2013-05-15T16:29:22-05:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 450226558 TRINITY HEALTH TRIN 7018575160 PO BOX 5020 MINOT ND 58702 JOHN M KUTCH 7018575160 2013-05-15 1 KOREY BOELTER P00775161 6123764500 2011 2016-02-24 21:20:13Z JOHN M KUTCH PO BOX 5020 MINOT ND 58702 85835139 0 X WWW.TRINITYHEALTH.ORG X 1929 ND PROVIDE HEALTH EDUCATION & HEALTHCARE SERVICES TO RESIDENTS OF CENTRAL & NORTHWEST NORTH DAKOTA. 13 9 3753 314 465583 102557 0 0 77122957 83879278 2766347 1265774 -79455 -224607 79809849 84920445 4029 25000 0 0 65844876 75318064 0 0 0 28539608 29359991 94388513 104703055 -14578664 -19782610 357232945 313704511 498252150 484477208 -141019205 -170772697 X TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 68734399 25000 58895471 TRINITY HEALTH PROVIDES EDUCATION AND HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 7657958 0 10694435 TRINITY HEALTH PROVIDES OPTOMETRY SERVICES FOR GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS; OPHTHALMOLOGY WHO PROVIDE COMPREHENSIVE EYE AND VISION CARE, INCLUDING SURGERY TO REPAIR AND ENHANCE VISION; OPTOMETRY WHO PROVIDES GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS AND OPTICAL SALE OF CONTACT LENS AND EYEGLASSES. 7371940 0 11270672 TRINITY HEALTH RADIOLOGISTS ARE HIGHLY TRAINED AND SKILLED AT ASSESSING AND INTERPRETING X-RAYS, CT, NUCLEAR MEDICINE, ULTRASOUND, MRI SCANS, AND MAMMOGRAPHY IMAGES. THEIR INTERPRETATION IS USED BY REFERRING PHYSICIANS, WHO ARE LESS WELL-TRAINED TO PLAN AND MANAGE PATIENT CARE. 5843637 0 3018700 TRINITY HEALTH HOSPITALISTS PROVIDE AND COORDINATE ALL ASPECTS OF INPATIENT AND OBSERVATION CARE FOR TRINITY HOSPITALS. 5843637 3018700 89607934 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 272 0 3753 1 1 1 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X MAX OWENS 7018575160 PO BOX 5020 MINOT ND 58702 X PATRICK HOLIEN 2.00 X X 0 0 0 TIMOTHY MIHALICK 2.00 X X 0 0 0 BLAINE DESLAURIERS 2.00 X X 0 0 0 KAREN KREBSBACH 2.00 X X 0 0 0 DAVID FULLER 2.00 X 0 0 0 CLARA SUE PRICE 2.00 X 0 0 0 MARTIN ROTHBERG MD 40.00 X 802667 0 34771 KEVIN COLLINS MD 40.00 X 969732 0 42143 BORGI BEELER 2.00 X 0 0 0 JOHN COUGHLIN 2.00 X 0 0 0 STEVE LYNSE 2.00 X 0 0 0 DARYL SOMERVILLE 2.00 X 0 0 0 JOHN KUTCH 20.00 X X 402846 0 33280 ALISON REPNOW 40.00 X 41349 0 5962 KEVIN SEEHAFER 20.00 X 213072 0 29773 RANDY SCHWAN 20.00 X 160940 0 23895 PAUL SIMONSON 20.00 X 222649 0 32922 THOMAS WARSOCKI 20.00 X 151996 0 25850 DAVE KOHLMAN 20.00 X 160640 0 26327 JUAN ULLOA MD 40.00 X 1148663 0 42143 MICHAEL MCMAHON MD 40.00 X 1127799 0 42143 DAVID BILLINGS MD 40.00 X 902524 0 42143 RAVINDRA JOSHI MD 40.00 X 1270773 0 42143 SAMIR TURK MD 40.00 X 1316552 0 42143 JOHN SHEEHAN MD 40.00 X 141676 0 32869 JEFFREY VERHEY MD 40.00 X 520810 0 42143 9554688 0 540650 226 1 1 0 COMMUNITY AMBULANCE SERVICE OF MINOT PO BOX 2195 MINOT ND 58702 AMBULANCE SERVICES 2558065 DELTA LOCUM TENES LP PO BOX 678082 DALLAS TX 75267 LOCUM PHYSICIAN SERVICES 1707971 COMPHEALTH MEDICAL STAFFING PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIAN SERVICES 1651845 UNITED BLOOD SERVICE PO BOX 53022 PHOENIX AZ 85072 BLOOD SERVICES 1576494 CREATIVE RADIOLOGY SOLUTIONS PC 1724 13TH STREET NW MINOT ND 58703 LOCUM PHYSICIAN SERVICES 1200000 55 NET PATIENT REVENUE 621110 80765999 80765999 OTHER PATIENT REVENUE 621110 2647696 2647696 OPTICAL SALES 446199 365583 365583 MAOPS & B&B/NORTHWEST 561000 100000 100000 83879278 767413 767413 401519 401519 837013 914694 -77681 -77681 -77681 96842 0 96842 96842 96842 JOINT VENTURE REVENUE 900099 -146926 -146926 -146926 84920445 83413695 465583 1041167 25000 25000 3642665 1849313 1793352 63670435 63641261 29174 3224782 3139897 84885 2192213 1935020 257193 2587969 2458467 129502 10476755 9943182 533573 773938 64458 709480 390630 263081 127549 193522 7807 185715 4012974 898564 3114410 87056 80993 6063 61617 41742 19875 427887 427887 1377758 532836 844922 626344 626344 BAD DEBT EXEPENSE 7733648 1264852 6468796 MEDICAL SUPPLIES / DRUG 2168350 2158590 9760 CME 565379 565379 0 DUES & FEES 444440 97362 347078 19693 13786 5907 104703055 89607934 15095121 0 798817 1284055 357323 850449 303970913 2138844 16729 5546734 2681901 476764 541869 157398 56058 57764721 25673272 17240675 32091449 7556389 10573565 2447036 250000 18680896 263219592 357232945 313704511 415048080 13030895 83204070 83067160 0 388379153 498252150 484477208 X -141019205 -170772697 -141019205 -170772697 357232945 313704511 X -19782610 -9970882 X 0 1 1 X 1 1 X X X 0 0 0 TRINITY HOSPITALS 412002771 3 1 1 1 25000 TRINITY KENMARE HOSPITAL 412002769 3 1 1 1 0 TRINITY HOMES 450404412 9 1 1 1 0 TRINITY HEALTH FOUNDATION 450215346 11 1 1 1 0 4 25000 0 0 305323 305323 313288 -5031 2934 305323 6823304 6823304 8548247 5800399 2747848 3519796 1380448 2139348 23841692 18021114 5820578 15031682 471311 14560371 32091449 FUNDS HELD BY TRUSTEE - BOND RESERVE 7556390 FUNDS HELD BY TRUSTEE - DEBT SERVICE 5554772 DEFERRED FINANCING COSTS 889222 PLEDGED INVESTMENTS FROM AFFILIATE 5500000 DUE FROM AFFILIATES 243719208 263219592 ASSET RETIREMENT OBLIGATION 8126800 DUE TO AFFILIATES 380252353 388379153 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TRINITY HEALTH AND THE FOLLOWING SUBSIDIARIES, TRINITY HOSPITALS, TRINITY HOMES, TRINITY HEALTH FOUNDATION, TRINITY KENMARE HOSPITAL AND COMMUNITY ABMULANCE SERVICE HAVE ALL BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. ALL UNRELATED BUSINESS INCOME GENERATED BY TRINITY IS SUBJECT TO FEDERAL INCOME TAX UNDER 511 OF THE IRC. TRINITY'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS, AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. TRINITY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 TRINITY HEALTH & AFFILIATES PO BOX 5020 MINOT ND 58702 331007002 501(C)(3) 25000 TO SUPPORT GENERAL OPERATIONS. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE DURING THE YEAR WERE TO A RELATED AFFILIATE UNDER COMMON MANAGEMENT AND WERE MONITORED AS PART OF THE INTERNAL FINANCIAL REPORTING PROCESS. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 MARTIN ROTHBERG MD 775584 0 27083 0 0 0 23704 0 11067 0 837438 0 0 0 KEVIN COLLINS MD 441451 0 510611 0 17670 0 23704 0 18439 0 1011875 0 0 0 JOHN KUTCH 402846 0 0 0 0 0 23704 0 9576 0 436126 0 0 0 KEVIN SEEHAFER 213072 0 0 0 0 0 22204 0 7569 0 242845 0 0 0 RANDY SCHWAN 160940 0 0 0 0 0 17098 0 6797 0 184835 0 0 0 PAUL SIMONSON 220849 0 0 0 1800 0 23686 0 9236 0 255571 0 0 0 THOMAS WARSOCKI 151996 0 0 0 0 0 16789 0 9061 0 177846 0 0 0 DAVE KOHLMAN 159289 0 0 0 1351 0 17243 0 9084 0 186967 0 0 0 JUAN ULLOA MD 496444 0 647852 0 4367 0 23704 0 18439 0 1190806 0 0 0 MICHAEL MCMAHON MD 497956 0 625476 0 4367 0 23704 0 18439 0 1169942 0 0 0 DAVID BILLINGS MD 441067 0 457090 0 4367 0 23704 0 18439 0 944667 0 0 0 RAVINDRA JOSHI MD 842876 0 322318 0 105579 0 23704 0 18439 0 1312916 0 0 0 SAMIR TURK MD 954494 0 220307 0 141751 0 23704 0 18439 0 1358695 0 0 0 JOHN SHEEHAN MD 137309 0 0 0 4367 0 14973 0 17896 0 174545 0 0 0 JEFFREY VERHEY MD 290443 0 130000 0 100367 0 23704 0 18439 0 562953 0 0 0 PART I, LINE 1A TRINITY HEALTH OWNS THEIR OWN AIRPLANE AND DURING FY 2012 OFFICERS USED THIS PLANE FOR BUSINESS USE TRAVEL. BECAUSE THE USE WAS RESTRICTED FOR BUSINESS THIS DID NOT EFFECT THE OFFICER'S COMPENSATION. COUNTY OF WARD ND HEALTH CARE FACILITIES REVENUE BONDS SERIES 2006 456002248 934023EMO 2006-11-01 78145000 SEE PART VI 0 0 0 5320000 78145000 6538606 71402536 712412 203858 2006 0 0 0 1 0 1 1 0 0 0.01810 0.01810 1 0 0 0 0 0 0 SCHEDULE K, PART I, COLUMN F DESCRIPTION OF PURPOSE OF BONDS PROCEEDS OF THE SERIES 2006 BONDS WERE USED (I) TO CURRENTLY REFUND THE COUNTY OF WARD, NORTH DAKOTA, ADJUSTABLE RATE DEMAND HEALTH CARE REVENUE BONDS (TRINITY OBLIGATED GROUP) TAX-EXEMPT SERIES 2002A (THE "SERIES 2002 BONDS"), OUTSTANDING IN THE AMOUNT OF $58,615,000, (II) TO FUND A TERMINATION PAYMENT FOR THE INTEREST RATE SWAP ASSOCIATED WITH THE SERIES 2002 BONDS, (III) TO ADVANCE REFUND THE COUNTY OF WARD, NORTH DAKOTA HEALTH CARE FACILITIES REVENUE REFUNDING BONDS (TRINITY OBLIGATED GROUP) SERIES 1996A (THE "SERIES 1996A BONDS"), OUTSTANDING IN THE AMOUNT OF $9,400,000, (IV) TO FINANCE OR REIMBURSE THE CORPORATION FOR THE COSTS OF CERTAIN RENOVATION, REMODELING, AND EQUIPPING OF ITS HEALTH CARE FACILITIES (THE "PROJECT"), (V) TO FUND A DEPOSIT TO A DEBT SERVICE RESERVE FUND, AND (VI) TO PAY CERTAIN EXPENSES RELATING TO THE ISSUANCE OF THE SERIES 2006 BONDS AND THE REFUNDING OF THE SERIES 2002 BONDS AND THE SERIES 1996A BONDS. KEVIN COLLINS RECRUITMENT & RETENTION X 150000 16729 0 1 1 16729 DARYL SOMERVILLE OWNER OF MINOT TOWN AND COUNTRY INVESTORS, LLC 240319 TRINITY HEALTH PAID RENT TO MINOT TOWN AND COUNTRY INVESTORS, LLC 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD OF DIRECTORS' CHAIRMAN, VICE CHAIRMAN, PRESIDENT, SECRETARY, TREASURER AND ONE ADDITIONAL MEMBER OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD OF DIRECTORS AT ITS FIRST MEETING AFTER ITS ELECTION. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT AL LMATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE FORM 990 IS EMAILED TO THE GOVERNING BODY OF TRINITY HEALTH FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL SALARIED EMPLOYEES (AT MANAGER LEVEL AND ABOVE AS DETERMINED BY TRINITY) AND SUCH OTHER EMPLOYEES AS FROM TIME TO TIME MAY BE DIRECTED TO DO SO, ARE REQUIRED TO COMPLETE TRINITY HEALTH'S CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. ANY EMPLOYEE WHO HAS ASSUMED, OR IS ABOUT TO ASSUME, A FINANCIAL OR OTHER INTEREST OR RELATIONSHIP THAT MIGHT INVOLVE A CONFLICT OF INTEREST MUST IMMEDIATELY INFORM HIS/HER SUPERVISOR, A MEMBER OF THE COMPLIANCE COMMITTEE, OR THE COMPLIANCE OFFICER. ISSUES INVOLVING CONFLICT OF INTEREST SHALL BE REVIEWED AND A DETERMINATION OF EACH SHALL BE MADE BY THE TRINITY COMPLIANCE COMMITTEE. IF A CONFLICT EXISTS, THE CONFLICTED PERSON MUST ABSTAIN FROM DISCUSSION OF AND VOTING ON THE CONFLICTED TOPIC. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE REVIEWED COMPENSATION INFORMATION FOR THE CEO PREPARED BY DELOITTE & TOUCHE. DELOITTE & TOUCHE ANALYZED FOUR COMPENSATION SURVEYS OF HEALTH CARE EMPLOYERS AND REVIEWED FORM 990 FILINGS FOR A PEER GROUP ANALYSIS. THIS PROCESS WAS LAST PERFORMED IN OCTOBER OF 2011. FORM 990, PART VI, SECTION C, LINE 19 ON OUR WEBSITE, WWW.TRINITYHEALTH.ORG, WE LIST OUR BOARD OF DIRECTORS, MISSION, VISION, VALUES, AND OUR ANNUAL REPORT WHICH INCLUDES FINANCIAL INFORMATION. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. BOARD OVERLAP FORM 990, PART VII, SECTION A ALL OF THE BOARD MEMBERS OF TRINITY HEALTH, ALSO SERVE ON THE BOARD OF DIRECTORS FOR TRINITY HEALTH & AFFILIATES, A RELATED ORGANIZATION. EACH BOARD MEMBER SERVES AN AVERAGE OF 2 HOURS PER WEEK SERVING ALL ORGANIZATIONS. JOHN KUTCH, PRESIDENT/CEO OF TRINITY HEALTH, ALSO SERVES AS THE PRESIDENT/CEO FOR TRINITY HEALTH & AFFILIATES, A RELATED ORGANIZATION. ON AVERAGE, JOHN KUTCH WORKS 40 HOURS PER WEEK SERVING ALL ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 78,345. PRIOR PERIOD ADJUSTMENTS: -10,049,227. TOTAL TO FORM 990, PART XI, LINE 5: -9,970,882. COMMUNITY AMBULANCE SERVICES OF MINOT INC PO BOX 2195 MINOT ND 58702 450363593 AMBULANCE SERVICES ND 501(C)(3) LINE 11A, I TRINITY HEALTH 1 MOUNTRAIL COUNTY MEDICAL CENTER PO BOX 399 STANLEY ND 58784 450447670 MEDICAL SERVICES ND 501(C)(3) LINE 3 N/A 0 B&B DRUG INC 20 BURDICK EXPRESSWAY WEST MINOT ND 58701 450260565 RETAIL DRUG STORE ND TRINITY HEALTH C 5301025 1528103 1.00000 MEDICAL ARTS OUTPATIENT SERVICES INC 400 BURDICK EXPRESSWAY EAST MINOT ND 58701 450278212 RETAIL PHARMACY & DURABLE MEDICAL EQUIPMENT ND N/A C 1 1 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 B&B DRUG A 28000 FMV MEDICAL ARTS OUTPATIENT SERVICES INC A 16000 FMV