2012-05-15T08:27:31-05:00 2011-06-30 BRADY MARTZ & ASSOCIATES PC POST OFFICE BOX 848 MINOT ND 587020848 990 2010-07-01 331007002 TRINITY HEALTH & AFFILIATES TRIN 7018575178 PO BOX 5020 MINOT ND 587025020 JOHN M KUTCH 7018575114 2012-05-11 1 RICK AWALT CPA 7018520196 2010 2016-02-24 21:20:13Z JOHN M KUTCH PO BOX 5020 MINOT ND 587025020 246994118 1 0 3904 X WWW.TRINITYHEALTH.ORG X 2003 ND TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH AND HEALTH RELATED SERVICES. TRINITY HOSPITALS IS THE LARGEST HOSPITAL PROVIDER IN NORTHWEST NORTH DAKOTA, WITH AN ACUTE CARE FACILITY WHICH IS VERIFIED BY THE AMERICAN COLLEGE OF SURGEONS AS A LEVEL 2 TRAUMA CENTER. THE FACILITY ALSO INCLUDES A NEONATAL INTENSIVE CARE UNIT, A KIDNEY DIALYSIS UNIT, AN INPATIENT REHABILITATION CENTER, AN INPATIENT PSYCHIATRIC UNIT AND A COMPREHENSIVE COMPLIMENT OF BOTH ACUTE CARE AND OUTPATIENT SERVICES ALONG WITH A SKILLED NURSING HOME FACILITY AND A CRITICAL ACCESS HOSPITAL IN KENMARE. TRINITY PROVIDED COMMUNITY EDUCATION PROGRAMS AND EVENTS, SCREENINGS AND SUPPORT OF UND FAMILY MEDICINE. 14 11 0 291 1463013 0 994417 2237788 236149423 242014918 129499 1356665 173480 384049 237446819 245993420 389223 417699 0 0 106480912 112977763 0 0 684643 99903542 125096428 206773677 238491890 30673142 7501530 441154307 508339689 216139933 274590263 225014374 233749426 X TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 21613913 20488003 TRINITY HOMES IS A 292 BED HOSPITAL BASED SKILLED NURSING FACILITY PARTICIPATING IN MEDICARE AND MEDICAID PROGRAMS. RESIDENTS OF TRINITY HOMES, UNDER THE DIRECTION OF THEIR PHYSICIAN, ARE ABLE TO RECEIVE SKILLED NURSING CARE, PHYSICIAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, DIETETIC SERVICES, SOCIAL SERVICE AND ACTIVITIES OF DAILY LIVING ASSISTANCE, SPIRITUAL CARE AND RECREATIONAL ACTIVITIES. 22002960 66171734 TRINITY HOSPITALS PHARMACY DEPARTMENT PROVIDES COMPREHENSIVE PHARMACEUTICAL SERVICES 24 HOURS PER DAY TO PROVIDERS AND PATIENTS. THROUGH INVESTMENTS IN TECHNOLOGY, OUR MEDICATION MANAGEMENT PROCESS ENSURES THE SAFE AND EFFECTIVE ADMINISTRATION AND MONITORING OF ALL MEDICATIONS. IN ADDITION TO PROVIDING MEDICATIONS AND RELATED SUPPLIES, THE PHARMACY PROVIDES DRUG INFORMATION TO PATIENTS AND HEALTHCARE PROVIDERS, DOSING AND PHARMACOKENETIC SERVICES, ADVERSE DRUG REACTION MONITORING, DRUG-DRUG AND DRUG-FOOD INTERACTION OF INFORMATION, DRUG COMPATIBILITIES, TOXICOLOGY AND NATURAL PRODUCT INFORMATION. SERVICES RANGE FROM MEDICATIONS DISPENSING TO PERFORMING COMPLEX PHARMACOKINETIC CALCULATIONS AND COMPOUNDING SPECIALIZED NUTRITION SOLUTIONS, CHEMOTHERAPY AND BIOLOGICAL REGIMENS. THE PHARMACY DEPARTMENT ALSO PARTICIPATED IN FMEA FAILURE MODE EFFECT ANALYSIS AND ROOT CAUSE ANALYSIS IN COOPERATION WITH OTHER DEPARTMENTS. RETROSPECTIVE AND CONCURRENT CHART REVIEWS ARE CONDUCTED TO ASSESS TIMELINESS AND APPROPRIATENESS OF THERAPY, AS WELL AS HOW WELL THE PATIENTS' NEEDS ARE BEING MET. 10182506 49685576 TRINITY HOSPITALS LABORATORY IS STAFFED 24/7, 365 DAYS/YR TO SERVE HOSPITAL, CLINIC AND OUTREACH PATIENTS. OUR PURPOSE IS TO PROVIDE LABORATORY TESTING TO AID THE PROVIDER IN DIAGNOSIS, TREATMENT AND FOLLOW-UP OF DISEASE AND WELLNESS. WE PROVIDE ROUTINE TESTING FREE OF CHARGE TO THE COMMUNITY "FREE CLINIC"; HAVE DONE PSA SCREENINGS AT THE ND STATE FAIR; AND DO SOME SCREENING TESTS FOR COMPANIES IN TOWN. WE HAVE PHLEBOTOMIST WHO GOES TO ASSISTED LIVING FACILITIES, NURSING HOMES AND PRIVATE HOMES TO DRAW BLOOD. 143774071 417699 105669605 TRINITY HEALTH & AFFILIATES PROVIDES HOSPITAL SERVICES TO CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 143774071 417699 105669605 197573450 1 1 1 1 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 5 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X JAMIE TOWNSEND 7018575160 PO BOX 5020 MINOT ND 587025020 BLAINE E DESLAURIERS 2.00 X X 0 0 0 DAVID FULLER 2.00 X 0 0 0 PATRICK HOLIEN 2.00 X X 0 0 0 KAREN KREBSBACH 2.00 X X 0 0 0 PHILIP LOWE 2.00 X 0 0 0 TIMOTHY MIHALICK 2.00 X X 0 0 0 CLARA SUE PRICE 2.00 X 0 0 0 MARTIN ROTHBERG MD 2.00 X 0 938535 53938 JOHN M KUTCH 20.00 X X 0 363778 48150 KEVIN COLLINS 40.00 X 0 655219 52442 BORGI BEELER 2.00 X 0 0 0 JOHN COUGHLIN 2.00 X 0 0 0 STEVEN D LYSNE 2.00 X 0 0 0 DARYL SOMERVILLE 2.00 X 0 0 0 KEVIN SEEHAFER 20.00 X 0 249412 41884 DAVID KOHLMAN 20.00 X 0 119905 31418 RHONDA TANBERG 40.00 X 0 107804 13835 RANDY SCHWAN 20.00 X 0 165842 37534 PAUL SIMONSON 20.00 X 0 222498 45486 THOMAS WARSOCKI 20.00 X 0 156688 36852 SHAWNA SMOTHERS 40.00 X 0 101490 13794 JOHN NELSON 40.00 X 0 479092 49888 JEFFREY SATHER 40.00 X 0 525267 50557 SCOTT KNUDSON 40.00 X 0 436997 49278 DANIAL R PADGETT 40.00 X 0 427487 39940 ASITHA R DIAS 40.00 X 0 362794 48202 TERRY G HOFF 20.00 X 0 20095 6175 JAMES JENSEN 2.00 X 0 0 0 JOHN SHEEHAN MD 2.00 X 0 141094 34331 JEFFREY VERHEY 2.00 X 0 532310 50660 CHESTER REITEN 2.00 X 0 0 0 ERNEST SELLAND 2.00 X 0 0 0 NANCY HOLMES 20.00 X 0 214674 35397 NICOLA ROED 20.00 X 0 101248 9581 JULIE WALDERA 20.00 X 0 30508 3473 RICK WITTMEIER 40.00 X 0 192939 41339 0 6185969 731634 0 1 1 0 0 2237788 11144 2237788 PATIENT CARE 541610 124045206 124045206 MEDICARE/MEDICAID 541610 115265978 115265978 DIETARY SERVICE 722320 1607965 1240721 367244 ADMINSTRATIVE & SUPPOR 561000 634601 634601 LABORATORY SERVICE 621500 347355 347355 113813 113813 242014918 1261421 1261421 51397 53397 -2000 -2000 -2000 1019882 3420 927162 896 92720 2524 95244 95244 9875 19243 -9368 -9368 VENDOR REBATE 900099 351374 351374 TUITION & FEES 900099 44043 44043 395417 245993420 241040566 1463013 1252053 382110 382110 35589 35589 94871562 77812744 16991624 67194 4357428 3537074 816572 3782 7224818 4998220 2216867 9731 6523955 5441565 1077357 5033 186978 1770 185208 90971 90971 8311019 4287219 4016076 7724 1378834 1378834 2370328 1716550 653778 385311 188050 196320 941 4298676 2709981 1542670 46025 11080558 4814243 6265400 915 714675 365242 349433 SUPPLIES 47143908 45560733 1343329 239846 BAD DEBT EXPENSE 29438486 29420335 18151 PURCHASED SERVICE 10990362 8093146 2698100 199116 RENTAL/MAINTANCE 10020987 5226242 4794745 MEDICAL DIRECTORS 3067524 2600607 466917 -4382189 382030 -4850404 86185 238491890 197573450 40233797 684643 13326538 19917936 1404324 1425844 2756 35465 321966850 398360380 843680 550182 5669703 6225426 2510493 2748412 200615442 138322635 62223300 62292807 11658298 12212523 0 21548365 4570714 441154307 508339689 22687588 41440652 981218 800114 192471127 232349497 216139933 274590263 X 220674527 228808953 4244702 4845422 95145 95051 225014374 233749426 441154307 508339689 X 7501530 1233522 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 51462 0 0 0 0 0 0 0 0 1 51462 51462 0 ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES: PART I-A, LINE 1: LOBBYING ACTIVITIES CONSIST OF PORTION OF ANNUAL MEMBERSHIP DUES IDENTIFIED ON RENEWAL AS ASSOCIATED WITH LOBBYING ACTIVITY. ASSOCIATIONS INCLUDE ND HEALTHCARE ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, ND LONG TERM CARE ASSOCIATION, NATIONAL HOSPICE ASSOCIATION AND HEALTH POLICY CONSORTIUM. EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING ACTIVITIES CONSIST OF PORTION OF ANNUAL MEMBERSHIP DUES IDENTIFIED ON RENEWAL AS ASSOCIATED WITH LOBBYING ACTIVITY. ASSOCIATIONS INCLUDE ND HOSPITAL ASSOCIATION, AMERICAL HOSPITAL ASSOCIATION, ND LONG TERM CARE ASSOCIATION, NATIONAL HOSPICE ASSOCIATION, HEALTH POLICY CONSORTIUM, AND SECTION 508 HOSPITAL COALITION. 1 226156 35881 2962 259075 0 95145 3902 3693 303 95051 305323 -214179 4001 95145 313288 -5031 2934 305323 0.30000 0.70000 0 0 355000 355000 45233465 22908188 22325277 19447 19447 0 152327414 115395000 36932414 2680116 2680116 62292807 RESIDENT TRUST 22455 CURRENT PORTION OF LONG-TERM LIABILITY 181171 OTHER CURRENT LIABILITY 13140 DUE FROM AFFILIATES 232132731 232349497 245993420 238491890 7501530 1155549 77973 1233522 8735052 247221609 1155549 72640 1228189 245993420 0 245993420 238564530 72640 72640 238491890 0 238491890 PART IV, LINE 1B: PUBLIC EDUCATION FOR HOSPICE CARE. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE PURPOSE OF THE ENDOWMENT FUNDS IS TO PROVIDE FUNDS FOR STAFF EDUCATION AND SCHOLARSHIPS, AND FOR THE PURCHASE OF NEW EQUIPMENT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: UNDER PROFESSIONAL STANDARDS, THE COMPANY'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURNS OF THE COMPANY ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF MAOPS 77,973. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 53,397. FUNDRAISER 19,243. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENT 53,397. FUNDRAISER 19,243. 1 1 X 1 X 125.000000000000 1 X 125.000000000000 1 0 1 0 2 1205790 1205790 0.00510 2 1205790 1205790 0.00510 16 5711 111659 111659 0.00050 16 5711 111659 111659 0.00050 18 5711 1317449 1317449 0.00560 1 10236309 70821739 60446011 10375728 X 1 1 12 1 TRINITY HOSPITAL

ONE BURDICK EXPRESSWAY WEST MINOT ND 58701

X X X X TRINITY HOSPITALS 2 TRINITY HOSPITAL ST JOSEPH'S

407 3RD STREET SE MINOT ND 58701

X X TRINITY HOSPITALS 3 TRINITY KENMARE HOSPITAL

PO BOX 697 KENMARE ND 587460697

X X TRINITY HOSPITALS 4 TRINITY HOMES

305 8TH AVENUE NE MINOT ND 58701

SKILLED NURSING HOME 5 TRINITY HEALTH CENTER MEDICAL ARTS

400 BURDICK EXPRESSWAY EAST MINOT ND 58701

PROVIDER BASED CLINIC 6 TRINITY HEALTH CENTER-EAST

20 BURDICK EXPRESSWAY WEST MINOT ND 58701

PROVIDER BASED CLINIC 7 TRINITY HEALTH CENTER-WEST

101 3RD AVENUE SW MINOT ND 58701

PROVIDER BASED CLINIC 8 TRINITY REGIONAL EYECARE-MINOT CENTER

120 BURDICK EXPRESSWAY EAST MINOT ND 58701

PROVIDER BASED CLINIC 9 TRINITY HEALTH CENTER-RIVERSIDE

1900 8TH AVENUE SE MINOT ND 58701

PROVIDER BASED CLINIC 10 TRINITY HEALTH CENTER-TOWN & COUNTRY

831 SOUTH BROADWAY MINOT ND 58701

PROVIDER BASED CLINIC 11 TRINITY HOSPITALS HOME HEALTHHOSPICE

1015 SOUTH BROADWAY STE 306 MINOT ND 58701

HOME HEALTH & HOSPICE 12 TRINITY HOSPITALS

HOSPITAL ROAD BELCOURT ND 58316

DIALYSIS SERVICES NA 1 PART III, LINE 4: IN FURTHERANCE OF ITS CHARITABLE PURPOSE, TRINITY PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY-BASED SERVICE PROGRAMS, SUCH AS FREE CLINICS, HEALTH SCREENINGS, IN-HOME CAREGIVER SERVICES, SOCIAL SERVICE AND SUPPORT COUNSELING FOR PATIENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY, A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, TELEPHONE INFORMATION SERVICES, AND COSTS RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. THE COST OF PROVIDING THE ABOVE SERVICES IS NOT INCLUDED IN TRINITY'S CHARITY CARE AMOUNT.TRINITY ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED CHARGE TO RESIDENTS OF ITS COMMUNITY THROUGH THE PROVISION OF CHARITY CARE. INCLUDED IN TRINITY'S DEFINITION OF CHARITY CARE ARE THE FOLLOWING: (A) SERVICES PROVIDED TO THE UNINSURED OR UNDERINSURED AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED TO BE UNABLE TO PAY BECAUSE OF SOCIOECONOMIC FACTORS.TRINITY MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR CHARITY CARE. THE AMOUNTS DO NOT INCLUDE THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS OR THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES.TRINITY USES THE MEDICARE COST TO CHARGE RATIO TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 AND 3. PART III, LINE 9B: IT IS THE POLICY OF TRINITY TO PROVIDE MEDICAL SERVICES TO THE COMMUNITY AND REGION REGARDLESS OF THE CUSTOMERS ABILITY TO PAY THROUGH CONSISTENT BILLING PRACTICES. ACCOUNTS WILL BE MONITORED TO ENSURE THAT CUSTOMERS ARE BILLED FOR ONLY THOSE SERVICES PROVIDED. TRINITY, THROUGH VERIFICATION OF INFORMATION, IS REQUIRED TO PROVIDE TIMELY AND ACCURATE, BILLING, COLLECTION, AND PATIENT ACCOUNT MAINTENANCE. INFORMATION REGARDING TRINITYS BILLING AND PAYMENT GUIDELINES, WHICH INCLUDES FINANCIAL ASSISTANCE PROGRAMS, ARE AVAILABLE AT REGISTRATION AND BUSINESS SERVICES LOCATIONS. THIS INFORMATION IS COMMUNICATED VERBALLY OR THROUGH THE USE OF THE TRINITY BILLING & PAYMENT GUIDELINES BROCHURE. TO ENHANCE VERBAL COMMUNICATIONS, INTERPRETERS ARE PROVIDED AS NECESSARY. 1 ST LUKES HOSPITAL PO BOX 10 CROSBY ND 58730 450254692 501(C)(3) 38430 TRAINING TIOGA MEDICAL CENTER 710 WELO ST TIOGA ND 58852 450308484 501(C)(3) 35475 TRAINING TRINITY HEALTH PO BOX 5020 MINOT ND 58702 450226558 501(C)(3) 105814 ETC ENHANCEMENT, NURSE CALL SYSTEM, MOPS AND CANCER EXERCISE NORSK HOSTFEST PO BOX 1347 MINOT ND 58702 450353644 501(C)(3) 26400 SPONSORSHIP WESTERN ND CHARITY PRO AM 7101 COUNTY ROAD WEST MINOT ND 58701 450368024 501(C)(3) 7000 SPONSORSHIP THE MINOT FAMILY YMCA PO BOX 69 MINOT ND 58702 450237612 501(C)(3) 50500 STUDIES ND STATE FAIR CENTER PO BOX 1796 MINOT ND 58702 450215346 501(C)(3) 15000 SPONSORSHIP OF STATE FAIR ACTIVITY 7 0 CASH 129 35589 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TRINITY HEALTH & AFFILIATES DOES NOT HAVE A PROCEDURE FOR MONITORING USE OF GRANT FUNDS IN THE UNITED STATES. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 MARTIN ROTHBERG MD 0 688264 0 52084 0 198187 0 0 0 53938 0 992473 0 980085 JOHN M KUTCH 0 322087 0 0 0 41691 0 0 0 48150 0 411928 0 224237 KEVIN COLLINS 0 290462 0 355373 0 9384 0 0 0 52442 0 707661 0 781893 KEVIN SEEHAFER 0 245846 0 0 0 3566 0 0 0 41884 0 291296 0 285797 RANDY SCHWAN 0 162276 0 0 0 3566 0 0 0 37534 0 203376 0 197870 PAUL SIMONSON 0 220698 0 0 0 1800 0 0 0 45486 0 267984 0 262509 THOMAS WARSOCKI 0 153122 0 0 0 3566 0 0 0 36852 0 193540 0 181897 JOHN NELSON 0 384395 0 0 0 94697 0 0 0 49888 0 528980 0 512772 JEFFREY SATHER 0 499925 0 20000 0 5342 0 0 0 50557 0 575824 0 537303 SCOTT KNUDSON 0 432495 0 0 0 4502 0 0 0 49278 0 486275 0 475033 DANIAL R PADGETT 0 205239 0 11200 0 211048 0 0 0 39940 0 467427 0 450254 ASITHA R DIAS 0 205266 0 15900 0 141628 0 0 0 48202 0 410996 0 0 TERRY G HOFF 0 20095 0 0 0 0 0 0 0 6175 0 26270 0 797077 JOHN SHEEHAN MD 0 136727 0 0 0 4367 0 0 0 34331 0 175425 0 0 JEFFREY VERHEY 0 293943 0 130000 0 108367 0 0 0 50660 0 582970 0 0 NANCY HOLMES 0 205638 0 0 0 9036 0 0 0 35397 0 250071 0 284303 NICOLA ROED 0 100320 0 0 0 928 0 0 0 9581 0 110829 0 0 RICK WITTMEIER 0 191139 0 0 0 1800 0 0 0 41339 0 234278 0 234444 FORM 990, PART VI, SECTION B, LINE 11 BEFORE THE FORM 990 IS FILED WITH THE IRS, THE GOVERNING BODY OF TRINITY HEALTH & AFFILIATES IS GIVEN A COPY OF THE FORM 990 TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL SALARIED EMPLOYEES (AT MANAGER LEVEL AND ABOVE AS DETERMINED BY TRINITY) AND SUCH OTHER EMPLOYEES AS FROM TIME TO TIME MAY BE DIRECTED TO DO SO, ARE REQUIRED TOP COMPLETE OUR CONFLICT OF INTEREST STATEMENT YEARLY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE REVIEWED COMPENSATION INFORMATION FOR THE CHIEF EXECUTIVE OFFICER PREPARED BY DELOITTE & TOUCHE. DELOITTE & TOUCHE ANALYZED FOUR COMPENSATION SURVEYS OF HEALTH CARE EMPLOYERS AND REVIEWED FORM 990 FILINGS FOR A PEER GROUP ANALYSIS. FORM 990, PART VI, SECTION C, LINE 18 WE WOULD MAKE OUR FORM 990, FORMS 1023, AND FORM 990-T AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 ON OUR WEB SITE WWW.TRINITYHEALTH.ORG WE LIST OUR BOARD OF DIRECTORS, MISSION, VISION, VALUES AND OUR ANNUAL REPORT WHICH INCLUDES FINANICAL INFORMATION. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,155,549. CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF MAOPS 77,973. TOTAL TO FORM 990, PART XI, LINE 5: 1,233,522. COMMUNITY AMBULANCE SERVICE OF MINOT INC 305 11TH AVE SW MINOT ND 58701 450363593 AMBULANCE SERVICE ND 501(C)(3) LINE 11A, I TRINITY HEALTH 0 MEDICAL ARTS OUTPATIENT SERVICES INC 400 BURDICK EXPRESSWAY EAST MINOT ND 58701 450278212 RETAIL PHARMACY AND DURABLE MEDICAL EDUIPMENT ND TRINITY HEALTH C 77972 6068071 1.00000 1 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 MEDICAL ARTS OUTPATIENTS SERVICE INC A 88000 FMV MEDICAL ARTS OUTPATIENTS SERVICE INC F 28468 FMV MEDICAL ARTS OUTPATIENTS SERVICE INC G 123399 FMV MEDICAL ARTS OUTPATIENTS SERVICE INC K 441500 FMV TRINITY HOSPITALS PO BOX 5020 MINOT ND 587025020 412002771 TRIN TRINTY KENMARE HOSPITAL PO BOX 5020 MINOT ND 587025020 412002769 TRIN TRINITY HOMES PO BOX 5020 MINOT ND 587025020 450404412 TRIN TRINITY HEALTH FOUNDATION PO BOX 5020 MINOT ND 587025020 450215346 TRIN