2013-11-14T15:29:24-06:00 2012-12-31 135665207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2012-01-01 410811697 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC LAKE 9528836584 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DOUGLAS E JOHNSON 9528836584 2013-11-14 1 JASON DIVINE P01076050 6123055000 2012 2016-02-25 16:41:14Z DOUGLAS E JOHNSON 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 86125919 0 X WWW.LAKEVIEW.ORG X 1880 MN SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS 9 8 823 199 0 0 284194 19653 65364949 86031944 -96457 37125 37197 37197 65589883 86125919 56961 222708 0 0 31603382 45784960 0 0 0 27227072 35165861 58887415 81173529 6702468 4952390 45148455 50509386 20569007 21841354 24579448 28668032 X TO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY. 0 0 71902275 222708 82194572 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS 71902275 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 823 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X X DOUG JOHNSON 6514304581 927 CHURCHILL STREET WEST STILLWATER MN 55082 X BRUCE BARTIE DO 0.10 X 0 0 0 ARBA-DELLA BECK 0.10 X 0 0 0 REBECCA BILLINGSLEY 0.10 X 0 0 0 PETER CLEMENTS 0.10 X 0 0 0 PHIL DONALDSON 0.10 X 0 0 0 RON PHILLIPPO 0.10 X 0 0 0 DAVID REAMER 0.10 X 0 0 0 JIM SCHUG 0.10 X 0 0 0 KENNETH D HOLMEN MD 0.50 54.50 X 0 598819 160346 CURT GEISSLER 53.50 0.50 X 346448 0 57133 DOUGLAS E JOHNSON 38.00 17.00 X 297995 0 50874 JEFFREY J ROBERTSON 31.70 14.30 X 570018 0 58940 MARY E JONES 56.00 X 211721 0 41045 JO E SITTLOW 50.00 X 160694 0 43918 CYNTHIA A APPLESETH 45.00 X 143570 0 45121 JEFFREY W MAANUM 40.00 X 131231 0 34614 BRUNILDA H FULLERTON 40.00 X 129032 0 15775 1990709 598819 507766 21 0 1 0 METROPOLITAN MECHANICAL CONTRACTORS 7450 FLYING CLOUD DR EDEN PRAIRIE MN 55344 CONSTRUCTION SERVICES 1011420 QUEST DIAGNOSTICS 1355 MITTEL BLVD WOODDALE IL 60191 REFERENCE LAB SERVICES 723063 PARSONS ELECTRIC COMPANY NW 9562 PO BOX 1450 MINNEAPOLIS MN 554859562 ELECTRICAL CONSTRUCTION & MAINTENANCE 426616 NURSE ANESTHESIA SERVICES PA 8990 SPRINGBROOK DR COON RAPIDS MN 55432 PROFESSIONAL NURSE ANESTHESIA CALL 399996 FAVORITE HEALTHCARE STAFFING PO BOX 803356 KANSAS CITY MO 641803356 HEALTHCARE STAFFING SERVICES 363321 15 19653 19653 NET PATIENT REVENUE 623990 82194590 82194590 OTHER REVENUE 900099 3351042 3351042 CAFETERIA 722210 313839 313839 GIFT SHOP 453220 137801 137801 CONTRACT REVENUE 900099 34672 34672 86031944 37125 37125 37197 0 37197 37197 37197 86125919 82194590 0 3911676 222708 222708 1381408 1381408 35480624 31407985 4072639 2722815 2512571 210244 3791623 3498851 292772 2408490 2222517 185973 8919 8919 2425108 2951248 -526140 54589 25662 28927 1213009 824730 388279 681495 438551 242944 817658 811023 6635 184768 172744 12024 40255 25171 15084 898328 898328 2694861 2087185 607676 333214 11401 321813 MEDICAL & PHARMACY SUPP 20107796 20104980 2816 EQUIPMENT & MAINTENANCE 2599904 2021397 578507 TAXES & ASSESSMENTS 1799103 1799103 OTHER EXPENSE 1305315 754532 550783 1539 997 542 81173529 71902275 9271254 0 8631377 10800908 9762651 11527891 1939961 1901718 525276 722081 27574431 3866194 22275672 23708237 1282532 1187410 730986 661141 45148455 50509386 9882228 8220515 10686779 13620839 20569007 21841354 X 24579448 28668032 24579448 28668032 45148455 50509386 X 4952390 -863806 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 0 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 3063819 3063819 13988017 1454212 12533805 326621 42958 283663 9084635 2106301 6978334 1111339 262723 848616 23708237 PENSION RESERVE 13620839 13620839 86125919 0 86125919 0 86125919 81173529 0 81173529 0 81173529 1 1 1 X 1 X 1 1 1 0 1 1 296704 296704 0.00370 9418978 7730930 1688048 0.02080 9715682 7730930 1984752 0.02450 233217 233217 0.00290 56237 56237 0.00070 14306653 10723933 3582720 0.04410 203014 203014 0.00250 14799121 10723933 4075188 0.05020 24514803 18454863 6059940 0.07470 21148 21148 0.00030 21148 21148 0.00030 1 1756802 0 20308605 22999577 -2690972 X 1 1 1 HIGH POINTE SURGERY CENTER AMBULATORY SURGERY 0.38000 0.62000 1 1 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION

927 CHURCHILL STREET W STILLWATER MN 55082

X X X LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 PART I, LINE 7: ACTUAL COSTS ESTIMATED USING COST-TO-CHARGE RATIO AND EXCLUDING BAD DEBT PART III, LINE 4: THE "ACTUAL COST" OF BAD DEBT INCLUDED IN COMMUNITY BENEFIT IS ESTIMATED. BAD DEBT EXPENSE REPRESENTS THOSE ACCOUNTS RECEIVABLE WRITTEN OFF FROM PATIENTS THAT HAVE THE ABILITY TO PAY, AS DETERMINED FROM CHARITY CARE APPLICATIONS AND OTHER DOCUMENTATION, BUT CHOOSE NOT TO. THE BAD DEBT AMOUNT IS THE RECEIVABLE AFTER INSURANCE PAYMENT AND ADJUSTMENTS HAVE ALREADY BEEN MADE, INCLUDING ADJUSTMENTS FOR SELF-PAY IN ACCORDANCE WITH THE AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL'S OFFICE. SINCE REDUCTIONS HAVE ALREADY BEEN MADE FOR DISCOUNTS AND OTHER ALLOWANCES, THE ENTIRE BALANCE IS CONSIDERED BAD DEBT AND NO FURTHER REDUCTIONS ARE CONSIDERED.THE 2012 AUDITED FINANCIAL STATEMENTS OF LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL) DO NOT INCLUDE A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. PREVIOUS FINANCIAL STATEMENTS INCLUDED THE FOLLOWING DESCRIPTION UNDER NOTE 1: "THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE SELF-PAY AND MISCELLANEOUS COMMERCIAL INSURANCE ACCOUNTS. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT BY INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTABILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THE TIME." PART III, LINE 8: THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE: 1) IT PROVIDES SERVICES TO A SIGNIFICANT PORTION OF OUR SERVICE POPULATION AT A NEGATIVE MARGIN; 2) THE HOSPITAL WOULD DISCONTINUE PROVIDING SERVICES TO MEDICARE PATIENTS IF THE DECISION WERE BASED STRICTLY ON A FINANCIAL BASIS; 3) THERE IS A COMMUNITY NEED TO PROVIDE THESE SERVICES LOCALLY; 4) IF THE HOSPITAL DID NOT PROVIDE THESE SERVICES, THEY WOULD BECOME THE OBLIGATION OF THE GOVERNMENT. PART III, LINE 9B: IF A PATIENT WAS NOT IDENTIFIED AS A POTENTIAL CHARITY CARE CANDIDATE UPON REGISTRATION, THE FIRST COLLECTIONS CONTACT IS WITH THE HOSPITAL'S INTERNAL BUSINESS STAFF, WHO INTERVIEW THE PATIENT AND DETERMINE IF THE PATIENT IS A CANDIDATE FOR CHARITY CARE. IF THE NECESSARY PAPERWORK IS COMPLETED AND THEY DO QUALIFY FOR CHARITY CARE, THERE IS NO FURTHER COLLECTION ACTIVITY; HOWEVER IF THE PAPERWORK IS NOT COMPLETED, OR IS COMPLETED AND THEY DO NOT MEET THE CRITERIA, THEY ARE SUBJECT TO FURTHER COLLECTION ACTIVITY. THIS FIRST OCCURS INTERNALLY THROUGH HOSPITAL STAFF. IF INTERNAL ATTEMPTS ARE UNSUCCESSFUL, THIS SUBSEQUENTLY OCCURS THROUGH OUTSIDE COLLECTION AGENCIES. LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 4: OTHER HOSPITAL FACILITIES INCLUDED IN THE CHNA WERE: - HUDSON HOSPITAL, HUDSON, WI - WESTFIELDS HOSPITAL, NEW RICHMOND, WI - REGIONS HOSPITAL, ST. PAUL, MN LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 7: "INCREASE ACCESS TO DENTAL SERVICES" WAS IDENTIFIED AS THE SIXTH PRIORITY IN THE COMMUNITIES SERVED BY REGIONS, THE HOSPITAL, HUDSON AND WESTFIELDS. WHILE THIS IS A CONCERN IN THE COMMUNITY, THE TEAM DECIDED TO FOCUS THEIR EFFORTS ON THE OTHER FIVE PRIORITIES BECAUSE HEALTHPARTNERS AS AN INSURANCE COMPANY IS CURRENTLY THE LEADING DENTAL CARE PROVIDER TO UNINSURED PEOPLE IN MINNEAPOLIS/ST. PAUL. ACCESS TO DENTAL CARE IS NOT A CORE SERVICE LINE FOR THE HOSPITALS AND IS OUTSIDE THE SCOPE OF THE HOSPITAL INFLUENCE. AS A RESULT COMMUNITY BENEFIT ACTIVITIES WOULD BE MORE BENEFICIAL IN THE OTHER PRIORITIZED AREAS.WHILE OVERALL THE TEAM DECIDED NOT TO FOCUS EFFORTS ON ORAL HEALTH SERVICES, IT IS NOTEWORTHY THAT ST. CROIX COUNTY IS ADDRESSING "ORAL HEALTH" AS A SUBSET WITHIN THE "ACCESS TO PRIMARY AND PREVENTIVE HEALTH SERVICES" HEALTH PRIORITY AND TASK FORCE. LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, PART V, SECTION B, LINE 20D: THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINE PRESCRIBED CALCULATION TO DETERMINE THE MAXIMUM CHARGEABLE AMOUNT FOR PATIENTS DETERMINED TO BE FAP ELIGIBLE. INPUT FROM THE COMMUNITY - PART 1 OF 2 SCHEDULE H, PART V, SECTION B, LINE 3 INPUT FROM PEOPLE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITYINTERVIEW FINDINGSAS PART OF THE DATA COLLECTION PROCESS, REPRESENTATIVES FROM COMMUNITY HOSPITAL CONSULTING CONDUCTED INTERVIEWS WITH TWENTY (20) STAKEHOLDERS FROM MARCH 14, 2012 APRIL 6, 2012. INTERVIEWS WERE CONDUCTED WITH PEOPLE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY INCLUDING:- PEOPLE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH- FEDERAL, TRIBAL, REGIONAL, STATE OR LOCAL HEALTH DEPARTMENTS OR AGENCIES WITH INFORMATION RELEVANT TO THE HEALTH NEEDS OF COMMUNITY SERVED- LEADERS, REPRESENTATIVES OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVEDTHE COUNTIES REPRESENTED INCLUDED WASHINGTON, DAKOTA, ST. CROIX AND RAMSEY. THE GOAL OF THE INTERVIEWS WAS TO GATHER OPINIONS AND PERCEPTIONS ON CURRENT HEALTH CARE ISSUES FACED IN THE COUNTIES SERVED AND/OR POPULATIONS REPRESENTED. THESE INSTITUTIONS SHARED STATISTICAL INFORMATION ALONG WITH ANECDOTAL INFORMATION ABOUT HEALTH NEEDS IN THE COMMUNITY.BACKGROUND INFORMATION WAS GATHERED FOR EACH INTERVIEW SUBJECT, INCLUDING:- ORGANIZATION DESCRIPTION AND FUNCTIONS- RESPONDENT POSITION AND TENURE WITH ORGANIZATION- SUBJECT'S BACKGROUND, RELATED YEARS' EXPERIENCE AND COMMUNITY CONNECTIONS THE SUBJECTS' COMBINED EXPERIENCE RELATED IN THEIR FIELDS EQUALS 357 YEARS. THE ORGANIZATIONS REPRESENTED INCLUDE:- AMHERST H. WILDER FOUNDATION- BOUTWELLS LANDING- CANVAS HEALTH- CATHOLIC CHARITIES- COMMUNITY THREAD- COURAGE CENTER- DAKOTA COUNTY PUBLIC HEALTH- EMERGENCY AND COMMUNITY HEALTH OUTREACH (ECHO)- FAMILY MEANS- GOOD SAMARITAN SOCIETY- MENTAL HEALTH CRISIS ALLIANCE- MINNESOTA DEPARTMENT OF HEALTH- NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI)- PORTICO HEALTHNET- RAMSEY COUNTY PUBLIC HEALTH AND THE CITY OF ST. PAUL PUBLIC HEALTH (A JOINT PROGRAM)- SOUTHSIDE COMMUNITY HEALTH SERVICES ST. CROIX FAMILY MEDICAL CLINIC- ST. CROIX COUNTY PUBLIC HEALTH- ST. CROIX COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES- UNITED WAY OF WASHINGTON COUNTY-EAST- WASHINGTON COUNTY PUBLIC HEALTHCOMMUNITY HEALTH NEEDS ASSESSMENT INTERVIEW PARTICIPANTSNAME ORGANIZATION TITLE- MAYKAO Y. HANG, AMHERST H. WILDER FOUNDATION C.E.O. MAYKAO ATTENDED BROWN UNIVERSITY (MASTERS IN PSYCHOLOGY), AND RECEIVED A PHD FROM HAMLIN. SHE HAS 15 YEARS EXPERIENCE IN NONPROFIT, HEALTH AND HUMAN SERVICES WITH THE LOW INCOME AND DISABILITIES POPULATIONS. SHE HAS SERVED AS HEALTH SERVICES DIRECTOR, ON THE REGIONS HOSPITAL BOARD, HEALTHPARTNERS BOARD AND HEALTHCARE REFORM BOARD, STATE OF MINNESOTA. SHE HAS BEEN AT WILDER 4 YEARS, 1.5 YEARS AS C.E.O.- SUE HEDLUND, WASHINGTON COUNTY PUBLIC HEALTH DEPUTY DIRECTOR. SUE HAS WORKED 23 YEARS WITH THE COUNTY AND 6 YEARS IN HER ROLE AS DEPUTY DIRECTOR. RESPONSIBILITIES INCLUDE: BUDGET, PLANNING, COMMUNITY HEALTH ASSESSMENTS, AND TECHNOLOGY.- MARNA CANTERBURY, UNITED WAY OF WASHINGTON COUNTY EAST EXECUTIVE DIRECTOR. MARNA HAS BEEN THE EXECUTIVE DIRECTOR OF UNITED WAY OF WASHINGTON COUNTY EAST FOR THE PAST 3+ YEARS. PREVIOUS WORK INCLUDES WORK IN HEALTHCARE AND WELLNESS PLANNING AND PRIVATE FOUNDATIONS. SHE HOLDS A MASTERS IN COMMUNITY HEALTH AND IS ALSO A REGISTERED DIETICIAN. MARNA'S NEXT ROLE WILL INCLUDE WORK ON THE HOSPITAL'S NEXT CHNA.- FRED JOHNSON & WENDY KRAMER, ST. CROIX HEALTH AND HUMAN SERVICES DIRECTOR/HEALTH OFFICER. FRED JOHNSON HAS BEEN DIRECTOR AT THE ST. CROIX HHS FOR 7 YEARS AND HAS BEEN WITH HHS SINCE 1995. WENDY IS HEALTH OFFICER AND HAS BEEN IN THIS ROLE 3 YEARS AND WITH THE DEPARTMENT IN VARIOUS POSITIONS FOR 27 YEARS.- SHARON REYZER, ST. CROIX COUNTY PUBLIC HEALTH PUBLIC HEALTH NURSE SUPERVISOR. SHARON HAS BEEN IN HER CURRENT ROLE FOR 3 TO 4 YEARS. PREVIOUSLY SHE WAS A PUBLIC HEALTH NURSE FOR ST. CROIX COUNTY AND HAS WORKED FOR THE PUBLIC HEALTH DEPARTMENT FOR A TOTAL OF 27 YEARS. SHE SUPERVISES 4 PUBLIC HEALTH NURSES, DIRECTS THE WIC PROGRAM, SUPERVISES 2 DIETICIANS, 2 CONTRACT DIETICIANS AND 3 SUPPORT STAFF.- BILL TENDLE, SOUTHSIDE COMMUNITY HEALTH SERVICES-ST. CROIX FAMILY MEDICAL CLINIC EXECUTIVE DIRECTOR/C.E.O. BILL HAS BEEN AN EMPLOYEE AT SOUTHSIDE FOR 16 YEARS AND HAS BEEN EXECUTIVE DIRECTOR FOR 15+ YEARS. HE HAS AN UNDERGRADUATE DEGREE FROM UNIVERSITY OF MINNESOTA AND A MASTERS IN HEALTH ADMINISTRATION FROM CARDELL SCRIPTS UNIVERSITY. HIS CAREER IN HEALTHCARE (OR CONSULTING FOR HEALTHCARE) SPANS OVER 30 YEARS.- RINA MCMANUS & SUZANN STENSO-VELO, RAMSEY COUNTY PUBLIC HEALTH /CITY OF ST. PAUL PUBLIC HEALTH DIRECTOR/PLANNING SPECIALIST. RINA SERVES AS DIRECTOR OF RAMSEY COUNTY PUBLIC HEALTH AND THE CITY OF ST. PAUL PUBLIC HEALTH (IT IS A JOINT PROGRAM). SHE HAS BEEN WITH THE PROGRAM FOR 8 MONTHS, BUT HAS A LONG PUBLIC HEALTH CAREER FROM THE 1970S; AND HOLDS MANY AWARDS IN PUBLIC HEALTH. SHE DIRECTS ALL PROGRAMS WHICH INCLUDE ENVIRONMENTAL HEALTH, FAMILY HEALTH, PUBLIC HEALTH HOME VISITING, HEALTH EDUCATION, CORRECTIONAL HEALTH, DISEASE PREVENTION, EMERGENCY PREPAREDNESS AND CLINICAL SERVICES. SUZANN IS A PLANNING SPECIALIST WHO HOLDS A MASTER'S IN PUBLIC HEALTH; WAS WITH WASHINGTON COUNTY FOR 16 YEARS, AND HAS BEEN WITH RAMSY COUNTY FOR 10 YEARS. SHE IS RESPONSIBLE FOR THE COMMUNITY HEALTH IMPROVEMENT PLANS AND ACCREDITATION PROCESS.- DEB HOLMGREN, PORTICO HEALTHNET EXECUTIVE DIRECTOR. DEB HAS SERVED AS EXECUTIVE DIRECTOR OF PORTICO HEALTHNET FOR APPROXIMATELY 17 YEARS; AND HAS BEEN AN EMPLOYEE OF PORTICO HEALTH FOR 19 YEARS. SHE WORKED ON OPENING THE ORGANIZATION FOR 2 YEARS PRIOR TO THIS. SHE HAS WORKED IN HEALTHCARE HER ENTIRE CAREER INCLUDING WORKING AS A HOSPITAL SOCIAL WORKER, PROGRAM PLANNING AND STRATEGIC PLANNING. SHE HAS A DEGREE IN MEDICAL SOCIOLOGY.- SUE ABDERHOLDEN, NATIONAL ALLIANCE ON MENTAL ILLNESS EXECUTIVE DIRECTOR. SUE IS EXECUTIVE DIRECTOR OF THE NATIONAL ALLIANCE ON MENTAL ILLNESS AND HAS BEEN AN EMPLOYEE FOR OVER 10 YEARS. NAMI OF MINNESOTA IS A NON-PROFIT ORGANIZATION DEDICATED TO IMPROVING THE LIVES OF ADULTS AND CHILDREN WITH MENTAL ILLNESS AND THEIR FAMILIES. NAMI MINNESOTA OFFERS EDUCATION, SUPPORT AND ADVOCACY.- JEANNE AYERS, MINNESOTA DEPARTMENT OF HEALTH ASSISTANT COMMISSIONER. JEANNE EARNED A MASTERS DEGREE IN PUBLIC HEALTH FROM THE UNIVERSITY OF MINNESOTA AND A BACHELORS DEGREE IN NURSING, WITH A MINOR IN PSYCHOLOGY, FROM MARQUETTE UNIVERSITY IN MILWAUKEE, WISCONSIN. SHE WAS APPOINTED IN JANUARY 2011 TO SERVE AS ASSISTANT COMMISSIONER FOR THE MINNESOTA DEPARTMENT OF HEALTH. AS ASSISTANT COMMISSIONER, JEANNE IS RESPONSIBLE FOR OVERSEEING THE DEPARTMENT'S COMMUNITY AND FAMILY HEALTH PROMOTION BUREAU. THIS BUREAU INCLUDES THE COMMUNITY AND FAMILY HEALTH DIVISION, THE HEALTH PROMOTION AND CHRONIC DISEASE DIVISION, THE OFFICE OF MINORITY AND MULTICULTURAL HEALTH AND THE OFFICE OF STATEWIDE HEALTH IMPROVEMENT INITIATIVES.- ROGER MEYER, MENTAL HEALTH CRISIS ALLIANCE EXECUTIVE DIRECTOR. ROGER IS A CONSULTANT WHO HAS WORKED PRIMARILY IN A FACILITATION ROLE IN NON-PROFITS. HIS ROLE INCLUDES STRATEGIC PLANNING, PROGRAM DIRECTOR, AND FACILITATION. HE HAS SPENT THE LAST 6 YEARS IN HIS FACILITATION ROLE AT MENTAL HEALTH CRISIS ALLIANCE.- NATHAN PEARSON, GOOD SAMARITAN SOCIETY-STILLWATER EXECUTIVE DIRECTOR. NATHAN IS EXECUTIVE DIRECTOR OF THE GOOD SAMARITAN SOCIETY IN STILLWATER, MN AND HAS BEEN AN EMPLOYEE FOR 14 1/2 YEARS. IN ADDITION TO SPEAKING WITH NATHAN, THE INTERVIEW INCLUDED CAROLINE FRASCONE, RN (DIRECTOR OF NURSING), REBECCA MARSNIK, LSW (DIRECTOR OF SOCIAL SERVICES) AND DIANE HOLMES.- ARBA-DELLA BECK, FAMILY MEANS PRESIDENT. ARBA HAS BEEN THE PRESIDENT OF FAMILY MEANS FOR 16 YEARS. SHE HOLDS A MASTERS DEGREE IN SOCIAL WORK, AND A MBA FROM THE UNIVERSITY OF SAINT THOMAS -SCHOOL OF BUSINESS. SHE SERVES ON THE BOARD AT THE HOSPITAL.- LILLIAN MCDONALD, EMERGENCY AND COMMUNITY HEALTH OUTREACH (ECHO) FOUNDING EXECUTIVE DIRECTOR. LILLIAN IS THE FOUNDING EXECUTIVE DIRECTOR OF ECHO, WHICH BEGAN ITS WORK IN 2004 IN RESPONSE TO A NEED FOR EMERGENCY SERVICES WITH NON-ENGLISH SPEAKING POPULATIONS.- BONNIE BRUESHOFF, DAKOTA COUNTY PUBLIC HEALTH PUBLIC HEALTH DIRECTOR. BONNIE IS PUBLIC HEALTH DIRECTOR OF THE DAKOTA COUNTY PUBLIC HEALTH DEPARTMENT (DCPHD) AND HAS BEEN AN EMPLOYEE FOR 22 YEARS. BONNIE'S BACKGROUND IS IN NURSING.- PETER POLGA, COURAGE CENTER-STILLWATER DIRECTOR OF STRATEGY AND PLANNING. PETER HAS BEEN IN HIS CURRENT POSITION WITH COURAGE CENTER FOR OVER 3 YEARS, AND AN EMPLOYEE FOR 35 YEARS. PREVIOUSLY HE SERVED AS DIRECTOR OF THE ST. CROIX COURAGE CENTER AND AS DIRECTOR OF PHYSICAL/MEDICAL REHABILITATION FOR THE GOLDEN VALLEY LOCATION. PETER IS A LICENSED PHYSICAL THERAPIST.SEE CONTINUATION IN PART 2 OF 2 INPUT FROM THE COMMUNITY - PART 2 OF 2 SCHEDULE H, PART V, SECTION B, LINE 3 CONTINUATION FROM PART 1 OF 2- VALERIE JONES, COMMUNITY THREAD EXECUTIVE DIRECTOR. VALERIE HAS SPENT HER ENTIRE CAREER IN THE NONPROFIT SECTOR. HER EXPERIENCE INCLUDES WORK IN A GOVERNMENT NONPROFIT ORGANIZATION CONDUCTING RESEARCH, PLANNING AND COORDINATION OF SERVICES IN NORTHWEST MINNEAPOLIS.- TIM MARX, CATHOLIC CHARITIES C.E.O. TIM BEGAN HIS DUTIES AS CEO OF CATHOLIC CHARITIES IN 2011, AND PREVIOUSLY SERVED AS EXECUTIVE DIRECTOR OF NEW YORK CITY-BASED COMMON GROUND. PRIOR TO THIS HE WORKED AS MINNESOTA HOUSING COMMISSIONER, ST. PAUL CITY ATTORNEY, DEPUTY MAYOR AND AS A LAWYER IN PRIVATE PRACTICE. HE SERVES ON THE BOARD OF DIRECTORS OF THE NATIONAL ALLIANCE TO END HOMELESSNESS. HE HOLDS A JD AND A MASTER'S DEGREE IN PUBLIC AFFAIRS FROM THE UNIVERSITY OF MINNESOTA.- MARK KUPPE, CANVAS HEALTH C.E.O. MARK HAS SERVED AS CEO OF CANVAS HEALTH (WHICH SERVES INDIVIDUALS WITH MENTAL OR CHEMICAL DISORDERS) SINCE 2007. HE HAS BEEN AN EMPLOYEE FOR 30 YEARS. HE IS A LICENSED PSYCHOLOGIST AND LICENSED MARRIAGE AND FAMILY THERAPIST.- GREG CARLSON, BOUTWELLS LANDING EXECUTIVE DIRECTOR. GREG IS INTERIM EXECUTIVE DIRECTOR OF BOUTWELLS LANDING AND HAS BEEN WITH THEM FOR 6 MONTHS. HE HAS BEEN AN EMPLOYEE OF PRESBYTERIAN HOMES AND SERVICES FOR 6 YEARS. HE WAS PREVIOUSLY A LONG TERM CARE HOSPITAL ADMINISTRATOR AND HAS BEEN A LICENSED NURSING HOME ADMINISTRATOR FOR OVER 40 YEARS.- INTERVIEW METHODOLOGY - REGIONS HOSPITAL AND THE HOSPITAL PROVIDED CHC CONSULTING WITH A LIST OF MORE THAN 90 PEOPLE WITH SPECIAL KNOWLEDGE OF DAKOTA, RAMSEY, WASHINGTON, AND ST. CROIX COUNTIES INCLUDING PUBLIC HEALTH REPRESENTATIVES, NOT-FOR-PROFIT ORGANIZATION PROFESSIONALS, CHARITIES AND OTHER INDIVIDUALS WHO FOCUS SPECIFICALLY ON UNDERREPRESENTED GROUPS. FROM THAT LIST, 20 IN DEPTH INTERVIEWS WERE CONDUCTED USING A STRUCTURED INTERVIEW GUIDE. BOTH THE LIST OF 20, AND THE LARGER GROUP OF 94 PEOPLE RECEIVED A SURVEY IN ORDER TO FURTHER QUANTIFY THE DATA. EXTENSIVE NOTES WERE TAKEN DURING EACH INTERVIEW AND THEN QUANTIFIED BASED ON RESPONSES, COMMUNITIES AND POPULATIONS (MINORITY, ELDERLY, UN/UNDERINSURED, ETC.) SERVED, AND PRIORITIES IDENTIFIED BY RESPONDENTS. QUALITATIVE DATA FROM THE INTERVIEWS WAS ALSO ANALYZED AND REPORTED.- SURVEY CONSTRUCTION, DISTRIBUTION, AND COLLECTION - AN ELECTRONIC SURVEY WAS CONSTRUCTED USING SURVEY MONKEY SOFTWARE IN ORDER TO GATHER OPINIONS AND INPUT OF THOSE WITH SPECIAL KNOWLEDGE REGARDING THE HEALTH NEEDS AND PRIORITIES OF THE SERVICE AREA. THE SURVEY WAS RESTRICTED SO THAT RESPONDENTS COULD ONLY COMPLETE THE SURVEY ONCE PER COMPUTER TO - PROTECT THE INTEGRITY OF THE DATA. THE SURVEY WAS INITIALLY DISTRIBUTED TO 94 ORGANIZATION LEADERS AND COMMUNITY MEMBERS (INCLUDING INTERVIEWEES AS A FOLLOW-UP). RECIPIENTS WERE ALLOWED TO FORWARD THE SURVEY TO OTHER STAKEHOLDERS WHO THEY DEEMED TO BE VALUABLE SOURCES OF INPUT. THE SURVEY REMAINED OPEN FOR APPROXIMATELY THREE WEEKS. RESPONSES WERE QUANTIFIED AND ANALYZED FOR REPORTING PURPOSES, INCLUDING ANY FREE-FORM COMMENTS.- FOCUS GROUPS/TOWN HALL METHODOLOGY - A FACILITATED FOCUS GROUP WAS CONDUCTED AT REGIONS HOSPITAL WITH 6 PEOPLE WHO HAD SPECIAL KNOWLEDGE OF A PARTICULAR MINORITY GROUP IN THE COMMUNITY. SURVEY AND INTERVIEW FINDINGS WERE PRESENTED IN A TOWN HALL STYLE MEETING TO A GROUP OF 12 COMMUNITY MEMBERS AND LEADERS AT THE HOSPITAL. FOLLOWING THE PRESENTATION THE GROUP WAS ASKED TO COMMENT AND DISCUSS THEIR REACTIONS TO THE DATA PRESENTED. PART VI, LINE 2: NEEDS ASSESSMENT:IN ORDER TO FURTHER IDENTIFY AND ADDRESS SPECIFIC NEEDS IN ITS MARKETAREA, THE HOSPITAL HAS ENGAGED A PARTNER, COMMUNITY HOSPITAL CONSULTING, TO HELP COORDINATE AND COMPLETE A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT FOR OUR MARKET AREA SERVING A POPULATION OF MORE THAN 250,000 RESIDENTS IN THE EASTERN TWIN CITIES' METRO AREA AND WESTERN WISCONSIN. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FOR HOSPITAL PATIENTS, EACH PATIENT BILLING STATEMENT AND COLLECTIONS LETTER PRODUCED BY THE HOSPITAL INCLUDES THE FOLLOWING NOTICE: "FINANCIAL ASSISTANCE AND PAYMENT ARRANGEMENTS: LAKEVIEW HOSPITAL OFFERS FINANCIAL ASSISTANCE TO PATIENTS EXPERIENCING DIFFICULTY PAYING THEIR MEDICAL BILLS. IF YOU ARE INSURED AND ARE EXPERIENCING DIFFICULTY PAYING THE BALANCE OF YOUR MEDICAL BILL, PLEASE CONTACT OUR BUSINESS OFFICE FOR MORE INFORMATION ABOUT SETTING UP A PAYMENT PLAN OR ABOUT OUR CHARITY CARE PROGRAM. IF YOU ARE UNINSURED AND YOUR HOUSEHOLD INCOME IS LESS THAN $125,000, PLEASE CONTACT OUR BUSINESS OFFICE FOR INFORMATION ON OUR UNINSURED DISCOUNT PROGRAM, SETTING UP A PAYMENT PLAN, OR OUR CHARITY CARE PROGRAM." PART VI, LINE 4: COMMUNITY INFORMATION:THE HOSPITAL SERVES THE EASTERN TWIN CITIES' METRO AREA AND WESTERNWISCONSIN. CORE SERVICE AREA - STILLWATER, BAYPORT, LAKE ELMO, LAKELAND, ANDMARINE ON ST. CROIX, MN ALONG WITH HOULTON AND SOMERSET, WI. PRIMARY SERVICE AREA - HUDSON, NEW RICHMOND AND STAR PRAIRIE, WI, AND AFTON, MN. SECONDARY SERVICE AREA - NEARBY CITIES IN EASTERN MINNESOTA AND WESTERN WISCONSIN MORE THAN 300,000 RESIDENTS IN THE HOSPITAL'S CORE SERVICE AREA ACROSS MINNESOTA AND WISCONSIN HAVE ACCESS TO THE HOSPITAL'S SERVICES. CENSUS FIGURES FOR 2010 SHOW THE FOLLOWING FOR WASHINGTON COUNTY:- PERSONS UNDER 5 YEARS: 6.4%- PERSONS UNDER 18 YEARS: 26.7%- PERSONS 65 YEARS AND OVER: 10.5% IT IS ESTIMATED THAT THE 65 AND OLDER GROUP IN WASHINGTON COUNTY WILL GROW BY 350% BY 2030.- POPULATION CHANGE FROM 2000 TO 2010: +18.4%- FEMALES: 50.5%- WHITE PERSONS: 87.8%- PERSONS OF COLOR: 12.2%- LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 8.9%- HIGH SCHOOL GRADUATES: 95.7%- BACHELOR'S DEGREE OR HIGHER: 40.0%- PERSONS BELOW POVERTY LEVEL 2006 - 2010: 5.2%- MEDIAN HOUSEHOLD INCOME IN WASHINGTON COUNTY FROM 2006 - 2010 WAS $79,109. PART VI, LINE 5: PROMOTION OF COMMUNITY BENEFITS:THE HOSPITAL PROVIDED EDUCATION SCHOLARSHIPS TODIABETIC PATIENTS THAT REQUIRED NUTRITION AND LIFE-STYLE EDUCATION; THEHOSPITAL ALSO PROVIDED FREE LAB AND PHARMACY SERVICES FOR PATIENTS OF THEST. CROIX FAMILY MEDICAL CENTER, A LOCAL MEDICAL CLINIC THAT PROVIDES FREEAND DISCOUNTED SERVICES FOR INDIGENT AND LOW INCOME PATIENTS OF THE AREA.FOR ADDITIONAL DISCUSSION, SEE FORM 990, SCHEDULE O - "EXEMPT PURPOSE ANDACHIEVEMENTS" PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:AS A MEMBER OF STILLWATER HEALTH SYSTEM, THE HOSPITAL PARTICIPATES WITH THE MULTI-SPECIALTY CLINIC AND HEALTH SYSTEM LEADERSHIP WITHIN OUR OVERALL ORGANIZATION IN PROVIDING ACCESS TO CARE, SUPPORT GROUPS, EDUCATIONAL ACTIVITIES, AND FINANCIAL CONTRIBUTIONS TO THE MARKET AREA DESCRIBED ABOVE. THE MULTI-SPECIALTY CLINIC FURTHER PARTICIPATES IN MINNESOTA COMMUNITY MEASUREMENT, PRACTICES AND MEASURES PROVIDER, PERFORMANCE WITH SPECIFIC PREVENTIVE CARE METRICS AND SPECIFIC CHRONIC DISEASE MANAGEMENT METRICS. IN 2011, THE STILLWATER HEALTH SYSTEM AFFILIATED WITH HEALTHPARTNERS. THE MISSION OF HEALTHPARTNERS IS TO IMPROVE THE HEALTH OF IT'S MEMBERS, IT'S PATIENTS AND THE COMMUNITY. LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT PART VI, LINE 7 THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH MINNESOTA THROUGHTHE MINNESOTA HOSPITAL ASSOCIATION (MHA). 1 STILLWATER AREA SCHOOLS 1875 GREELEY ST S STILLWATER MN 55082 17000 CASH AMOUNT PROGRAM SUPPORT PORTICO HEALTHNET 2610 UNIVERSITY AVENUE WEST ST PAUL MN 55114 57058 CASH AMOUNT PROGRAM SUPPORT HEALTH AND HUMAN SERVICES 7066 STILLWATER BLVD N STILLWATER MN 55082 5500 CASH AMOUNT PROGRAM SUPPORT FAMILY MEANS 1875 NORTHWESTERN AVENUE STILLWATER MN 55082 25000 CASH AMOUNT PROGRAM SUPPORT 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE HOSPITAL'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE HOSPITAL'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. X X X X 0 1 0 0 0 0 0 0 0 KENNETH D HOLMEN MD 0 442508 0 124115 0 32196 0 114931 0 45415 0 759165 0 16957 CURT GEISSLER 251174 0 91483 0 3791 0 33268 0 23865 0 403581 0 0 0 DOUGLAS E JOHNSON 227324 0 70671 0 0 0 28672 0 22202 0 348869 0 0 0 JEFFREY J ROBERTSON 390617 0 179401 0 0 0 33007 0 25933 0 628958 0 0 0 MARY E JONES 207078 0 4643 0 0 0 17613 0 23432 0 252766 0 0 0 JO E SITTLOW 140338 0 20356 0 0 0 24180 0 19738 0 204612 0 0 0 CYNTHIA A APPLESETH 133785 0 9785 0 0 0 20788 0 24333 0 188691 0 0 0 JEFFREY W MAANUM 131231 0 0 0 0 0 12450 0 22164 0 165845 0 0 0 PART I, LINE 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: KENNETH D. HOLMEN, MD $ 22,664 -------- TOTAL $ 22,664 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART II - PRIOR REPORTED COMPENSATION: PART II, COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION. ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, OF ANY PARTICIPANT OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. EXEMPT PURPOSE AND ACHIEVEMENTS FORM 990, PART III, LINE 4A I. CORPORATE STRUCTURE, PURPOSE, GOVERNANCE LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL), A STATE LICENSED 97-BED, ACUTE CARE FACILITY, IS A MINNESOTA NON-PROFIT ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THE HOSPITAL IS A MEMBER OF STILLWATER HEALTH SYSTEM (SHS), A MINNESOTA 501(C)(3) TAX EXEMPT ORGANIZATION, ALONG WITH THE STILLWATER MEDICAL GROUP, A MINNESOTA 501(C)(3) TAX EXEMPT ORGANIZATION (MULTI-SPECIALTY CLINIC); LAKEVIEW MEMORIAL HOSPITAL FOUNDATION, A MINNESOTA 501(C)(3) TAX EXEMPT ORGANIZATION; AND ST. CROIX VALLEY HEALTHCARE AND RESEARCH FOUNDATION, A MINNESOTA 501(C)(3) TAX EXEMPT PRIVATE FOUNDATION WHICH DISSOLVED SEPTEMBER 2012. THE HOSPITAL IS PART OF THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS (HEALTHPARTNERS). HEALTHPARTNERS, INC. (HPI), A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) WHICH IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4), IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL AND REGIONS HOSPITAL'S SISTER ORGANIZATIONS, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, SHS, AND RAMSEY INTEGRATED HEALTH SERVICES, ALL OF WHICH ARE MINNESOTA NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). HPI-RAMSEY IS ALSO THE SOLE CORPORATE MEMBER OF RH-WISCONSIN, INC., A WISCONSIN NON-STOCK CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). HPI IS ALSO THE SOLE CORPORATE MEMBER OF THE FOLLOWING ORGANIZATIONS THAT ARE MINNESOTA NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C) (3): GROUP HEALTH PLAN, INC. (GHI) (A MINNESOTA LICENSED STAFF MODEL HMO) WHICH IS ALSO THE SOLE CORPORATE MEMBER OF PHYSICIANS NECK & BACK CLINICS, WHICH IS ALSO A MINNESOTA NON-PROFIT CORPORATION EXEMPT UNDER SECTION 501(C) (3); HEALTHPARTNERS RESEARCH & EDUCATION (D/B/A HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH (HPIER)), AND RHSC, INC. RH-WISCONSIN, INC. AND GHI ARE CORPORATE MEMBERS OF HUDSON HOSPITAL, INC. AND WESTFIELDS HOSPITAL, INC., BOTH OF WHICH ARE WISCONSIN NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN, INC. IS ALSO THE SOLE CORPORATE MEMBER OF WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY, AN AMBULANCE SERVICE WHICH IS A WISCONSIN NON-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). TOGETHER, ALL OF THESE RELATED ORGANIZATIONS COMPRISE THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS (HEALTHPARTNERS), WHICH IS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM THAT COMBINES THE PROVISION AND FINANCING OF HEALTH CARE SERVICES, FOR THE PURPOSE OF IMPROVING THE HEALTH OF ITS VARIOUS ENTITIES' MEMBERS, PATIENTS, AND THE BROADER COMMUNITY. HEALTHPARTNERS AND THE HOSPITAL ALSO PARTNER WITH OTHER PLANS, CARE PROVIDERS AND NON-PROFIT ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION; TO INCREASE ACCESS, CREATE AND DISSEMINATE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY AND COLLABORATE ON SYSTEM IMPROVEMENTS. THE HOSPITAL CONTINUES TO BE AN INTEGRAL PART OF THE STILLWATER COMMUNITY AND SURROUNDING AREA - A VITAL AND NECESSARY COMMUNITY RESOURCE SINCE 1880, THE FIFTH OLDEST HOSPITAL, AND SECOND OLDEST CONTINUALLY OPERATING HOSPITAL IN MINNESOTA. THE HOSPITAL IS DESIGNATED A LEVEL 3 TRAUMA HOSPITAL AND HAS 112 ACTIVE MEDICAL STAFF IN A VARIETY OF SPECIALTIES, INCLUDING FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, OB/GYN, GENERAL SURGERY, ORTHOPEDICS, OTOLARYNGOLOGY, OCCUPATIONAL HEALTH, EMERGENCY MEDICINE, PODIATRY, HOSPITALISTS, NEUROLOGY, GERIATRICS, ONCOLOGY, UROLOGY, CARDIOLOGY, SPORTS MEDICINE, ALLERGY/IMMUNOLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, DERMATOLOGY, RADIOLOGY, PATHOLOGY AND ANESTHESIOLOGY. COURTESY AND CONSULTING STAFF PROVIDES ADDITIONAL SERVICES, INCLUDING PLASTIC SURGERY, PAIN MANAGEMENT, INFECTIOUS DISEASE, PULMONARY/SLEEP MEDICINE AND ORAL SURGERY. HOSPITALISTS PROVIDE THE MAJORITY OF CARE FOR THE HOSPITAL INPATIENTS. APPROXIMATELY 49% OF SURGICAL PROCEDURES PERFORMED AT THE HOSPITAL ARE SAME-DAY SURGERIES. THE HOSPITAL EMPLOYS 728 INDIVIDUALS, TOTALING 489 FULL TIME EQUIVALENTS (FTES). APPROXIMATELY 33% OF EMPLOYEES ARE FULL-TIME, 45% ARE PART-TIME AND 22% ARE CASUAL. THE AVERAGE NUMBER OF YEARS OF SERVICE FOR ALL EMPLOYEES AT THE HOSPITAL IS 7.55 YEARS. THE HOSPITAL PROVIDES FIELD EXPERIENCE FOR A VARIETY OF HEALTH PROFESSIONS, INCLUDING (BUT NOT LIMITED TO) STUDENTS IN NURSING, IMAGING PHARMACY, AND PHYSICAL MEDICINE. VOLUNTEERS AND STUDENT VOLUNTEERS PROVIDE NON-DIRECT CARE SUPPORT AT THE HOSPITAL. DUTIES VARY ACCORDING TO THE SERVICE AREA, BUT EXAMPLES INCLUDE STAFFING THE GIFT SHOP, WORKING AT THE INFORMATION DESKS, AND KNITTING BABY CAPS. ALL VOLUNTEERS AND STAFF RECEIVE HOSPITAL OR CLINIC ORIENTATION (DEPENDING ON THEIR LOCATION), AS WELL AS ORIENTATION TO THEIR DEPARTMENT. THE HOSPITAL EMPLOYS THE BEST IN MEDICINE THROUGHOUT ALL STAGES OF LIFE - FROM THE BIRTH OF A CHILD TO HOSPICE CARE FOR A FAMILY MEMBER. AS A RESULT, IT HAS GARNERED NATIONAL AND LOCAL ACCLAIM FOR ITS ACHIEVEMENTS IN A NUMBER OF AREAS, INCLUDING PATIENT SATISFACTION, ORTHOPEDICS, AND OVERALL OPERATIONS. AMONG ITS RECENT AWARDS: - RECIPIENT OF THE HEALTHGRADES PATIENT SAFETY EXCELLENCE- AWARD FOR 2 YEARS IN A ROW (2010-2011). - RECIPIENT OF THE HEALTHGRADES OUTSTANDING PATIENT EXPERIENCE AWARD FOR 5 YEARS IN A ROW (2008-2012). - RECIPIENT OF THE HEALTHGRADES ORTHOPEDIC SURGERY EXCELLENCE AWARD FOR 7 YEARS IN A ROW (2006-2012). - RECIPIENT OF THE HEALTHGRADES JOINT REPLACEMENT EXCELLENCE AWARD FOR 6 YEARS IN A ROW (2007-2012). - RECIPIENT OF THE HEALTHGRADES SPINE SURGERY EXCELLENCE AWARD- FOR 5 YEARS IN A ROW (2008-2012). - NAMED ON THE BECKER'S HOSPITAL REVIEW LIST OF 101 HOSPITALS WITH GREAT ORTHOPEDIC PROGRAMS (2012). - PATH TO EXCELLENCE AWARD (CATEGORY - TOP PERFORMER: RATE HOSPITAL), FROM NRC PICKER (2011). - HOMECARE ELITE AND TOP 500 AGENCY FOR LAKEVIEW HOMECARE (2011, 2012). - PATIENT SAFETY EXCELLENCE AWARD FOR THE SAFE ACCOUNT INITIATIVE FROM MINNESOTA HOSPITAL ASSOCIATION (2011). - RECOGNIZED AS A COMMUNITY VALUE FIVE-STAR HOSPITAL BY CLEVERLEY & ASSOCIATES, BASED ON OUR COMMUNITY VALUE INDEX SCORE (2011). - NAMED ONE OF THE 40 HOSPITALS WITH GREAT ORTHOPEDIC AND SPINE PROGRAMS BY BECKER'S HOSPITAL REVIEW (2010). - NRC PICKER PATH TO EXCELLENCE AWARD WINNER (2010) - FIRST PLACE FOR OVERALL HOSPITAL RATING; SECOND PLACE IN THE CATEGORY OF PAIN MANAGEMENT (AMONG ALL HOSPITALS LESS THAN 250 BEDS). - LAKEVIEW HOMECARE NAMED TO THE LIST OF HOMECARE ELITE (TOP 25% OF HOME HEALTH AGENCIES IN THE U.S.), AS WELL AS ONE OF THE TOP 500 HOME HEALTH AGENCIES BY OCS HOMECARE (2010). - RECIPIENT OF A MINNESOTA HOSPITAL ASSOCIATION (MHA) PATIENT SAFETY EXCELLENCE AWARD, 2009. - IN THE CATEGORY OF "OVERALL CARE" THE HOSPITAL HAD A PERFORMANCE AVERAGE OF 88.2% - .7% LOWER THAN THE HIGHEST PERFORMANCE AVERAGE IN MINNESOTA - PLACING LAKEVIEW WITHIN THE TOP 1% OF MINNESOTA ON THIS WEB SITE WWW.MYHEALTHCOMPARE.COM, 10/09). - FIRST HOSPITAL IN MINNESOTA TO PERFORM MINIMALLY INVASIVE SURGERY (MIS) FOR KNEE AND HIP REPLACEMENTS. - RECIPIENT OF AN "EXCELLENCE IN BIRTH REGISTRATION AWARD" FROM THE MINNESOTA DEPARTMENT OF HEALTH (2011) - NAMED A "100 TOP" HOSPITAL BY THOMSON REUTERS FIVE TIME (2003, 2006, 2007, 2008, AND 2012) A PATIENT'S WILLINGNESS TO RECOMMEND IS A LEADING INDICATOR OF SUCCESSFUL CUSTOMER SERVICE. THE HOSPITAL INPATIENT SCORES CONSISTENTLY SCORE ABOVE THE 90TH PERCENTILE NATIONAL RANKING FOR "WOULD DEFINITELY RECOMMEND" AMONG NRC PICKER HOSPITALS OF COMPARABLE SIZE. II. BENEFITS TO PATIENTS AND THE COMMUNITY IN 2012. THE HOSPITAL AIMS TO BE THE PREMIER PARTNER IN THE COMMUNITY'S QUEST FOR HEALTH AND HAPPINESS. WORKING IN PARTNERSHIP WITH EACH OTHER, THE LAKEVIEW HEALTH ORGANIZATIONS, THE COMMUNITY, AND THE HOSPITAL ACCOMPLISHED A GREAT DEAL IN 2012. OUR PARTNERSHIP WAS ADVANCED ON APRIL 1, 2011, WITH A FORMAL AFFILIATION WITH HEALTHPARTNERS AND ITS FAMILY OF ORGANIZATIONS. ADVANCEMENTS WERE MADE TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. THE HOSPITAL CONTINUED TO GROW ITS REPUTATION FOR EXCELLENT CLINICAL OUTCOMES AND SERVICE. HIGHLIGHTS INCLUDE: - PATIENT SAFETY EXCELLENCE AWARDS (SAFE ROADMAPS) - INFLUENZA VACCINATION FOR HEALTHCARE WORKERS - ACHIEVED FLU SAFE STATUS WITH A RATE OF 77% VACCINATIONS FOR 3RD YEAR. THIS YEAR THE CAMPAIGN INCLUDED LICENSED INDEPENDENT PRACTITIONERS, STUDENTS, AND VOLUNTEERS. - RARE CAMPAIGN (READMISSIONS) THE HOSPITAL CONTINUES TO PERFORM BETTER THAN THE STATE/CAMPAIGN GOAL OF .80 ACTUAL TO EXPECTED READMISSIONS. - INCREASED TDAP VACCINATIONS TO PROMOTE COMMUNITY WELLNESS. THE MINNESOTA ALLIANCE FOR PATIENT SAFETY AWARDED THE HOSPITAL'S TDAP PROJECT THE MAPS PATIENT AND FAMILY ENGAGEMENT AWARD - PATIENT SATISFACTION SCORES, THE HOSPITAL CONTINUES TO PERFORM IN THE TOP DECILE FOR PATIENT EXPERIENCE. - THE HOSPITAL CONTINUES TO RECEIVE RECOGNITION FOR THE 2010 PERFORMANCE IMPROVEMENT INITIATIVE TO REDUCE RISK OF VENOUS THROMBOEMBOLISM USING A TEAM APPROACH. MHA PUBLISHED OUR SUCCESS AND WE HAVE SUSTAINED THIS MEASURE AT 100% IN 2012. - IMPROVEMENT ANALYSIS OF RAPID RESPONSE AND CODE BLUE EVENTS (2007-2012) - IMPLEMENTATION OF ELECTRONIC HEALTH RECORD SUPPORTS OUR GOAL OF PROVIDING EXCEPTIONAL, SAFE, AND COORDINATED CARE TO OUR PATIENTS. WHILE 2012 CONTINUED TO BE A YEAR OF CHANGE, CHALLENGES AND CHOICES FOR THE HOSPITAL, IT WAS ALSO ONE OF CONTINUED COMMUNITY SUPPORT. CHARITABLE TRADITION CONTINUED AS THE HOSPITAL REACHED OUT TO THOSE IN NEED OF ITS SERVICES. THE HOSPITAL ENGAGED IN COMMUNITY PARTNERSHIPS WITH SCHOOLS, BUSINESSES, AGENCIES AND OTHER HEALTH PROVIDERS INVESTED IN COMMUNITY PROGRAMS AND SERVICES THAT POSITIVELY SUPPORT AND STRENGTHEN COMMUNITY HEALTH, EDUCATION, ECONOMIC DEVELOPMENT, AND CULTURE. THESE PROGRAMS AND PARTNERSHIPS EMBODY THE HOSPITAL'S MISSION OF "CARING FOR THE HEALTH OF OUR COMMUNITY." IN ORDER TO FURTHER IDENTIFY AND ADDRESS SPECIFIC NEEDS IN OUR MARKET AREA, THE HOSPITAL ENGAGED A PARTNER, COMMUNITY HOSPITAL CONSULTING, TO HELP COORDINATE AND COMPLETE A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT FOR OUR MARKET AREA SERVING A POPULATION OF MORE THAN 250,000 RESIDENTS IN THE EASTERN TWIN CITIES' METRO AREA AND WESTERN WISCONSIN. TOTAL 2012 COMMUNITY BENEFIT CONTRIBUTION EQUALED $6,059,940, WHICH REPRESENTS 7.47% OF TOTAL EXPENSES. THIS FIGURE IS REPORTED AT COST PER THE CATHOLIC HEALTH ASSOCIATION (CHA) COMMUNITY BENEFIT REPORTING GUIDELINES. TRADITIONAL CHARITY CARE AND HEALTHCARE ACCESS FOR LOW-INCOME INDIVIDUALS. CHARITY CARE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. THE HOSPITAL PROVIDED $296,704 IN FREE OR DISCOUNTED CARE TO LOW INCOME AND UNINSURED PATIENTS. CARE FOR MEDICAID PATIENTS. THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT CARE, INCLUDING EMERGENCY DEPARTMENT SERVICES, TO MEDICAID PATIENTS. PAYMENTS RECEIVED FOR THESE SERVICES ARE BELOW THE COST OF CARE PROVIDED. THE HOSPITAL'S EXPENSE TO COVER UNREIMBURSED MEDICAID COSTS FOR PATIENTS TOTALED $1,688,048. SUBSIDIZED HEALTH SERVICES. THE HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2012, LOSS ON SERVICES FOR INPATIENT AND OUTPATIENT HEALTH SERVICES INCLUDING EMERGENCY AND TRAUMA (INCLUDING EMERGENCY DEPARTMENT AND AMBULANCE/EMS SERVICES), HOSPITAL OUTPATIENT SERVICES (CLINICAL NUTRITION, CARDIAC REHABILITATION), OB/GYN SERVICES, AND HOMECARE AND HOSPICE SERVICES, TOTALED $3,582,720. COMMUNITY HEALTH IMPROVEMENT SERVICES. THE HOSPITAL SPONSORED AND COORDINATED OVER 55 COMMUNITY BENEFIT CLASSES, EVENTS, AND SUPPORT GROUPS DURING THE YEAR AT A NET COST OF $233,217. THE FOLLOWING ACTIVITIES OR PROGRAMS WERE CARRIED OUT AND SUPPORTED BY THE HOSPITAL: - A DIFFERENT APPROACH TO HIP REPLACEMENT - ADVANCE CARE PLANNING FOR MN RESIDENTS - ADVANCE DIRECTIVES CLASS - BIG + LOUD FOR PARKINSONS' PATIENTS - BUYING A HEARING AID: WHAT YOU SHOULD KNOW BEFORE YOU BUY - CHOLESTEROL SCREENING - COMMUNITY HEALTH ACTION TEAM - COMMON KNEE PROBLEMS - COOKING CAMP FOR AGES 6-9 - COOKING CAMP FOR FAMILIES - COURAGE ST. CROIX PARKINSON'S SUPPORT GROUP - DON'T LET LYME DISEASE TICK YOU OFF - EXPLAINING THE PSA CONTROVERSY - EXPLAINING THE PSA CONTROVERSY: PROSTATE SUPPORT GROUP - EXPLORER'S - FIBER: FACTS AND FUNCTION - FREEDOM FROM SMOKING - GIRL SCOUT TROOP - HAND-IN-HAND CHILD CARE CENTER - HEADACHE MANAGEMENT - HEALTHY EATING ON A BUDGET CLASS - HEARING IMPAIRED OR LISTENING IMPAIRED CLASS - HEART ARRHYTHMIAS CLASS - HEART DISEASE RISK FACTORS AND LIFESTYLE CHOICES - HEEL PAIN - HOULTON ELEMENTARY SCHOOL - IRRITABLE BOWEL SYNDROME - IS IT A HEART ATTACK OR NOT? - LAKEVIEW CUSTOMER APPRECIATION BG SCREENING - LOOK GOOD, FEEL BETTER - MANAGING CHRONIC PAIN - MIND BODY SKILLS CLASS - MY BLADDER LEAKS....NOW WHAT? - NEED A NEW KNEE?....SURGERY FOR YOU? - PARENTING CLASS SERIES #1, #2, #3 - PARISH NURSE PROGRAM - RED CROSS BLOOD DRIVE - ROCK POINT CHURCH DONATION - SENIOR HEALTH AND FAITH DAY - SKIN CANCER CLASS - SLEEP APNEA: WHAT'S ALL THE FUSS ABOUT - STEP IT OUT FOR DIABETES WALK - STILLWATER PUBLIC LIBRARY FOUNDATION - STRAIGHT TALK CLASS - TINNITUS CLASS - YOUR PHARMACY QUESTIONS ANSWERED - BORN TO READ - NEW PARENT CONNECTION - RESOLVE SUPPORT GROUP - FIBROMYALGIA SUPPORT GROUP - KIDS AND TEENS IN GRIEF - BREAST CANCER SUPPORT GROUP - PRESCRIPTION ASSISTANCE PROGRAM - FINDING YOUR WAY THROUGH CANCER COMMUNITY BASED CLINICAL SERVICES. THE HOSPITAL PROVIDES SCHOLARSHIPS FOR DIABETIC EDUCATIONAL SERVICES TO PATIENTS THAT ARE UNABLE TO ATTEND NECESSARY CLASSES THAT TEACH MANAGEMENT OF AND TREATMENT OF DIABETES DUE TO COSTS. THE HOSPITAL ALSO PROVIDES LAB AND PHARMACY SERVICES AT NO CHARGE TO THE ST. CROIX FAMILY MEDICAL CLINIC (FORMERLY THE COMMON HEALTH CLINIC), A CLINIC, WHICH PROVIDES FREE AND SIGNIFICANTLY DISCOUNTED CARE TO LOW INCOME ST. CROIX VALLEY AREA RESIDENTS. THE TOTAL COST OF THESE SCHOLARSHIPS AND SERVICES PROVIDED FOR THE YEAR WAS $21,148. HEALTH PROFESSIONS EDUCATION. THE HOSPITAL COORDINATES AND SUPPORTS WEEKLY CONTINUING MEDICAL EDUCATION (CME) PROGRAMS FOR STAFF AND COMMUNITY EDUCATION. TOTAL DIRECT COSTS FOR STIPENDS, PURCHASED SERVICES, SUPPLIES, ROOM RENTALS, AND INDIRECT COSTS FOR THE YEAR WERE $56,237. CASH DONATIONS. THE HOSPITAL'S CASH DONATIONS TO OTHER TAX-EXEMPT COMMUNITY ORGANIZATIONS IN THE FORM OF SPONSORSHIPS OR CONTRIBUTIONS TOTALED $167,279. IN-KIND DONATIONS. IN-KIND SERVICES PROVIDED INCLUDED STAFF HOURS SPENT IN SUPPORT OF BOARD OR COMMITTEE WORK (STILLWATER ROTARY CLUB, UNITED WAY OF WASHINGTON COUNTY, ETC.); SPECIAL EVENTS PLANNING; AND OVERHEAD EXPENSES OF SPACE PROVIDED TO NOT-FOR-PROFIT COMMUNITY GROUPS FOR MEETINGS. VARIOUS SUPPLIES AND EQUIPMENT DONATED FOR SPECIFIC MISSION TRIPS, WAS $35,736. COMMUNITY-BUILDING ACTIVITIES. THE HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION BUILDING, HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT INCLUDING THE ST. CROIX VALLEY BRIDGE COALITION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS SHS. FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT OF SHS IS APPOINTED BY SHS AND IS AUTOMATICALLY GIVEN A POSITION AS A VOTING MEMBER OF THE BOARD OF DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B SHS HAS RESERVED TO ITSELF THE FOLLOWING POWERS CONCERNING THE GOVERNANCE OF THE HOSPITAL: 1. RATIFICATION, APPROVAL AND REMOVAL ALL MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE. 2. APPROVAL OF ANY MISSION OR VISION STATEMENT OR STATEMENT OF CORPORATE PURPOSE ADOPTED BY THE HOSPITAL. 3. APPROVAL OF THE HOSPITAL'S STRATEGIC PLANS, CAPITAL BUDGETS, OPERATING BUDGETS AND FINANCIAL POLICIES. 4. APPROVAL OF ANY PLANS OF MERGER OR CONSOLIDATION BY THE HOSPITAL WITH ANY FOREIGN OR DOMESTIC ORGANIZATION VOLUNTARY DISSOLUTION OF THE HOSPITAL, OR SALE, LEASE OR TRANSFER OF THE HOSPITAL'S REAL ESTATE OR A SIGNIFICANT PORTION OF THE OPERATIONS OR ASSETS OF THE HOSPITAL. 5. APPROVAL OF THE GRANT OF A SECURITY INTEREST IN ALL OR SUBSTANTIALLY ALL OF THE HOSPITAL'S ASSETS, OR THE INCURRENCE OF INDEBTEDNESS OR THE GUARANTEE OF ANY INDEBTEDNESS. 6. APPROVAL OF INDIVIDUAL CAPITAL EXPENDITURES BY THE HOSPITAL, WHETHER BUDGETED OR UNBUDGETED, IN EXCESS OF $500,000. 7. APPROVAL OF PHYSICIAN, EMPLOYEE AND EXECUTIVE COMPENSATION PLANS FOR THE HOSPITAL, INCLUDING CRITERIA FOR INCENTIVE COMPENSATION ARRANGEMENTS. 8. APPROVAL OF ALL SUBSTANTIVE AFFILIATIONS BETWEEN THE HOSPITAL AND A THIRD PARTY. 9. APPROVAL OF CONFLICTS OF INTEREST POLICIES FOR THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE HOSPITAL'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE HOSPITAL, GHI'S INTERNAL LEGAL DEPARTMENT AND THE HOSPITAL'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. THE HOSPITAL MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY WILL BE PROVIDED IN A MAILING TO THE BOARD MEMBERS PRIOR TO THE FILING OF THE 990. EACH BOARD MEMBER WILL HAVE AN OPPORTUNITY TO COMMENT OR ASK QUESTIONS ABOUT THE 990 BEFORE IT IS FILED. THIS PROCESS WILL BE NOTED AND DOCUMENTED IN A WRITTEN MEMO IN THE FILES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARD OF DIRECTORS MONITORS POTENTIAL CONFLICTS OF INTEREST OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES, BY MAINTAINING A CONFLICT OF INTEREST POLICY. ANNUALLY, UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. A REPORT OF THESE POTENTIAL CONFLICTS IS SHARED WITH THE GOVERNANCE COMMITTEE, THE CHAIR AND THE CEO. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING OFFICERS' COMPENSATION INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. EACH YEAR, UNDER THE DIRECTION OF THE LAKEVIEW HEALTH SYSTEM'S COMPENSATION COMMITTEE, AN ANNUAL TOTAL COMPENSATION MARKET REVIEW IS COMPLETED TO PROVIDE A COMPREHENSIVE MARKET REVIEW FOR THE FOLLOWING EXECUTIVE POSITIONS WITHIN LAKEVIEW HEALTH SYSTEM CEO, SYSTEM CFO, CLINIC PRESIDENT, CLINIC ADMINISTRATOR, AND HOSPITAL PRESIDENT. IN 2011, THE COMPENSATION COMMITTEE RETAINED AN INDEPENDENT EXECUTIVE CONSULTING FIRM TO PROVIDE A REVIEW OF ALL COMPONENTS OF COMPENSATION INCLUDING BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. IN 2012, UNDER THE COMMITTEE'S DIRECTION, THE GHI HUMAN RESOURCES DEPARTMENT USED THE SAME RECOGNIZED THIRD PARTY SALARY SURVEYS TO DETERMINE MEDIAN SALARY STRUCTURE CHANGES. BASED ON THIS UPDATED DATA, THE COMMITTEE LEARNED THE COMPENSATION RATES THAT ARE CONSIDERED P50 TO P60 OF THE MARKET FOR COMPARABLE LAKEVIEW POSITIONS. OTHER CONSIDERATIONS OF THE COMMITTEE INCLUDE: ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES, INDIVIDUAL PERFORMANCE, EXPERIENCE, SUBJECTIVE EVALUATION BY BOARD MEMBERS, GENERAL ECONOMIC CONDITIONS, COSTS OF REPLACEMENT, PREVAILING COMMUNITY ATTITUDES AND BELIEFS REGARDING COMPENSATION. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND W2S. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE HOSPITAL OR HEALTHPARTNERS, INC. THE HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE. AVERAGE HOURS PER WEEK - RELATED ORGANIZATION FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) AVERAGE WEEKLY HOURS: THE COMPENSATED BOARD MEMBERS AND OFFICERS FREQUENTLY DEVOTE THEIR TIME TO MULTIPLE RELATED ORGANIZATIONS IN A PARTICULAR WEEK. EACH INDIVIDUAL WORKS AN AVERAGE OF APPROXIMATELY 55 HOURS PER WEEK FOR STILLWATER HEALTH SYSTEM AND ITS RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FASB 158 POST RETIREMENT ADJUSTMENT -782,824. TRANSFER TO AFFILIATE - STILLWATER HEALTH SYSTEM -500,001. TRANSFER FROM AFFILIATE - LAKEVIEW MEMORIAL HOSPITAL FOUNDATION 414,544. TSFR. FROM AFFILIATE - ST. CROIX VALLEY HEALTH & CARE RESEARCH FOUNDATION 4,475. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 1 HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 1 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 1 HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411670163 HEALTHCARE EDUCATION & RESEARCH MN 501(C)(3) 509(A)(3) TYPE I GROUP HEALTH PLAN INC 1 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 412011453 POST HOSPITALIZATION PATIENT CARE MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 1 REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410956618 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 1 REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411888902 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY 1 RHSC INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411891928 HEALTHCARE STAFFING MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC 1 WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390808442 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 1 WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391770913 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 509(A)(3) TYPE I WESTFIELDS HOSPITAL INC 1 RH-WISCONSIN 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 1 PHYSICIANS NECK AND BACK CLINICS 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 270684883 SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC 1 HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390804125 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 1 HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391279567 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC 1 WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 263616590 PROVIDE MEDICAL TRANSPORT SERVICES WI 501(C)(3) 509(A)(3) TYPE II RH-WISCONSIN 1 LAKEVIEW MEMORIAL HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411386635 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 509(A)(3) TYPE II STILLWATER HEALTH SYSTEM 1 ST CROIX VALLEY HEALTHCARE & RESEARCH FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411923524 FOUNDATION MN 501(C)(3) PF STILLWATER HEALTH SYSTEM 1 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 830379473 PHYSICIANS GROUP MN 501(C)(3) 509(A)(2) STILLWATER HEALTH SYSTEM 1 STILLWATER HEALTH SYSTEM 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 300221189 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 1 RAMSEY INTEGRATED HEALTH SERVICES 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411503090 IN-HOME PATIENT CARE MN 501(C)(3) 509(A)(2) HPI - RAMSEY 1 HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411629390 THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC C 1 HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 522365151 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 1 HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683568 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 1 HEALTHPARTNERS VENTURES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411838197 DEVELOP HEALTHCARE BUSINESS OPPORTUNITIES MN HEALTHPARTNERS INC C 1 HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683523 MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC C 1 DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 451297583 DENTAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC C 1 HEALTHPARTNERS CENTRAL MINNESOTA CLINICS 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411236798 MEDICAL CLINIC STAFFING AND MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 1 1 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES L 2791962