2013-11-14T09:25:45-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-01-01 311667875 RIDGEVIEW MEDICAL CENTER RIDG 9524422191 500 SOUTH MAPLE STREET WACONIA MN 553871791 GORDON GABLENZ 9524422191 2013-11-13 1 KURT BENNION P01469618 6123764500 2012 2016-02-24 21:20:13Z ROBERT STEVENS 500 SOUTH MAPLE STREET WACONIA MN 553871791 198639393 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1999 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 9 9 1681 500 2067739 323958 1193038 2087639 156374640 162082431 2139168 2895409 3849942 5724336 163556788 172789815 636208 0 0 0 86559788 96162707 0 0 31097 77965442 75786006 165161438 171948713 -1604650 841102 183569933 186542662 75263718 76740588 108306215 109802074 X RIDGEVIEW MEDICAL CENTER EXISTS TO ENHANCE THE HEALTH OF PEOPLE IT SERVES BY CREATING A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. 0 0 123811648 0 162082431 RIDGEVIEW MEDICAL CENTER ENHANCED AND PROVIDED QUALITY HEALTHCARE SERVICES FOR THE COMMUNITY OF WACONIA AND THE SURROUNDING AREAS. THE HOSPITAL PROVIDED CHARITY CARE AND OTHER UNCOMPENSATED CARE IN THE AMOUNT OF $1,320,487 DURING 2012. THE UNPAID COST FOR SERVICES PROVIDED TO MEDICAID AND MEDICARE PATIENTS WAS $3,122,151 AND $8,567,691 IN 2012. UNREIMBURSED COSTS ASSOCIATED WITH THE TRAINING OF HEALTHCARE PROFESSIONALS SUCH AS HIGH SCHOOL STUDENTS SHADOWING FOR INTERNSHIPS FOR PHARMACY, IMAGING, DIETARY STUDENTS, AND MORE TOTALED $312,362. IN 2012 THE HOSPITAL SPENT $6,155,406 ON OTHER UNCOMPENSATED COMMUNITY SERVICES INCLUDING TAXES AND FEES. THE HOSPITAL SERVED 6,067 INPATIENTS, 26,143 EMERGENCY CARE VISITS, 23,641 HOME HEALTH VISITS, 6,258 SURGERIES, 1,259 BIRTHS, 9,382 AMBULANCE CALLS, AND 153,833 OUTPATIENT VISITS IN 2012. RIDGEVIEW MEDICAL CENTER SERVES MORE THAN 100,000 PEOPLE, OPERATES ONE HOSPITAL, ONE FREE-STANDING EMERGENCY AND URGERNT CARE FACILITY, AND SEVEN MULTI-SPECIALTY CLINIC LOCATIONS. 123811648 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 74 0 1681 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MN X GORDON GABLENZ 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 MITCHELL KILIAN 0.80 X X 2000 0 0 WAYNE HUBIN 0.80 X X 1600 0 0 JULIE HERMAN 0.80 X X 1600 0 0 MARIA GLYNN 0.80 X X 1600 0 0 MIKE WERNER 0.80 X 1600 0 0 JEFF NELSON 0.80 X 1600 0 0 DEL PLOEN 0.80 X 1600 0 0 SHARON COOK 0.80 X 1600 0 0 STAN BANDUR 0.80 X 1338 0 0 ROBERT HEETER MD 0.80 X 5000 191924 0 ROBERT STEVENS 44.50 5.50 X 339986 0 164486 PATRICIA MICHAELSON 50.00 X 221592 0 22226 JOHN PRONDZINSKI 50.00 X 194534 0 21359 GORDON GABLENZ 49.00 1.00 X 200608 0 26020 MICHAEL PHELPS 40.00 10.00 X 217879 0 24090 DOUGLAS STASEK 2.50 47.50 X 181836 0 23192 SARAH HASTINGS 50.00 X 159664 0 23558 BERNARD BUCKLAND 40.00 X 174867 0 13205 LINDA HONSTAD 40.00 X 167568 0 11399 KRISTI WIDSETH 40.00 X 166231 0 5836 CYNTHIA BRICK 40.00 X 166055 0 17347 ARLIEN CORTLAND 40.00 X 164472 0 5798 2374830 191924 358516 62 0 1 0 EMPAC 500 SOUTH MAPLE STREET WACONIA MN 55387 ED PHYSICIAN SERVICES 7235225 MINNEAPOLIS HEART INSTITUTE 500 SOUTH MAPLE STREET WACONIA MN 55387 CARDIOLOGY SERVICES 3776627 EMERGENT NETWORKS 768 SOUTHCROSS DRIVE WEST STE 201 BURNSVILLE MN 55306 MIS SERVICES 1932415 CHILDRENS HEALTHCARE 2525 CHICAGO AVE SOUTH MINNEAPOLIS MN 55404 CHILDREN'S NCU CONTRACT & MEDICAL DIRECT 1089855 CHUTE AND DREW PA 111 HUNDERTMARK ROAD CHASKA MN 55318 BARIATRIC SERVICES 907868 5 1611616 476023 2087639 NET PATIENT REVENUE 621610 162082431 162082431 162082431 938324 938324 4272403 2658745 1613658 1613658 1613658 24184965 10545 22238425 0 1946540 10545 1957085 1957085 2821986 952408 1869578 1831619 37959 MISCELLANEOUS 621610 1215024 236120 978904 CAFETERIA REVENUE 722210 553687 553687 PHARMACY SERVICES 621610 270166 270166 202223 202223 2241100 172789815 162082431 2067739 6552006 1840567 1840567 79988732 60158802 19829930 2106508 1646899 459609 7090950 4967967 2122983 5135950 3713418 1422532 436161 436161 92736 92736 16151931 5450262 10701669 705648 665105 40543 5779481 3493009 2286472 946254 181527 764727 10817776 7527130 3290646 553728 263885 289843 466242 146103 320139 2035284 2035284 9875652 8023956 1851696 769113 138543 630570 MEDICAL SUPPLIES 19071358 19071358 BAD DEBT EXPENSE 4214459 4214459 MINNESOTA CARE TAX 2327811 2327811 COLLECTIONS EXPENSE 392091 392091 1150281 -213870 1333054 31097 171948713 123811648 48105968 31097 4188252 5618420 32026296 25992834 316666 20750864 21286825 3144222 3065570 2427719 3282707 187333387 103067815 79718559 84265572 9736180 10304064 31577841 32410004 183569933 186542662 16283718 19668507 112715 44578948 42694761 7501495 8559871 6899557 5704734 75263718 76740588 X 101679865 103090394 5554161 5639401 1072189 1072279 108306215 109802074 183569933 186542662 X 841102 732470 -77712 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7029 7029 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: RIDGEVIEW MEDICAL CENTER PAYS DUES TO MHA AND AHA, OF WHICH A PORTION ARE LOBBYING EXPENSES. 8643503 8643503 75263550 35867345 39396205 7201445 4446857 2754588 85881038 62753613 23127425 10343851 10343851 84265572 INVESTMENT IN CHASKA PLAZA SURGERY CENTER 589155 F INVESTMENT IN JOINT VENTURES 679729 F INVESTMENT IN RIDGEVIEW INSURANCE 748695 F INVESTMENT IN FOUNDATION 8218958 F INVESTMENT IN MN OTOLARYNGOLOGY 67527 F 10304064 UNAMORTIZED FINANCING COSTS 414768 AMOUNTS HELD UNDER SECURITY AGREEMENT 5407616 DUE FROM MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW MEDICAL CENTER 269833 SELF INSURANCE RESERVES 3366089 DEFERRED COMPENSATION PLAN 4830364 DUE FROM RIDGEVIEW CLINICS 17858668 DUE FROM FOUNDATION 100000 DUE FROM CHASKA PLAZA SURGERY CENTER 49545 DUE FROM KIDNEY SPECIALISTS AT RMP 592 DUE FROM 212 2601 DUE FROM NORTHLAND COUNSELING 50 STEP LEASE ASSET 95712 DUE FROM RIDGEVIEW REAL ESTATE, LLC 4166 INVESTMENT IN AFFILIATE 10000 32410004 DEFERRED COMPENSATION 1497759 THIRD PARTY PAYABLE 1350313 WORKERS COMPENSATION 1367493 ASSET RETIREMENT OBLIGATION 12224 BRIDGE LOAN FROM RIDGEVIEW FOUNDATION 816524 DUE TO CARDIOLOGY JOINT VENTURE 660421 5704734 X 168837272 -7099323 -7099323 175936595 -3146780 -3146780 172789815 171345408 3611153 3611153 167734255 4214459 4214459 171948714 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. GENERALLY, THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2007. THE ORGANIZATION IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT INCOME -938,324. BAD DEBT EXPENSE -4,214,459. REALIZED GAIN (LOSSES) ON INVESTMENTS -1,946,540. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -2,658,745. HOME MEDICAL EQUIPMENT COST OF GOODS SOLD -824,690. CONTRIBUTIONS 464,373. GIFT SHOP EXPENSE -127,718. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,658,745. HOME MEDICAL EQUIPMENT COST OF GOODS SOLD 824,690. GIFT SHOP EXPENSES 127,718. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,214,459. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 532464 532464 0.00320 5920255 2889694 3030561 0.01810 1411335 1411335 0.00840 7864054 2889694 4974360 0.02970 23333 403813 6508 397305 0.00240 319 312362 312362 0.00190 389 96129 13499 82630 0.00050 116 34832 34832 0.00020 15 116606 116606 0.00070 24172 963742 20007 943735 0.00570 24172 8827796 2909701 5918095 0.03540 12516 71310 71310 0.00040 12516 71310 71310 0.00040 1 4214459 368000 29287628 39989441 -10701813 X 1 1 2 1 RIDGEVIEW MEDICAL CENTER

500 SOUTH MAPLE STREET WACONIA MN 55387

X 2 MINNEAPOLIS HEART INSTITUTE AT RHC LCC

500 SOUTH MAPLE STREET WACONIA MN 55387

X PROVIDES CARDIOLOGY SERVICES RIDGEVIEW MEDICAL CENTER 1 1 1 250.000000000000 1 250.000000000000 1 X X X X X X X 1 0 1 0 X 1 X 0 0 MINNEAPOLIS HEART INSTITITUE AT RHC 2 0 0 0 0 0 0 0 0 0 X X 0 0 9 CLINICS

500 SOUTH MAPLE STREET WACONIA MN 55387

GENERAL MEDICAL CLINIC SAME DAY SURGERY

3000 HUNDERTMARK ROAD CHASKA MN 55318

GENERAL MEDCIAL & SURGICAL CLINIC SPECIALTY CLINICS

500 SOUTH MAPLE STREET WACONIA MN 55387

SEE PART VI FOR DESCRIPTION HOME HEALTH HOSPICE

500 SOUTH MAPLE STREET STE 1 WACONIA MN 55387

HOME HEALTH & HOSPICE REHAB SPECIALTIES

560 SOUTH MAPLE STREET WACONIA MN 55387

REHABILITATION SERVICES HOME MEDICAL EQUIPMENT

500 SOUTH MAPLE STREET STE 2 WACONIA MN 55387

MEDICAL EQUIPMENT SUPPLIER RIDGEVIEW SLEEP CENTER

560 SOUTH MAPLE STREET STE 103 WACONIA MN 55387

SLEEP DISORDER SERVICES PEDIATRIC REHAB

490 SOUTH MAPLE STREET STE 125 WACONIA MN 55387

PEDIATRIC SERVICES RIDGEVIEW RESEARCH

3000 HUNDERTMARK ROAD STE 8 CHASKA MN 55318

RESERACH FACILITY PART I, LINE 7: THE COSTING METHODOLOGY USED BY RMC TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON RMC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS CALCULATED BY RIDGEVIEW AS FOLLOWS: PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF THE INVOICE OR CLAIM SUBMITTED. PATIENT ACCOUNTS THAT ARE MORE THAN 90 DAYS PAST DUE ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE ORGANIZATION. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE. PART II: RIDGEVIEW OFFERS REDUCED-COST MAMMOGRAMS TO ELIGIBLE WOMEN, FREE HEALTH SCREENINGS, SUPPORT GROUP SESSIONS, HEALTH EDUCATION SEMINARS, AND COMMUNITY HEALTH INFORMATION RESOURCES.IN ADDITION, RIDGEVIEW PROVIDES FREE BIOMETRIC SCREENINGS TO AREA EMPLOYERS, BLOOD PRESSURE CHECKS AT COMMUNITY EVENTS, HAND-ONLY CPR TRAINING IN SCHOOLS, AND STAFFS COMMUNITY EVENTS WITH ITS AMBULANCE/PARAMEDIC SUPPORT AND ATHLETIC TRAINER/SPORTS MEDICINE SERVICES. PART III, LINE 4: RIDGEVIEW ESTIMATES THE BAD DEBT AMOUNT INCLUDED IN PART III, LINE 3 RELATED TO PATIENTS UNDER THEIR FINANCIAL ASSISTANCE POLICY WOULD BE ABOUT 25% OF THE TOTAL COST OF CHARITY CARE. FOR 2012, THIS AMOUNT IS ESTIMATED TO BE $368,000.THE FOOTNOTE OF RIDGEVIEW'S 2012 FINANCIAL STATEMENTS THAT INCLUDES THE EXPLANATION OF BAD DEBT EXPENSE IS THE "PATIENT RECEIVABLES, NET" FOOTNOTE INCLUDED ON PAGE 10. PART III, LINE 8: RIDGEVIEW USED THE 2012 FILED MEDICARE COST REPORT TO CALCULATE THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6. APPLIED AGAINST ACTUAL RECEIPTS RIDGEVIEW EXPERIENCED COSTS NOT COVERED BY MEDICARE IN THE AMOUNT OF $10,701,813 IN 2012. THIS IS A DIRECT BENEFIT TO THE MEDICARE POPULATION IN OUR COMMUNITY. PART III, LINE 9B: RIDGEVIEW'S CHARITY PROGRAM ALLOWS FOR ACCOUNTS IN BAD DEBT STATUS TO COMPLETE A CHARITY CARE APPLICATION. IF APPROVED, THE ACCOUNT WILL BE RETURNED FROM BAD DEBT AND APPLIED TO OUR CHARITY CARE PROGRAM. ALL PATIENTS ARE ADVISED OF OUR CHARITY CARE PROGRAM THROUGH OUR MONTHLY BILLING PROCESS. RIDGEVIEW MEDICAL CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING PATIENT ACCOUNT BALANCES. MINNEAPOLIS HEART INSTITITUE AT RHC PART V, SECTION B, LINE 10: THE MINNEAPOLIS HEART INSTITUTE DOES NOT HAVE A FORMAL GUIDELINE TO FOLLOW IN DETERMINING A PATIENT'S ELIGIBILITY FOR FREE CARE. IT IMPLEMENTS THE GUIDELINES USED BY RIDGEVIEW MEDICAL CENTER TO CERTAIN MEDICAL PROCEDURES. MINNEAPOLIS HEART INSTITITUE AT RHC PART V, SECTION B, LINE 11: THE MINNEAPOLIS HEART INSTITUTE DOES NOT HAVE A FORMAL GUIDELINE TO FOLLOW IN DETERMINING A PATIENT'S ELIGIBILITY FOR DISCOUNTED CARE. IT IMPLEMENTS THE GUIDELINES USED BY RIDGEVIEW MEDICAL CENTER TO CERTAIN MEDICAL PROCEDURES. MINNEAPOLIS HEART INSTITITUE AT RHC PART V, SECTION B, LINE 19C: THE MINNEAPOLIS HEART INSTITUTE DOES NOT HAVE A FORMAL WRITTEN POLICY TO FOLLOW RELATING TO EMERGENCY MEDICAL CARE. IT APPLIES RIDGEVIEW MEDICAL CENTER'S GUIDELINES TO CERTAIN MEDICAL PROCEDURES. RIDGEVIEW MEDICAL CENTER PART V, SECTION B, LINE 20D: RIDGEVIEW MEDICAL CENTER USES ITS LARGEST NON-GOVERNMENTAL PAYOR'S DISCOUNT PERCENTAGE WHEN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED. THE DISCOUNT GIVEN TO ALL FAP ELIGIBLE PATIENTS IS EQUAL TO THE DISCOUNT GIVEN TO THE ORGANIZATION'S LARGEST NON-GOVERNMENTAL PAYOR IN ACCORDANCE WITH THEIR AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL. MINNEAPOLIS HEART INSTITITUE AT RHC PART V, SECTION B, LINE 20D: THE MINNEAPOLIS HEART INSTITUTE DOES NOT HAVE A FORMAL WRITTEN POLICY TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. IT APPLIES RIDGEVIEW MEDICAL CENTER'S GUIDELINES TO CERTAIN MEDICAL PROCEDURES. PART V, SECTION C ENDOCRINOLOGY, PEDIATRIC INTEGRATIVE MEDICINE, DERMATOLOGY, PODIATRY, PULMONOLOGY, RHEUMATOLOGY, OTOLARYNGOLOGY, GASTROENTEROLOGY, AND BARIATRIC PART VI, LINE 2: RIDGEVIEW MEDICAL CENTER ASSESSES THE CURRENT HEALTH STATUS, HEALTH OUTCOMES, AND UNMET NEEDS IN THE 46+ COMMUNITIES IT SERVES THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS. COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND PUBLIC REPORTING ENSURES THAT RIDGEVIEW HEALTH IMPROVEMENT EFFORTS AND RESOURCES AND ALIGNED WITH COMMUNITY HEALTH PRIORITIES.RIDGEVIEW HAS AND WILL CONTINUE TO USE A CHNA AND OTHER INTERNAL, EXTERNAL (INCLUDING DISCHARGE, QUALITY MEASURES, PREDICTIVE, AND POPULATION DATA) TO AID STRATEGIC PLANNING PROCESSES AND ALIGN ORGANIZATIONAL SERVICES/RESOURCES ACCORDINGLY. PART VI, LINE 4: RIDGEVIEW SERVES A POPULATION OF APPROXIMATELY 300,000 PEOPLE, PRIMARILY FROM ITS FIVE-COUNTY SERVICE AREA OF CARVER, NORTHER SIBLEY, SOUTHERN WRIGHT, WESTERN HENNEPIN, AND EASTERN MCLEOD.AS OF THE 2010 CENSUS, THE SERVICE AREA POPULATION DISTRIBUTION BY AGE COHORT WAS 10% ARE 65+, 28% ARE 45-64, 35% ARE 18-44, AND 27% ARE 0-17. ACCORDING TO CARVER COUNTY DATA (PRIMARY SERVICE AREA), FAMILY HOUSEHOLDS MAKE UP 42% OF THE SERVICE AREA, 90% OF THE TOTAL POPULATION ARE OF CAUCASIAN DESCENT, 4% ARE OF HISPANIC DESCENT, AND 3% ARE OF ASIAN DESCENT. CARVER COUNTY MEDIAN HOUSEHOLD INCOME IS $82,710 AND 5% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PART VI, LINE 5: RIDGEVIEW MEDICAL CENTER'S PHYSICIANS, AND MEDICAL AND SUPPORT STAFF, PROVIDE SERVICES AND IN-KIND CONTRIBUTIONS TO THE COMMUNITIES IT SERVES IN A FIVE-COUNTY AREA. EXAMPLE OF RIDGEVIEW'S COMMUNITY BENEFIT CONTRIBUTIONS INCLUDE UNDERFUNDING OF MEDICARE AND MEDICAID AND CHARITY CARE, FREE LACTATION CONSULTATIONS TO NEW MOTHERS, JOB SHADOWS FOR HIGH SCHOOL AND COLLEGE STUDENTS, INTERNSHIP OPPORTUNITIES FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS(BOTH CLINICAL AND NON-CLINICAL), AND DISCOUNTS TO THE UNINSURED. RIDGEVIEW ALSO PROVIDES IN-KIND AND FINANCIAL DONATIONS TO OTHER NON-PROFITS' COMMUNITY HEALTH INITIATIVES (INCLUDING WESTONKA WECAB TRANSPORTATION SERVICE, PAY IT FORWARD FUND, AND COMMUNITY HEALTH AND WELLNESS EVENTS). REPORTS FILED WITH STATES PART VI, LINE 7 MN X X 0 1 0 0 0 0 0 0 0 ROBERT HEETER MD 5000 191924 0 0 0 0 0 0 0 0 5000 191924 0 0 ROBERT STEVENS 339986 0 0 0 0 0 154233 0 10253 0 504472 0 0 0 PATRICIA MICHAELSON 221592 0 0 0 0 0 15339 0 6887 0 243818 0 0 0 JOHN PRONDZINSKI 194534 0 0 0 0 0 14472 0 6887 0 215893 0 0 0 GORDON GABLENZ 200608 0 0 0 0 0 14814 0 11206 0 226628 0 0 0 MICHAEL PHELPS 217879 0 0 0 0 0 13861 0 10229 0 241969 0 0 0 DOUGLAS STASEK 181836 0 0 0 0 0 13337 0 9855 0 205028 0 0 0 SARAH HASTINGS 159664 0 0 0 0 0 13305 0 10253 0 183222 0 0 0 BERNARD BUCKLAND 174867 0 0 0 0 0 6339 0 6866 0 188072 0 0 0 LINDA HONSTAD 167568 0 0 0 0 0 5674 0 5725 0 178967 0 0 0 KRISTI WIDSETH 166231 0 0 0 0 0 5806 0 30 0 172067 0 0 0 CYNTHIA BRICK 166055 0 0 0 0 0 6141 0 11206 0 183402 0 0 0 ARLIEN CORTLAND 164472 0 0 0 0 0 5768 0 30 0 170270 0 0 0 PART I, LINE 4B ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN ACCRUED $154,233 DURING 2012. A CITY OF WINSTED MINNESOTA 416005652 2007-04-27 5000000 BUILDING ADDITION TO HOSPITAL 0 0 0 B CITY OF DELANO MINNESOTA 416005093 2007-05-14 4337423 BUILDING ADDITION TO HOSPITAL 0 0 0 C CITY OF WACONIA MINNESOTA 411754003 2003-11-25 9670000 REFUND SERIES 1993 BONDS & BUILDING CLINIC 0 0 0 D CITY OF EXCELSIORMINNESOTA 416005143 2005-07-12 4212750 BUILD NEW CLINIC AND FINANCE MRI 0 0 0 A 72888 5000000 100000 4900000 2007 0 0 1 1 B 63229 4337423 85000 4252423 2007 0 0 1 1 C 7469903 9670000 6502339 117661 3050000 2003 1 0 1 1 D 1656237 4212750 82500 4130250 2005 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 1 1 0 0.02400 0.02400 0 0 1 D 0 0 0 0 0 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 A CITY OF COLOGNE MINNESOTA 416005068 2007-03-13 9000000 DEFEASE 1999 BONDS 0 0 0 B CITY OF CARVER MINNESOTA 416005037 2007-03-28 7000000 DEFEASE 1999 BONDS 0 0 0 C CITY OF HAMBURG MINNESOTA 410941733 2007-04-12 7000000 DEFEASE 1999 BONDS 0 0 0 A 131415 9000000 8950000 50000 2007 0 1 1 1 B 104991 7000000 6950000 50000 2007 0 1 1 1 C 102043 7000000 6102423 50000 847577 2007 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 A 1 B 1 C 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON, THE VICE CHAIRPERSON, THE SECRETARY, AND THE TREASURER AS EX OFFICIO VOTING MEMBERS THEREOF. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE FULL AUTHORITY OF THE BOARD EXCEPT AS OTHERWISE LIMITED BY LAW, BY THE BOARD, OR BY THESE BYLAWS. THE EXECUTIVE COMMITTEE SHALL TRANSACT THE BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL CONDUCT AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND REPORT THE FINDINGS AND RECOMMENDED COMPENSATION AND BENEFITS TO THE BOARD OF DIRECTORS. AFTER RECEIVING THE EXECUTIVE COMMITTEE'S REPORT, THE ENTIRE BOARD SHALL THEN SET THE COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AS THE BOARD DEEMS APPROPRIATE. THE EXECUTIVE COMMITTEE SHALL ESTABLISH A PROCESS FOR STRATEGIC PLANNING WHICH SHALL ALSO ENCOMPASS BOARD RETREATS. FORM 990, PART VI, SECTION A, LINE 4 RIDGEVIEW MEDICAL CENTER AMENDED THE BYLAWS DURING 2012. THE CHANGES WERE AS FOLLOWS: - THE EXECUTIVE COMMITTEE SHALL ESTABLISH A PROCESS FOR STRATEGIC PLANNING WHICH SHALL ALSO ENCOMPASS BOARD RETREATS. - THE EDUCATION COMMITTEE SHALL CONSIST OF NOT FEWER THAN THREE (3) MEMBERS OF THE BOARD, EACH OF WHOM SHALL BE APPOINTED BY THE CHAIRPERSON. THIS COMMITTEE SHALL MEET NOT LESS THAN QUARTERLY. - THE EDUCATION COMMITTEE SHALL ESTABLISH AND ADMINISTER A BOARD EDUCATION PROGRAM, INCLUDING GUIDELINES AND RECOMMENDATIONS WITH REGARD TO CONFERENCES AND SEMINARS. FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S HEALTH CARE, D/B/A CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA, IS A MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE MAYOR OF WACONIA SERVES AS AN EX-OFFICIO NON-VOTING MEMBER OF THE BOARD. CERTAIN RIGHTS, LIKE AUTHORITY OVER CAPITAL EXPANDITURES, ARE RESERVED BY THE CITY OF WACONIA. AS A CORPORATE MEMBER OF RIDGEVIEW MEDICAL CENTER, CHILDREN'S HOSPITAL AND CLINICS SHALL HAVE THE RIGHT TO APPROVE ANY AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS TO THE EXTENT SUCH AMENDMENT WOULD MATERIALLY ADVERSELY AFFECT THE RIGHTS OR OBLIGATIONS OF CHILDREN'S AS A MEMBER OF RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWES THE FORM 990. THE BOARD OF DIRECTORS ARE PROVIDED A COPY OF THE FORM AFTER THER CFO'S REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION. THE BOARD USES COMPARABILITY DATA FROM A COMPENSATION SURVEY AND VOTES ON HIS COMPENSATION. HOWEVER, ONE BOARD MEMBER, A PHYSICIAN WHO IS EMPLOYED BY RIDGEVIEW CLINICS, DOES NOT VOTE ON THE CEO'S COMPENSATION. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. THE CEO DETERMINES THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES. HIS DUE DILIGENCE PROCEDURES INCLUDE REVIEWING COMPENSATION SURVEYS AND PRESENTING HIS CONCLUSIONS TO THE BOARD OF DIRECTORS FOR APPROVAL. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW MEDICAL CENTER HOLDS A PUBLIC MEETING ANNUALLY, AT WHICH THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PRESENTED. OTHERWISE THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INVESTMENT IN FOUNDATION -77,712. 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