2013-11-05T16:11:47-06:00 2013-03-31 420714325 MCGLADREY LLP 227 W FIRST ST STE 700 DULUTH MN 558021919 990 2012-04-01 411724637 LONGVILLE LAKES CLINIC INC LONG 2185464366 180 JORDAN LANE LONGVILLE MN 56655 KYLE BAUER 2185464366 2013-10-23 1 JULIE BOYER P01278549 2187275025 2012 2016-02-24 21:20:13Z KYLE BAUER 180 JORDAN LANE LONGVILLE MN 56655 541777 0 X N/A X 1992 MN TO PROVIDE PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA. 18 18 13 19 0 0 21525 31546 521421 510135 78 96 0 0 543024 541777 0 0 0 0 287756 320741 0 0 0 486162 499495 773918 820236 -230894 -278459 278256 264541 197234 161978 81022 102563 TO PROVIDE PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA. 0 0 750099 510135 THE CARE TEAM AT LONGVILLE LAKES CLINIC PROVIDES A WIDE RANGE OF FAMILY MEDICINE FROM PREVENTATIVE HEALTH SERVICES TO CHRONIC DISEASE MANAGEMENT. IN A STYLE THAT , MORE THAN EVER, REFLECTS LONGVILLE'S UNIQUE SENSE OF COMMUNITY. THE CLINIC IS AVAILABLE FIVE DAYS A WEEK.LONGVILLE LAKES CLINIC PROVIDES THE COMMUNITY WITH A VARIETY OF ADVANCED TREATMENTS AND SUPPORT, AS WELL AS REFERRAL OPTIONS TO MEET MORE SPHISICATED MEDICAL NEEDS.ON MARCH 28, 2010, LONGVILLE LAKES CLINIC BECAME A CERTIFIED RURAL HEALTH CLINIC. 750099 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 13 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 MN X KYLE BAUER 2185467000 320 EAST MAIN ST CROSBY MN 56441 EARL W BEDARD 1.00 X X 0 8225 0 MYRON MIDTHUN 1.00 X X 0 5200 0 THEODORA SKATTUM 1.00 X 0 2000 0 ROGER TWIGG 1.00 X X 0 5800 0 RUTH HANSEN 1.00 X 0 2900 0 DANNO MAHONEY 1.00 X 0 900 0 MARY ZILLMER 1.00 X 0 1900 0 MIKE VANHORN 1.00 X 0 2000 0 BETTY PLATISHA 1.00 X 0 3100 0 ANDREA BEDARD 1.00 X 0 2600 0 HARRY GOTTSCH 1.00 X X 0 3500 0 BRIAN DOBSON 1.00 X 0 1600 0 JOLIENNE LUNDQUIST 1.00 X 0 2500 0 AL EBNET 1.00 X 0 2100 0 DAVE KAUPHUSMAN 1.00 X 0 2100 0 FLOYD HALE 1.00 X 0 2500 0 RICHARD SCHILLER 1.00 X 0 1600 0 KATHY PIERSON 1.00 X 0 300 0 NANCY MORITZ 1.00 X 0 2500 0 KYLE BAUER 40.00 X 0 152000 31269 THERESA SULLIVAN 40.00 X 0 122000 27393 0 327325 58662 0 0 1 0 CENTRAL LAKES MEDICAL CLINIC 318 MAIN STREET CROSBY MN 56441 PHYSICIAN SERVICES 199831 1 31546 31546 PATIENT REVENUE 621500 510135 510135 510135 96 96 541777 510135 0 96 X 275743 275743 10383 10383 12812 12812 21803 21803 325092 274236 50856 64377 64377 48424 41224 7200 6955 6955 22121 22121 4829 4829 MINNESOTA CARE TAX 7365 7365 PROVISION FOR DOUBTFUL 6553 6553 DUES & SUBSCRIPTIONS 6476 6476 PUBLIC RELATIONS 5528 5528 1775 1775 820236 750099 70137 0 50421 24008 97814 76341 4862 7685 2131 2333 361849 207675 123028 154174 278256 264541 28090 33428 169144 128550 197234 161978 X 81022 102563 81022 102563 278256 264541 X -278459 300000 X 0 1 X 1 0 X 21605 25131 12442 21525 31546 112249 462333 470924 451493 521421 510135 2416306 483938 496055 463935 542946 541681 2528555 0 0 0 2528555 223 83 59 78 96 539 223 83 59 78 96 539 484161 496138 463994 543024 541777 2529094 0.99980 0.99970 0.00020 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 361849 207675 154174 154174 DUE TO CUYUNA RANGE HOSPITAL DISTRICT 128550 128550 0 0 0 0 0 0 0 0 0 KYLE BAUER 0 152000 0 0 0 0 0 11657 0 19612 0 183269 0 0 JANEL KAUPSHMANN WIFE OF DAVID KAUPSHMAN, DIRECTOR 84299 EMPLOYMENT 0 BOBBIE MIDTHUN DAUGHTER IN LAW OF MYRON MIDTHRUN, DIRECTOR 44943 EMPLOYMENT 0 0 CARLA CARLSON SISTER IN LAW OF ANDREA BEDARD, DIRECTOR 32995 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 4 SECTION 3.2 NUMBER OF DIRECTORS. THE BOARD OF DIRECTORS WILL CONSIST OF THE DULY ELECTED DIRECTORS OF THE CUYUNA RANGE HOSPITAL DISTRICT D/B/A CUYUNA REGIONAL MEDICAL CENTER, A HOSPITAL DISTRICT WITHIN MINNESOTA STATUTES, CHAPTER 447, ("HOSPITAL DISTRICT"). PURSUANT TO THE PROVISIONS OF MINNESOTA STATUTES, SECTIONS 447.31 TO 447.37, INCLUSIVE, AS AMENDED, THERE SHALL BE ELECTED FROM EACH CITY OR TOWN COMPRISING THE HOSPITAL DISTRICT ONE DIRECTOR, AND IN ADDITION THERETO THERE SHALL BE, PURSUANT TO THE PROVISIONS OF LAW, ONE DIRECTOR ELECTED AT LARGE. SECTION 3.3 TERMS. A DIRECTOR'S TERM OF OFFICE IS FOUR (4) YEARS COMMENCING ON THE FIRST MONDAY IN JANUARY AND UNTIL A SUCCESSOR QUALIFIES. SECTION 3.4 ATTENDANCE. THE BOARD MAY REMOVE ANY BOARD MEMBER WHO IS ABSENT FROM THE CORPORATION BOARD MEETINGS FOR THREE CONSECUTIVE MONTHS, IF THE BOARD DETERMINES THAT THE MEMBER HAS ABANDONED THE OFFICE. IN THE EVENT OF SUCH A REMOVAL, A MAJORITY OF THE BOARD SHALL APPOINT A SUCCESSOR TO HOLD OFFICE UNTIL THE FIRST MONDAY IN JANUARY AFTER THE NEXT REGULAR HOSPITAL DISTRICT ELECTION. AT THE ELECTION A SUCCESSOR MUST BE ELECTED TO FILL THE UNEXPIRED TERM, REGARDLESS OF WHETHER THE REMOVED MEMBER'S TERM WOULD OTHERWISE HAVE CONTINUED PAST THAT ELECTION DATE. SECTION 3.5 VACANCIES. IF A BOARD MEMBER DIES, RESIGNS, FAILS TO QUALIFY, OR MOVES FROM THE HOSPITAL DISTRICT, A SUCCESSOR SHALL BE APPOINTED BY A MAJORITY OF THE REMAINING MEMBERS OF THE BOARD. THE SUCCESSOR SHALL HOLD OFFICE UNTIL THE FIRST MONDAY IN JANUARY AFTER THE NEXT REGULAR HOSPITAL DISTRICT ELECTION. AT THE ELECTION A SUCCESSOR MUST BE ELECTED TO FILL THE UNEXPIRED TERM REGARDLESS OF WHETHER THE DEPARTING MEMBER'S TERM WOULD OTHERWISE HAVE CONTINUED PAST THE ELECTION DATE. FORM 990, PART VI, SECTION A, LINE 6 CUYUNA RANGE HEALTH CORPORATION IS THE SOLE MEMBER OF LONGVILLE LAKES CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS CONSISTS OF EIGHTEEN DIRECTORS WHO ARE DESIGNATED BY CUYUNA RANGE HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND SUGGESTS APPROVAL TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C 1. DUTY TO DISCLOSE: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. 2. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS BY MAJORITY VOTE. 3. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: A. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. B. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. C. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. D. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY UNANIMOUS VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. 4. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: A. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. B. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. RECORDS OF PRECEDINGS: THE MINUTES OF THE GOVERNING BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN: 1. THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE GOVERNING BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS. COMPENSATION: 1. A VOTING MEMBER OF THE GOVERNING BOARD WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO VOTING MEMBER OF THE GOVERNING BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. ANNUAL STATEMENTS: EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, 2. HAS READ AND UNDERSTANDS THE POLICY, 3. HAS AGREED TO COMPLY WITH THE POLICY. PERIODIC REVIEWS: TO ENSURE THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH PUBLIC HOSPITAL DISTRICT REQUIREMENTS, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION AND THE RESULT OF ARM'S LENGTH BARGAINING. 2. WHETHER PARTNERSHIPS, JOINT VENTURES AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15B THE COMPENSATION FOR KEY EMPLOYEES IS REVIEWED BY THE COMPENSATION COMMITTEE, ALL COMPENSATION IS REVIEWED AGAINST HHRAM AND MMGMA AVERAGES FOR REASONABLENESS. LONGVILLE LAKES CLINIC DOES NOT COMPENSATE ANY TOP MANAGEMENT OFFICIALS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 274,236. MANAGEMENT AND GENERAL EXPENSES 50,856. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 325,092. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FORGIVENESS OF DEBT BY CUYUNA RANGE HOSPITAL DISTRICT 300,000. CUYUNA REGIONAL MEDICAL CENTER 320 E MAIN STREET CROSBY MN 56441 410879376 HEALTH CARE MN 115 N/A 0 CUYUNA RANGE HEALTH CORP 320 EAST MAIN STREET CROSBY MN 56441 411696402 HEALTH CARE MN CUYUNA RANGE HOSPITAL DISTRICT C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0