americans at free/low cost community health screenings that have been offered. The reasons why participation from this population is low requires further investigation. Turtle Lake Community Memorial Hospital Part V, Section B, Line 7: It was noted in our community needs assessment that the respondents would like to have more local access and availability to more specialized care. Turtle Lake Community Hospital has a few specialists that provide services locally. At present time we have an orthopedic specialist that visits Turtle Lake on a monthly basis. In the past we have had OB/GYN physician and a General Surgeon but due to the lack of patient numbers they no longer are willing to provide services in Turtle Lake. Community Memorial Hospital is located in a small community and the chances of getting specialists to provide on site services is cost prohibitive. We will explore offering more specialized services through tele-medicine. St. Alexius Medical Center Part V, Section B, Line 14g: In addition to having the full financial assistance policy available upon request or via website, St. Alexius contacts patients through pre-admissions and meets with them to discuss the policy prior to procedures. Patient financial staff is available during normal office hours to discuss patient payment options and explain were the full financial assistance policy is available. Turtle Lake Community Memorial Hospital Part V, Section B, Line 14g: In addition to having the full financial assistance policy available upon request or via website, Community Memorial Hospital contacts patients through pre-admissions and meets with them to discuss the policy prior to procedures. Patient financial staff is available during normal office hours to discuss patient payment options and explain were the full financial assistance policy is available. St. Alexius Medical Center Part V, Section B, Line 20d: The maximum amount charged to a patient by St. Alexius under the financial assistance policy for emergency and medically necessary care is 45% of the gross charges. The organization determines the amount generally billed using a blended rate of Medicare and non-government payors. This is calculated annually. Turtle Lake Community Memorial Hospital Part V, Section B, Line 20d: The maximum amount charged to a patient by Community Memorial Hospital under the financial assistance policy for emergency and medically necessary care is 94.68% of the gross charges. The organization determines the amount generally billed using a blended rate of Medicare and non-government payors. This is calculated annually. Part VI, Line 2: The Organization completed a community health needs assessment during fiscal year 2013. Part VI, Line 3: The charity care policy is available on our website. Currently patients are contacted through pre-admissions and they meet with patient financial staff that go through information prior to procedures. Patient Financial Services also works with patients that need assistance with their billings. Free copies of the policy and application are available by mail, phone, or at the hospital campus. Part VI, Line 4: St. Alexius provides outreach services across its service area of central and western North Dakota. St. Alexius operates the Garrison Memorial Hospital in Garrison, North Dakota and manages the Community Memorial Hospital in Turtle Lake. St. Alexius owns and operates clinics in Mandan, Minot, Garrison, and Washburn. North Dakota's population is 672,591 of which 61,272 reside in the city of Bismarck. The population is 90.0% white, 5.4% Native American, and the remaining 4.6% being African American, Asian, and Hispanic. By the year 2020, 45 of the 53 counties will have more than 22% of their population age 65 or older. From 2000-2005 our state had a 15% decrease in the number of youth and a 13.8% increase in the minority population which was primarily Native American Reservations. North Dakota has 12% of their population living in poverty. The leading causes of death in Burleigh county ranked in order are Diseases of the Heart, Alzheimers, Respiratory Cancer, Accidental, Cerebrovascular Disease, COPD, Diabetes, Breast Cancer, and Colorectal Cancer. Health related behaviors influence cardiovascular diseases such as smoking, physical inactivity, poor nutrition, and unhealthy weight status. Hypertension is a chronic disease associated with aging that has a high risk factor for heart disease and stroke. In North Dakota, 26% adults have high blood pressure. North Dakota adults are a part of the national trend towards increased obesity. 63% of the adults here have an unhealthy weight/BMI. Some of the health screenings that St. Alexius is conducting throughout the service region are vascular, wellness, memory, sleep apnea, and chronic obstructive pulmonary disease. Those individuals that are being screened at no or minimal cost are being alerted of health risks that might go undetected. Through screenings, it is our hope that these individuals seek further treatment and are empowered to make healthier lifestyle choices. Part VI, Line 5: The governing body is comprised of people in the community who are knowledgeable to advise the organization and are compensated for their expertise and time (see Part VII of Form 990).The organization extends medical staff privileges to Primecare physicians. The organization applies surplus funds, if available, to their reinvestment in equipment and facilities to improve patient care.The Hospital provides serveral services at reduced or no costs. Those included are as follows:1. INTERACTIVE NETWORK - Consists of twenty five communities located in Montana, South and North Dakota covering 70,000 square miles are serviced by the St. Alexius Medical Center network. INTERACTIVE NETWORK provides electrocardiogram management, interactive cardiac management, remote cardiac monitoring, electroencephalogram monitoring, fetal monitoring, biomedical services, dialysis and infant pneumocardiograms to patients in western and central North Dakota. These services might not be provided if not for the Hospital servicing these areas.2. OTHER ACTIVITES INCLUDED ON PART 1, LINE 7E: - In keeping with the Hospital's commitment to serve all members of its community St. Alexius Medical Center: -participated in health fairs-provided patient educational materials and classes-provided patient support groups for different diseases-conducted health screenings-sponsored "Wellness" type programs ranging from Lamaze instruction and parenting to babysitting to diet and weight control to social issues.-operated a Hospice Program-has telemedicine capabilities set-up in several rural communities-provides PAC's (radiology) services and radiology reading to many rural communities 3. OTHER ACTIVITES INCLUDED ON PART 1, LINE 7E: - Services are provided to Standing Rock Sioux Indian Reservation with emphasis focused on improving the quality of care in the area of maternal and child nursing and mental health with a goal to reduce infant mortality. The program consists of support from a OB trained physician to provide prenatal and ongoing care in the Fort Yates community. Also in that community a bi-monthly newsletter is distributed that addresses the following topics:-Pregnancy and prenatal care-Labor and delivery-Infant nutrition-Teen pregnancy-Self esteem-Suicide prevention-Drug and alcohol abuse 4. St. Alexius manages a non-profit critical access hospital in Turtle Lake North Dakota. St. Alexius offers administrative expertise and purchasing economies that it passes on to this facility. This allows the facility to continue to provide health care services and operate more efficiently. Turtle Lake also provides primary care providers to clinics in McClusky and Washburn, ND.5. St. Alexius manages a non-profit critical access hospital in Garrison North Dakota. Garrison Memorial Hospital operates a 22 bed acute care hospital and a 26 bed skilled nursing facility. They also operate a 24 hour, Level IV Certified Emergency Room.6. St. Alexius operates a Telemedicine network, known as The Telecare Network. It is a service St. Alexius Medical Center and affiliated physicians offer in cooperation with 27 healthcare providers throughout the Dakotas. The service features telemedicine consultations between rural physicians and specialists in Bismarck using real time video and audio telepresence equipment. Consultations of both urgent and routine nature are available.7. St. Alexius provides support to other rural communities like Hettinger, North Dakota to help maintain needed primary care physician coverage in rural communities. 1 ND-SD Medical Transport 8295 7th Avenue SE Linton ND 58552 272849014 501(c)(3) 50000 Support Angel Air Care Helicopter EMS Program Sakakawea Medical Center 510 8th Ave NE Hazen ND 58545 450308379 501(c)(3) 75000 Outreach Care Grant West River Regional 1000 Highway 12 Hettinger ND 58639 450340688 501(c)(3) 300000 Rural Healthcare Support Grant 3 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: St. Alexius makes donations to entities with charitable missions to ensure that our donations are used for the purposes intended. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Gary Miller 503716 0 190038 0 0 0 10000 0 7596 0 711350 0 0 0 Shiraz Hyder 387657 0 141873 0 0 0 10000 0 20872 0 560402 0 0 0 Rosanne Schmidt 199605 0 76273 0 0 0 10000 0 18405 0 304283 0 0 0 Duwayne Schlittenhard 186267 0 68493 0 0 0 9987 0 10040 0 274787 0 0 0 Wanda Pfaff 181586 0 65753 0 0 0 9689 0 17519 0 274547 0 0 0 Frank Kilzer 161430 0 60946 0 0 0 8979 0 19749 0 251104 0 0 0 Kurt Waldbillig 149833 0 55537 0 0 0 8409 0 13327 0 227106 0 0 0 Susan Sisk 139345 0 52949 0 0 0 7274 0 13287 0 212855 0 0 0 Eric Belanger 1330264 0 629768 0 0 0 10000 0 15519 0 1985551 0 0 0 Steven Kraljic 1330106 0 245451 0 0 0 10000 0 15512 0 1601069 0 0 0 Leslie Rainwater 517025 0 458274 0 0 0 9809 0 14438 0 999546 0 0 0 Brent Herbel 739468 0 145509 0 0 0 10000 0 14783 0 909760 0 0 0 Robert Oatfield 636324 0 95049 0 14982 0 10000 0 14577 0 770932 0 0 0 Part I, Line 1a President/CEO is allowed up to annual maximum executive benefit allowance of $10,000 for expenses incurred for: airline, club memberships, wellness/fitness programs, financial planning and tax preparation services, membership in community club, and cell phone and wireless connectivity. The amount of benefit used is included in taxable income. Part I, Line 7 At the beginning of each fiscal year, the Compensation Committee establishes a financial threshold which must be met before any awards are paid and establishes guidelines defining the size of any awards available to participants. At the end of the plan year, the Committee decides whether to make any awards to participants and how large any award shall be, in accordance with the guidelines established at the beginning of the plan year. Incentive compensation is earned as a percent of base salary. Base salary is defined as the annualized rate of pay (summation of monthly base salary for the plan year). A City of Garrison 456002076 2007-12-20 3200000 2007-Improvements to the Infrastructure Relating to Energy Management 0 0 0 B Burleigh County 456002204 2010-05-27 8156220 Building Construction 1 0 0 C Burleigh County 456002204 2010-11-16 6119852 Building Construction 1 0 0 D Burleigh County 456002204 2011-03-31 8159645 Building Construction 1 0 0 A 3200000 3200000 2008 0 0 1 1 B 8000000 8377663 221443 156220 8221443 2010 0 0 1 1 C 6000000 6270931 151079 119852 6151079 2011 0 0 1 1 D 8000000 8380327 220682 157645 8222682 2011 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 1 US Bank NA 10.000000000000 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A Burleigh County 456002204 120906DR0 2012-01-31 40208479 Bond Refinance for 12/01/98, 4/15/09, 5/27/10, 11/16/10 and 3/31/11 Bonds 0 0 0 A 885000 40210338 7514823 798251 16451448 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 Blue Cross Blue Shield Gary Miller BCBS board member 1657926 Insurance services 0 Wells Fargo John Giese is Wells Fargo CEO 282585 Banking and insurance services 0 Lynn Dosch Spouse of Board Member 20923 Employee 0 Martha Reichert Daughter of Board Member 40992 Employee 0 David Gayton Brother of Board Member 408038 Employee 0 Kari Emery Daughter of Board Member 55884 Employee 0 Skylar Dosch Daughter-in-law of Board Member 47650 Employee 0 UND School of Medicine Nicholas Neumann is Associate Dean 375541 Resident/CME Program 0 Karen Brown Spouse of Board Member 328979 Employee 0 Adam Miller Son of CEO 17714 Employee 0 Eric Kilzer Son of Key Employee 74986 Employee 0 Joleen Waldbillig Spouse of Key Employee 33927 Employee 0 Jarin Sprecher Stepson of Key Employee 11691 Employee 0 Michael Anderson Stepson of Key Employee 29911 Employee 0 Form 990, Part VI, Section A, line 2 John Giese and Gary Miller have a business relationship. Form 990, Part VI, Section A, line 6 Members: The corporation shall have one class of members, which shall consist of members of the monastic community known as the Benedictine Sisters of the Annunciation, BMV, who have made their perpetual monastic profession and who have been elected to or appointed to the Sponsorship Group of the Benedictine Sisters of the Annunciation, BMV. Form 990, Part VI, Section A, line 7a Joint Powers of Members and Board of Directors: The following powers shall be reserved jointly to the members of the corporation and the board of directors: 1. Approve a new candidate appointed to serve as President/Chief Executive Officer of the corporation. 2. Approve any person to be elected to serve on the board of directors. 3. Remove any director if this action is indicated. The power of the board of directors to act on any of these matters is subject to the requirement that the members of the corporation shall approve such action prior to the submission of the matter to a vote of the board of directors. Form 990, Part VI, Section A, line 7b Powers Reserved to Members: Exercise of the following powers shall be reserved exclusively to the members of the corporation to: 1. Change the sponsorship, reserved powers or mission of the corporation as an institution founded on Gospel values, the Benedictine heritage of healing and the healing ministry of Jesus. 2. Make any major policy change on ethical issues. 3. Authorize the sale or encumbrance of all or substantially all of the assets or property of the corporation. 4. Merge, liquidate or dissolve the corporation. 5. Change the name of the corporation. 6. Change or amend the structure of the board of directors of the corporation. 7. Amend, alter or repeal the articles of incorporation and/or the bylaws of the corporation. 8. Approve or disapprove a proposed course of action which could reasonably be anticipated to adversely affect the sponsorship or mission of the corporation as an institution founded on Gospel values, the Benedictine heritage of healing and the healing ministry of Jesus. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the board of directors. Form 990, Part VI, Section B, line 11 Internal staff will present to the audit and compliance committee and that committee recommends approval to the board. A draft is presented at a board meeting. Form 990, Part VI, Section B, line 12c Annually all employees are asked conflict of interest questions at evaluation time. Employees are responsible for disclosing potential conflicts of interest by completing a disclosure form. Each year the compliance officer initiates a review of all conflicts of interests within the medical center. The following annually complete a disclosure form: board members, President/CEO, Vice Presidents, Directors/Managers, other employees with significant decision making authority or who are in a position to influence decisions. The forms are reviewed by the compliance officer and if a conflict is "new" or requires review, the CEO and the Audit & Compliance Committee discuss the conflict and determine appropriate course of action. Form 990, Part VI, Section B, line 15 Compensation is reviewed annually by an independent group using comparability data and recommendations are presented to the President/CEO and/or Board of Directors for approval. Form 990, Part VI, Section C, line 19 An annual report is available to the public that includes financial statements. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Fair Value of Interest Rate Swap 57,024. Rounding -1. Statement of Program Service Accomplishment Continuance: Form 990, Part III -The St. Alexius Medical Center Rehabilitation Center has been accredited from the Commission on Accreditation of Rehabilitation Facilities (CARF). This accreditation represents the highest level of accreditation that can be awarded to an organization and shows the organization's substantial conformance to the standards established by CARF. -St. Alexius was awarded the 100 Top Hospital Cardiovascular Benchmarks for Success Study, 9th Edition per Thomson Healthcare. Thomson Healthcare developed the 100 Top Cardiovascular Hospitals' study to identify high-performing cardiovascular hospitals nationally and to set performance targets for improving clinical outcomes and management of the high-risk, high-cost cardiovascular service line. To qualify, hospitals must achieve high scores across eight equally weighted performance criteria that reflect clinical processes and outcomes, volume, efficiency and cost. -St. Alexius received a health care quality award for our own overall performance on the Centers for Medicare & Medicaid Services quality measures. The award is based on the hospital's performance and degree of improvement on the quality measures for the treatment of acute myocardial infarction, heart failure, pneumonia, and surgical care. This award is a reflection of the commitment we have made to provide quality health care to the patients we serve. -One of our Emergency Room physicians earned the Best Doctor in America award. The Best Doctors in America database is the result of a survey of more than 40,000 physicians in the United States. Only those doctors recognized to be in the top 3-5% of their specialty earn the honor of being named one of the Best Doctors in America. The only way to be recognized as one of the best Doctors in America is for a doctor to earn high marks for clinical ability from his or her peers. -St. Alexius was the first in western ND to offer non-surgical treatment of atrial septal defect (ASD). ASD is a hole between the two upper chambers of the heart and is most commonly diagnosed in infants and children. If the defect is large and doesn't close patients may be more susceptible to colds, pneumonia and other infectious diseases. Left untreated, ASD can lead to heart arrhythmias, heart failure, high blood pressure, stroke and even death. Traditionally, the only treatment for ASD was open heart surgery. With the AMPLATZER device, it allows a less invasive, non-surgical approach to treat our patients with ASD. By using this device, most patients leave the hospital within 24 hours and resume normal activity soon thereafter. -The Noninvasive Cardiovascular Lab has accreditation in the area of Extracranial Cerebrovascular Testing and Peripheral Venous Testing by the Intersocietal Commission for the Accreditation of Vascular Laboratories. -St. Alexius has been awarded an accreditation by the Commission on Laboratory Accreditation of the College of American Pathologists (CAP). The CAP accreditation program is recognized by the federal government as being equal to or more stringent than the government's own inspection program. The inspectors examine the laboratory's records and quality control of procedures for the preceding two years. This stringent inspection program is designed to specifically ensure the highest standard of care for the laboratory's patients. -St. Alexius performed our first carotid stent procedure utilizing the current FDA approved Embolic Protection System. This procedure provides a minimally invasive treatment alternative to conventional open carotid artery surgery to patients who are at high surgical risk. The embolic protection system is designed to capture and remove particles of plaque that might be dislodged during the procedure, which could potentially lead to stroke and other complications. -St. Alexius was only one of fourteen hospitals in the entire United States to gain an award for Patient Safety, Patient Quality and Patient satisfaction from the HealthGrades Rating organization. -St. Alexius provides and supports an inpatient Psychiatric Unit and a Partial Psych outpatient unit. -St. Alexius was recently named a Top 50 Hospital by Becker's Hospital Review St Alexius Heart & Lung Clinic LLC 900 East Broadway Avenue Bismarck ND 58501 861123162 Speciality Clinic-Cardiology, etc. ND -7466732 2988973 N/A Garrison Memorial Hospital 407 3rd Ave SE Garrison ND 58540 450227752 Hospital ND 501(c)(3) Line 3 St Alexius Medical Center 0 Benedictine Sisters of the Annunciation BMV 7520 University Drive BISMARCK ND 58504 450261530 Religious Purposes ND 501(c)(3) Line 1 N/A 0 St Alexius Health Services Inc 900 East Broadway Ave Bismarck ND 58501 450402817 General Business Purpose ND St Alexius Medical Center C 1263 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0