2012-05-14T13:48:15-05:00 2011-06-30 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2010-07-01 450226711 St Alexius Medical Center STAL 7015307000 900 East Broadway Avenue Bismark ND 585014520 Gary Miller 7015307000 2012-05-09 1 KIM C HUNWARDSEN 7012398500 2012-05-09 2010 2016-02-24 21:20:13Z Gary Miller 900 East Broadway Avenue Bismark ND 585014520 270734453 0 0928 X www.st.alexius.org X 1905 ND Providing Healthcare 15 9 2539 296 10384337 0 502924 589977 246267321 260619860 567952 735935 8393486 8788681 255731683 270734453 36314 390092 0 0 100717797 106967150 0 0 530602 144001746 151393712 244755857 258750954 10975826 11983499 211958975 250993916 74459650 101111985 137499325 149881931 X Based on the Gospel values and our own heritage of healing, the mission of St. Alexius Medical Center is to use our community presence as a means of touching and healing people in a Christ-like manner, and to always exhibit the hospitality as reflected in the rule of St. Benedict: "Let all be received as Christ." 0 0 25076957 123800864 St. Alexius Medical Center began as a 20-bed hospital 125 years ago but has evolved into a 306-bed, full-service, certified Level II Trauma Acute Care Center that provides advanced healthcare services. St Alexius served 12,010 inpatients during the fiscal year ended June 30th, 2010. In 2006, St. Alexius was recognized as a Magnet Hospital being the first hospital to achieve this distinction. To be considered, the hospital must satisfy a set of criteria designed to measure the strength and quality of their nursing, which includes low employee turnover rates, a highly educated nursing staff, optimal nurse-to-patient ratios and high quality of care. Studies have shown that patients who are treated in Magnet facilities average a shorter length of stay and a higher rate of satisfaction. With over 1,200 births each year, two out of every three babies born in this region are born at St. Alexius Medical Center. Our family-focused care provides a wide range of services for mother and baby, and our specially trained nurses and physicians are prepared to handle every birthing experience with care. St. Alexius' 24-bed Level III NICU has served the region for more than 25 years, which is staffed by neonatal nurses, therapists, board-certified neonatologists, a pediatric neurologist and the region's only pediatric cardiologist. St. Alexius' Heart & Vascular Center provides comprehensive care to patients with cardiovascular, lung, and peripheral artery disease. We are comprised of an interventional radiologist, cardiologists, heart and vascular surgeons as well as other highly trained support personnel. 32172736 32091230 Specialty Clinics: The Clinics of St. Alexius is a unique multi-specialty group practice located mainly inside St. Alexius Medical Center. Over 40 providers in 14 different specialties work together to care for patients. Specialists must complete seven or more years of medical school and post-graduate training and then complete fellowships in their chosen specialties. All physicians are board eligible or board certified in one or more specialties. The providers see approximately 62,000 encounters a year. We provide clinic services in many off site satellite clinics and bring specialty services to the region. The Clinics of St. Alexius include Center for Family Medicine Mandan, Minot Medical Clinic, Infectious Disease, Neonatology, Nephrology, Nephrology, Neurosurgery, Pain, Pediatric Cardiology, Pediatric Neurology, Adult Physical Medicine, Primary Care, Rheumatology, Sleep Medicine, and Urology. 174768286 390092 102546509 Outpatient:1. St. Alexius operates an outpatient family service program called Archway Family Services. This program offers sensitive and responsive services for individual, marital and family problems.This program is keeping with St. Alexius Medical Center's philosophy of being a leader in progressive and quality services to the people of North Dakota. Archway services are also provided in Hazen, Garrison and Linton, ND.2. Great Plains Rehabilitation Services is a division of St. Alexius Medical Center that provides Home Medical Equipment, Orthotic & Prosthetic, Home Respiratory Care, ADA Environmental, and Rehabilitation Technology services. Great Plains provides needed medical equipment and supplies to help individuals lead active and independent lives. Great Plains services all of North Dakota, Central and Eastern Montana, and Northern South Dakota.OTHER:-St. Alexius Medical Center served 11,788 inpatients, 110,135 outpatients, 27,588 emergency patients, and 17,712 Home Health Care patients during the fiscal year ended June 30, 2011.-St. Alexius Medical Center provided community activities and services at reduced or no cost. Those included:1. EMPLOYEE ASSISTANCE - Two hundred fourteen employer contracts servicing 38,841 employees by providing problem assessment, short term counseling and referral to appropriate resources for follow-up care. 2. EMPLOYEE ACTIVITIES - In keeping with the Medical Center's commitment to its employees:-Actively participated in the United Way fund campaign.-Journey Beyond Excellence program with a new rewards and recognition program.-Nursing Education Council develops and implements a preceptor reward and recognition program.-The vacation donation program assisted employees who used 2,366.75 hours of donated vacation. Employees have donated 890 vacation hours.-The Employee Emergency Fund is for any St. Alexius employee who experiences a crisis or is directly affected by a crisis involving a family member. The funds are available to employees who are facing personal tragedies or hardships for reasons such as a loss of a spouse or child, catastrophic illness, loss of home by fire or flood, or other calamities. Since its inception, $194,837 has been raised with a total of 165 employee gifts awarded.3. ACUTE CARE FACILITY - St. Alexius is a partner with another acute care facility to operate a radiation therapy facility known as The Cancer Center. The Cancer Center helps to ensure that patients with cancer receive quality care and management of their disease without having to drive a long distance to receive the same type of care. 4. AWARDS/ACCOMPLISHMENTS--St. Alexius ranked among the top 5 percent in the nation and #1 in North Dakota for cardiac care. The ranking is based on the Tenth Annual HealthGrades Hospital Quality in America Study. HealthGrades is the leading healthcare ratings organization. Other outcomes from this study:-Ranked among the Top 5% in the Nation for Overall Cardiac Services-Ranked among the Top 5% in the Nation for Cardiac Surgery-Ranked among the Top 5% in the Nation for Coronary Interventional Procedures-Ranked among the Top 10% in the Nation for Cardiology Services-Ranked #1 in ND for Cardiac Care, Cardiac Surgery, Cardiology Services and Coronary Interventional Services-Five-Star Rated for Overall Cardiac Care, Cardiac Surgery, Cardiology Services, Coronary Bypass Surgery, Valve Replacement Surgery, Coronary Interventional Procedure, and Treatment for Heart Attack -St. Alexius fulfilled the requirements to become North Dakota's first Magnet(TM) Hospital. Magnet is considered to be the gold standard in patient care. Achieving Magnet designation helps consumers locate health care organizations that have a proven level of excellence in nursing care. -Great Plains Rehab Services Orthotics & Prosthetics area received unconditional accreditation for 3 years from The American Board of Certification in Orthotics & Prosthetics. Surveyor comments included having the best patient record and performance improvement practices that the surveyor had seen in the industry.-St. Alexius Medical Center has met the criteria necessary to be designated a Blue Distinction Center for bariatric surgery, knee and hip replacement, and spine surgery. This designation means that St. Alexius has met or exceeded certain criteria that demonstrate reliability in delivering bariatric surgical care and better overall outcomes for patients. 232017979 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 250 0 1 2539 1 1 1 0 0 0 0 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 X Gary Miller 7015307610 900 East Broadway Avenue Bismarck ND 585014520 John Castleberry 3.00 X X 10175 0 0 Sr Nancy Miller 3.00 X X 0 0 0 Sr Thomas Welder 3.00 X X 0 0 0 Sr Gerard Wald 3.00 X X 0 0 0 Linda Knodel 40.00 X 0 0 0 Sr Rosanne Zastoupil 3.00 X X 0 0 0 Sr Mariah Dietz 3.00 X 0 0 0 Kenneth Ziegler 3.00 X 5600 0 0 Chuck Reichert 3.00 X 7150 0 0 Robert Gayton 3.00 X 3275 0 0 Vernon Dosch 3.00 X 4250 0 0 Nicholas Neumann MD 3.00 X 3800 0 0 John Giese 3.00 X 4525 0 0 Ernest Godfread 3.00 X 3950 0 0 Ben Roller 3.00 X 0 0 0 Gary Miller 50.00 X X 283884 0 14182 Andrew Wilson through Jan 2011 50.00 X X 593093 0 22828 Frank Kilzer 40.00 X 189808 0 23296 Wanda Pfaff 40.00 X 208217 0 25148 Duwayne Schlittenhard 40.00 X 217971 0 16279 Dr Syed Hyder 40.00 X 457269 0 27828 Rosanne Schmidt 40.00 X 228715 0 24630 Kurt Waldbillig 40.00 X 162720 0 21811 Brent Herbel 40.00 X 738232 0 22828 Eric Belanger 40.00 X 1481566 0 22423 Steven Kraljic 40.00 X 1419864 0 22828 Leslie Rainwater 40.00 X 773075 0 23728 John Windsor 40.00 X 892786 0 22828 7689925 0 290637 156 0 1 0 Bismarck Radiology Associates 810 E Rosser Ave Ste 201 Bismarck ND 58501 Radiology Services 5905342 Northern Plains Laboratory LLC PO Box 2036 Bismarck ND 58502 Pathology Services 3539161 DMS Health Technologies PO Box 86 Minneapolis MN 554862208 Radiology Services 761398 Dell Marketing PO Box 802816 Chicago IL 606802816 Computer Services 459273 Mayo Collaborative Services PO Box 9146 Minneapolis MN 554809146 Laboratory Services 346696 16 589977 589977 Patient service revenu 541900 251336253 249154996 2181257 Other revenue 900099 7977446 7977446 Cafeteria 900099 1143986 1143986 Health and Education 900099 162175 162175 260619860 372227 372227 585601 585601 585601 585601 361312 2396 361312 2396 363708 363708 Community pharmacy 446110 5909430 5909430 Northern plains lab 621500 1121032 1121032 Outside lab 621500 796160 796160 376458 376458 8203080 270734453 258438603 10384337 1321536 390092 390092 2755198 2755198 81868406 70758261 10948745 161400 3483184 2968603 508329 6252 12000919 10112129 1866306 22484 6859443 5941041 907785 10617 152136 152136 63571 63571 35302356 34646190 656166 23732013 16494307 6909844 327862 2716048 2290078 425970 941469 816237 123740 1492 2523300 2523300 14621718 14536626 85092 1064798 1056301 8497 Medical Supplies 40028954 40028954 Pharmacy 17340764 17340764 Bad debt 8003428 8003428 Equipment Rental/Mainte 4903157 4111668 790994 495 258750954 232017979 26202373 530602 19918885 25299376 36895675 38833918 301511 433540 3593378 4026051 1809174 1239404 298918022 168658412 103744517 130259610 28084236 35325650 15765845 14533098 1845754 1043269 211958975 250993916 24524819 33967090 42242200 54104428 2824986 7326532 4867645 5713935 74459650 101111985 X 136272278 148430719 1227047 1451212 137499325 149881931 211958975 250993916 X 11983499 399107 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3419691 448744 93749 305526 17090 3639568 3228718 347995 50166 202661 4526 3419692 3007949 415278 -7070 176999 10440 3228718 1.00000 0 0 34150778 34150778 158941353 91734341 67207012 102196584 74366037 27830547 3629307 2558034 1071273 130259610 Cancer Center 3797791 C Cancer Center Foundation 115844 C Cash and Cash Equivalents 1658710 C Central Dakota Laundry Coop -9751 C NCHCA - Primecare 21563 C Northern Plains Lab 3173945 C Real Estate and Specialty Assets 207893 C SA Health Services, Inc. 1263 C Under Bond Indenture Agreements 5488318 C West River Coop 77522 C 14533098 Capital lease obligations 5713935 5713935 270734453 258750954 11983499 367867 31240 399107 12382606 253632935 367867 -4901556 -4533689 258166624 12567829 12567829 270734453 241563894 0 241563894 17187060 17187060 258750954 Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment is utilized to provide funding to continue to enhance patient care at St. Alexius Medical Center set forth in our mission, "Let all be received as Christ." Description of Uncertain Tax Positions Under FIN 48: Part X: St. Alexius undergoes an annual analysis of its various tax positions, assessing the likelihood of those positions being upheld upon examination with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. St. Alexius believes that it is compliant with all IRS tax regulations, and as of June 30, 2011 has not recorded a tax liability for a tax uncertainty. St. Alexius would recognize future accrued interest and penalties related to unrecognized liabilities in income tax expense if such interest and penalties are incurred. Under normal circumstances, St. Alexius is no longer subject to federal tax examinations by tax authorities for years before 2008. Part XI, Line 8 - Other Adjustments: Fair Value of Interest Rate Swap 31,243. Rounding -3. Part XII, Line 2d - Other Adjustments: Income from subsidiary included in revenue for financial statements -4,601,556. Grant Expense included in income for financials statements -300,000. Part XII, Line 4b - Other Adjustments: Temporily restricted contributions 224,167. Revenues of Disregarded Entity-St. Alexius Heart and Lung 12,285,504. Contribution of Long-Lived Assets 58,158. Part XIII, Line 4b - Other Adjustments: Expenses of Disregarded Entity-St. Alexius Heart and Lung 16,887,060. Grant Expense included in income for financials statements 300,000. 1 1 X 1 X 1 X 1 1 1 0 0 1769808 1769808 0.00710 10899174 8766678 2132496 0.00850 12668982 8766678 3902304 0.01560 177276 177276 0.00070 446827 446827 0.00180 54158358 42119770 12038588 0.04800 390092 390092 0.00160 55172553 42119770 13052783 0.05210 67841535 50886448 16955087 0.06770 0 2558160 306979 71790208 69715837 2074371 X 1 1 1 Northern Plains Lab Labratory Services 0.50000 0.50000 2 1 St Alexius Medical Center

900 East Broadway Bismarck ND 585065510

X X X X 8 Community Memorial Hospital

220 5th Ave Turtle Lake ND 58575

X X X Not Required 1 Not Required 2 6 St Alexius Mandan Clinic

403 Burlington Street SE Mandan ND 58554

Family Medicine Clinic St Alexius Minot Clinic

1600 2nd Ave SW Ste 19 Minot ND 58701

Family Medicine Clinic Great Plains Rehabilitation Services

1212 East Main Bismarck ND 58501

Provide Home Medical Products to General Public St Alexius Same Day Surgery Center

810 East Rosser Ave Bismarck ND 58501

Ambulatory Surgery Center for Individuals Who Require Overnight Stay St Alexius Heart & Lung Clinic

310 North 10th Street Bismarck ND 58501

Heart, Lung & Peripheral Vascular Disease Clinic Great Plains Health Company

3222 28th Street South Fargo ND 58104

Provide Home Medical Products to General Public Part I, Line 7: The charity care included in Part I, Line 7a is based on the cost to charge ratio using Worksheet 1.The unreimbursed Medicaid in Part I, Line 7b is based on gross charges and claims from the Medicaid cost report.The community health services, education and contributions in Part I, Lines 7e and f are based on actual expenses.The subsidized health services in Part I, Line 7g are based on estimated costs from the internal cost accounting general ledger systems. Part I, Line 7g: Subsidized health services includes $52,757,290 in costs attributable to physician clinics.In addition, line 7g also includes $15,697 of costs that were associated with emergency ambulance and air medical services that were provided to patients with the understanding they would not be able to pay for these services. The Hospital identified four patients in the fiscal year that required transfers, of which the associated costs were directly recorded in their general and administrative ledger accounts and not billed to the patients. Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculation on Part 1, Line 7, column f was $8,003,428. Part III, Line 4: Footnote to the organization's financial statements that describes bad debt expense:The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.The bad debt expense was converted to cost using the cost to charge ratio calculated using Worksheet 2.The estimated amount of the organization's bad debt expense that is attributable to patients eligible under the organization's charity care policy is approximately $306,979. This was based off the most recent community needs assessment reported in March 2011, which indicated that 12% of the population is below the Federal Poverty Guidelines. The 12% was applied to the amount of bad debt expense at cost.Discounts and payments on accounts are applied directly to the principal of the account. The Hospital does not charge interest or fees related to the use of a collection agency to collect these payments. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by CMS. Part III, Line 9b: Any individual who indicates the financial inability to pay a bill for a medically necessary service shall be evaluated for Charity Care assistance. The Financial Counselor along with the Social Work Department staff attempt to identify all inpatients prior to discharge and begin the discussion of available programs including, but not limited to, the charity care program. Determination of eligibility should be made prior to discharge or as close to the date of service as possible. However, retroactive determinations are also eligible. The Customer Service staff in Patient Financial Services discusses Charity Care options with patients after services are rendered, usually, after the patient has received their first statement and provided the necessary documentation.A patient's employment status and earning capacity is taken into consideration when evaluating a Charity Care request. The Charity Care application for a patient that is unemployed at the time of the application but is expected to return to work will be placed on hold for a short time period. Students, with less than two years remaining until graduation, will not be considered for Charity Care. Students, with more than two years to graduation, will be considered for deferment of payment or allowed to make minimal payments until graduation. Documented outstanding bills and expenses may be considered when the income is above the poverty guidelines.Reasonable efforts are taken for patients qualifying under financial assistance policy before turning over the account to a third party collector. Part VI, Line 2: The Organization is in the process of assessing the health needs of the community through feedback from the physicians and from patients.The University of Mary, N.D. Department of Health, Centers for Disease Control & Prevention, John Goodman & Associates Study, and Minot Feasibility Study are together working on a community assessment for St. Alexius Medical Center. The results were presented to the Community Benefit Committee in March 2011.St. Alexius is planning to finalize the community health needs assessment prior to June 30, 2012. Part VI, Line 3: Charity care is currently not posted but we are looking at changing this policy. Currently patients are contacted through pre-admissions and they meet with patient financial staff that go through information prior to procedures. Patient Financial Services also works with patients that need assistance with their billings. Part VI, Line 4: St. Alexius provides outreach services across its service area of central and western North Dakota. St. Alexius operates the Garrison Memorial Hospital in Garrison, North Dakota and manages the Community Memorial Hospital in Turtle Lake. St. Alexius owns and operates clinics in Mandan, Minot, Garrison, and Washburn. North Dakota's population is 672,591 of which 61,272 reside in the city of Bismarck. The population is 90.0% white, 5.4% Native American, and the remaining 4.6% being African American, Asian, and Hispanic. By the year 2020, 45 of the 53 counties will have more than 22% of their population age 65 or older. From 2000-2005 our state had a 15% decrease in the number of youth and a 13.8% increase in the minority population which was primarily Native American Reservations. North Dakota has 12% of their population living in poverty. The leading causes of death in Burleigh county ranked in order are Diseases of the Heart, Alzheimers, Respiratory Cancer, Accidental, Cerebrovascular Disease, COPD, Diabetes, Breast Cancer, and Colorectal Cancer. Health related behaviors influence cardiovascular diseases such as smoking, physical inactivity, poor nutrition, and unhealthy weight status. Hypertension is a chronic disease associated with aging that has a high risk factor for heart disease and stroke. In North Dakota, 26% adults have high blood pressure. North Dakota adults are a part of the national trend towards increased obesity. 63% of the adults here have an unhealthy weight/BMI. Some of the health screenings that St. Alexius is conducting throughout the service region are vascular, wellness, memory, sleep apnea, and chronic obstructive pulmonary disease. Those individuals that are being screened at no or minimal cost are being alerted of health risks that might go undetected. Through screenings, it is our hope that these individuals seek further treatment and are empowered to make healthier lifestyle choices. Part VI, Line 6: The governing body is comprised of people in the community who are knowledgeable to advise the organization and are compensated for their expertise and time (see Part VII of Form 990).The organization extends medical staff privileges to Primecare physicians. The organization applies surplus funds, if available, to their reinvestment in equipment and facilities to improve patient care.The Hospital provides serveral services at reduced or no costs. Those included are as follows:1. INTERACTIVE NETWORK - Consists of twenty five communities located in Montana, South and North Dakota covering 70,000 square miles are serviced by the St. Alexius Medical Center network. INTERACTIVE NETWORK provides electrocardiogram management, interactive cardiac management, remote cardiac monitoring, electroencephalogram monitoring, fetal monitoring, biomedical services, dialysis and infant pneumocardiograms to patients in western and central North Dakota. These services might not be provided if not for the Hospital servicing these areas.2. OTHER ACTIVITES INCLUDED ON PART 1, LINE 7E: - In keeping with the Hospital's commitment to serve all members of its community St. Alexius Medical Center: -participated in health fairs-provided patient educational materials and classes-provided patient support groups for different diseases-conducted health screenings-sponsored "Wellness" type programs ranging from Lamaze instruction and parenting to babysitting to diet and weight control to social issues.-maintained a tumor registry-operated a Hospice Program-has telemedicine capabilities set-up in several rural communities-provides PAC's (radiology) services and radiology reading to many rural communities 3. OTHER ACTIVITES INCLUDED ON PART 1, LINE 7E: - Standing Rock Sioux Indian Reservation network of services with emphasis focused on improving the quality of care in the area of maternal and child nursing and mental health with a goal to reduce infant mortality. The program consists of support from a OB trained physician to provide prenatal and ongoing care in the Fort Yates community. Also in that community a bi-monthly newsletter that addresses the following topics:-Pregnancy and prenatal care-Labor and delivery-Infant nutrition-Teen pregnancy-Self esteem-Suicide prevention-Drug and alcohol abuse 4. St. Alexius manages a non-profit critical access hospital in Turtle Lake North Dakota. St. Alexius offers administrative expertise and purchasing economies that it passes on to this facility. This allows the facility to continue to provide health care services and operate more efficiently. Turtle Lake also provides primary care providers to clinics in McClusky and Washburn, ND.5. St. Alexius manages a non-profit critical access hospital in Garrison North Dakota. Garrison Memorial Hospital operates a 22 bed acute care hospital and a 26 bed skilled nursing facility. They also operate a 24 hour, Level IV Certified Emergency Room.6. St. Alexius operates a Telemedicine network, known as The Telecare Network. It is a service St. Alexius Medical Center and affiliated physicians offer in cooperation with 27 healthcare providers throughout the Dakotas. The service features telemedicine consultations between rural physicians and specialists in Bismarck using real time video and audio telepresence equipment. Consultations of both urgent and routine nature are available.7. St. Alexius provides support to other rural communities like Hettinger, North Dakota to help maintain needed primary care physician coverage in rural communities. 1 ND-SD Medical Transport 8295 7th Avenue SE Linton ND 58552 272849014 501(c)(3) 25000 Support Angel Air Care Helicopter EMS Program University of Mary 7500 University Drive Bismarck ND 58504 450273403 501(c)(3) 15000 Support for Institute for Culture and Public Service Sakakawea Medical Center 510 8th Ave NE Hazen ND 58545 450308379 501(c)(3) 37500 Outreach Care Grant West River Regional 1000 Highway 12 Hettinger ND 58639 450340688 501(c)(3) 300000 Rural Healthcare Support Grant 4 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: St. Alexius makes donations to entities with charitable missions to ensure that our donations are used for the purposes intended. X 1 1 X X X X X 1 0 0 0 0 1 0 0 0 Gary Miller 219127 0 64757 0 0 0 9338 0 9190 0 302412 0 0 0 Andrew Wilson through Jan 2011 447065 0 146028 0 0 0 9800 0 20800 0 623693 0 0 0 Frank Kilzer 145711 0 44097 0 0 0 7682 0 19701 0 217191 0 0 0 Wanda Pfaff 160701 0 47516 0 0 0 8184 0 22645 0 239046 0 0 0 Duwayne Schlittenhard 167717 0 50254 0 0 0 8721 0 12012 0 238704 0 0 0 Dr Syed Hyder 350927 0 106342 0 0 0 9800 0 26751 0 493820 0 0 0 Rosanne Schmidt 182334 0 46381 0 0 0 9296 0 21368 0 259379 0 0 0 Kurt Waldbillig 124452 0 38268 0 0 0 6687 0 16039 0 185446 0 0 0 Brent Herbel 738232 0 0 0 0 0 9800 0 15132 0 763164 0 0 0 Eric Belanger 1196728 0 284838 0 0 0 9800 0 14728 0 1506094 0 0 0 Steven Kraljic 898506 0 498300 0 23058 0 9800 0 15132 0 1444796 0 0 0 Leslie Rainwater 423020 0 350055 0 0 0 9800 0 16032 0 798907 0 0 0 John Windsor 671171 0 221615 0 0 0 9800 0 15132 0 917718 0 0 0 Part I, Line 1a President/CEO is allowed up to annual maximum executive benefit allowance of $10,000 for expenses incurred for: airline, club memberships, wellness/fitness programs, financial planning and tax preparation services, membership in community club, and cell phone and wireless connectivity. The amount of benefit used is included in taxable income. Part I, Line 4a A severance package in the amount of $235,149 was paid to Andrew Wilson, CEO through January 2011. Part I, Line 6 At the beginning of each fiscal year, the Compensation Committee establishes a financial threshold which must be met before any awards are paid and establishes guidelines defining the size of any awards available to participants. At the end of the plan year, the Committee decides whether to make any awards to participants and how large any award shall be, in accordance with the guidelines established at the beginning of the plan year. Incentive compensation is earned as a percent of base salary. Base salary is defined as the annualized rate of pay (summation of monthly base salary for the plan year). Burleigh County 456002204 2005-11-15 3059378 2005-Hospital Equipment 0 0 0 Burleigh County 456002204 2009-04-15 9160311 2009-Remodeling, Renovation and Expansion of Medical Center 0 0 0 City of Garrison 456002076 2007-12-20 3200000 2007-Improvements to the Infrastructor Relating to Energy Management 0 0 0 City of Bismarck 456002036 1998-12-01 24563857 1998-Building & Capital Equipment, Refund Prior Bonds 0 0 0 3059378 59378 3000000 2006 0 0 1 1 9160311 173311 8987000 2010 0 0 1 1 3200000 3200000 2008 0 0 1 1 24563857 4753093 670200 19140564 1999 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 US Bank NA 10.000000000000 0 0 0 0 0 1 0 0 0 0 0 Burleigh County 456002204 2010-05-27 8156220 Building Construction 0 0 0 Burleigh County 456002204 2010-11-16 6119852 Building Construction 0 0 0 Burleigh County 456002204 2011-03-31 8159645 Building Construction 0 0 0 8156220 156220 8000000 2010 0 0 1 1 6119852 119852 6000000 2011 0 0 1 1 8159645 157645 8000000 2011 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Steve Kraljic Promissory Note X 108000 1800 0 1 1 John Windsor Promissory Note X 250000 244000 0 1 1 245800 Blue Cross Blue Shield Gary Miller BCBS board member 1429156 Insurance services 0 Wells Fargo John Giese is Wells Fargo CEO 234877 Banking and insurance services 0 Lynn Dosch Spouse of Board Member 11904 Employee 0 Martha Reichert Daughter of Board Member 37141 Employee 0 David Gayton Brother of Board Member 366898 Employee 0 Jacqueline Castleberry Miller Daughter of Board Member 15520 Employee 0 Kari Emery Daughter of Board Member 43208 Employee 0 Form 990, Part VI, Section A, line 6 Members: The corporation shall have one class of members, which shall consist of members of the monastic community known as the Benedictine Sisters of the Annunciation, BMV, who have made their perpetual monastic profession and who have been elected to or appointed to the Sponsorship Group of the Benedictine Sisters of the Annunciation, BMV. Form 990, Part VI, Section A, line 7a Joint Powers of Members and Board of Directors: The following powers shall be reserved jointly to the members of the corporation and the board of directors: 1. Approve a new candidate appointed to serve as President/Chief Executive Officer of the corporation. 2. Approve any person to be elected to serve on the board of directors. 3. Remove any director if this action is indicated. The power of the board of directors to act on any of these matters is subject to the requirement that the members of the corporation shall approve such action prior to the submission of the matter to a vote of the board of directors. Form 990, Part VI, Section A, line 7b Powers Reserved to Members: Exercise of the following powers shall be reserved exclusively to the members of the corporation to: 1. Change the sponsorship, reserved powers or mission of the corporation as an institution founded on Gospel values, the Benedictine heritage of healing and the healing ministry of Jesus. 2. Make any major policy change on ethical issues. 3. Authorize the sale or encumbrance of all or substantially all of the assets or property of the corporation. 4. Merge, liquidate or dissolve the corporation. 5. Change the name of the corporation. 6. Change or amend the structure of the board of directors of the corporation. 7. Amend, alter or repeal the articles of incorporation and/or the bylaws of the corporation. 8. Approve or disapprove a proposed course of action which could reasonably be anticipated to adversely affect the sponsorship or mission of the corporation as an institution founded on Gospel values, the Benedictine heritage of healing and the healing ministry of Jesus. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the board of directors. Form 990, Part VI, Section B, line 11 Internal staff will present to the audit and compliance committee and that committee recommends approval to the board. A draft is presented at a board meeting. Form 990, Part VI, Section B, line 12c Annually all employees are asked conflict of interest questions at evaluation time. Employees are responsible for disclosing potential conflicts of interest by completing a disclosure form. Each year the compliance officer initiates a review of all conflicts of interests within the medical center. The following annually complete a disclosure form: board members, President/CEO, Vice Presidents, Directors/Managers, other employees with significant decision making authority or who are in a position to influence decisions. The forms are reviewed by the compliance officer and if a conflict is "new" or requires review, the CEO and the Audit & Compliance Committee discuss the conflict and determine appropriate course of action. Form 990, Part VI, Section B, line 15 Compensation is reviewed annually by an independent group using comparability data and recommendations are presented to the President/CEO and/or Board of Directors for approval. Form 990, Part VI, Section C, line 19 An annual report is available to the public that includes financial statements. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 367,867. Fair Value of Interest Rate Swap 31,243. Rounding -3. Total to Form 990, Part XI, Line 5: 399,107. Statement of Program Service Accomplishment Continuance: Form 990, Part III -The St. Alexius Medical Center Rehabilitation Center has been accredited from the Commission on Accreditation of Rehabilitation Facilities (CARF). This accreditation represents the highest level of accreditation that can be awarded to an organization and shows the organization's substantial conformance to the standards established by CARF. -St. Alexius was awarded the 100 Top Hospital Cardiovascular Benchmarks for Success Study, 9th Edition per Thomson Healthcare. Thomson Healthcare developed the 100 Top Cardiovascular Hospitals' study to identify high-performing cardiovascular hospitals nationally and to set performance targets for improving clinical outcomes and management of the high-risk, high-cost cardiovascular service line. To qualify, hospitals must achieve high scores across eight equally weighted performance criteria that reflect clinical processes and outcomes, volume, efficiency and cost. -St. Alexius received a health care quality award for our own overall performance on the Centers for Medicare & Medicaid Services quality measures. The award is based on the hospital's performance and degree of improvement on the quality measures for the treatment of acute myocardial infarction, heart failure, pneumonia, and surgical care. This award is a reflection of the commitment we have made to provide quality health care to the patients we serve. -One of our Emergency Room physicians earned the Best Doctor in America award. The Best Doctors in America database is the result of a survey of more than 40,000 physicians in the United States. Only those doctors recognized to be in the top 3-5% of their specialty earn the honor of being named one of the Best Doctors in America. The only way to be recognized as one of the best Doctors in America is for a doctor to earn high marks for clinical ability from his or her peers. -St. Alexius was the first in western ND to offer non-surgical treatment of atrial septal defect (ASD). ASD is a hole between the two upper chambers of the heart and is most commonly diagnosed in infants and children. If the defect is large and doesn't close patients may be more susceptible to colds, pneumonia and other infectious diseases. Left untreated, ASD can lead to heart arrhythmias, heart failure, high blood pressure, stroke and even death. Traditionally, the only treatment for ASD was open heart surgery. With the AMPLATZER device, it allows a less invasive, non-surgical approach to treat our patients with ASD. By using this device, most patients leave the hospital within 24 hours and resume normal activity soon thereafter. -The Noninvasive Cardiovascular Lab has accreditation in the area of Extracranial Cerebrovascular Testing and Peripheral Venous Testing by the Intersocietal Commission for the Accreditation of Vascular Laboratories. -St. Alexius has been awarded an accreditation by the Commission on Laboratory Accreditation of the College of American Pathologists (CAP). The CAP accreditation program is recognized by the federal government as being equal to or more stringent than the government's own inspection program. The inspectors examine the laboratory's records and quality control of procedures for the preceding two years. This stringent inspection program is designed to specifically ensure the highest standard of care for the laboratory's patients. -St. Alexius performed our first carotid stent procedure utilizing the current FDA approved Embolic Protection System. This procedure provides a minimally invasive treatment alternative to conventional open carotid artery surgery to patients who are at high surgical risk. The embolic protection system is designed to capture and remove particles of plaque that might be dislodged during the procedure, which could potentially lead to stroke and other complications. -St. Alexius was only one of fourteen hospitals in the entire United States to gain an award for Patient Safety, Patient Quality and Patient satisfaction from the HealthGrades Rating organization. -St. Alexius provides and supports an inpatient Psychiatric Unit and a Partial Psych outpatient unit. -St. Alexius was recently named a Top 50 Hospital by Becker's Hospital Review St Alexius Heart & Lung Clinic LLC 900 East Broadway Avenue Bismarck ND 58501 861123162 Speciality Clinic-Cardiology, etc. ND -4601556 2279472 N/A Garrison Memorial Hospital 407 3rd Ave SE Garrison ND 58540 450227752 Hospital ND 501(c)(3) 3 Benedictine Sisters of the Annunciation BMV 0 Benedictine Sisters of the Annunciation BMV 7520 University Drive BISMARCK ND 58504 450261530 Religious Purposes ND 501(c)(3) 1 N/A 0 Northern Plains Lab 401 N 9 St Bismarck ND 585014507 841641341 Lab Operation ND N/A Unrelated 1054268 3327513 0 1 0.50000 Central Dakota Hospital Laundry Inc 1300 Industrial Dr Bismarck ND 58501 450317366 Hospital Laundry ND N/A C 14685 738654 0.50000 St Alexius Health Services Inc 900 East Broadway Ave Bismarck ND 58501 450402817 General Business Purpose ND N/A C 1263 1.00000 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 Northern Plains Laboratory R 1105000 General Ledger