2014-11-13T10:03:45-06:00 2013-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2013-01-01 410729979 NORTH MEMORIAL HEALTH CARE NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 TODD OSTENDORF CHIEF FINANCIAL OFFICER 7635205200 2014-10-16 1 LAWRENCE H MOHR CPA P00447603 6128764500 2014-10-16 2013 2015-11-30 17:44:51Z LOREN TAYLOR 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 773015019 0 X WWW.NORTHMEMORIAL.COM X 1954 MN GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. 15 13 5213 670 7628696 -3261397 760857 1250375 643415269 631102778 9554787 14778356 -2758020 -490606 650972893 646640903 0 0 0 0 392891408 370462198 0 0 0 267259635 263129622 660151043 633591820 -9178150 13049083 574490605 581188207 250822311 220859367 323668294 360328840 X INSPIRING EACH OTHER TO GIVE OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. 0 0 554105958 573896075 NORTH MEMORIAL HEALTH CARE (NMHC) IS A GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE, OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL- SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATION, BEHAVIORAL HEALTH, MEDICAL TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NMHC ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST) IN FURTHERANCE OF ITS CHARITABLE PURPOSE. NORTH MEMORIAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED PROGRAMS, SUCH AS HEALTH SCREENINGS, SUPPORT COUNSELING FOR PARENTS 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, UNREIMBURSED COSTS OF MEDICAL EDUCATION, TELEPHONE INFORMATION SERVICES, AND COST RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. NORTH MEMORIAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES, AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, NORTH MEMORIAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE. 554105958 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 459 0 5213 1 1 1 1 BD 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X TODD OSTENDORF 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 LOREN TAYLOR CEO NORTH MEMORIAL 50.00 5.00 X X 776215 0 23125 ROBERT D POTTS CHAIR OF BOARD 2.00 0.00 X X 4500 0 0 TIMOTHY BAYLOR BOARD MEMBER 2.00 0.00 X 4500 0 0 SCOTT COLSON BOARD MEMBER 2.00 0.00 X 1800 0 0 DANA CARLSON MD BOARD MEMBER 2.00 0.00 X 4500 0 0 WARREN MACK BOARD MEMBER 2.00 0.00 X 4500 0 0 PAT MCHALE BOARD MEMBER 2.00 0.00 X 0 0 0 JON NIELSON MD BOARD MEMBER (PART-YEAR) 2.00 0.00 X 1800 0 0 ROBERT PRENTISS JR BOARD MEMBER 2.00 0.00 X 5400 0 0 ROBERT DAHL BOARD MEMBER 2.00 0.00 X 1800 0 0 MIKE STEINHAUSER BOARD MEMBER 2.00 1.00 X 0 0 0 MATTHIAS FELDKAMP MD BOARD MEMBER 2.00 0.00 X 3600 0 0 JOHN GRAY MD BOARD MEMBER 2.00 0.00 X 0 0 0 STEVE BECK SECRETARY 2.00 0.00 X X 0 0 0 KAREN RAUENHORST BOARD MEMBER (PART-YEAR) 2.00 0.00 X 1800 0 0 AMY KOLAR MD BOARD MEMBER 2.00 0.00 X 471224 0 24790 BILL TOBIN BOARD MEMBER 2.00 0.00 X 4500 0 0 TODD OSTENDORF VP FINANCE, CFO (PART-YEAR) 50.00 2.00 X 129998 0 4912 PATRICK BORAN VP FINANCE, CFO (PART-YEAR) 50.00 4.00 X 619221 0 10370 KEVIN CROSTON MD CHIEF MEDICAL OFFICER 50.00 2.00 X 464710 0 22533 TIFFANY ZITZEWITZ VP BUSINESS DEVELOPMENT 50.00 2.00 X 288619 0 24485 ANDREW COCHRANE CEO MAPLE GROVE HOSPITAL 0.00 50.00 X 381414 0 24893 GAYLE MATTSON PRESIDENT OF NORTH MEMORIAL 50.00 0.00 X 353861 0 13397 DAVID ABRAMS VP HUMAN RESOURCES 50.00 0.00 X 266404 0 59332 JOSEPH BOSTON VP FOUNDATION 0.00 50.00 X 408031 0 15408 MICHAEL PARRISH VP EMERGENCY & ENTERPRISE OPERATIONS 50.00 0.00 X 318480 0 22857 PATRICK TAFFE CHIEF INFORMATION OFFICER 50.00 0.00 X 301110 0 22587 ANDREW HOULTON MEDICAL DIRECTOR 50.00 0.00 X 276288 0 25246 JEFF WICKLANDER VP OPERATIONS 50.00 0.00 X 267046 0 13616 TRACY KIRBY VP INPATIENT CARE/CNO 50.00 0.00 X 182540 0 11427 ROBERT KING CARDIAC SURGEON 50.00 0.00 X 709750 0 25139 ALOK MAHESHWARI CARDIOLOGIST 50.00 0.00 X 727784 0 24496 STEVEN ROH CARDIOLOGIST 50.00 0.00 X 799532 0 27104 THOMAS ROSSINI STAFF EMERGENCY PHYSICIAN 50.00 0.00 X 725026 0 24955 JOSEPH VAN CAMP CARDIAC SURGEON 50.00 0.00 X 688139 0 25139 9194092 0 445811 434 0 1 0 NORTH CLINIC 3366 OAKDALE AVE N 601 ROBBINSDALE MN 55422 PHYSICIAN SERVICES 6391992 DJ KRANZ COMPANY INCORPORATED 725 HIGHWAY 169 NORTH PLYMOUTH MN 554416403 CONSTRUCTION 4545773 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 MANAGEMENT SUPPORT FOR DIETARY 2965276 RESPIRATORY CONSULTANTS PA 3366 OAKDALE AVE N 605 ROBBINSDALE MN 55422 INTENSIVISTS STAFFING 2504067 UNIVERSITY OF MINNESOTA PHYSICIANS 720 WASHINGTON AVE SE STE 200 MINNEAPOLIS MN 55414 PHYSICIAN SERVICES 2488964 35 517335 733040 72256 1250375 HOSPITAL PATIENT REVENUE 621500 576540127 568911431 7628696 CONTRACT REVENUE 900099 25922957 25922957 EHR/MEDICARE & OTHER 900099 13969484 13969484 PHARMACY 900099 5590548 5590548 JOINT VENTURE REVENUE 900099 5475250 5475250 3604412 3604412 631102778 4776114 4776114 64099 64099 11311838 11802444 -490606 -490606 -490606 124479190 30625 114308876 262796 10170314 -232171 9938143 9938143 646640903 573896075 7628696 63865757 6108824 6108824 293968847 257891864 36076983 9449043 8289420 1159623 40768249 35765013 5003236 20167235 17692235 2475000 1106193 970437 135756 302387 265277 37110 105017 105017 748801 748801 48156507 42246556 5909951 2455374 2241769 213605 5469135 4797942 671193 8851733 7765414 1086319 15862273 13915594 1946679 3959715 3473764 485951 32286737 28295892 3990845 5394743 4732679 662064 SUPPLIES 83751147 73472885 10278262 BAD DEBT EXPENSE 24225425 24225425 MAINTENANCE & REPAIR 12972740 11380676 1592064 GOVERNMENT TAXES 10937643 10937643 6544052 5745473 798579 633591820 554105958 79485862 0 19409 18424 9514694 8446193 91286511 83422384 5351746 6582936 4999020 3962207 599339798 386732231 226269194 212607567 157932141 205615544 51392579 38756112 27725311 21776840 574490605 581188207 69203465 62622331 443845 699070 148644676 138985212 32530325 18552754 250822311 220859367 X 323668294 360328840 323668294 360328840 574490605 581188207 13049083 23611463 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 40000 1 60000 0 0 100000 0 PART II-B, LINE 1: CONTACTS AND VISITS WERE MADE WITH STATE LEVEL LEGISLATORS TO PROMOTE HEALTH CARE RELATED ISSUES. 2683970 710628 85294 33800 3446092 2382667 270795 92571 62063 2683970 2251229 72500 71751 12813 2382667 1737891 513452 25341 25455 2251229 1537773 247046 17937 64865 1737891 0.00000 0.96590 0.03410 0 1 1 15594663 15594663 232409363 116556726 115852637 13779642 9641553 4138089 327811891 254555955 73255936 9744239 5977997 3766242 212607567 RREEF AMERICA REIT II 21525495 F MELLON AGGREGATE BOND INDEX FUND 10557706 F CASH ON DEPOSIT WITH BOND TRUSTEE 5525336 F AGENCY ACCOUNT 15575 F CASUALTY INSURANCE SECURITY 1132000 F 38756112 EXECUTIVE PENSION PLAN 3660101 RESTORATION PENSION PLAN 55031 PY PENSION LIABILITY 9153907 POST RETIREMENT HEALTH INSURANCE 1137856 SECURITIES LENDING 4044544 CAA DEPOSIT RESERVE 138387 SETTLEMENTS AND CLAIMS PAYABLE 362928 18552754 X PART V, LINE 4: ALL ENDOWMENT FUNDS ARE HELD BY A RELATED ENTITY: NORTH MEMORIAL FOUNDATION. 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD THE PAY IT FORWARD FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN. MICHELLE RECOGNIZED A NEED TO HELP WOMEN STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, UNITY AND MONTICELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE NORTH MEMORIAL FOUNDATION. 7) MEDICAL STAFF ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. 8) MAPLE GROVE MEDICAL STAFF ENDOWMENT WAS ESTABLISHED IN 2013 BY THE MAPLE GROVE MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND MAPLE GROVE PROGRAMS. PART X, LINE 2: NORTH MEMORIAL EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2013 OR 2012. NORTH MEMORIAL IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAX JURISDICTION, HOWEVER, WE HAVE BEEN INFORMED BY THE STATE OF MINNESOTA THAT THEY WILL CONDUCT A SALES TAX AUDIT FOR THE PERIOD OF SEPTEMBER 2010 THROUGH DECEMBER 2013. 1 1 1 X 1 X 1 1 1 0 1 1 11409217 11409217 0.01800 78706288 52068619 26637669 0.04200 90115505 52068619 38046886 0.06000 1735387 1735387 0.00270 5704908 1749040 3955868 0.00620 54974826 41354749 13620077 0.02150 155983 21267 134716 0.00020 768102 768102 0.00120 63339206 43125056 20214150 0.03180 153454711 95193675 58261036 0.09180 1 8592642 134554544 183550210 -48995666 X 1 1 1 MAPLE GROVE HOSPITAL HOSPITAL 0.75000 0.00000 0.00000 2 NM SURGERY CENTER MAPLE GROVE OUTPATIENT SURG CTR 0.50000 0.00000 0.50000 3 MN DIAGNOSTIC IMAGING PARTNERS OUTPATIENT IMAGING CTR 0.60000 0.00000 0.40000 4 PREFERRED ONE ADMINISTRATIVE SERVICES CLAIMS ADMINISTRATOR 0.25000 0.00000 0.25000 5 PREFERRED ONE COMMUNITY HEALTH PLAN INSURANCE COMPANY 0.50000 0.00000 0.00000 6 INSTITUTE OF ATHLETIC MEDICINE CLINIC 0.37000 0.00000 0.00000 7 MONTICELLO CANCER CENTER OPTNT CANCER CLINIC 0.40000 0.00000 0.00000 8 NORTH RADIATION ONCOLOGY OPTNT RADIATION ONC CLNC 0.50000 0.00000 0.00000 9 BLAINE URGENCY CENTER URGENT CARE 0.50000 0.00000 0.00000 10 PLYMOUTH CITY CENTER MEDICAL BUILDING MEDICAL OFFICE BUILDING 0.50000 0.00000 0.00000 1 1 NORTH MEMORIAL MEDICAL CENTER 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 X X X X NORTH MEMORIAL MEDICAL CENTER 1 1 X X X X X X X X X X 13 1 0 1 X WWW.NORTHMEMORIAL.COM X X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 1 NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 3: ONE OF THE KEY OBJECTIVES IN CONDUCTING THE 2013 CHNA WAS TO IDENTIFY HEALTH ISSUES MOST IMPORTANT TO OUR COMMUNITY MEMBERS. THIS WAS ACCOMPLISHED IN SEVERAL WAYS. NORTH MEMORIAL HEALTH CARE CONVENED 4 FOCUS GROUPS FROM TARGET POPULATIONS FROM THROUGHOUT THE COMMUNITY. WE FURTHER INTERVIEWED COMMUNITY LEADERS REPRESENTING LOCAL GOVERNMENT, LAW ENFORCEMENT, EDUCATION, RELIGIOUS ORGANIZATION, PUBLIC HEALTH AND COMMUNITY-BASED ORGANIZATIONS. LASTLY, WE CONDUCTED AN ONLINE SURVEY FOR COMMUNITY MEMBERS AND NORTH MEMORIAL EMPLOYEES. WE RETAINED AN OUTSIDE CONSULTING FIRM TO LEAD THE FOCUS GROUPS. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 20D: THE MINNESOTA ATTORNEY GENERAL'S OFFICE REQUIRES HOSPITALS TO RENDER SERVICES TO THOSE PATIENTS WHO DO NOT HAVE INSURANCE AT A REDUCED RATE EQUAL TO THE DISCOUNT INCURRED FROM THE HIGHEST VOLUME MANAGED CARE PLAN. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 22: PER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT, THIRD PARTY LIABILITY AND PROCEDURES THAT ARE NOT MEDICALLY NECESSARY ARE NOT COVERED UNDER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT AND THOSE PATIENTS CAN BE BILLED FULL CHARGES. 1 MINNESOTA DIAGNOSTIC IMAGING PARTNERS LL 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 OUTPATIENT RADIOLOGY PART III, LINE 2: AMOUNT REPRESENTS THE HOSPITAL'S BAD DEBT PROVISION REDUCED BY THE HOSPITAL'S COST TO CHARGE RATIO WHICH REPRESENTS THE BEST ESTIMATE OF COST FOR THE BAD DEBT PROVISION. PART III, LINE 4: NORTH MEMORIAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT. PART III, LINE 8: THE SHORTFALL REPORTED REPRESENTS THE AMOUNT MEDICARE REIMBURSEMENT IS LESS THAN THE ESTIMATED COST OF PROVIDING SERVICES TO THOSE PATIENTS. THE METHOD USED TO ESTIMATE THOSE COSTS IS THE COST TO CHARGE RATIO APPROACH WHICH CALCULATES THE RATIO OF TOTAL HOSPITAL COSTS / TOTAL HOSPITAL GROSS REVENUE AND THEM APPLIES THAT RATIO TO TOTAL MEDICARE GROSS REVENUE. PART III, LINE 9B: NORTH MEMORIAL HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATIONS INTRANET AND PERTAIN TO ALL ENTITIES UNDER THE NORTH MEMORIAL CORPORATE UMBRELLA. PART VI, LINE 2: NORTH MEMORIAL WORKS CLOSELY WITH COMMUNITY MEMBERS TO DETERMINE AREAS OF INTEREST AND NEED IN HEALTHCARE SERVICES. IN 2013 WE COMPLETED A FULL COMMUNITY NEEDS ASSESSMENT, INCLUDING COMMUNITY FOCUS GROUPS, TO BETTER UNDERSTAND THE COMMUNITY'S HEALTH NEEDS. PART VI, LINE 3: NORTH MEMORIAL HEALTH CARE HAS A VERY PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE AN IMMEDIATE DISCOUNT TO UNINSURED MINNESOTA RESIDENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.OUR CHARITY CARE PROGRAM IS PUBLISHED IN THE CORPORATE POLICIES AND PROCEDURES AND PROVIDES FOR 100% COVERAGE OF MEDICAL BILLS FOR ANYONE WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND NEEDS ASSISTANCE IN RESOLVING THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. THERE IS A GRADUAL REDUCTION IN THE CHARITY COVERAGE BETWEEN THE 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES.IF WE ARE UNABLE TO MEET WITH THE PATIENT BEFORE DISCHARGE FROM NORTH MEMORIAL, THE PATIENT IS GIVEN A PAMPHLET THAT LISTS CONTACT NUMBERS TO OUR BUSINESS OFFICE CUSTOMER SERVICE AREA TO DISCUSS OPTIONS FOR ASSISTANCE WITH THEIR MEDICAL BILLS. THIS CONTACT INFORMATION IS ALSO PROVIDED ON EVERY STATEMENT THAT IS SENT TO OUR CUSTOMERS. IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE. PART VI, LINE 4: NORTH MEMORIAL SERVES A GEOGRAPHIC AREA THAT INCLUDES 42 ZIP CODES IN THE NORTHWEST QUADRANT OF THE TWIN CITIES METRO. THIS SERVICE AREA INCLUDES BOTH URBAN, SUBURBAN, EX-URBAN, AND RURAL AREAS. THIS SERVICE AREA INCLUDES A DIVERSE POPULATION OF MORE THAN 900,000 PEOPLE LIVING IN HENNEPIN, WRIGHT, SHERBURNE AND RAMSEY COUNTIES. PART VI, LINE 5: NORTH MEMORIAL HEALTH CARE IS A GENERAL ACUTE CARE HOSPITAL PROVIDING SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CARDIOVASULAR AND OPEN HEART SERVICES, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATIVE AND BEHAVIORAL SERVICES. NMHC ALSO PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO OUR COMMUNITY INCLUDING PRIMARY CARE, AMBULANCE TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. NORTH MEMORIAL IS GOVERNED BY A BOARD OF 15 REPRESENTATIVES CONSISTING OF PHYSICIANS AND VARIOUS LEADERS FROM THROUGHOUT THE COMMUNITY. BOARD MEMBERS ARE ELECTED TO SERVE THREE-YEAR TERMS FOR A TOTAL OF FIVE TERMS. THE MEDICAL CENTER ALSO SUPPORTS AN OPEN MEDICAL STAFF ORGANIZATION INCLUDING APPROXIMATELY 900 BOARD CERTIFIED PHYSICIANS AND 300 ALLIED HEALTH PROFESSIONSALS. THE NORTH MEMORIAL BOARD OF TRUSTEES ESTABLISHES AN ANNUAL MARGIN TARGET FOR MANAGEMENT. PER BOARD POLICY 75% OF ANY EXCESS AVAILABLE CASH FLOW IS REINVESTED IN THE FORM OF CAPITAL IMPROVEMENTS TO THE CENTER. THE REMAINING 25% IS REINVESTED TO SUPPORT LONG TERM OPERATIONS. PART VI, LINE 6: NORTH MEMORIAL HEALTH SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. THROUGH TARGETED OUTREACH, EDUCATION AND PARTNERSHIPS, WE IMPROVE THE HEALTH OF OUR COMMUNITIES BY LISTENING TO THEIR NEEDS AND RESPONDING WITH APPROPRIATE PROGRAMS AND SERVICES.OUR PROGRAMS, MANY OF WHICH HAVE BEEN NATIONALLY RECOGNIZED, RANGE FROM HEALTH EDUCATION AND FREE SCREENINGS TO TRAINING HEALTH PROFESSIONALS. X 1 1 X X X X 1 0 0 0 0 1 0 0 0 LOREN TAYLOR CEO NORTH MEMORIAL 606008 0 0 0 170207 0 17850 0 5275 0 799340 0 0 0 AMY KOLAR MD BOARD MEMBER 184066 0 40000 0 247158 0 17850 0 6940 0 496014 0 0 0 PATRICK BORAN VP FINANCE, CFO (PART-YEAR) 115113 0 0 0 504108 0 8581 0 1789 0 629591 0 0 0 KEVIN CROSTON MD CHIEF MEDICAL OFFICER 400446 0 0 0 64264 0 17850 0 4683 0 487243 0 0 0 TIFFANY ZITZEWITZ VP BUSINESS DEVELOPMENT 250000 0 0 0 38619 0 17500 0 6985 0 313104 0 0 0 ANDREW COCHRANE CEO MAPLE GROVE HOSPITAL 330000 0 0 0 51414 0 17850 0 7043 0 406307 0 0 0 GAYLE MATTSON PRESIDENT OF NORTH MEMORIAL 304990 0 0 0 48871 0 13138 0 259 0 367258 0 0 0 DAVID ABRAMS VP HUMAN RESOURCES 225000 0 0 0 41404 0 53165 0 6167 0 325736 0 37675 0 JOSEPH BOSTON VP FOUNDATION 146771 0 0 0 261260 0 10274 0 5134 0 423439 0 0 0 MICHAEL PARRISH VP EMERGENCY & ENTERPRISE OPERATIONS 272463 0 0 0 46017 0 17850 0 5007 0 341337 0 0 0 PATRICK TAFFE CHIEF INFORMATION OFFICER 256203 0 0 0 44907 0 17591 0 4996 0 323697 0 0 0 ANDREW HOULTON MEDICAL DIRECTOR 272308 0 0 0 3980 0 18196 0 7050 0 301534 0 0 0 JEFF WICKLANDER VP OPERATIONS 216731 0 15000 0 35315 0 7431 0 6185 0 280662 0 0 0 TRACY KIRBY VP INPATIENT CARE/CNO 157154 0 0 0 25386 0 5261 0 6166 0 193967 0 0 0 ROBERT KING CARDIAC SURGEON 675880 0 25000 0 8870 0 17850 0 7289 0 734889 0 0 0 ALOK MAHESHWARI CARDIOLOGIST 716650 0 7500 0 3634 0 17850 0 6646 0 752280 0 0 0 STEVEN ROH CARDIOLOGIST 721650 0 74000 0 3882 0 19849 0 7255 0 826636 0 0 0 THOMAS ROSSINI STAFF EMERGENCY PHYSICIAN 581837 0 140269 0 2920 0 17850 0 7105 0 749981 0 0 0 JOSEPH VAN CAMP CARDIAC SURGEON 684900 0 0 0 3239 0 17850 0 7289 0 713278 0 0 0 PART I, LINE 1A THE ORGANIZATION REIMBURSES ONE OF THE EXECUTIVE MEMBERS FOR THE MONTHLY SOCIAL DUES AT THE GOLDEN VALLEY COUNTRY CLUB. THE DUES FOR 2013 WERE $90 PER MONTH OR $1,080 PER YEAR. THE NORTH MEMORIAL COMMUNITY FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUNDRAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORT VARIOUS ACTIVITIES FOR NORTH MEMORIAL. PART I, LINE 4A A PORTION OF THE AMOUNTS REPORTED IN "OTHER REPORTABLE COMPENSATION" REFLECTS PAYMENTS MADE IN 2013 PURSUANT TO SEVERANCE AGREEMENTS WITH 2 EMPLOYEES AS FOLLOWS: PAT BORAN- $425,133 JOE BOSTON- $231,556 PART I, LINE 6 NORTH MEMORIAL HEALTH CARE'S ANNUAL INCENTIVE PLAN REQUIRES ACHIEVEMENT OF STATED PERFORMANCE METRICS, WHICH INCLUDE OPERATING CASH FLOW MARGIN. PART III, LINE 2: ALL EXPENSES ARE REVIEWED PRIOR TO REIMBURSEMENT AND SIGNED OFF BY THE CEO. NORTH MEMORIAL REPORTS EXECUTIVE EXPENSE REIMBURSEMENT DATA TO THE BOARD OF TRUSTEES ON A PERIODIC BASIS. A CITY OF MAPLE GROVE 410873250 56516TAD7 2005-09-22 55000000 CONSTRUCTION OF OUTPATIENT CENTER 0 1 0 B CITY OF ROBBINSDALE 716005496 2011-06-07 60000000 REFUND SERIES 2008 BONDS 0 1 0 C CITY OF ROBBINSDALE 716005496 2011-06-07 15000000 REFUND SERIES 2008 BONDS 0 1 0 A 54851782 4767980 1083801 49000001 2007 0 0 1 1 B 7564220 60000000 749350 58710650 2011 1 0 1 1 C 1372500 15000000 15000000 2011 1 0 1 1 A 0 1 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MAPLE GROVE DATE THE REBATE COMPUTATION WAS PERFORMED: 08/31/2010 ROBIN DRUG AND MERWIN PHARMACIES BOARD MEMBER IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES 514548 MICHAEL STEINHAUSER, A BOARD MEMBER, IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES, WHICH SUPPLIES DRUGS AND PHARMACEUTICALS TO NORTH MEMORIAL HEALTH CARE. 0 OAKDALE OBGYN BOARD MEMBER IS AN OWNER OF OAKDALE OBGYN 448956 JON NIELSEN, A BOARD MEMBER, IS AN OWNER OF OAKDALE OBSTETRICS & GYNECOLOGY (A.K.A. OAKDALE OBGYN) WHICH PROVIDES GYNECOLOGICAL SERVICES TO NORTH MEMORIAL HEALTH CARE. 0 X FURNITURE 1 48077 COST X PIANO PLAYER 1 8545 COST X FURNITURE REU 1 8158 COST X WHITEBOARDS 1 7476 COST 0 0 0 0 PART I, COLUMN (B): LISTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 2 LOREN TAYLOR AND BOB POTTS - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE REVIEWS THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEW THE FORM 990 WITH THE FINANCE AND AUDIT COMMITTEE IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE FINANCE AND AUDIT COMMITTEE APPROVES THE FORM 990 AND FORWARDS IT TO THE FULL BOARD FOR ITS REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY POSITIONS IS REVIEWED BY THE EXECUTIVE COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE ONLINE THROUGH THE OFFICE OF THE ATTORNEY GENERAL VIA THE CHARITY REPORT FILED WITH THE STATE OF MINNESOTA. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT WERE CHANGED DURING THE TAX YEAR. OAKDALE MEDICAL CENTER 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 320022819 LEASE MEDICAL OFFICE SPACE MN 820561 16241841 NORTH MEMORIAL NORTH MEMORIAL FOUNDATION 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411777966 FUNDRAISING MN 501(C)(3) 7 NORTH MEMORIAL 0 ASSOCIATED HEALTH ASSURANCE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 980343815 INSURANCE BD 501(C)(3) LINE 11A, I NORTH MEMORIAL 1 MAPLE GROVE HOSPITAL CORPORATION 9875 HOSPITAL DRIVE MAPLE GROVE MN 55369 208316475 ACUTE CARE MN 501(C)(3) 3 NORTH MEMORIAL 1 NORTH COLLABORATIVE CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 461680666 PRIMARY CARE MN 501(C)(3) 7 0 NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE 9855 HOSPITAL DRIVE MAPLE GROVE MN 55369 260393039 OUTPATIENT SURGERY MN RELATED 1736890 2944836 0 1 0.50000 MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 352162215 RADIOLOGY MN RELATED 1082434 2374047 0 1 0.60000 NORTH RADIATION THERAPY CENTER LLC 6950 FRANCE AVE S SUITE 200 EDINA MN 55435 743069974 RADIOLOGY MN RELATED 1419770 2131734 0 1 0.50000 BLAINE URGENCY CENTER 480 OSBORNE RD NE FRIDLEY MN 55432 461630126 URGENT CARE MN RELATED -7610 880502 0 1 0.50000 PLYMOUTH CITY CENTER MEDICAL BUILDING 5700 SMETANA DRIVE SUITE 120 MINNETONKA MN 55343 463883617 MEDICAL OFFICE BUILDING MN RELATED 2780145 0 0 0.50000 OAKDALE HEALTH ENTERPRISES INC 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411546422 AMBULANCE MN NORTH MEMORIAL C 627846 1315397 1.00000 1 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 NORTH MEMORIAL FOUNDATION (CONTRIBUTIONS) C 670812 FMV MAPLE GROVE HOSPITAL CORPORATION (RETURN OF CAPITAL) C 7373860 FMV MAPLE GROVE HOSPITAL CORPORATION (DEBT GUARANTEE) D 105443016 FMV MAPLE GROVE HOSPITAL CORPORATION (LEASE PMTS) J 458957 FMV MAPLE GROVE HOSPITAL CORPORATION (MGMT FEE) S 8682665 FMV MAPLE GROVE HOSPITAL CORPORATION (SALARY REIMBURSMENT) Q 7479153 FMV ASSOCIATED HEALTH ASSURANCE (PREMUIMS) M 2631250 FMV OAKDALE HEALTH ENTERPRISES (PAYROLL) P 1593140 FMV OAKDALE HEALTH ENTERPRISES (MGMT FEES) S 244743 FMV OAKDALE HEALTH ENTERPRISES (INTEREST ON LOAN) S 10768 FMV OAKDALE MEDICAL OFFICE BUILDING (LEASE PAYMENTS) J 676356 FMV OAKDALE MEDICAL OFFICE BUILDING (EXPENSE REIMBURSMENTS) Q 426528 FMV MINNEAPOLIS RADIATION ONCOLOGY (LEASE PMTS) J 227191 FMV NORTH MEMORIAL AMBULATORY SURGERY CENTER (LEASE PMTS) J 1615853 FMV MINNEAPOLIS RADIATION ONCOLOGY (DIVIDEND) J 805827 FMV MINNEAPOLIS RADIATION ONCOLOGY (DIVIDEND) R 1225000 FMV NORTH MEMORIAL FOUNDATION (STAFF SUPPORT) O 581245 FMV BLAINE URGENCY CENTER (LINE OF CREDIT) D 935766 FMV PLYMOUTH CITY CENTER MEDICAL BUILDING (CAPITAL CONTRIBUTION) B 2780145 FMV