2012-11-08T15:29:44-06:00 2011-12-31 Deloitte Tax LLP 50 South Sixth Street Minneapolis MN 55402 990 2011-01-01 455023260 Park Nicollet Group Return PARK 9529936790 6500 Excelsior Boulevard St Louis Park MN 55426 Sheila McMillan 9529936790 2012-11-01 1 Kristina Rasmussen P00143920 6123974000 2011 2016-02-24 21:20:13Z X Sheila McMillan 6500 Excelsior Boulevard St Louis Park MN 55426 1425429506 1 1 5874 X www.parknicollet.com X MN Cares for and supports the health, healing, and learning of those served. 24 11 0 1087 4032986 -729543 18790749 14391919 1165706743 1141830201 7046714 17727333 6447050 6353193 1197991256 1180302646 5939785 186876 0 601848526 611537104 0 560866 550000008 544022710 1157788319 1155746690 40202937 24555956 929740783 925315895 505633819 487581753 424106964 437734142 X Cares for and supports the health, healing, and learning of those served. 0 0 893535110 186876 1048037604 Park Nicollet Health Services is the parent organization to an integrated care system that includes Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Health Care Products, Park Nicollet Institute and PNMC Holdings. Park Nicollet Health Services and affiliates have more than 8,100 team members, including more than 1,000 physicians on staff. Park Nicollet Health Services is a nonprofit system staffed by nationally recognized doctors, clinical professionals, nurses and other team members who help patients stay healthy and take care of them when they are sick.In 2011, Park Nicollet Health Services and affiliates, a national health care improvement leader, continued to make dramatic patient care advances, win prominent awards, expand access to services and integrate efficiency into Park Nicollet Health Services' operations. Park Nicollet Health Services and affiliates also have enhanced community health, increased team member satisfaction and promoted research and education. Park Nicollet Health Services mission is to care for and support the health, healing and learning of those served. Park Nicollet Health Services uses five core values to accomplish its mission: care, service, stewardship, joy and learning. Highlights of 2011 that support Park Nicollet Health Service's values include the following: - Park Nicollet opened Park Nicollet Clinic-Lakeville on Aug. 22 near the intersection of 185th Street and I-35W. The clinic opened with 25 team members, including four physicians. It offers family medicine, pediatrics and extended hours. - Park Nicollet Melrose Institute expanded its eating disorders care to Park Nicollet Clinic-Burnsville in October after the number of Melrose patient from Dakota County doubled over a three-year period. - Melrose Institute added a metabolic health and weight management program to its eating disorders treatment offerings. - Park Nicollet International Diabetes Center (IDC) began working with Mayo Clinic to develop a clinical diabetes training program for Chinese physicians after signing a $3.9 million contract with the China Ministry of Health. This is a five-year initiative to train 500 emerging expert physicians in China regarding advances in diabetes research, care and education. - With a $1.5 million grant awarded by the Leona M. and Harry B. Helmsley Charitable Trust, IDC worked to further standardize glucose analysis to improve type 1 diabetes clinical outcomes. - Park Nicollet Frauenshuh Cancer Center (FCC) became the first program in Minnesota to be certified as a Quality Oncology Practice Initiative. - In February, the 1,700 United Health Group employees who work at UHG's Minnetonka headquarters began using The Well, a new work-site clinic staffed by Park Nicollet clinicians and Optum Health wellness providers. - Launched Head + Heart, Together internal culture that combines intellect and the science of medicine with the compassion, spirit and humanity of Park Nicollet team members. The launch included team vision meetings, rollout of HHT competencies, a new appraisal system and HHT magazine for team members. - Park Nicollet completed its electronic medical record (EMR) transition from Last Word to Epic in early July. This was the culmination of three years of planning and implementations. The EPIC Command Center received more than 13,000 calls between July 2 and 18, and 130 people were working in the center when Epic went live on July 5. As part of the transition to Epic, Park Nicollet launched My Chart service, so patients can access portions of their EMR at mychart.parknicollet.com. - Park Nicollet began conducting patient surveys at all locations as part of our effort to continually improve our Patient and Family Experience. Results will be tied to team member surveys. - For the third consecutive year, Park Nicollet achieved 100 percent of its quality goals as part of its participation in the Physicians Group Practice (PGP) Demonstration, Medicare's first physician pay-for-performance initiative at the group practice level. Park Nicollet's 2011 federal PGP bonus payment was nearly $5.7 million. - Park Nicollet is one of 32 health systems to receive Accountable Care Organization (ACO) status from the Centers for Medicare & Medicaid Services (CMS). Through the Pioneer ACO Model, Park Nicollet is working with CMS to test new payment models in order to provide Medicare beneficiaries with higher quality care while reducing growth in Medicare expenditures through enhanced care coordination.We are gratified that many of our clinical and cost-saving achievements were recognized by respected third-party organizations. These honors and recognition included: - Park Nicollet received 2011 HealthGrades recognition that included: * Distinguished Hospital Award for Patient Safety * Cardiac Excellence Award * Stroke Care Excellence Award * Critical Care Excellence Award * Pulmonary Care Excellence Award * Gastrointestinal Medical Treatment Excellence Award * Women's Health Excellence Award * Innovation in Health Care Award - Park Nicollet's Leigh Myers-Higgins, RN, received the Good Catch for Patient Safety Award from the Minnesota Hospital Association. - Methodist Hospital's vascular laboratory was the only one in the Twin Cities to receive accreditation in four major testing areas from the Intersocietal Commission for the Accreditation of Vascular Labs. - Thomson Reuters named Methodist Hospital as one of its 50 Top Cardiovascular Hospitals. - Park Nicollet was named a Leader in Lesbian, Gay, Bi-sexual and Transgender (LGBT) Equality by the Human Rights Campaign Foundation, which publishes the annual Healthcare Equality Index report. The index focuses on policies and practices that help create a welcoming environment for LGBT patients and families. - 2011 Nurse of Excellence Award recipients were: Angel Larson, RN; Carrie Wickland, LPN; Kelly Albers, RN; Mary Jo Macklem, RN; Laura Nicklay, RN; Kris Smith, RN; and Vicki Norton, RN. - Joel Jahrus, MD, Medical Director of the Melrose Institute, received the Ellis Island Medal of Honor, which recognizes leadership dedicated to community service and a commitment to teaching and improving the health and well-being of others. Past recipients include former presidents Bill Clinton, George H. Bush and Gerald Ford. - FCC received the Commission on Cancer Outstanding Achievement Award. - IDC was selected as one of the top 25 medical organizations to participate in the Type 1 Diabetes Exchange. 60467729 60911521 Park Nicollet Health Care Products is part of Park Nicollet Health Services, a nonprofit integrated care delivery system, staffed by nationally recognized hospital and clinic doctors, clinical professionals, nurses, researchers and other staff at Park Nicollet Methodist Hospital and Park Nicollet Clinic who help patients stay healthy and take care of patients when they are sick. Park Nicollet Health Care Products is a supporting organization to Park Nicollet Methodist Hospital and Park Nicollet Clinic, providing durable medical equipment (DME)/supplies and pharmaceuticals supporting ongoing patient care. Park Nicollet Health Care Products focus on the health, healing and learning of patients by providing easy access to products and services that support successful self-management of a health condition at home. The products support both short term acute conditions and chronic lifelong conditions, such as eyewear, hearing aids, and many products that cross into almost every medical subspecialty. The Pharmacy @ Park Nicollet, meets growing demand for self-care products and services. The Pharmacies are at these Park Nicollet Clinic locations: Bloomington, Brookdale, Burnsville, Carlson Parkway (Minnetonka), Chanhassen, Eagan, Maple Grove, Minneapolis, St. Louis Park, and Wayzata as well as the Heart and Vascular Center and Meadowbrook at the Park Nicollet Methodist Hospital.The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for The Pharmacy @ Park Nicollet in 2011 include: - Enhanced product and pharmaceutical assortments available for patients, especially patients living with chronic health conditions such as diabetes, cancer, and bone and joint disease. - Educated physicians and care provider's about Pharmacy services and products to better link solutions for patient health care needs, including smoking cessation. - Developed standard work around provider referrals to Park Nicollet Pharmacies, assuring that patients have the products needed as they go home from clinic or hospital. - Continue to provide customer service and sales training to all store staff and management. - Expanded Pharmacy MTM, (Medication Therapy Management) services directly into the care environment to assist both providers and patients alike. - Update e-commerce Web site for Pharmacy @ Park Nicollet to make it easier for providers and patients to locate and purchase health care products. - Worked with staff to ensure their job satisfaction and self worth so that they can, in turn, share their positive attitude with clinical team members and customers. - Enhanced the focus on customer satisfaction scores to reinforce best practices and provide superior service. - Enhanced tracking systems to measure and monitor customer success of sales strategies. - Ensured all Pharmacy staff attended learning events to achieve their continuing education requirements. - Attended major trade shows to keep current with pharmacy assortment and billing information. - Held meetings and educational sessions for Pharmacy staff to learn the complexities of billing 3rd party payers to ensure compliance and accuracy of claims submission.The Contact Lens and Optical Store @ Park Nicollet Health Care Products, which meet growing demand for self-care products and services, are at these Park Nicollet Clinic sites: Bloomington, Brookdale, Burnsville, Carlson Parkway (Minnetonka), Chanhassen, Maple Grove, Minneapolis, Shakopee, and St. Louis Park. The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for The Contact Lens and Optical Store @ Park Nicollet in 2011 include: - Enhanced optical product assortments available for patients, especially patients living with chronic health conditions affecting their vision. - Enhanced the optical benefit program offered to PN employees to increase the affordability of eyewear.Park Nicollet Health Care Products, branded as The Stores @ Park Nicollet, is a group of departments within Park Nicollet Health Services providing durable medical equipment (DME)/supplies and pharmaceuticals, supporting ongoing patient care. HCP partners with your clinician to provide products and services to help you live more comfortably.The Health and Care Stores, which meet a growing demand for self-care products and services, located within Park Nicollet Clinics, include: Health & Care Store offering DME products at 4 locations, Hearing Center & Store with 3 locations, CPAP clinic/Store with 2 locations and Breastfeeding Center, (1 location within the Meadowbrook Health & Care store).The Health & Care Stores are at these Park Nicollet Clinic sites: Burnsville, St. Louis Park, as well as the Heart and Vascular Center and Meadowbrook at the Park Nicollet Methodist Hospital.The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for The Health & Care Stores in 2011 include: - Enhanced product assortments available for patients, especially patients living with chronic health conditions. - Educated physicians and care provider's about Health Care Stores product offerings to better link patient health care needs to product solutions, including smoking cessation. - Developed standard work for provider referrals to Health Care stores, assuring that patients have the products needed as they go home from clinic or hospital. - Continued customer service and sales training to all store staff and management. - Expanded point of care operation and specialty stores to help bring more products directly into the care environment to assist both providers and patients alike. 39057879 32881076 Members of the Park Nicollet Group incur expenses on behalf of the affiliated tax exempt organizations, (Park Nicollet Health Services, Park Nicollet Clinic, Park Nicollet Health Care Products, Park Nicollet Methodist Hospital, PNMC Holdings, and Park Nicollet Institute.) These organizations provide rental space, employment and management services in order to assure the efficient and professional delivery of health care to the community. 993060718 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 X 478 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 24 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X Sheila McMillan 9529936790 6500 Excelsior Blvd St Louis Park MN 55426 David Abelson MD 55.00 X X 0 1037727 204677 Steven Connelly MD 55.00 X X 0 605453 101236 Judith Corson 3.00 X X 0 0 0 Michael Kaupa 55.00 X X 0 712622 140460 Donald Lewis JD 3.00 X X 0 0 0 Sheila McMillan 55.00 X X 0 455991 93913 Richard E Struthers 3.00 X X 0 0 0 Kenneth L Thome 3.00 X X 0 0 0 Barbara Degnan 3.00 X 0 0 0 Paul Dominski 55.00 X 0 548428 141934 Bruce W Engelsma 3.00 X 0 0 0 Steve Frank 3.00 X 0 0 0 Roxanna Gapstur PhD 55.00 X 0 228552 67467 Christa Getchell 55.00 X 0 181653 21496 David Homans MD 55.00 X 0 502433 78019 Jeffrey B Husband MD 55.00 X 559721 0 47479 Tom Jones MD 55.00 X 696192 0 30136 Charles McCoy MD 55.00 X 195593 0 26937 Ken Melrose 3.00 X 0 0 0 Ruth Mickelsen 3.00 X 0 0 0 Lee N Newcomer MD 3.00 X 0 0 0 James O Pohlad 3.00 X 0 0 0 William Richards MD 55.00 X 285948 0 29327 Janet Schaffer MD 55.00 X 348834 0 44421 Eric Schned MD 55.00 X 358528 0 40282 Dan Schumacher 3.00 X 0 0 0 Janette Strathy MD 55.00 X 283879 0 33474 Katherine Tarvestad 55.00 X 0 40790 17235 Mark Wilkowske MD 55.00 X 515192 0 46833 Susan Zwaschka 55.00 X 0 556458 39930 Mary Johnson 55.00 X 0 310138 20473 Theodore Wegleitner 55.00 X 0 333820 54800 Dane Christensen MD 55.00 X 813975 0 51166 Timothy Diegel MD 55.00 X 1067526 0 67063 Darin Epstein MD 55.00 X 916553 0 52653 Steven Rakes MD 55.00 X 827746 0 51365 Anton Willerscheidt MD 55.00 X 806752 0 67561 Kathryn D Kallas 0.00 X 0 481623 59060 7676439 5995688 1629397 1035 1 1 0 RJM Construction 5455 HWY 169 Plymouth MN 55442 Construction Services 5641005 Mequist Transcriptions LTD PO Box 102467 Atlanta GA 30368 Transcription 3790333 ABM Janitorial Services Inc 75 Remittance Dr Suite 3048 Chicago IL 60693 Janitorial 3115880 Digital Prospectors Corporation 100 High Street Building B Exeter NH 03833 Training 3081690 Memorial Blood Center of Minneapolis PO Box 1164 Minneapolis MN 55480 Medical Services 2699816 133 2149214 3983539 8259166 14391919 Medical Services 621400 733475025 732582199 892826 Medicare/Medicaid 621400 310225584 310225584 Retail Sales 446110 60911521 56843848 4032986 34687 Services to Affilates 561000 32881076 32881076 Research 541700 4336995 4336995 1141830201 6125159 6125159 364955 364955 5811 5811 1980491 1495573 484918 484918 484918 252573248 1762777 242103996 994810 10469252 767967 11237219 11237219 1494243 532481 961762 961762 Cafeteria 722210 2439519 2439519 Property Management 812930 2271308 2271308 Misc Services 900099 189875 189875 4900702 1180302646 1136869702 4032986 25008039 167777 167777 19099 19099 2816444 2417758 398686 498723262 477128084 21224357 370821 31441915 29359501 2053059 29355 47971945 45028746 2887779 55420 30583538 29018823 1531445 33270 1036953 1036953 448883 448883 740657 740657 34159131 31354780 2732351 72000 3654242 271119 3383123 14850089 10538470 4311619 8935225 8593519 341706 43704336 40082286 3622050 936195 778246 157949 801880 698213 103667 9789418 9789418 30430126 27527472 2902654 7889654 7889654 Management Fees 156429670 51414077 105015593 0 Medical Supplies 134980485 134548555 431930 0 Cost of Goods Sold 40837694 40837694 0 0 Bad Debt Expense 26018410 26018410 0 0 28379662 27468671 910991 1155746690 993060718 162125106 560866 602996 830871 192677 282705 1972690 3414212 112572899 135003069 11219361 10046399 8249643 11936459 954957878 613787542 358091019 341170336 386672271 394731187 28139728 42108311 7819845 929740783 925315895 93815825 82424257 6191231 11939650 388720675 379891311 2698222 1984777 4132852 1930180 10075014 9411578 505633819 487581753 X 422917533 436481051 914699 976854 274732 276237 424106965 437734142 929740783 925315895 X 24555956 -10928779 X X 0 1 1 X 1 1 X Schedule A, Part IV, Supplemental Information: Park Nicollet Methodist Hospital Line 3; 170(b)(1)(a)(iii) Park Nicollet Clinic Line 3; 170(b)(1)(a)(iii) Park Nicollet Institute Line 4; 170(b)(1)(a)(iii) Park Nicollet Health Care Products Line 11 Type II; 509(a)(3) PNMC Holdings Line 11 Type I; 509(a)(3) Part I, Line 11: Supporting organizations detail: PNMC Holdings and Park Nicollet Healthcare Products provide support to following organizations: PNMC Holdings: Line 11, column (i) Park Nicollet Clinic, (ii) 41-0834920, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $2,205,011 Park Nicollet Health Care Products: Line 11, column (i) Park Nicollet Methodist Hospital, (ii) 41-0132080, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $5,385,974 Line 11, column (i) Park Nicollet Clinic, (ii) 41-0834920, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $ 65,563,597 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 55089 55089 0 Explanation of Lobbying Activities: Part II-B, Line 1: Park Nicollet reimburses certain professional membership dues of employees. A portion of such membership dues are used by the professional associations for lobbying activities. 22048592 1489934 -341465 2342091 20854970 23127080 1474161 850097 3402746 22048592 40045623 3239794 538558 20696895 23127080 40780143 3726005 -162788 4297737 40045623 0.00000 0.43000 0.57000 0 1 1 27670907 27670907 445936748 250225141 195711607 50098266 33571055 16527211 426937522 329991346 96946176 4314435 4314435 341170336 Capital Lease Obligation 73179 Long-term Capital Lease Obligation 3164318 Securities Loan Agreement 6174081 9411578 Description of Intended Use of Endowment Funds: Part V, Line 4: The Term endowment funds for use within Park Nicollet Clinic, Park Nicollet Institute and Park Nicollet Methodist Hospital are for Grants related to Education, Research and Patient Care. Description of Uncertain Tax Positions Under FIN 48: Part X: Park Nicollet Health Services and affiliates adopted the provisions of FIN 48, Accounting for Uncertainty in Income Taxes - an interpretation of FASB Statement No. 109, on January 1, 2007. As a result of the implementation of FIN 48, Park Nicollet Health Services and affiliates were not required to recognize a liability for unrecognized tax benefits. There were no unrecognized tax benefits for the years ended December 31, 2009, 2010 and 2011. East Asia and the Pacific 0 0 Program Services Education 13733 Europe (including Iceland & Greenland) 0 0 Program Services Education 29333 Middle East and North Africa 0 0 Program Services Education 14288 0 0 0 0 0 0 57354 0 57354 0 0 0 0 0 0 1 1 X 1 X 275.000000000000 1 X 275.000000000000 1 0 1 1 11580871 165368 11415503 0.01010 105691914 58427819 47264095 0.04180 117272785 58593187 58679598 0.05190 20072 5144526 441943 4702583 0.00420 5794367 1487507 4306860 0.00380 7176759 4712706 2464053 0.00220 50000 50000 0.00000 20072 18165652 6642156 11523496 0.01020 20072 135438437 65235343 70203094 0.06210 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 1 16279755 0 220257408 260611957 -40354549 X 1 1 1 1 Park Nicollet Methodist Hospital

6500 Excelsior Blvd St Louis Park MN 55426

X X X X Park Nicollet Methodist Hospital 1 1 1 275.000000000000 1 275.000000000000 1 X X X 1 1 X 1 0 1 X 0 1 28 Struther's Parkinson Center

6701 Country Club Drive Golden Valley MN 55427

Research and Treatment of Parkinson's Disease Park Nicollet Melrose Institute

3625 Monterey Drive St Louis Park MN 55416

Eating disorder clinic/General Medical 3900 ClinicAmbulatory Surgical Center

3900 Park Nicollet Boulevard St Louis Park MN 55416

Ambulatory Surgical Center and General Medical and Retail Meadowbrook Medical Building

3931 Louisiana Ave S St Louis Park MN 55426

Physican offices, ancillary medical services and Medical Retail Prairie Center

8455 Flying Cloud Drive Eden Prairie MN 55344

Physican offices, ancillary medical services and Medical Retail Bloomington Clinic

5320 Hyland Greens Drive Bloomington MN 55437

Physican offices, ancillary medical services and Medical Retail Brookdale Clinic

6000 Earle Brown Drive Brooklyn Center MN 55430

Physican offices, ancillary medical services and Medical Retail Burnsville Clinic

1400 Fairview Drive Burnsville Clinic MN 55337

Physican offices, ancillary medical services and Medical Retail Carlson Parkway Clinic

15111 Twelve Oaks Center Drive Minnetonka MN 55305

Physican offices, ancillary medical services and Medical Retail Chanhassen Clinic

300 Lake Drive E Chanhassen MN 55317

Physican offices, ancillary medical services and Medical Retail Creekside

6600 Excelsior Blvd St Louis Park MN 55426

Physican offices, ancillary medical services and Medical Retail CT-MRI Center

4951 Excelsior Blvd St Louis Park MN 55416

Imaging Center/Optical Retail Eagan Clinic

1885 Plaza Drive Eagan MN 55122

Physican offices, ancillary medical services and Medical Retail Golden Valley Clinic

8240 Golden Valley Drive Golden Valley MN 55427

Physican offices, ancillary medical services and Medical Retail Lakeville Clinic

18432 Kenrick Ave Lakeville MN 55044

Physican offices, ancillary medical services and Medical Retail Maple Grove Clinic

15800 95th Ave N Maple Grove MN 55369

Physican offices, ancillary medical services and Medical Retail Maple Grove OB

9855 Hospital Drive Suite 275 Maple Grove MN 55369

OB services Maple Grove Rehab

9827 Maplge Grove Pkwy N Maple Grove MN 55369

Rehabiliation Services Minneapolis Clinic

2001 Blaisdell Ave S Minneapolis MN 55404

Physican offices, ancillary medical services and Medical Retail Minnetonka - Shorewood Clinic

19685 Highway 7 Shorewood MN 55331

Physican offices, ancillary medical services and Medical Retail Plymouth Clinic

3007 Harbor Lane N Plymouth MN 55447

Physican offices, ancillary medical services and Medical Retail Prior Lake Clinic

4670 Park Nicollet Ave SE Prior Lake MN 55372

Physican offices, ancillary medical services and Medical Retail Shakopee Clinic

1415 St Francis Ave Shakopee MN 55379

Physican offices, ancillary medical services and Medical Retail Shakopee Clinic

1515 St Francis Ave Shakopee MN 55379

Physican offices, ancillary medical services and Medical Retail Shakopee Clinic

1601 St Francis Ave Shakopee MN 55379

Physican offices, ancillary medical services and Medical Retail St Louis Park Clinic

3800 Park Nicollet Blvd St Louis Park MN 55416

Physican offices, ancillary medical services and Medical Retail St Louis Park Clinic

3850 Park Nicollet Blvd St Louis Park MN 55416

Physican offices, ancillary medical services and Medical Retail Wayzata Medical Building

250 Central Ave N Wayzata MN 55391

Physican offices, ancillary medical services and Medical Retail Part I, Line 6a: Park Nicollet Foundation, a related organization of Park Nicollet Methodist Hospital, completes an organization wide annual community benefit report that includes Park Nicollet Methodist Hospital and other affiliated entities. Part I, Line 7: Park Nicollet Methodist Hospital uses the cost-to-charge ratio method when calculating the amounts reported on Part I, line 7. The cost-to-ratio was derived using Worksheet 2, ratio of patient care-cost-to charge, from the schedule H instructions. Part I, L7 Col(f): Bad Debt Expense of $26,018,410 was subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f).Part III, Line 3: Park Nicollet Methodist Hospital and its affiliates work with those qualifying for charity care along every step of the process including accepting applications for financial assistance after previous attempts to work with the patient fail. Every effort is made to work with the patient to provide financial assistance when appropriate. While there are people who do not cooperate with the hospital regarding payment plans, financial assistance or with those trying to help them get on government programs, it is impossible to know their reason for not cooperating and therefore know whether they may have qualified for charity care. Park Nicollet doesn't have predictive software which would make assumptions based on housing situation, credit reports, etc. and recommend assistance without a process for gathering income verification. In light of the foregoing facts, Park Nicollet is unable to reasonably determine whether any amount of bad debt could have been classified as charity care. Part III, Line 4: Park Nicollet Methodist Hospital's audited financial statement do not include a footnote discussing bad debt expense, or allowance of doubtful accounts. Bad debt is accounted for on the financial statements by estimating patient liability net of any charity care and then calculating what portion of that will not be collected based historical uncollectable rates. When a patient meets our financial requirements it is classified as charity care; if they do not quality, their services will be written off as bad debt. Park Nicollet Methodist Hospital does not include any charity care in their bad debt expense calculation. Part III, Line 8: Park Nicollet Methodist Hospital believes that all of the Medicare loss should be classified as a community benefit. The reason is that if these services were not provided by us they would become the obligation of the federal government. Based on this, Medicare losses should be included as a community benefit because the losses are incurred in performing an important public service. The allowable costs in our calculation came from the Medicare Cost Report as instructed per the 990 Schedule H instructions. Part III, Line 9b: The collection policy incorporates the requirements as stated by the Minnesota Attorney general and views account resolution through the Park Nicollet financial assistance program as an option for account resolution. This option is shared with debtors via statements and as part of collection calls to debtors from Park Nicollet staff and collection agencies. Park Nicollet's financial assistance is also described in pamphlets and on our website. The website includes a simple interactive schedule to allow a debtor to see if they may qualify. If the Debtor qualifies for financial assistance, collection efforts cease and charges are cleared from their account. Park Nicollet Methodist Hospital Part V, Section B, Line 19d: Park Nicollet uses the discount rate associated with our "most preferred payer" which is defined as our largest commercial payer. Park Nicollet Methodist Hospital Part V, Section B, Line 21: Park Nicollet charges its patients gross charges if the patient has elective surgery, which is not medically necessary. Part VI, Line 2: Integrated in our strategic planning process, Park Nicollet Methodist Hospital and its affiliates actively involve its patients, employees, board members and community partners in identifying patient and community needs. This process encourages awareness of changing patterns of need to improve the health of our patients and community members. As part of current assessment of needs, Park Nicollet Foundation convenes patients and community partners at monthly and quarterly meetings of several Healthy Communities Collaboratives and Advisory Groups located throughout our service area. A few examples of participating members include 1) representatives from the school districts of St. Louis Park, Hopkins, Wayzata/Plymouth, Brooklyn Center, Osseo and Burnsville/Eagan/Savage, 2) Mental health providers such as The Family Partnership and North Psychology, 3) Groups working with underserved populations such as Northwest Hennepin Family Services Collaborative, Portico HealthNet, 360 Communities, Interfaith Outreach and providers who work with the developmental needs of young children such as St. David's Center. In 2011, Park Nicollet continued its joint sponsorship of the Successful Aging Initiative in St. Louis Park. This community based group meets monthly to identify and focus on the needs of senior citizens including improving coordination of community and health related services. Sixty to eighty participants regularly attend these sessions which include educational and networking opportunities for seniors and those working with seniors. In addition, patient advisory groups and councils have been established to foster collaboration between patients, families and care teams. These councils focus on topics such as patient safety, facility design, clinician-patient communication, quality improvement, patient/family education, ethics and research. Councils support work in the following areas: - Methodist Hospital Patient Family Council - focusing on quality and safety - Frauenshuh Cancer Center - Health Care Home quality teams - After teams grown from four to seven "Health Care Home Patient Partner Councils" - Melrose Institute - Struthers Parkinson's CenterIn 2011, Park Nicollet Methodist Hospital began the planning and research phase for a formal Community Health Needs Assessment which will be completed in 2012. This formal assessment builds on the strength of Park Nicollet Health Services as a convener of the community by inviting 1100 community leaders, workers, and members of the community to participate in an online health needs survey and also convening focus groups utilizing the World Cafe model of facilitation. Results will be prioritized and presented to the Board of Directors in 2012 along with recommendations for an implementation plan to be incorporated into the strategic planning process for 2013-2015.Park Nicollet Institute participated in strategic planning in 2011 and used data gathered as part of this process to prioritize work in research and education. The key to assessing the needs for patient education involve including patients in the assessment process. Steps in the needs assessment process include defining the community or population, followed by determining what type of data is needed to complete the assessment and then collecting the data from a variety of sources which include but are not limited to patient and clinician surveys, local and national statistics related to the problem that is being addressed, evidence-based care guidelines, quality and safety outcome reports, proprietary data sources as appropriate and published literature. For professional education, understanding the gaps in clinical practice and the educational needs of physicians is critical to the success of the overall CME program and its planned activities. As part of the semi-annual review process, the Medical Education Committee (MEC) and the CME team identify data sources and methods to review data for CME program planning. We identify our learners' professional practice gaps and needs by reviewing one or more of the following: - organizational planning survey of target audience, which includes e-surveys, structured interviews and biannual staff surveys - patient care audit and quality assurance reports - morbidity and mortality statistics - peer-reviewed abstracts - faculty input - individual clinician behavior and prescribing data - community measures quality data - clinician registries - quality outcomes reports - dashboards - desirable patient care improvements identified from measurement of clinical practice guidelines - literature review of recent trends in biomedical science research - evaluation data from preceding CME activities - input from regional and national medical education and research communities provided by the MEC committee, CME faculty and Park Nicollet leadership - HEDIS data - Institute for Clinical Systems Improvement guidelines - focused patient and staff surveys - feedback from planning committees and focus groups representative of the target audience - patient surveys regarding quality of care and interaction with providers (Press Ganey reports) - topic-specific patient surveys - annual Park Nicollet quality reports - safety tracking database-quality tracking - physician competencies - Park Nicollet planning - maintenance of certification requirements - Lean results (Rapid Process Improvement Workshop)In research, clinical areas work with principal investigators to determine whether a study fills a gap in patient care. If the study addresses an identified need, a feasibility checklist is reviewed to address scientific merit, impact on patient care, mission of department and cost. Part VI, Line 3: Park Nicollet Methodist Hospital participates in multiple unique financial assistance programs, including our own Financial Assistance (FA). We inform our patients in multiple ways about our FA program and other financial assistance options for services received at PNHS. Approximately 14 percent of hospital patients participate in state public programs and approximately 2 percent are uninsured. A list of communications for patients relating to financial assistance follows: - Hospital booklets given to inpatients - Website, FA information found in billing and insurance section - FAQ on FA - FA calculator - online calculator allows quick and easy estimation of eligibility under the program - FA application - application may be printed for submission - Information on Medical Assistance, including eligibility and application process - Patient statements - All balance forward statements, regardless of balance, include a financial assistance application and responses to frequently asked questions regarding FA.In addition to the written material, Customer Service, Collections and hospital Patient Access Liaisons (PALs) inform patients about assistance options, including government programs and FA. PALs are on-site in the hospital and can meet with patients in their rooms or prior to admission. Most customer service and collections work is done though phone calls, but our main clinic has an on-site location for personal conversations. Park Nicollet Methodist Hospital staff is trained in helping patients apply for Medical Assistance and has also contracted with outside services to assist patients in the application process for Medical Assistance in more complicated circumstances. Part VI, Line 4: Park Nicollet Health Services, through its 19 Twin Cities primary care clinics, other care locations and Methodist Hospital and specialty facilities, provides health care access to more than 1.6 million people, primarily in the western Twin Cities area. The majority (75.5 percent)of this population, spread over 96 ZIP codes, is white, 7.1 percent is black, 4.2 percent is Asian, 2.5 percent is Latino , with those defining themselves as "multiracial" or "other" making up the rest of those we serve. Park Nicollet clinics are strategically located in communities to provide access to care, regardless of economic status or means of transportation. The socio-economics of our population served varies both between and within each community. Our clinic locations span the entire west metro from Maple Grove and Brooklyn Center in the northwest to Minnetonka and St. Louis Park in the central west to Shakopee and Prior Lake in the southwest, to Eagan in the southeast and to Lakeville (which opened in 2011) in the south. These clinics serve communities (and individuals) across the socio-economic spectrum. True to their metropolitan nature, each community served enjoys diversity within its own borders. For example, in Brooklyn Center, in addition to Park Nicollet Clinic - Brookdale, Park Nicollet has set up a health clinic for school district students. This clinic is located in the high school and is available to all students regardless of their ability to pay. Minorities make up half of the Brooklyn Center population, and 72 percent of district students are from low-income families. Three other school based or affiliated clinics operate in Wayzata, Burnsville and St. Louis Park. In St. Louis Park, home to many of the state's 12,500 Russian immigrants, we offer services, including translation, for those whose primary language is not English. Part VI, Line 5: Park Nicollet Methodist Hospital is a 426-bed facility recognized as an area leader in cancer care, cardiovascular services, maternity care and neuro-rehabiliation medicine, located in St. Louis Park, Minnesota. Medical staff privileges at the hospital are extended to all qualified physicians in the community. Park Nicollet Methodist Hospital's Board of Directors is a community board with all of its independent members living in the area served by the organization.Park Nicollet Methodist Hospital owns a facility in Golden Valley, Minnesota that houses the Struthers Parkinson's Center, which is dedicated to providing comprehensive assessment, treatment, support, education and research to improve the quality of life of people touched by this disease. Health professionals help patients from around the world receive specialized programs and services for Parkinson's Disease at Struthers.A national leader in the treatment of eating disorders, Park Nicollet Methodist Hospital owns and operates the Park Nicollet Melrose Institute for eating disorders, located in St. Louis Park, Minnesota. This facility, was specially constructed for treating those with eating disorders. The Melrose Institute treatment model revolutionizes care, taking individualized treatment to a whole new level. The care teams work with patients to determine appropriate placement in inpatient, residential or one of four levels of outpatient care, including unique specialty areas not currently found elsewhere. In 2011, the Melrose Institute sponsored over 100 presentations, trainings, webinars, exhibits, and other events to increase community awareness and prevention.Methodist Hospital sponsors and supports the Creekside Family Medicine Residency program, affiliated with the University of Minnesota. This 3 year residency trains 6 new family physicians each year to work in primary care including underserved areas. In addition to its training program, the Creekside residency provides vital community services for the uninsured and underinsured along with outreach programs to promote community health. Methodist Hospital participates as a training site for other specialty training of residents including the areas of general surgery, ob/gyn and critical care.As a part of the Emergency Management program, a Hazard Vulnerability Assessment is completed for the Methodist Hospital Campus. This survey assesses numerous risks in the community that may impact hospital operations. Risks unique to the geographical area of Methodist Hospital include numerous industrial worksites with multiple chemicals on site and close proximity to a rail line that transports hazardous chemicals. Because of these hazards in the community, Methodist Hospital plans with local first responders for the decontamination and treatment of affected community members.The ongoing process for assessing community health needs as described in Schedule H, Part VI, Question 2 has enabled the entire PNHS organization to focus attention to the needs described below in addition to other health needs.Park Nicollet Foundation's community connectivity model of convening on need, building relationships and raising support has brought responses in these priority areas: 1. Healthy kids are better learners:Park Nicollet Methodist Hospital, Park Nicollet Foundation and Park Nicollet Clinic partner with 21 school districts to assure that all students are up to date with their immunizations on the first day of school each year.- Four school-affiliated clinics, built, staffed and funded in partnership with Park Nicollet Foundation, Park Nicollet Methodist Hospital and Park Nicollet Clinic provide access to no cost or low cost medical, mental health and dental care to children and youth in the community.- The Ophthalmology department reaches out to the schools in an effort to assure eye health, by providing comprehensive eye exams and a prescription pair of eyewear yearly for children without health insurance.- Students referred by school nurses, whose families are unable to afford medications, receive needed medications at no charge through Park Nicollet Pharmacies.2. Increasing access to care for the uninsured:- In 2011, Park Nicollet Methodist Hospital, along with Park Nicollet Clinic and other affiliates provided needed comprehensive care, including primary, specialty, hospital and pharmacy services, at no charge to 1,400 individuals enrolled in the St. Mary's program, an innovative model of providing continuity of care for the uninsured.- Provided 6300 prescriptions for outpatient medications to low income individuals and families, assuring medical treatment for acute and chronic conditions such as asthma and diabetes.- Traditional financial assistance provided to individuals and families in need who are not enrolled in the St. Mary's program. 3. Focus on seniors:- The Successful Aging Initiative continues to respond to the needs of senior citizens in St. Louis Park, utilizing multidisciplinary work groups specifically focused on helping seniors stay safe in their homes by reducing the risk of falls and other injuries, increasing opportunities for fitness and exercise, improving transportation options, providing education to improve one's self-management of chronic illnesses, and encouraging completion of health care directives.4. Creating the health care home:- Growing economic and ethnic diversity in our communities has widened the gap of health disparities. Increased rates of obesity and diabetes, a growth in early childhood mental health issues, increased numbers of new immigrants unfamiliar with accessing our country's model of health care delivery and still struggling with issues of war and civil strife from their countries of origin and seniors isolated in their homes are just a few of the challenges that threaten the health of members of our communities.- Park Nicollet Clinics are leading the way in developing "health care homes" that not only provide needed medical care, but do so in a comprehensive model of support for patients and families to assure that they have timely access, effective coordination of care, a personal relationship with their physician and clinical care team, and a connection to other community resources.- An example of a Park Nicollet Clinic that has taken the lead in creating a model for the Health Care Home is the Plymouth Park Nicollet Clinic. In 2011 this clinic: * Offered classes at the clinic on Medicare and CareNextion. Participated in the Plymouth parade annually and the Plymouth Healthy Living Fair. Formed an onsite Healthy Living Support group facilitated by a Care Coordinator and a Patient Partner. The clinic participates on the Plymouth Yellow Ribbon Campaign Steering Committee. Established a partnership with Plymouth Community Center to work together to provide community needs. * Serves clients that come from group homes and assisted living facilities. * Patients involved in the clinic's Quality Committee. * Care Coordination in place for patient care, aimed at addressing the patient's medical and social needs and helping them navigate healthcare and community resources. This results in better patient outcomes and reduced total cost of care through reduced hospitalizations and ER visits. 5. Sticking with patients when they need us most: - Often the services needed to maintain one's health and wellbeing during a serious or life-threatening illness are not fully funded or reimbursed under traditional health insurance. Park Nicollet Methodist Hospital and Park Nicollet Foundation strive to assure the help is there when needed. * Club CREATE, a therapeutic adult day program at Struthers Parkinson's Center, offers activities that enrich patients physically, mentally, spiritually and socially. The program utilizes a variety of artistic and creative outlets, relaxation and meditative programs, and movement and exercise opportunities. * Park Nicollet Methodist Hospital's INSPIRE program is a unique service offering stroke survivors and their family support and education through seminars and support groups. * Park Nicollet Methodist Hospital's Melrose Institute offers comprehensive care, education and support through innovative curriculum-based programs for those struggling with eating disorders. * Reducing the number of "sleepless nights" while waiting for a diagnosis, helping patients conserve their energy by bringing services to them during treatments, offering spiritual care, social services and financial assistance for medications, groceries and other expenses while patients recover from their illness are commitments Frauenshuh Cancer Center at Park Nicollet Methodist Hospital makes to its patients. Part VI, Line 6: The Park Nicollet Institute reaches thousands each year through research studies, professional and patient education, and library services. In 2011, we held 223 patient education classes for 2,387 attendees. We conducted more than 5,000 diabetes education visits. The Health Library received 2,261 visitors. We published 326 new or revised patient education materials. Our Office of Continuing Medical Education granted 32,097 CME credits through 95 professional education activities. Almost 500 research studies were active in 2011 at Park Nicollet and through Minnesota Metro Community Clinical Oncology Program. Park Nicollet authors published 72 peer-reviewed papers, books and book chapters. - Community health: Throughout the year, employees participate in health fairs and screenings, most frequently in the area of diabetes and nutrition. International Diabetes Center hosts a Back to School fair for children with diabetes and hosts diabetes support groups for men, women and children. Numerous employees participate on national and local society and Park Nicollet committees that serve the community. Rich Bergenstal, MD, serves in a leadership role for the American Diabetes Association (ADA). We also provide health education lectures and workshops, and respond to media inquiries to share expertise about diabetes and nutrition. - Research: Research is embedded in departments and strategies across Park Nicollet to support quality initiatives and the patient experience. Research encompasses investigator-initiated studies, clinical trials, practice-based research, outcomes and quality improvement projects, data analytics, statistics, survey development and focus groups. At Park Nicollet and its affiliates, more than 500 research studies are active each year. Park Nicollet Institute provides the infrastructure and resources to support research and clinical quality goals of the organization, which includes the following:- Needs assessment and feasibility- Mentoring and training- Scientific and humans subjects review- Regulatory compliance and reporting- Grant management, including application preparation and submission, contract and agreement negotiation, finance, budget development, identification of funding sources- Protocol development and research design- Manuscript and poster/presentation preparation- Database development, data cleaning, statistics and analytics, survey review and design, focus group facilitation- Study operations support including recruitment, consenting, enrolling, data collection/entry- Patient Education:Park Nicollet Institute's Patient Education department provides educational tools to support patients in preventing and managing illness and improving health. We work closely with clinicians to create programs, classes, videos, web content and decision support tools to help patients take an active role in their health. These resources help patients prevent and manage common health problems, live well with chronic conditions, prepare for procedures and improve overall health and well-being. Our Park Nicollet Health Library provides resources and services for patients, family and the community. This includes literature searches and document delivery, as well as access to print, online and Internet resoures. - Professional Education:The Institute's Professional Education department provides learning activities to enhance physician knowledge, competence and performance. Continuing medical education (CME) staff partners with Park Nicollet physicians and departments to manage a comprehensive educational program through activities designed to meet individual and department needs. Part Vi, Line 6: Park Nicollet Methodist Hospital is part of Park Nicollet Health Services, an integrated health system. Other affiliates include 1) Park Nicollet Clinics in 19 locations, and other care locations, 2) Park Nicollet Foundation, the philanthropic arm of Park Nicollet Health Services helping to bring resources to needs in its communities, 3) Park Nicollet Institute, focused on education and research for Park Nicollet Health Services and its community, 4)Park Nicollet Health Care Products, providing retail pharmacy and health related products through existing Park Nicollet locations.All affiliates are under a common Board of Directors. Park Nicollet Foundation has a separate board which is overseen by the Park Nicollet Health Services Board. The communities' health needs are shared among the affiliates and decisions regarding the effective use of resources to respond to these needs are coordinated.A specific example of this coordination of services to respond to community need is with the four school-affiliated community clinics. Initial development, funding and ongoing facilitation is provided by the Park Nicolet Foundation, staffing through the Park Nicollet Clinics, laboratory and other diagnostic services through Park Nicollet Methodist Hospital, and outpatient medications, eye glasses, and DME supplies through Park Nicollet Health Care Products. Part VI, Line 7: List of States Receiving Community Benefit Report: MN 1 Park Nicollet Foundation 6500 Excelisior Blvd St Louis Park MN 55416 237346465 501(c)(3) 117777 Community Services Minnesota Medical Foundation 200 Oak Street SE Suite 300 Minneapolis MN 55455 416027707 501(c)(3) 50000 Neurosurgery Fund 2 0 Individual scholarships 19 18500 Earl Young Award 1 599 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Park Nicollet Service League has a student volunteer scholarship program to give financial support to student volunteers who have provided exceptional volunteer service and are interested in furthering their education. Applicants must be an active student volunteer, a senior in high school and who has applied to a post-high school education program and must be dedicated volunteer at Park Nicollet Methodist Hospital. Occasionally Park Nicollet Methodist Hospital grants monies to other tax-exempt organizations conducting programs and/or research that will ultimately benefit those served by Park Nicollet Health Services and affiliates. During calendar year 2011, grants were made to Park Nicollet Foundation and Park Nicollet Institute for improvements to medical services and medical research. These grants were made to parties related to Park Nicollet Methodist Hospital, so employees of Park Nicollet Methodist Hospital were able to verify the use of the monies contributed. 1 1 0 0 0 0 0 1 0 David Abelson MD 0 650840 0 294551 0 92336 0 148500 0 56177 0 1242404 0 70698 Steven Connelly MD 0 431266 0 163086 0 11101 0 52265 0 48971 0 706689 0 0 Michael Kaupa 0 429776 0 224172 0 58674 0 68879 0 71581 0 853082 0 47105 Sheila McMillan 0 388862 0 54982 0 12147 0 48000 0 45913 0 549904 0 0 Paul Dominski 0 328596 0 180560 0 39272 0 25175 0 116759 0 690362 0 0 Roxanna Gapstur PhD 0 221227 0 0 0 7325 0 20250 0 47217 0 296019 0 0 Christa Getchell 0 172981 0 0 0 8672 0 13125 0 8371 0 203149 0 0 David Homans MD 0 485365 0 6392 0 10676 0 40441 0 37578 0 580452 0 0 Jeffrey B Husband MD 526839 0 24249 0 8633 0 0 0 47479 0 607200 0 0 0 Tom Jones MD 630325 0 31491 0 34376 0 0 0 30136 0 726328 0 0 0 Charles McCoy MD 182907 0 8046 0 4640 0 0 0 26937 0 222530 0 0 0 William Richards MD 201183 0 8992 0 75773 0 0 0 29327 0 315275 0 0 0 Janet Schaffer MD 328864 0 9022 0 10948 0 0 0 44421 0 393255 0 0 0 Eric Schned MD 295500 0 14041 0 48987 0 0 0 40282 0 398810 0 0 0 Janette Strathy MD 242907 0 6920 0 34052 0 0 0 33474 0 317353 0 0 0 Mark Wilkowske MD 473344 0 32868 0 8980 0 0 0 46833 0 562025 0 0 0 Susan Zwaschka 0 117360 0 99929 0 339169 0 5561 0 34369 0 596388 0 47651 Mary Johnson 0 161192 0 105629 0 43317 0 0 0 20473 0 330611 0 32193 Theodore Wegleitner 0 247202 0 59584 0 27034 0 4810 0 49990 0 388620 0 16976 Dane Christensen MD 769804 0 43096 0 1075 0 0 0 51166 0 865141 0 0 0 Timothy Diegel MD 627296 0 33320 0 406910 0 0 0 67063 0 1134589 0 0 0 Darin Epstein MD 878782 0 36706 0 1065 0 0 0 52653 0 969206 0 0 0 Steven Rakes MD 784627 0 38811 0 4308 0 0 0 51365 0 879111 0 0 0 Anton Willerscheidt MD 768324 0 34143 0 4285 0 0 0 67561 0 874313 0 0 0 Kathryn D Kallas 0 68383 0 125336 0 287904 0 29713 0 29347 0 540683 0 30600 Part I, Lines 4a-b During 2011, Park Nicollet Health Services, a related entity, terminated without cause the employment of individuals in reportable positions. Severance payments were determined to be payable under the Park Nicollet Health Services Executive Management Group Severance Policy (the "Policy"). The policy provides that if Park Nicollet Health Services terminates a covered individual without cause, and if the individual releases all legal claims against Park Nicollet Health Services, then Park Nicollet Health Services will provide the terminated individual severance compensation for a period of one year including salary, health, life, dental and disability benefits, as well as deferred compensation, incentive compensation, and pension plan payments. Based on the foregoing, the amount of severance compensation and benefits provided to each of the individual on severance during 2011 is as follows: - Kathryn D. Kallas, $255,000 - Susan R. Zwaschka, $240,000 Part I, Line 4B: Senior leaders of Park Nicollet Health Services and affiliates are given the opportunity to participate in the Capital Accumulation Account Plan. The Capital Accumulation Account Plan (CAA Plan) participation is limited to senior leaders and all the vice presidents. Each participant receives an annual allowance equal to the sum of (i) a stated percent of salary, (ii) voluntary salary deferrals. The allowance is credited to a bookkeeping account. Earnings are credited to the account based on the performance of simulated investments. Benefits vest upon the earliest of remaining employed to an elective vesting date (two years to age 68), involuntary termination without cause, disability, death, or not competing for 24 months following voluntary or for-cause termination. Benefits are paid in a single lump sum upon vesting. Participants are general creditors of the employer for the payment of the benefits. The following participants received payouts from a related organization, Park Nicollet Health Services, related to CAA plan: - David Abelson, $70,698 - Mary Johnson $32,193 - Kathryn D. Kallas, $30,600 - Michael Kaupa, $47,105 - Theodore Wegleitner, $16,976 - Susan R. Zwaschka, $47,651 Part I, Line 7 All physicians, employed by and seeing patients for Park Nicollet Health Services and affiliates, are eligible for a 3% access incentive payout based on their department reaching certain goals including access for patients and quality initiatives. In their roles as executives employed by Park Nicollet Health Services, the executives are eligible for incentive payouts. The incentive award will be 35% of base pay compensation for the CEO, 30% for the CFO, COO, CMO and 25% for all other executives with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Each participant will be responsible for two financial goals, and not less than three and not more than five individual strategic objectives. In their roles as management employed by Park Nicollet Health Services, certain managers are eligible for incentive payouts. The incentive award will be 15% of their annual base pay compensation with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Incentive payments are a function of both individual and organizational performance. The participant must be assigned at least three, and not more than four focused incentive objective, one of which must be financial in nature. Shannon Neale MD William Richards, MD Family Member 178230 Employment: Shannon Neale is a Medical Doctor employed by Park Nicollet Clinic. 1 RJM Construction James Pohlad: owner 5641005 Construction: RJM Construction performed construction services for Park Nicollet Clinic. 0 Gregg Strathy MD Jannette Strathy, MD: Family Member 233975 Employment: Gregg Strathy, MD is a Medical Doctor employed by Park Nicollet Clinic. 1 List of Subordinate Organizations: Names, Addresses and EINs Page 1, Line H(a): Park Nicollet Methodist Hospital 41-0132080 6500 Excelsior Blvd, St. Louis Park, MN 55426 Park Nicollet Institute 41-0961862 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Park Nicollet Health Care Products 01-0638901 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Park Nicollet Clinic 41-0834920 3800 Park Nicollet Blvd St. Louis Park, MN 55416 PNMC Holdings 41-1741792 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Form 990, Part IV, Line 24A: Park Nicollet Health Services, along with related organizations, is jointly liable for the tax exempt bonds held by Park Nicollet Health Services under a master trust agreement. The members of the jointly liable group, which is collectively referred to as the "Obligated Group", include Park Nicollet Clinic, Park Nicollet Methodist Hospital, PNMC Holdings, Park Nicollet Institute, and Park Nicollet Health Care Products. In accordance with reporting requirements for Schedule K, all outstanding tax exempt bonds are reported solely on the Schedule K of Park Nicollet Health Services. Part V, Line 3a: Park Nicollet Health Care Products has unrelated business gross income over $1,000. Form 990, Part VI, Section A, line 2 Park Nicollet Health Services and its related entities have a common board. The following officers, Board Members and key employees are employees of and paid by Park Nicollet Health Services or its related organizations. These employees serve together on the common board which serves Park Nicollet Health Services and its related entities. David Abelson, MD Steven Connelly, MD Paul Dominski Roxanna Gapstur, PhD Christa Getchell David Homans, MD Jeffrey B, Husband, MD Tom Jones, MD Michael Kaupa Charles McCoy, MD Sheila McMillan William Richards, MD Janet Schaffer, MD Janette Strathy, MD Katherine Tarvestad Mark Wilkowske, MD Susan Zwaschka Form 990, Part VI, Section A, line 6 Park Nicollet Health Services is the sole member of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute and Park Nicollet Health Care Products. Park Nicollet Clinic is the sole member of PNMC Holdings. Form 990, Part VI, Section A, line 7a The Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. Form 990, Part VI, Section A, line 7b All decisions, including dissolution of the organization, made by the governing body of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are subject to the approval of the Board of Directors of Park Nicollet Health Services. However, the Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. Form 990, Part VI, Section B, line 11 The Form 990 filed on behalf of the subordinate organizations (Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products) is prepared within the finance department at Park Nicollet Health Services with assistance from individuals in human resources, marketing, and operations. Upon completion of gathering the necessary information for the return, the form was compiled by the Park Nicollet accounting firm. Drafts of the form were reviewed by the Assistant Controller - Accounting Operations, Vice President of Finance, Chief Financial Officer, and the Audit and Compliance Committee. After all internal reviews were complete; the final version of the Form 990 was given to each member of the Board of Directors for approval prior to filing the return. Form 990, Part VI, Section B, line 12c At Park Nicollet Health Services all key employees, directors, and officers are asked to complete a conflict of interest disclosure statement each year; however the obligation to report conflicts is ongoing. The Governance Committee, which meets five times per year, reviews all potential conflict disclosures and discusses the impact on the organization. If a potential conflict arises during the year, it is disclosed and reviewed by the Governance Committee. The Governance Committee presents the disclosure information and makes recommendations to the Board of Directors regarding management of any conflicts identified. When a transaction involving a potential conflict of interest is identified, the Board of Directors may appoint a disinterested individual or committee to review that conflict and ensure discussions related to those transactions can occur separately from those individuals with potential conflicts. All significant transactions include an analysis of fair market value. Form 990, Part VI, Section B, line 15 The Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of executive compensation and benefit plans for Park Nicollet. Park Nicollet uses an outside consultant to provide yearly market based indexes of salary adjustments for executives in similar leadership positions. The Board of Directors reviews the salary ranges and recommends salary increases for each executive, including the CEO, based upon the Board of Directors' evaluation of job performance and experience level of the individual within the organization. The average salary increases for all Park Nicollet executives cannot exceed the average market salary increase reported for executives by the consultant. The compensation committee then reviews and approves compensation adjustments based on the information provided by the outside consultants and the Board of Directors' recommendations. For certain physicians, the majority of pay disclosed is for his/her work as a physician for Park Nicollet. A small stipend is added for serving on the Board of Directors. The following is a description of how pay for physicians' patient care work is determined. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of the physician compensation and benefit plans for Park Nicollet. The Board of Directors delegates the day-to-day administration of the physician compensation plan to the Clinical Board of Governors and the Physician Compensation and Benefits Subcommittee. The purpose of the Physician Compensation and Benefits Subcommittee is to oversee physician and other clinician compensation and benefits plans and administration within the budget to ensure fairness and alignment with Park Nicollet Health Services' goals. The responsibilities of this committee include: Recommending of compensation policies and plan designs for physicians to the clinical board and Board of Directors; Overseeing compensation plan operation and payments to clinical departments; Evaluating compensation plan for performance on a periodic basis; Serving as final appeal process for issues unresolved by individuals, department chairs and chiefs of services. Annually, information on each physician's pay and productivity is graphed against the survey results for the same year. This information is presented to the compensation committee of the Park Nicollet Health Services Board of Directors for review. Park Nicollet Health Services' physician pay program is designed to ensure market based pay for market based productivity standards. The market is determined by the American Medical Group Association (AMGA) national physician compensation survey data, which provides market data for both compensation and productivity. When appropriate, the Clinic Compensation and Benefit Subcommittee grants adjustments to these guidelines with evidence of local market data. Form 990, Part VI, Section C, line 19 Park Nicollet Group members' governing documents, conflict of interest policy and financial statements are available to the public upon request. Park Nicollet Health Services, as the parent organization of the Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products, mails its consolidated audited financial statements to financial institutions, governmental institutions, board members, media representatives, vendors, and the Minnesota Hospital Association (MHA). Park Nicollet Health Services discloses quarterly consolidated financial statements to bondholders and MHA. The annual consolidated audited and quarterly financial statements are also posted at emma.msrb.org. The Forms 990 are available upon request or from the state of Minnesota or at Guidestar.org. Form 990, Part VII: Certain board members for Park Nicollet Group also provide services as employees to Park Nicollet Health Services and its subsidiaries. Hours worked are estimates and are not tracked on an entity by entity basis. Therefore, these officers, directors, and key employees' hours reported on Form 990, Part VII represent aggregate hours worked per week for all Park Nicollet Health Services entities. Community board members hours reported on Form 990, Part VII are an estimate and are not tracked on an entity by entity basis. Therefore, these directors hours reported on Form 990, Part VII represent aggregate hours of service provided per week for all Park Nicollet Health Services entities. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -10,858,332. Net Assets Released from Restrictions -70,447. Total to Form 990, Part XI, Line 5: -10,928,779. Form 990, Part XII, Line 2C: Neither the oversight process for the audit nor the auditor selection process for Park Nicollet Health Services and affiliates' financial statements have changed during the tax year. Park Nicollet Health Services 6500 Excelsior Blvd St Louis Park MN 55426 363465840 Health Care Adminstration MN 501(c)(3) 11 Type III 0 Park Nicollet Foundation 6500 Excelsior Blvd St Louis Park MN 55426 237346465 Grants to Serve the Community MN 501(c)(3) 7 Park Nicollet Health Services 1 TRIA Orthopaedic Center Research Institute 8100 Northland Drive Bloomington MN 55431 200033919 Health Care Research and Education MN 501(c)(3) 11 Type I Park Nicollet Health Services 1 Methodist Brain Lab Leasing LLC 6500 Excelsior Blvd St Louis Park MN 55426 208725994 Health Care MN Park Nicollet Methodist Hospital Related 290552 70370 0 1 0.60000 Park Nicollet Health Services Investment Partnership 6500 Excelsior Blvd St Louis Park MN 55426 411675033 Investment MN Park Nicollet Methodist Hospital Investment 16428822 0 1 0.92500 Park Nicollet Enterprises 6500 Excelsior Blvd St Louis Park MN 55426 411656735 Real Estate for Related Organization MN Park Nicollet Health Services C 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 Park Nicollet Enterprises K 166577 Cost Park Nicollet Health Services K 1916325 Cost Park Nicollet Health Services P 20769628 Cost Park Nicollet Health Services R 23335177 Cost Park Nicollet Health Services Q 94955 Cost Methodist Brain Lab Leasing LLC J 800854 Cost Methodist Brain Lab Leasing LLC R 804472 Cost Park Nicollet Foundation C 2149214 Cost Park Nicollet Foundation B 117777 Cost TRIA Orthopaedic Research Institute N 212021 Cost