2012-11-13T08:39:16-06:00 2011-12-31 990 2011-01-01 410714079 ST LUKE'S HOSPITAL OF DULUTH STLU 2182495555 915 EAST FIRST STREET DULUTH MN 55805 SUSAN BENJAMIN 2182495555 2012-11-12 2011 2016-02-24 21:20:13Z JOHN STRANGE 915 EAST FIRST STREET DULUTH MN 55805 332671175 0 X WWW.SLHDULUTH.COM X 1881 MN TO SERVE AS A LEADING HEALTHCARE PROVIDER OF QUALITY HEALTHCARE SERVICES IN OUR SURROUNDING REGION. 16 13 2607 340 6758855 -1429996 515372 691492 313827445 324371421 1991534 2402110 1165708 2085015 317500059 329550038 9564247 237395 0 0 188065195 199162993 0 0 0 115967026 129559403 313596468 328959791 3903591 590247 144997293 157002357 116888629 149991647 28108664 7010710 X THE PATIENT ABOVE ALL ELSE. 0 0 277858219 237395 324371421 ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT:A. OUR MISSION IS TO SERVE AS A LEADING PROVIDER OF QUALITY HEALTHCARE SERVICES IN OUR LOCAL COMMUNITY AND THE SURROUNDING 17-COUNTY REGION OF NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. AS THE FEDERALLY DESIGNATED REGIONAL TRAUMA CENTER FOR THIS REGION, ST. LUKE'S PROVIDES CRITICAL ACCESS TO HIGH QUALITY ACUTE HEALTHCARE SERVICES.B. ST. LUKE'S RECOGNIZES ITS RESPONSIBILITY TO THE COMMUNITY BY PROVIDING FINANCIAL SUPPORT TO COMMUNITY ORGANIZATIONS; OFFERING EDUCATION PROGRAMS, OUTREACH PROGRAMS AND SUPPORTING THE COMMUNITY THROUGH EMPLOYEE VOLUNTEER EFFORTS AND DONATIONS. WE SUPPORT THE LAKE SUPERIOR COMMUNITY HEALTH CENTER AND THE HEALTH CARE ACCESS OFFICE. IN 2010, ST. LUKE'S DONATED MORE THAN 800 HOURS TO ENRICH THE HEALTHCARE OF THE COMMUNITY, INCLUDING SERVING ON BOARDS OF THE MN HOMECARE ASSOCIATION,UNITED WAY, AND OTHER NON-PROFIT ORGANIZATIONS IN OUR COMMUNITY.C. ST. LUKE'S SERVES A DISPROPORTIONATE SHARE OF MEDICARE AND MEDICAID PATIENTS. ALSO, THROUGH OUR PATIENT ASSISTANCE PROGRAM, WE PROVIDE FULL OR PARTIALLY SUBSIDIZED SERVICES TO INDIVIDUALS AND FAMILIES WHO ARE UNABLE TO PAY. AT ADMISSION AND THROUGH PATIENT HANDBOOKS, PATIENTS ARE GIVEN INFORMATION TO CONTACT ST. LUKE'S FINANCIAL COUNSELORS FOR INFORMATION ON OUR FINANCIAL ASSISTANCE PROGRAMS. ALSO, ST. LUKE'S PROVIDES MEDICAL TRANSPORT SERVICES AT LESS THAN COST TO OUR PATIENTS IN THE REGION. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION:ST. LUKE'S IS A NOT-FOR-PROFIT, COMMUNITY-BASED, NON-DENOMINATIONAL HOSPITAL, GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS. OUR MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS AND ALLIED HEALTH PROFESSIONALS. ST. LUKE'S EMERGENCY DEPARTMENT SERVES PATIENTS REGARDLESS OF ABILITY TO PAY. ST. LUKE'S RESEARCH DEPARTMENT, THE WHITESIDE INSTITUTE FOR CLINICAL RESEARCH, PARTICIPATES IN INVESTIGATIONAL DRUG PROTOCOLS THAT ARE NON-FUNDED OR UNDER-FUNDED.ST. LUKE'S IS A CLINICAL TRAINING SITE FOR MANY HEALTHCARE STUDENTS. IN ADDITION TO MEDICAL STUDENTS AND RESIDENTS, WE PROVIDE CLINICAL TRAINING FOR STUDENTS IN NURSING, PHYSICAL MEDICINE, RADIOLOGY, RESPIRATORY, LAB, MEDICAL ASSISTANT, OCCUPATIONAL THERAPY, PHYSICIAN ASSISTANT, DIETETICS, SOCIAL WORK, MEDICAL RECORD CODING, PARAMEDIC, HEALTH UNIT COORDINATOR, SURGICAL TECHNOLOGY, ANESTHESIA AND PHARMACY.WE CONTRIBUTED TO SCHOLARSHIP FUNDS FOR MEDICAL STUDENTS AT THE UNIVERSITY OF MINNESOTA, DULUTH SCHOOL OF MEDICINE AND NURSING STUDENTS AT THE COLLEGE OF ST. SCHOLASTICA AND LAKE SUPERIOR COLLEGE.OTHER EDUCATION ACTIVITIES REACH TENS OF THOUSANDS OF PEOPLE THROUGH COMMUNITY EDUCATION AND OUTREACH, HEALTH SCREENINGS, SUPPORT GROUPS AND OTHER COMMUNITY SERVICES. OUR SPEAKERS BUREAU OFFERED PROGRAMS AT NO CHARGE TO THOUSANDS MORE. TOPICS PRESENTED INCLUDED MEN'S HEALTH, WOMEN AND BREAST CANCER, CHILDREN'S NUTRITION, MENTAL HEALTH ISSUES, CARDIAC ISSUES, FALL PREVENTION, FIRST AID, DIABETES, EYE AND LUNG ISSUES, AND INFECTION CONTROL.WE ALSO OFFERED TOURS TO DOZENS OF COMMUNITY AND SCHOOL GROUPS, MADE MEDICAL SUPPLIES/EQUIPMENT DONATIONS TO COMMUNITY AND MEDICAL RELIEF ORGANIZATIONS, DONATED NEWSPAPER ADVERTISING SPACE FOR THE JUNIOR LEAGUE OF DULUTH, PARTICIPATED IN THE COMMUNITY COALITION FOR FALL PREVENTION AND OFFERED BROCHURE PRINTING SERVICES TO A LOCAL MEDICAL PROFESSIONAL GROUP. ANNUALLY, WE PROVIDE RENT-FREE, HUNDREDS OF HOURS OF FREE MEETING SPACE FOR COMMUNITY GROUPS, SUCH AS LYME DISEASE SUPPORT GROUP, MOTHERS OF MULTIPLES AND THE OSTOMY CLUB, AND ORGANIZATIONS SUCH AS THE MINNESOTA HOMECARE ASSOCIATION, THE BOY SCOUTS, AND THE COLLEGE OF ST. SCHOLASTICA.WE OFFER SUPPORT GROUPS TO THE COMMUNITY, INCLUDING: - HEART-TO-HEART SUPPORT GROUP - PARKINSON'S DISEASE - LOOK GOOD, FEEL GOOD GROUP (THROUGH THE AMERICAN CANCER SOCIETY) - CANCER INFORMATION AND SUPPORT GROUP - OSTOMY CLUB - BREAST CANCER SUPPORT GROUP - DIABETES SUPPORT GROUP (SPONSORED BY ST. LUKE'S, DULUTH DIABETES CENTER AND THE DULUTH FAMILY PRACTICE CENTER) - INSULIN PUMP SUPPORT GROUP (SPONSORED BY ST. LUKE'S, DULUTH DIABETES CENTER AND THE DULUTH FAMILY PRACTICE CENTER) - CELIAC SUPPORT GROUP (SPONSORED BY ST. LUKE'S AND ST. MARY'S/DULUTH CLINIC)WE PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, TRICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS.DURING 2011, THERE WERE 11,424 ADMISSIONS, 48,833 PATIENT DAYS, 442,373 CLINIC VISITS, 157,420 OUTPATIENT REGISTRATIONS AND 63,471 EMERGENCY/URGENT CARE VISITS. ORGANIZTIONAL DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS:A. ALL PATIENTS RECEIVE SERVICES AT ST. LUKE'S REGARDLESS OF ABILITY TO PAY. IN ADDITION, ST. LUKE'S MENTAL HEALTH SERVICES MAINTAIN A PHARMACEUTICAL SAMPLE PROGRAM FOR ITS CLIENTS. THESE MEDICATIONS ARE PROVIDED THROUGH PHARMACEUTICAL COMPANIES AND MANAGED THROUGH THE OUTPATIENT MENTAL HEALTH DEPARTMENT.THE HEALTH AND SAFETY OF OUR COMMUNITY WERE ADDRESSED THROUGH HEALTH SCREENINGS AT NO CHARGE FOR BLOOD PRESSURE, BLOOD SUGAR, CHOLESTEROL AND BONE DENSITY AT COMMUNITY HEALTH FAIRS. MONTHLY CHILD CARE SEAT SAFETY CLINICS WERE HELD IN CONJUNCTION WITH THE DULUTH FIRE DEPARTMENT, AND TRAUMAROO, A BIKE AND PLAYGROUND SAFETY PROGRAM FOR CHILDREN IN KINDERGARTEN THROUGH 2ND GRADE WAS OFFERED TO LOCAL SCHOOLS AT NO CHARGE.WE PARTICIPATE IN OUR COMMUNITY'S DISASTER DRILLS HELD TWICE A YEAR AND WE WORK WITH OTHER HOSPITALS IN THE REGION TO PLAN IN THE EVENT OF A BIOTERRORISM ATTACK OR OTHER MAJOR CALAMITY. THE FINANCIAL INFORMATION IN THIS REPORT WAS PREPARED FOLLOWING GUIDELINES SUGGESTED BY MINNESOTA HOSPITAL ASSOCIATION AND OTHER NATIONALLY RECOGNIZED HEALTHCARE ASSOCIATIONS. THESE GUIDELINES RECOMMEND THE FOLLOWING INCLUDING MEDICARE SHORTFALL:REPORT CHARITY CARE AT COST, NOT CHARGES. DOES NOT INCLUDE BAD DEBT, CONTRACTUAL ALLOWANCES, AND PROMPT PAY DISCOUNTS AS CHARITY CARE EXPENSES. REPORTS THE NET EXPENSE FOR COMMUNITY BENEFIT SERVICES, I.E., THE TOTAL COMMUNITY BENEFIT EXPENSE MINUS ANY ASSOCIATED REVENUE FROM PATIENTS, PAYORS, AND OTHER EXTERNAL SOURCES.FOR FISCAL YEAR ENDED: DECEMBER 31, 2011PATIENT ASSISTANCE - AT COST $ 2,742,825 GOVERNMENT SPONSORED HEALTH CARE - NET EXPENSE 38,300,126COMMUNITY HEALTH IMPROVEMENT SERVICES 712,743SUBSIDIZED HEALTH SERVICES 4,317,123HEALTH PROFESSIONS EDUCATION 5,808,618MNCARE TAX, MEDICAID SURCHARGE & OTHER TAXES 5,558,941FINANCIAL AND IN-KIND CONTRIBUTIONS 438,221COMMUNITY-BUILDING ACTIVITIES 323,390 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $58,201,717 277858219 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 87 0 2607 0 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X SUSAN BENJAMIN 2182495475 915 EAST FIRST STREET DULUTH MN 55805 X JOHN STRANGE 36.00 X X 802545 0 140923 DALE MOE 1.00 X X 0 0 0 MARK EMMEL 1.00 X X 0 0 0 SUSAN GOLTZ MD 1.00 X X 0 0 0 BRIAN RYKS 1.00 X X 0 0 0 MELINDA MACHONES 1.00 X X 0 0 0 GAIL BALDWIN MD 1.00 X 0 0 0 LISA BODINE 1.00 X 0 0 0 RAY CHRISTENSEN MD 1.00 X 0 0 0 MARLENE DAVID 1.00 X 0 0 0 JESSE FRYE 1.00 X 0 0 0 DAVE MCMILLAN 1.00 X 0 0 0 KATHLEEN NELSON EDD 1.00 X 0 0 0 DEL PREVOST 1.00 X 0 0 0 KRISTI STOKES 1.00 X 0 0 0 PAUL SANFORD MD 40.00 X 242736 0 28503 JAMES WUELLNER 36.00 X 315369 0 82655 JOHN YOON MD 40.00 X 1392149 0 27487 JOHN WATKINS MD 40.00 X 829373 0 22366 MARSHALL WATSON JR MD 40.00 X 821176 0 22994 DAVID FOGARTY MD 40.00 X 800290 0 9692 MARY BOYLAN MD 40.00 X 799508 0 28939 6003146 0 363559 274 0 1 0 STONEARCH CREATIVE 710 S 2ND STREET MINNEAPOLIS MN 55401 MARKETING SERVICES 1728022 DONALD HOLM CONSTRUCTION 3211 W 3RD STREET DULUTH MN 55086 CONSTRUCTION SERVICES 1363682 MAYO COLLABORATIVE SERVICES PO BOX 4100 ROCHESTER MN 55903 LABORATORY SERVICES 1070804 ECLINICAL WORKS LLC 110 TURNPIKE RD STE 308 ESTBOROUGH MA 01581 IT SERVICES 1054886 MEMORIAL BLOOD CENTER 737 PELHAM BLVD ST PAUL MN 55144 LABORATORY SERVICES 900709 44 433870 139136 118486 691492 MEDICAL SERVICES 621990 246447036 246447036 PHARMACY 446110 77650526 71435249 6215277 CREDENTIALING 541900 119337 119337 TRANSCRIPTION 541900 61400 42045 19355 GUEST CARE 721000 39108 39108 54014 52411 1603 324371421 2460908 2460908 1384427 1362216 22211 22211 22211 1532672 16294 1589696 18068 -57024 -1774 -58798 -58798 161198 151157 10041 10041 MEALS/VENDING INCOME 900099 1319410 1319410 PARKING LOT INCOME 900099 403568 403568 ANSWERING SERVICES 561000 228626 228626 101159 101159 2052763 329550038 317882285 6758855 4217406 237395 237395 1341491 1341491 155332415 137967764 17364651 8050669 7089734 960935 24902744 21930330 2972414 9535674 8076602 1459072 25500 25500 788881 788881 140049 140049 20227 20227 77757 77757 12837287 4405477 8431810 478492 478492 8765764 4313755 4452009 2336851 1932057 404794 15005084 10466600 4538484 1453887 1243654 210233 3758458 3637235 121223 7941862 5785392 2156470 1911815 1911815 MEDICAL SUPPLIES 31927235 31927235 DRUGS 21984804 21984804 CHARITY CARE 7461322 7461322 BAD DEBT EXPENSE 6621167 2409624 4211543 6022961 4553205 1469756 328959791 277858219 51101572 0 12186113 11693617 39341753 45260432 5149584 5380796 1143385 1517518 149571142 99789440 44825670 49781702 9380018 9112526 20697406 21814593 1933219 1775579 10340145 10665594 144997293 157002357 29814264 43253811 48073092 47843362 39001273 58894474 116888629 149991647 X 28108664 7010710 28108664 7010710 144997293 157002357 X 590247 -21688201 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20227 20227 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF THE DUES THAT ST. LUKE'S HOSPITAL PAYS TO THE AMERICAN HOSPITAL ASSOCIATION AND MINNESOTA HOSPITAL ASSOCIATION ARE USED TO ADVOCATE ON BEHALF OF THE HOSPITAL AND ISSUES RELATING TO HEALTHCARE. IN ADDITION TO THE ABOVE, ST. LUKE'S HOSPITAL ALSO PAID A LAW FIRM TO LOBBY ON BEHALF OF THE HOSPITAL. 4218799 4218799 65351851 46092194 19259657 1340090 1084041 256049 74549253 52613205 21936048 4111149 4111149 49781702 SHORT TERM INVESTMENTS 21814593 F 21814593 DEFERRED COMPENSATION 6202164 PREPAID BOND EXPENSE 1340280 CASH SURRENDER LIFE INSURANCE 1112490 INVESTMENT IN SURGERY CENTER 555991 INVESTMENT IN IMAGING CENTER 536592 OTHER ASSETS 754237 DUE FROM RELATED PARTY 163840 10665594 EMPLOYEE BENEFIT OBLIGATIONS 56984804 OTHER LIABILITIES 1741539 DUE TO RELATED PARTY 168131 58894474 329550038 328959791 590247 199531 -21887732 -21688201 -21097954 322448895 -7461322 -7461322 329910217 -360179 -360179 329550038 323011842 1513373 1513373 321498469 7461322 7461322 328959791 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SYSTEM IS COMPRISED OF THREE SEPARATE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE THAT ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE SYSTEM HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE SYSTEM FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL TAX AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN MINIMUM PENSION LIABILITY -21,992,666. CAPITAL REIMBURSEMENT FROM ST. LUKE'S FOUNDATION 114,934. CONTRIBUTION TO SLH VOLUNTEER SERVICE GUILD -10,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -21,887,732. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHARITY CARE -7,461,322. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 1,153,194. RENTAL EXPENSES -1,362,216. GIFT SHOP EXPENSES -151,157. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,362,216. GIFT SHOP EXPENSES 151,157. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 7,461,322. 1 1 X 1 X 1 X 1 1 0 1 1 4534 2742825 2742825 0.00850 42665888 28702134 13963754 0.04330 4534 45408713 28702134 16706579 0.05180 8807 712473 712473 0.00220 1324 5808618 5808618 0.01800 48153 4317123 4317123 0.01340 80 438221 438221 0.00140 58364 11276435 11276435 0.03500 62898 56685148 28702134 27983014 0.08680 222959 222959 0.00070 435 1162 1162 0.00000 53 26856 26856 0.00010 198 72413 72413 0.00020 686 323390 323390 0.00100 1 6621167 2743599 112781269 143669797 -30888528 X 1 1 1 CENTER FOR DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING 0.21000 0.00000 0.21000 2 PAVILION SURGERY CENTER OUTPATIENT AMBULATORY SURGERY 0.50000 0.05000 0.45000 1 1 ST LUKES HOSPITAL

915 EAST FIRST STREET DULUTH MN 55805

X X X X X ST LUKE'S HOSPITAL OF DULUTH 1 1 1 300.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 37 ST LUKE'S INTERNAL MEDICINE ASSOCIATES

1001 E SUPERIOR ST DULUTH MN 55802

OUTPATIENT MEDICAL ST LUKE'S RADIATION ONCOLOGY ASSOCIATES

1001 E SUPERIOR ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S CARDIOLOGY ASSOCIATES

1001 E SUPERIOR ST DULUTH MN 55802

OUTPATIENT MEDICAL MARINER MEDICAL CLINIC

109 N 28TH ST E SUPERIOR WI 54880

OUTPATIENT MEDICAL ST LUKE'S PAVILION SURGICAL ASSOCIATES

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL & AMBULATORY SURGERY CHEQUAMEGON CLINIC

415 ELLINS AVE ASHLAND WI 54806

OUTPATIENT MEDICAL ST LUKE'S CARDIOTHORACIC SURGICAL ASSOC

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL PS RUDIE MEDICAL CLINIC

26 EAST SUPERIOR STREET DULUTH MN 55802

OUTPATIENT MEDICAL HIBBING FAMILY MEDICAL CENTER

1120 E 34TH ST HIBBING MN 55746

OUTPATIENT MEDICAL ST LUKE'S GASTROENTEROLOGY ASSOCIATES

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S MENTAL HEALTH

220 N 6TH AVE E DULUTH MN 55802

OUTPATIENT MEDICAL DULUTH INTERNAL MEDICINE ASSOCIATES

220 MEDICAL ARTS BLDG DULUTH MN 55802

OUTPATIENT MEDICAL MOUNT ROYAL MEDICAL CLINIC

1400 WOODLAND AVE DULUTH MN 55803

OUTPATIENT MEDICAL MARINER CLINIC URGENT CARE

109 N 28TH ST E SUPERIOR WI 54880

OUTPATIENT MEDICAL ST LUKE'S PULMONARY MEDICINE ASSOCIATES

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S RHEUMOTOLOGY ASSOCIATES

1000 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S UROLOGY ASSOCIATES

1001 E SUPERIOR ST DULUTH MN 55802

OUTPATIENT MEDICAL ST LUKE'S NEUROSURGERY ASSOCIATES

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S ORTHOPAEDIC & SPORTS MEDICINE

1000 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL DENFELD MEDICAL CLINIC

4702 GRAND AVE DULUTH MN 55807

OUTPATIENT MEDICAL & OCCUPATIONAL THERAPY MARINER OUTPATIENT SURGERY CENTER

109 N 28TH ST E SUPERIOR WI 54880

OUTPATIENT MEDICAL & AMBULATORY SURGERY ST LUKE'S DERMATOLOGY ASSOC

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S HOME CARE

220 N 6TH AVE E DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S PEDIATRIC ASSOCIATES

1000 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL LAURENTIAN MEDICAL CLINIC

8373 UNITY DRIVE MT IRON MN 55768

OUTPATIENT MEDICAL & PHYSICAL THERAPY MILLER CREEK MEDICAL CLINIC

4884 MILLER TRUNK HWY HERMANTOWN MN 55811

OUTPATIENT MEDICAL & PHYSICAL THERAPY ST LUKE'S PHYSICAL MEDICINE & REHAB ASS

1011 E 1ST ST DULUTH MN 55805

PHYSICAL THERAPY ST LUKE'S PLASTIC SURGERY ASSOCIATES

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL BAY AREA MEDICAL CLINIC

50 OUTER DRIVE SILVER BAY MN 55614

OUTPATIENT MEDICAL & PHYSICAL THERAPY ST LUKE'S ENDOCRINOLOGY ASSOCIATES

1011 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S ALLERGY & IMMUNOLOGY ASSOCIAT

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S ONCOLOGY & HEMATOLOGY ASSOCIA

1001 E SUPERIOR ST DULUTH MN 55805

OUTPATIENT MEDICAL ST LUKE'S OCCUPATIONAL HEALTH

4702 GRAND AVE DULUTH MN 55807

OCCUPATIONAL HEALTH ST LUKE'S INFECTIOUS DISEASE ASSOCIATES

1001 E SUPERIOR ST DULUTH MN 55802

OUTPATIENT MEDICAL ST LUKE'S SURGICAL ASSOCIATES

920 E 1ST ST DULUTH MN 55805

OUTPATIENT MEDICAL Q-CARE EXPRESS CLINIC

619 W CENTRAL ENTRANCE DULUTH MN 55811

OUTPATIENT MEDICAL LESTER RIVER MEDICAL CLINIC

6351 E SUPERIOR ST DULUTH MN 55804

OUTPATIENT MEDICAL PART I, LINE 7: ST. LUKE'S USED COST-TO-CHARGE RATIOS DERIVED FROM THE MOST RECENT COMPLETED MEDICARE COST REPORT. PART I, LINE 7G: ST. LUKE'S INCLUDED SUBSIDIZED HEALTH SERVICES FROM A MENTAL HEALTH CLINIC ($1,862,825), A PEDIATRICS CLINIC ($1,862,825), AND HOMECARE/HOSPICE SERVICES ($717,928). PART I, L7 COL(F): BAD DEBT EXPENSE FOR 2011 IS $6,621,167 AS REPORTED IN PART III SECTION A, LINE 2. THIS AMOUNT HAS BEEN ELIMINATED WHEN CALCULATING THE COMMUNITY BENEFIT AS A PERCENT OF TOTAL EXPENSE. BAD DEBT ACCOUNTS WILL MEET ALL OF THE FOLLOWING CRITERIA:I. PATIENT OR GUARANTOR HAS RECEIVED AT LEAST 3 STATEMENTS.II. AT LEAST THREE TELEPHONE CONTACTS HAVE BEEN MADE OR ATTEMPTED.III. PATIENT OR GUARANTOR HAS NOT RESPONDED DURING THE COLLECTION CYCLE IN A TIMELY AND RESPONSIBLE MANNER OR HAS DEFAULTED ON A PAYMENT ARRANGEMENT.IV. THERE ARE NO KNOWN CIRCUMSTANCES WHICH WOULD JUSTIFY RECONSIDERATION FOR CHARITY ASSISTANCE.APPROVAL FOR BAD DEBT WRITE OFFS ARE AS FOLLOWS:$0 TO 2,499 -- PATIENT ACCOUNTS MANAGER OR CBO MANAGER$2,500 TO 9,999 -- BUSINESS SERVICES DIRECTOR OR CBO MANAGER$10,000 AND OVER -- CHIEF FINANCIAL OFFICER PART II: ST. LUKE'S COMMUNITY-BUILDING ACTIVITIES INCLUDE CASH, IN-KIND DONATIONS, AND OTHER EXPENDITURES FOR THE DEVELOPMENT OF COMMUNITY HEALTH PROGRAMS AND PARTNERSHIPS. PART III, LINE 4: ST. LUKE'S DOES NOT INCLUDE A FOOTNOTE IN IT'S AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT.ST. LUKE'S ACCOUNTS FOR DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS THROUGH A RECORD KEEPING SYSTEM IN THE BUSINESS SERVICES DEPARTMENT. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF A BILL OR STATEMENT. ALL SELF PAY ACCOUNTS ARE ANALYZED FOR COLLECTABILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CALCULATED BY APPLYING HISTORICAL EXPERIENCE TO AN AGING OF THESE ACCOUNTS. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME.THE COST OF BAD DEBT WAS REPORTED IN PART III, LINE 2. THIS AMOUNT IS CALCULATED USING THE MEDICARE COST REPORT RATIO FOR THE HOSPITAL AND CLINIC, MULTIPLIED BY ST. LUKE'S BAD DEBT EXPENSE FOR FY ENDING 12/31/11. THE COST OF CHARITY CARE WAS REPORTED IN PART III, LINE 3. THIS AMOUNT IS CALCULATED USING THE MEDICARE COST REPORT RATIO FOR THE HOSPITAL, MULTIPLIED BY ST. LUKE'S CHARITY CARE EXPENSE FOR FY ENDING 12/31/11. PART III, LINE 8: THE COST-TO-CHARGE RATIO WAS THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THE ENTIRE SHORTFALL ($30,888,528) IS INCLUDED IN THE TOTAL VALUE OF COMMUNITY CONTRIBUTIONS LISTED UNDER "OTHER COMMUNITY CONTRIBUTIONS" (PER VHA GUIDELINES THE SHORTFALL CANNOT BE INCLUDED IN THE TOTAL COST OF COMMUNITY BENEFITS). PART III, LINE 9B: THE GENERAL DEBT COLLECTION PROCESS BEGINS EITHER AT THE TIME OF BILLING, OR AFTER ALL IDENTIFIED INSURANCE PAYMENTS HAVE BEEN RECEIVED AND POSTED. ANY REMAINING PATIENT LIABILITY WILL BE TRANSFERRED TO THE PATIENT RESPONSIBILITY CATEGORY. ANY MONTHLY PAYMENT LESS THAN $50 A MONTH MUST BE APPROVED BY THE BUSINESS SERVICES DIRECTOR OR THE CENTRAL BILLING OFFICE (CBO) MANAGER. UNINSURED PATIENTS WHOSE HOUSEHOLD INCOME IS LESS THAN $125,000 MAY APPLY FOR A SELF PAY UNINSURED PATIENT DISCOUNT BY SUBMITTING COPIES OF THE PREVIOUS YEAR'S INCOME TAX FORM, COPIES OF THEIR PAST 3 PAY STUBS, AND A COMPLETED APPLICATION. IF THAT DOCUMENTATION SHOWS A QUALIFYING ANNUAL INCOME, THE PATIENT WILL RECEIVE A DISCOUNT ON THEIR OUTSTANDING HOSPITAL BALANCE EQUAL TO THE RATE GIVEN TO ST. LUKE'S LARGEST CONTRACTED NON-GOVERNMENTAL PAYER. THIS DISCOUNT DOES NOT APPLY TO ELECTIVE PROCEDURES OR PHYSICIAN CLINIC BALANCES. THE DISCOUNT RATE WILL BE EVALUATED ON EACH JULY 1ST BASED ON THE PAYER DISCOUNT RATES FOR THE PREVIOUS CALENDAR YEAR'S ACTIVITY. COLLECTION, LITIGATION AND OR GARNISHMENT ACTIVITIES WILL NOT BE INITIATED UNTIL THE BUSINESS SERVICES DIRECTOR, PATIENT ACCOUNTING MANAGER AND/OR CBO MANAGER VERIFIES THAT:I. THE PATIENT OR GUARANTOR OWES THE DEBTII. ALL THIRD PARTY PAYERS HAVE BEEN BILLEDIII. WHEN APPLICABLE, THE PATIENT/GUARANTOR HAS BEEN OFFERED A REASONABLE PAYMENT PLANIV. THE PATIENT/GUARANTOR HAS BEEN MADE AWARE OF THE UNINSURED PATIENT DISCOUNT OR FINANCIAL ASSISTANCE PROGRAM, HAS BEEN OFFERED AN APPLICATION AND THE OFFER OF ASSISTANCE TO COMPLETE THE APPLICATION.PATIENTS WHO DESIRE ELECTIVE INPATIENT OR OUTPATIENT SERVICES AND ARE UNINSURED OR HAVE LARGE INSURANCE DEDUCTIBLES FIRST MEET WITH A FINANCIAL COUNSELOR TO DISCUSS FINANCIAL ARRANGEMENTS PRIOR TO SERVICES BEING RENDERED. ST. LUKE'S COLLECTION CYCLE WILL INCLUDE A MINIMUM OF 4 STATEMENTS (1 SUMMARY BILL AND 3 DUNNING STATEMENTS) AND A MINIMUM OF 3 TELEPHONE CONTACTS. A 100% DEPOSIT IS EXPECTED FOR THE EXPECTED PATIENT LIABILITY IN ADVANCE OF SERVICES BEING RENDERED. IF THE 100% DEPOSIT CANNOT BE MET, THEN A MINIMUM DEPOSIT OF 50% OF THE EXPECTED PATIENT LIABILITY WILL BE REQUIRED AND THE PATIENT MUST SIGN A PROMISSORY NOTE FOR THE REMAINING BALANCE TO BE PAID WITHIN 30 DAYS OF SERVICES. IF NEITHER OF THESE CONDITIONS CAN BE MET, AN ELECTIVE PROCEDURE MAY BE CANCELLED UNTIL SUCH TIME AS THESE FINANCIAL CONDITIONS CAN BE MET. ST LUKE'S HOSPITAL OF DULUTH PART V, SECTION B, LINE 19D: ST. LUKE'S HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. PART VI, LINE 2: ST. LUKE'S HAS A LONG HISTORY OF PARTICIPATING IN SUCCESSFUL, SUSTAINABLE COLLABORATIVE INITIATIVES ON LOCAL, REGIONAL AND NATIONAL LEVELS. 1) ST. LUKE'S RESEARCH DEPARTMENT, THE WHITESIDE INSTITUTE FOR CLINICAL RESEARCH, WAS FORMED IN 1996 AS THE RESULT OF A PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH (UMMSD), AND CONTINUES TO PROVIDE SERVICES TO ST. LUKE'S PATIENTS IN ACCESS TO LOCAL, NATIONAL AND MULTI-NATIONAL CLINICAL STUDIES AS WELL AS TO ST. LUKE'S STAFF IN DEVELOPMENT OF RESEARCH STUDIES, REFERRAL TO UM COLLABORATORS AND GRANT WRITING RESOURCES. 2) ST. LUKE'S HAS COLLABORATED WITH THE MULTI-STATE CONSORTIUM OF ABOUT 56 SUPPORTING ORGANIZATIONS INCLUDING COUNTY PUBLIC HEALTH DEPARTMENTS, HOSPITALS AND CLINICS TO FUND THE BRIDGE TO HEALTH PROJECT. THIS PROJECT COLLECTED POPULATION-BASED, HEALTH STATUS DATA ON ADULTS (AGED 18+) IN THE REGION USING A 70 QUESTION TELEPHONE SURVEY FORMAT AND WAS CONDUCTED IN 1995, 2000, 2005 AND 2010. TO ADDRESS A NEED THAT BECAME APPARENT AS A RESULT OF THE BRIDGE TO HEALTH SURVEY, THE TWIN PORTS HEALTHCARE ACCESS GROUP WAS FORMED. ST. LUKE'S JOINED WITH OTHER HEALTHCARE PROVIDERS IN THE COMMUNITY TO DEVELOP TWO PROGRAMS: SHARECARE WHICH ESTABLISHED SLIDING FEE SCALES FOR CLINIC AND OUTPATIENT SERVICES TO DIMINISH THE FINANCIAL BARRIER TO PREVENTIVE, MENTAL HEALTH AND PRIMARY CARE SERVICES; AND HEALTHSHARE WHICH IS A COVERAGE MODEL FOR SMALL BUSINESSES FUNDED COLLABORATIVELY BY THE EMPLOYERS, EMPLOYEES AND THE COMMUNITY. THIS COVERAGE MODEL PROVIDES A CONTINUUM OF HEALTH CARE SERVICES FOR EMPLOYEES WITHIN A DEFINED NETWORK OF COMMUNITY PROVIDERS. 3) ST. LUKE'S WAS A LEAD PARTICIPANT IN THE WILDERNESS COALITION PHARMACY SERVICES PROJECT FUNDED BY THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY. THIS 3-YEAR PROJECT SUCCESSFULLY IMPLEMENTED 24/7 PROFESSIONAL PHARMACY SERVICES FOR 10 RURAL HOSPITALS IN NORTHEASTERN MINNESOTA USING ST. LUKE'S 24 HOUR PHARMACY, AN ITV-BASED SYSTEM OF CONTINUING EDUCATION FOR SITES, PHARMACY POLICIES AND PROCEDURES ADAPTABLE FOR INDIVIDUAL SITES, AS WELL AS BEDSIDE VERIFICATION OF MEDICATION ADMINISTRATION AND MEDICATION BAR CODING AT SOME LOCATIONS. THOUGH PROJECT FUNDING HAS ENDED, THE SERVICES REMAIN AND THE PROGRAM IS NOW SELF-SUSTAINING. 4) ST. LUKE'S IS AN ACTIVE PARTICIPANT IN THE COMMUNITY HEALTH INFORMATION COLLABORATIVE (CHIC) WHICH RECENTLY LAUNCHED "HIE-BRIDGE", A SECURE "HEALTH INFORMATION EXCHANGE" WHICH ALLOWS HEALTH CARE PROVIDERS TO QUICKLY DETERMINE THE LOCATION OF PATIENT MEDICAL RECORDS IN THE REGION AND COMMUNICATE WITH PATIENT'S HOME FACILITY IN ORDER TO PROVIDE PROMPT QUALITY CARE. ST. LUKE'S ASSISTED CHIC IN THE TEST PHASE OF THIS PROJECT FUNDED BY THE NATIONAL LIBRARY OF MEDICINE. PART VI, LINE 3: ST. LUKE'S INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT ELIGIBILITY FOR ASSISTANCE THE FOLLOWING WAYS:- INFORMATION IS INCLUDED ON THE ST. LUKE'S WEB SITE (WWW.SLHDULUTH.COM) REGARDING WHO PATIENTS SHOULD CONTACT FOR INFORMATION OR FINANCIAL ASSISTANCE.- THERE ARE POSTINGS IN ALL REGISTRATION AREAS WITH CONTACT INFORMATION AND PHONE NUMBERS REGARDING HOW PATIENTS CAN OBTAIN ASSISTANCE (BOTH FROM ST. LUKE'S AND EXTERNAL ORGANIZATIONS). - ALL ST. LUKE'S EXTERNAL BILLING AND COLLECTION VENDORS HAVE BEEN INSTRUCTED TO REFER ANY PATIENT INDICATING THEY LACK THE FINANCIAL WHEREWITHAL TO MEET THEIR FINANCIAL OBLIGATIONS TO ST. LUKE'S FINANCIAL COUNSELORS. AS REQUIRED UNDER A BILLING AND COLLECTION AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL, ST. LUKE'S PERFORMS AN ANNUAL AUDIT OF ALL EXTERNAL VENDORS TO ENSURE COMPLIANCE WITH THIS INSTRUCTION AND ALL OTHER ST. LUKE'S POLICIES AND PROCEDURES. - ST. LUKE'S FINANCIAL COUNSELORS' BUSINESS CARDS ARE PROMINENTLY DISPLAYED AND AVAILABLE AT ALL REGISTRATION AREAS (INCLUDING THE EMERGENCY/URGENT CARE AREA) WITH THEIR CONTACT INFORMATION AND PHONE NUMBERS. PATIENTS ARE ENCOURAGED TO CONTACT FINANCIAL COUNSELORS. - THE ST. LUKE'S FINANCIAL COUNSELORS' PHONE NUMBER IS LISTED PROMINENTLY ON THE PATIENT BILLING STATEMENTS.- THE FINANCIAL COUNSELORS ARE AVAILABLE WEEKDAYS BY PHONE OR IN PERSON TO DISCUSS AND APPLY FOR FINANCIAL ASSISTANCE PROGRAMS. - ST. LUKE'S HAS ENGAGED AN EXTERNAL VENDOR TO MEET WITH PATIENTS AT BEDSIDE TO DISCUSS ELIGIBILITY FOR ASSISTANCE WITH GOVERNMENTAL ASSISTANCE PROGRAMS OR ST. LUKE'S FINANCIAL ASSISTANCE PROGRAM.- ST. LUKE'S INPATIENT BOOKLET CONTAINS INFORMATION REGARDING FINANCIAL ASSISTANCE AND CONTACT INFORMATION.- AT LEAST ANNUALLY, THE ST. LUKE'S AND MEDICAL STAFF NEWSLETTERS CONTAIN ARTICLES REGARDING PATIENT FINANCIAL ASSISTANCE. HOSPITAL AND MEDICAL STAFF MEMBERS ARE INFORMED THAT THEY HAVE THE RESPONSIBILITY TO LISTEN FOR FINANCIAL CONCERNS EXPRESSED BY PATIENTS AND TO PROACTIVELY REFER THOSE PATIENTS TO ST. LUKE'S FINANCIAL COUNSELORS. PART VI, LINE 4: COMMUNITY OR COMMUNITIES THE ORGANIZATION SERVES: ST. LUKE'S SERVICE AREA CONSISTS OF A 17-COUNTY REGION OF NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN AND THE WESTERN UPPER PENINSULA OF MICHIGAN WITH A POPULATION OF APPROXIMATELY 500,000. THE PRIMARY MARKET CONSISTS OF DULUTH, CLOQUET AND TWO HARBORS, MINNESOTA, AND SUPERIOR, WISCONSIN. THIS PRIMARY MARKET SERVES URBAN AND SUBURBAN AREAS WITH A POPULATION OF APPROXIMATELY 166,000.DEMOGRAPHICS OF THE COMMUNITY OR COMMUNITIES (PRIMARY MARKET):POPULATIONS: DULUTH, MN (86,265); SUPERIOR, WI (27,244)MEDIAN HOUSEHOLD INCOME: DULUTH, MN ($33,766); SUPERIOR, WI ($31,921)MEDIAN FAMILY INCOME: DULUTH, MN ($46,394); SUPERIOR, WI ($41,093)% OF FAMILIES BELOW FPG: DULUTH, MN (8.6%); SUPERIOR, WI (9.6%)% OF INDIVIDUALS BELOW FPG: DULUTH, MN (15.5%); SUPERIOR, WI (13.4%)% OF HOSPITAL MEDICAID PAYOR MIX: INPATIENT (12%), OUTPATIENT (13%)% OF HOSPITAL SELF PAY PAYOR MIX: INPATIENT (4%), OUTPATIENT (3%)NUMBER OF HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES (PRIMARY MARKET):ST. LUKE'S HOSPITALLAKE VIEW HOSPITALCLOQUET COMMUNITY MEMORIAL HOSPITAL ESSENTIA HEALTH SMDC MEDICAL CENTER (FORMERLY MILLER DWAN)ESSENTIA HEALTH ST. MARY'S HOSPITAL OF SUPERIORESSENTIA HEALTH ST. MARY'S MEDICAL CENTERNUMBER OF FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS PRESENT IN THE COMMUNITY:MUA/P: DULUTH, MN (11); SUPERIOR, WI (7) PART VI, LINE 5: ST. LUKE'S HAS BUILT A REPUTATION OF PROVIDING QUALITY CARE AND PUTTING THE PATIENT FIRST. SINCE OPENING IN 1881, ST. LUKE'S HAS GROWN INTO A NATIONALLY RECOGNIZED HEALTH CARE SYSTEM SERVING 17 COUNTIES THROUGHOUT NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. ST. LUKE'S HOSPITAL, ALONG WITH ITS PRIMARY AND SPECIALTY CARE CLINICS, OFFERS A COMPREHENSIVE CONTINUUM OF CARE THAT INCLUDES TRAUMA, MEDICAL, SURGICAL, DIAGNOSTIC, THERAPEUTIC AND REHAB SERVICES. MORE THAN 2,000 HEALTH CARE PROFESSIONALS, INCLUDING A MEDICAL STAFF OF 365 PHYSICIANS AND OTHER MEDICAL PROVIDERS, MAKE UP ST. LUKE'S STAFF. WITH RAPID ACCESS TO ST. LUKE'S ELECTRONIC MEDICAL RECORDS, PHYSICIANS CAN MAKE INFORMED TREATMENT DECISIONS FOR THEIR PATIENTS. ST. LUKE'S 13 PRIMARY CARE CLINICS INCLUDE 10 FAMILY PRACTICE CLINICS LOCATED IN DULUTH (4), AND ACROSS MINNESOTA IN SILVER BAY, HIBBING, MOUNTAIN IRON AND HERMANTOWN, MN AS WELL AS IN ASHLAND AND SUPERIOR, WI. IN ADDITION, ST. LUKE'S DULUTH INTERNAL MEDICINE ASSOCIATES (DIMA) IS LOCATED IN DOWNTOWN DULUTH WHILE ST. LUKE'S INTERNAL MEDICINE ASSOCIATES AND ST. LUKE'S PEDIATRIC ASSOCIATES ARE LOCATED ON THE ST. LUKE'S CAMPUS. AN ADDITIONAL 23 SPECIALTY CLINICS LOCATED PRIMARILY ON THE ST. LUKE'S CAMPUS, PROVIDE EXPERTISE IN MANY AREAS OF HEALTH CARE INCLUDING CANCER CARE, CARDIAC CARE, HOME CARE AND HOSPICE, ADULT PSYCHIATRY,PLASTIC SURGERY, ALLERGY, ENDOCRINOLOGY, DERMATOLOGY, GASTROENTEROLOGY, INFECTIOUS DISEASE, PHYSICAL MEDICINE AND REHAB,UROLOGY, RHEUMATOLOGY, NEUROSURGERY AND PULMONARY MEDICINE. 1 LAKE SUPERIOR COMMUNITY HEALTH CENTER 4325 GRAND AVENUE DULUTH MN 55807 237167576 501(C)(3) 82500 TO SERVE LOW INCOME, UNINSURED CLIENTS. UNITED WAY 424 WEST SUPERIOR STREET DULUTH MN 55802 410857077 501(C)(3) 5500 TO SUPPORT THE WORK OF THE UNITED WAY. PROGRAM FOR AID TO VICTIMS OF SEXUAL ASSAULT 32 EAST 1ST STREET SUITE 200 DULUTH MN 55802 411350021 501(C)(3) 41600 TRAINING AND SUPPORT FOR SEXUAL ASSAULT NURSE EXAMINER PROGRAM. AMERICAN HEART ASSOCIATION 130 W SUPERIOR ST STE700 DULUTH MN 55802 135613797 501(C)(3) 7000 SUPPORT THE HEART WALK AND GO RED FOR WOMEN CAMPAIGNS AMERICAN CANCER SOCIETY 130 WEST SUPERIOR STREET DULUTH MN 55802 410724036 501(C)(3) 9500 TO SUPPORT THE RELAY FOR LIFE, DAFFODIL DAYS, AND THE LIZ PREBICH GOLF CLASSIC. MN MEDICAL FOUNDATION PO BOX 86 MINNEAPOLIS MN 55486 416027707 501(C)(3) 7500 SUPPORT FOR THE UNIVERSITY OF MINNESOTA DULUTH MEDICAL SCHOOL. AREA PARTNERSHIP FOR ECONOMIC DEVELOPMENT 306 W SUPERIOR ST STE902 DULUTH MN 55802 320079166 501(C)(6) 15000 SUPPORT FOR GOOGLE TWIN PORTS EXPANSION PROJECT GRANDMA'S MARATHON-DULUTH INC PO BOX 16234 DULUTH MN 55816 411573627 501(C)(3) 4500 SPONSOR MINNESOTA MILE WALK FOR BREAST CANCER AND YOUNG ATHLETES FOUNDATION DULUTH AREA CHAMBER OF COMMERCE 5 WEST FIRST STREET 101 DULUTH MN 55802 410225910 501(C)(6) 10950 SPONSOR FOR 2010 DULUTH DAYS AT THE CAPITAL ARROWHEAD EMS ASSOCIATION INC 4219 ENTERPRISE CIRCLE DULUTH MN 55811 411522627 501(C)(3) 5000 SPONSOR FOR THE ARROWHEAD EMS ANNUAL CONFERENCE COLLEGE OF ST SCHOLASTICA 1200 KENWOOD AVE DULUTH MN 55811 410598301 501(C)(3) 7500 SUPPORT FOR THE ST. SCHOLASTICA HEALTH SCIENCE SCHOLARSHIP PROGRAM ST LUKE'S FOUNDATION 1000 EAST FIRST STREET SUITE 102 DULUTH MN 55805 411448118 501(C)(3) 21104 SUPPORT GENERAL OPERATIONS 10 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE HOSPITAL REQUESTS THAT GRANTEES PROVIDE AN UPDATE ON THE IMPACT OF THE GRANT SIX MONTHS AFTER THE GRANT HAS BEEN MADE. IN ADDITION, THE ACCOUNTING DEPARTMENT REVIEWS INVOICES SUPPORTING THE FUNDS USED FROM THE GRANT. THE AFOREMENTIONED PROCESS HELPS ENSURE THE GRANT WAS USED FOR THE INDENDED PURPOSE. X X X X X 0 0 0 0 0 0 0 0 0 JOHN STRANGE 798688 0 0 0 3857 0 9308 0 131615 0 943468 0 0 0 PAUL SANFORD MD 207805 0 34241 0 690 0 5101 0 23402 0 271239 0 0 0 JAMES WUELLNER 313235 0 0 0 2134 0 4544 0 78111 0 398024 0 0 0 JOHN YOON MD 1391523 0 0 0 626 0 4544 0 22943 0 1419636 0 0 0 JOHN WATKINS MD 829073 0 0 0 300 0 4544 0 17822 0 851739 0 0 0 MARSHALL WATSON JR MD 820876 0 0 0 300 0 4544 0 18450 0 844170 0 0 0 DAVID FOGARTY MD 799840 0 0 0 450 0 0 0 9692 0 809982 0 0 0 MARY BOYLAN MD 798218 0 0 0 1290 0 5878 0 23061 0 828447 0 0 0 GAIL BALDWIN BOARD MEMBER 103620 FAMILY EMPLOYMENT RELATIONSHIPHUSBAND IS EMPLOYED AS A PHARMACIST BY ST LUKE'S HOSPITAL AND WAS PAID WAGES DURING FY 2011. 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD AS THE PRESIDING OFFICER, ALL OTHER OFFICERS OF THE HOSPITAL WHO ARE DIRECTORS, AND SUCH ADDITIONAL DIRECTORS AS THE CHAIRPERSON MAY APPOINT. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHAL HAVE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL, INCLUDEING THE AUTHORITY TO REVIEW THE COMPENSATION PAID TO THE HOSPITAL'S EMPLOYED PHYSICIANS, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE, AND SHALL MEET AS NECESSARY. IN ADDITION, THE EXECUTIVE COMMITTEE SHALL OVERSEE THE HOSPITAL'S PUBLIC RELATIONS ACTIVITIES AND KEEP THE CORPORATION'S HEALTH CARE EFFORTS CONTINUALLY BEFORE THE COMMUNITIES SERVED THROUGH THE USE OF PUBLICATIONS AND OTHER COMMUNICATIONS DESCRIBING THE HOSPITAL'S SERVICES, PROGRAMS, AND NEEDS. FORM 990, PART VI, SECTION A, LINE 6 ST. LUKE'S HOSPITAL SHALL HAVE THREE CLASSES OF MEMBERSHIPS: A) PAST MEMBERS OF ST. LUKE'S HOSPITAL OF DULUTH - THE INDIVIDUALS AND ORGANIZATIONS LISTED ON THE HOSPITAL'S OFFICIAL ROSTER OF MEMBERS AS OF MAY 20, 2004 SHALL BE MEMBERS AND HAVE THE NUMBER OF VOTES AS IDENTIFIED ON THAT LIST. B) MEMBERS OF THE ST. LUKE'S HOSPITAL OF DULUTH - ANY INDIVIDUAL OR ORGANIZATION THAT, SUBSEQUENT TO MAY 20, 2004, CONTRIBUTES $100 OR MORE TO THE HOSPITAL SHALL, UPON REQUEST FROM SUCH INDIVIDUAL OR ORGANIZATION AND APPROVAL BY THE BOARD OF DIRECTORS, BE A MEMBER OF THE ORGANIZATION WITH ONE VOTE. C) EX OFFICIO MEMBERS - EACH DIRECTOR AND THE PRESIDENT/CEO OF THE HOSPITAL SHALL BE A VOTING MEMBER OF THE HOSPITAL DURING HIS OR HER TERM IN SUCH OFFICE AND SHALL HAVE ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING RIGHTS OF THE MEMBERS OF THE CORPORATION SHALL BE LIMITED TO THE FOLLOWING MATTERS: A) APPROVAL OF ANY TRANSACTION THAT WOULD CULMINATE IN THE TRANSFER OF CONTROL OF HOSPITAL OPERATIONS TO A SECRETARIAN OR RELIGIOUS ORGANIZATION. B) APPROVAL OF ANY TRANSACTIONS WHICH WOULD CULMINATE IN THE TRANSFER OF CONTORL OF THE HOSPITAL'S OPERATIONS TO A FOR-PROFIT ENTITY. C) APPROVAL OF THE DISSOLUTION OF THE HOSPITAL OR THE CESSATION OF THE HOSPITAL OPERATIONS. THE FOREGOING ACTIONS SHALL BE APPROVED AND ADOPTED ONLY AFTER AUTHORIZATION BY THE BOARD OF DIRECTORS AND APPROVAL BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT REFERENCED MULTIPLE SOURCES OF INFORMATION IN ORDER TO ACCURATELY PREPARE THE 2011 FORM 990. THESE SOURCES INCLUDE THE INTERNAL REVENUE SERVICE WEBSITE, LEGAL COUNSEL, HEALTHCARE TRADE ASSOCIATIONS, AND OTHER VARIOUS PUBLICATIONS. ONCE THE FORM 990 WAS PREPARED, IT WAS REVIEWED BY THE FOLLOWING GROUPS: 1. ST. LUKE'S SENIOR MANAGEMENT (OCTOBER 2012) 2. ST. LUKE'S BOARD OF DIRECTORS (OCTOBER 2012) 3. ST. LUKE'S FINANCE COMMITTEE (OCTOBER 2012) ALL OF THE ABOVE GROUPS WERE PROVIDED WITH A COMPLETE COPY OF THE 2011 FORM 990. IN OCTOBER 2012, THE CHIEF FINANCIAL OFFICER MADE A PRESENTATION TO THE BOARD REGARDING THE FORM 990 AND THEIR RESPONSIBILITIES. IN THE CASE OF THE FINANCE COMMITTEE AND BOARD OF DIRECTORS, THE FORM 990 REVIEW WAS LISTED AS AN AGENDA ITEM AT THEIR RESPECTIVE MEETINGS. THE CFO OF ST. LUKE'S PROVIDED AN OVERVIEW OF THE RETURN AND ANSWERED ANY QUESTIONS OR CONCERNS FROM THE BOARD/COMMITTEE MEMBERS. ANY SUGGESTED CHANGES TO THE FORM 990 WERE EVALUATED, WITH LEGAL COUNSEL IF NECESSARY, AND INCORPORATED INTO THE RETURN AS APPROPRIATE. THE RETURN WAS THEN FILED ON OR BEFORE NOVEMBER 15, 2012. FORM 990, PART VI, SECTION B, LINE 12C 1. ALL EMPLOYEES AND BOARD MEMBERS OF ST. LUKE'S MUST DISCLOSE POTENTIAL CONFLICTS OF INTEREST TO THEIR SUPERVISOR(S), AND REFRAIN FROM MAKING DECISIONS BASED ON OUTSIDE INTERESTS. 2. AT LEAST ANNUALLY, AFFECTED INDIVIDUALS MUST REVIEW THIS POLICY AND COMPLETE THE CONFLICT OF INTEREST STATEMENT. A. THE COMPLIANCE OFFICE MAINTAINS A LIST OF AFFECTED INDIVIDUALS. DEPARTMENT DIRECTORS IDENTIFY ADDITIONAL EMPLOYEES WITH SIGNIFICANT PURCHASING AND DECISION-MAKING RESPONSIBILITY FOR THE COMPLIANCE OFFICE. B. THE COMPLIANCE OFFICE REQUESTS THAT AFFECTED INDIVIDUALS REVIEW THIS POLICY, COMPLETE AND RETURN THE CONFLICT OF INTEREST STATEMENT. C. THE COMPLIANCE OFFICE REVIEWS THE STATEMENTS OF EMPLOYEES, DIRECTORS AND PHYSICIANS, AND NOTIFIES THE APPROPRIATE EXECUTIVE OF ANY POTENTIAL CONFLICT OR DUALITY OF INTEREST. D. THE PRESIDENT REVIEWS THE STATEMENTS OF EXECUTIVES FOR POTENTIAL CONFLICT OR DUALITY OF INTEREST. E. THE CHAIRMAN OF THE BOARD OF DIRECTORS REVIEWS THE STATEMENTS OF THE PRESIDENT/CEO AND BOARD MEMBERS. F. EMPLOYEE STATEMENTS ARE FILED IN HUMAN RESOURCES; BOARD OF DIRECTOR STATEMENTS ARE FILED IN THE ADMINISTRATION OFFICE. 3. THE STATEMENT MUST BE COMPLETED UPON APPOINTMENT / HIRING TO AN ADMINISTRATIVE, DIRECTOR OR MANAGEMENT POSITION. A. HUMAN RESOURCES INCLUDES THE CONFLICT OF INTEREST POLICY AND STATEMENT IN THE NEW HIRE PACKET AND FORWARDS THE COMPLETED STATEMENT TO COMPLIANCE OFFICE FOR REVIEW. B. HUMAN RESOURCES NOTIFIES COMPLIANCE OFFICE OF INTERNAL TRANSFERS TO ADMINISTRATIVE, DIRECTOR AND MANAGEMENT POSITIONS. COMPLIANCE OFFICE REQUESTS COMPLETION OF THE CONFLICT OF INTEREST STATEMENT. C. IF AN EMPLOYEE'S DUTIES CHANGE DURING THE YEAR, RESULTING IN A POTENTIAL CONFLICT OF INTEREST, THE DEPARTMENT DIRECTOR NOTIFES THE COMPLIANCE OFFICE TO OBTAIN A CONFLICT OF INTEREST STATEMENT. 4. AT ANY TIME DURING THE YEAR, WHEN AN ACTUAL, POTENTIAL OR PERCEIVED CONFLICT OF INTEREST ARISES, AN AFFECTED INDIVIDUAL MUST CONTACT HIS OR HER SUPERVISOR OR THE COMPLIANCE OFFICE AND COMPLETE THE CONFLICT OF INTEREST STATEMENT. 5. AFFECTED INDIVIDUALS ARE REQUIRED TO SUBMIT IN WRITING A LIST OF ALL BUSINESSES OR OTHER ORGANIZATIONS IF THEY OR MEMBERS OF THEIR FAMILY ARE AN OFFICER, MEMBER, OWNER, OR EMPLOYEE AND ST. LUKE'S HAS OR MIGHT REASONABLY BE EXPECTED TO ENTER INTO A RELATIONSHIP OR A TRANSACTION WITH THE BUSINESS OR ORGANIZATION IN THE FUTURE. 6. IF RESOLUTION OF POTENTIAL CONFLICTS OF INTEREST IS NEEDED, IT WILL BE HANDLED THROUGH THE CHAIN OF COMMAND OR AT THE BOARD OF DIRECTORS LEVEL. 7. EMPLOYEES ACCEPT NO PERSONAL GIFTS, FAVORS, OR COMPENSATION FROM PATIENTS, VENDORS, OR OTHER INDIVIDUALS OR ORGANIZATIONS SEEKING A BUSINESS RELATIONSHIP WITH ST. LUKE'S. A. BUSINESS TRAVEL PAID IN PART OR COMPLETELY BY AN OUTSIDE INDIVIDUAL, AGENCY, CORPORATION OR ORGANIZATION REQUIRES PRIOR APPROVAL BY MANAGEMENT. B. PERISHABLE OR CONSUMABLE GIFTS (CANDY, DONUTS, FLOWERS, ETC.) GIVEN TO A DEPARTMENT OR GROUP OF EMPLOYEES ALLOWED. C. CASH GIFTS ARE PROHIBITED. D. IF AN EMPLOYEE IS GIVEN A GIFT THAT CANNOT BE RETURNED, THE EMPLOYEE WILL CONSULT HIS OR HER SUPERVISOR AND/OR HUMAN RESOURCES TO DETERMINE AN ACCEPTABLE COURSE OF ACTION SUCH AS DONATION OF THE GIFT TO ST. LUKE'S FOUNDATION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION REVIEW PROCESS DESCRIBED BELOW PERTAINS TO THE CHIEF EXECUTIVE OFFICE (CEO) AND THE CHIEF FINANCIAL OFFICER (CFO) POSITIONS. THE CEO IS THE TOP MANAGEMENT OFFICIAL. THE CFO IS AN OFFICER OF THE CORPORATION. THERE ARE NO EMPLOYEES WHO QUALIFY AS KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION REVIEW PROCESS OCCURS DURING AN ANNUAL REVIEW OF THE COMPENSATION FOR BOTH POSITIONS AND LAST OCCURRED IN 2011. TOTAL COMPENSATION FOR THE CEO WAS ITEMIZED INCLUDING BASE SALARY, HEALTH INSURANCE, DENTAL INSURANCE, LIFE INSURANCE, DISABILITY, VACATION AND HOLIDAY PAY AND EXECUTIVE COMPENSATION. ALL AMOUNTS WERE COMBINED TO DETERMINE THE TOTAL COMPENSATION FOR THIS POSITION. THE TOTAL COMPENSATION AMOUNT OF EACH POSITION WAS THEN MEASURED AGAINST THE 2008 - 2009 WATSON WYATT DATA FOR HOSPITAL SYSTEMS IN THE NORTH CENTRAL U.S. REGIONS WITH $150 - $450 MILLION IN NET OPERATING REVENUE. THE TOTAL COMPENSATION WAS ALSO MEASURED AGAINST THE MINNESOTA HOSPITAL ASSOCIATION DATA FOR HOSPITALS WITH $200 MILLION OR MORE IN TOTAL EXPENSE BUDGET. THE COMPENSATION REVIEW FOR THE CFO FOLLOWS THE SAME PROCESS. THE AFOREMENTIONED DATA FOR BOTH THE CEO AND CFO WAS THEN REVIEWED WITH AND APPROVED BY THE EXECUTIVE COMMITTEE AND THE BOARD OF DIRECTORS. CONTEMPORANEOUS DOCUMENTS AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS ARE MAINTAINED BY THE CEO AND HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 ST. LUKE'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND UPDATED ANNUALLY BY THE BOARD OF DIRECTORS. THEY ARE NOT AVAILABLE TO THE GENERAL PUBLIC. FINANCIAL INFORMATION IS MADE AVAILABLE THROUGH ST. LUKE'S ANNUAL REPORT (PUBLISHED EVERY YEAR AND AVAILABLE ON ST. LUKE'S WEBSITE AT WWW.SLHDULUTH.COM) AND THE FORM 990 IS MADE AVAILABLE TO THE PUBLIC IN ACCORDANCE WITH THE INTERNAL REVENUE SERVICE GUIDANCE. ALLOCATION OF HOURS FORM 990, PART VII, SECTION A, LINE 1 JOHN STRANGE, CEO, DEVOTED APPROXIMATELY 40 HOURS PER WEEK AS FOLLOWS BETWEEN THE REPORTING ORGANIZATION AND ITS RELATED AFFILIATES: ST. LUKE'S HOSPITAL OF DULUTH: 36 HOURS LAKE VIEW MEMORIAL HOSPITAL, INC.: 2 HOURS ST. LUKE'S FOUNDATION: 2 HOURS JAMES WUELLNER, CEO, DEVOTED APPROXIMATELY 40 HOURS PER WEEK AS FOLLOWS BETWEEN THE REPORTING ORGANIZATION AND ITS RELATED AFFILIATES: ST. LUKE'S HOSPITAL OF DULUTH: 36 HOURS LAKE VIEW MEMORIAL HOSPITAL, INC.: 2 HOURS ST. LUKE'S FOUNDATION: 2 HOURS IN ADDITION TO BEING A BOARD MEMBER OF ST. LUKE'S HOSPITAL OF DULUTH, THE FOLLOWING BOARD MEMBERS, DALE MOE AND MARLENE DAVID, ALSO SERVE AS BOARD MEMBERS OF THE RELATED ORGANIZTION LAKE VIEW MEMORIAL HOSPITAL. IN ADDITION TO BEING A BOARD MEMBER OF ST. LUKE'S HOSPITAL OF DULUTH, THE FOLLOWING BOARD MEMBERS, MELINDA MACHONES, PAUL SANFORD, AND BRIAN RYKS, ALSO SERVE AS BOARD MEMBERS OF THE RELATED ORGANIZTION ST. LUKE'S FOUNDATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 199,531. CHANGE IN MINIMUM PENSION LIABILITY -21,992,666. CAPITAL REIMBURSEMENT FROM ST. LUKE'S FOUNDATION 114,934. CONTRIBUTION TO SLH VOLUNTEER SERVICE GUILD -10,000. TOTAL TO FORM 990, PART XI, LINE 5: -21,688,201. ST LUKE'S FOUNDATION 1000 EAST FIRST STREET NO 102 DULUTH MN 55805 411448118 FUNDRAISING SUPPORT FOR HEALTH CARE/HOSPITAL MN 501(C)(3) LINE 11A, I ST LUKE'S HOSPITAL OF DULUTH 1 LAKE VIEW MEMORIAL HOSPITAL INC 325 11TH AVENUE TWO HARBORS MN 55616 410786046 HEALTH CARE/HOSPITAL MN 501(C)(3) LINE 3 ST LUKE'S HOSPITAL OF DULUTH 1 LAKE VIEW MEMORIAL HOSPITAL FOUNDATION OF NORTHEAST MINNESOTA 325 11TH AVENUE TWO HARBORS MN 55616 411700972 FUNDRAISING SUPPORT FOR LAKE VIEW MEMORIAL HOSPITAL MN 501(C)(3) LINE 7 ST LUKE'S HOSPITAL OF DULUTH & LAKE VIEW MEMORIAL HOSPITAL 0 CRITICAL CARE SERVICES INC DBA LIFELINK III 3010 BROADWAY STREET NE MINNEAPOLIS MN 554131768 411518013 HEALTH CARE EMERGENCY TRANSPORTATION MN 501(C)(3) LINE 11C, III-FI N/A 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 ST LUKE'S FOUNDATION C 433870 FAIR MARKET VALUE ST LUKE'S FOUNDATION P 273639 FAIR MARKET VALUE LAKE VIEW MEMORIAL HOSPITAL INC P 931162 FAIR MARKET VALUE LAKE VIEW MEMORIAL HOSPITAL INC D 4705675 FAIR MARKET VALUE