2012-08-13T16:38:23-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-10-01 410724034 KITTSON MEMORIAL HOSPITAL KITT 2188433612 PO BOX 700 HALLOCK MN 56728 RICHARD FAILING 2188433612 2012-08-13 1 DARRYN MCGARVEY 6123764500 2010 2016-02-24 21:20:13Z KITTSON MEMORIAL HEALTHCARE CENTER RICK FAILING PO BOX 700 HALLOCK MN 56728 12550110 0 X WWW.KHMC.NET X 1919 MN KITTSON ENSURES THAT NORTHWESTERN MINNESOTA RESIDENTS HAVE ACCESS TO HEALTH SERVICES. 9 9 274 35 14394 0 68042 224832 10725366 11921392 966436 31823 3756 324565 11763600 12502612 8251 15955 0 0 6496286 7061237 0 0 2263 4504547 4887244 11009084 11964436 754516 538176 9113015 9765851 4208153 4347263 4904862 5418588 X CARING FOR FRIENDS AND NEIGHBORS, KITTSON MEMORIAL HEALTHCARE CENTER PROVIDES AND COOPERATES WITH OTHERS TO ENSURE THAT RESIDENTS HAVE ACCESS TO SERVICES NECESSARY TO MAINTAIN THEIR HEALTH AND WELL-BEING. 0 0 9841812 15955 11921392 KITTSON MEMORIAL HEALTHCARE CENTER (KMHC) PROVIDES SERVCE TO EMERGENCY, ACUTE, AND CLINIC PATIENTS. ALL PATEINTS ARE TREATED IN AN EMERGENCY SETTING REGARDLESS OF ABILITY TO PAY OR FINANCIAL CLASS STATUS.KMHC'S NURSING HOME PROVIDES AREA RESIDENTS WITH QUALITY CARE, WHETHER THEIR STAY IS SHORT-TERM OR LONG-TERM. OUR COMPASSIONATE STAFF PROVIDES STIMULATING SOCIAL ACTIVITIES FOR AREA RESIDENTS, AND THE QUALITY OF CARE IS SECOND TO NONE.KMHC PROVIDES MEDICAL AND PERSONAL ASSISTANCE TO THOSE PATIENTS WHO ARE HOME BOUND. THIS VALUED SERVICE PROVIDES AREA RESIDENTS WITH THE ASSSITANCE THEY NEED TO LIVE INDEPENTTLY WHETHER IT BE HOUSEKEEPING SERVICES, MEDICATION DISPENSTION, OR DAILY DRESSING CHANGES.A VOLUNTEER AMBULANCE SERVICE RESPONDS TO EMERGENCY SITUATIONS AS DISPATCHED. KMHC'S ASSISTED LIVING COMPLEX PROVIDES THOSE AREA RESIDENTS WITH OPTIONS TO ASSIST IN THEIR TRANSGRESSION FROM LIVING INDEPENDENTLY TO CONGREGATE DINING WITH OTHER ASSISTED LIVING RESIDENTS, MEDICATION DISPESNION ASSISTANCE, AND ACCESS TO ACTIVITIES IN THE NURSING HOME. RESIDENTS ARE ALSO ABLE TO "COME AND GO" AS THEY PLEASE WITH ACCESS TO THEIR OWN TRANSPORTATION OR TRANSPORTATION MAY BE ARRANGED. 9841812 1 1 0 1 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 21 0 1 274 1 1 1 0 0 0 0 1 1 0 0 0 0 X 9 9 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X JENI SCHWENZFEIER 2188433612 1010 SOUTH BIRCH HALLOCK MN 56728 CEDRIC GUSTAFSON 1.00 X X 870 0 0 JANELLE CRAIGMILE 1.00 X X 550 0 0 LEE PEMBERTON 1.00 X X 810 0 0 TODD JOHNSON 1.00 X X 660 0 0 STEVE GROSZ 1.00 X 0 0 0 SANDRA NELSON 1.00 X 430 0 0 JON BLOMQUIST 1.00 X 460 0 0 MARLENE PEARSON 1.00 X 450 0 0 JUDY BAHR 1.00 X 400 0 0 RICK FAILING 40.00 X 123898 0 16891 JENI SCHWENZFEIER 40.00 X 68277 0 1751 DR THOMAS LOHSTRETER 40.00 X 323624 0 6360 PAUL ANDERSON 40.00 X 147798 0 17482 JULIE JOHNSON 40.00 X 102838 0 14812 771065 0 57296 4 0 1 0 PETERSON SHEET METAL 3728 BEMIDJI AVE NORTH BEMIDJI MN 56601 CONTRACTOR 431559 DMS PO BOX 86 MINNEAPOLIS MN 55486 MOBILE IMAGING SERVICES 327751 ALTRU HEALTH SYSTEMS 1300 S COLUMBIA ROAD GRAND FORKS ND 58201 OUTREACH THERAPY 230653 CL LINFOOT 4805 DEMERS AVE GRAND FORKS ND 58201 CONTRACTOR 134970 AUTOMATIC HEATING COMPANY 1446 3RD AVE NORTH FARGO ND 58102 CONTRACTOR 125985 5 14760 68803 141269 224832 PATIENT & RESIDENT SER 622110 11809551 11809551 MISCELLANEOUS 900099 60309 60309 CAFETERIA INCOME 722320 28204 17613 10591 AMBULANCE REVENUE 621910 19525 19525 3803 3803 11921392 31747 31747 13499 13499 13499 13499 40000 39924 76 76 76 5865 14760 5537 328 328 1512 2037 -525 -525 INSURANCE PROCEEDS 900099 311263 311263 311263 12502612 11906998 14394 356388 15955 15955 240111 48022 192089 5484868 5123346 361522 163278 142069 21209 677671 428562 249109 495309 377686 117623 103997 103997 1083670 1067085 16585 63006 43044 19962 1851013 1538972 312041 117805 117805 197695 45509 152186 181241 169170 12071 35846 30757 5089 151908 49588 102320 525297 525297 84552 84552 NH DHS SURCHARGE 202111 202111 BAD DEBT EXPENSE 158535 158535 DISASTER EXPENSE 74546 74546 HOSPITAL DHS SURCHARGE 43559 43559 OTHER EXPENSES 12463 3669 6531 2263 11964436 9841812 2120361 2263 1345980 711 1439261 1120752 1052978 49069 87664 82392 74824 31174 43904 13339624 7535746 5238035 5803878 1185644 908271 16666 0 43303 354360 9113015 9765851 698280 886950 37029 101227 5433 3879 3034133 2940271 150000 125000 283278 289936 4208153 4347263 X 4904862 5418588 4904862 5418588 9113015 9765851 X 538176 -24450 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 132 132 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION OF WHICH A PORTION IS RELATED TO LOBBYING EXPENSES. 1 9309 7089 9868 6531 1 12985 12985 8556097 5157958 3398139 3773530 2221485 1552045 997012 156303 840709 5803878 DUE TO DR. LARTER 289936 289936 12502612 11964436 538176 -24450 -24450 513726 12007673 7574 7574 12000099 502513 502513 12502612 11972010 7574 7574 11964436 0 11964436 PART IV, LINE 1B: A SMALL AUXILIARY OPERATES UNDER THE HOSPITAL'S EIN PART IV, LINE 2B: THE CENTER HOLDS FUNDS UNDER AN AGENCY RELATIONSHIP FOR THE RESIDENTS OF THE NURSING FACILITY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CENTER IS ORGANIZED AS A MINNESOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE CENTER UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THESE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. THE CENTER BELIEVES THAT IT IS COMPLIANT WITH ALL IRS TAX REGULATIONS AND AS OF SEPTEMBER 30, 2011 AND 2010 HAS NOT RECORDED LIABILITIES FOR INCOME TAXES. THE CENTER WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE IF INCURRED. THE CENTER IS NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008 AND STATE EXAMINATION FOR YEARS BEFORE 2008. PART XII, LINE 2D - OTHER ADJUSTMENTS: GOLF TOURNAMENT 5,537. INVENTORY SALES EXPENSES 2,037. PART XII, LINE 4B - OTHER ADJUSTMENTS: GAIN FROM INSURANCE RECOVERY 311,263. INVESTMENT INCOME 31,747. UNRESTRICTED GIFTS AND OTHER 26,152. GAIN ON DISPOSAL OF PROPERTY AND EQUIPMENT 76. CONTRIBUTIONS AND GRANTS FOR PROPERTY AND EQUIPMENT 133,275. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GOLF TOURNAMENT EXPENSES 5,537. INVENTORY SALES EXPENSES 2,037. GOLF TOURNAMENT 20625 14760 5865 4350 0 1187 20625 14760 5865 4350 1187 5537 328 1 1 X 1 X 1 X 0.0 1 1 0 1 1 14189 14189 0.00120 1407515 1052274 355241 0.03010 1421704 1052274 369430 0.03130 10417 10417 0.00090 1086626 781648 304978 0.02580 1097043 781648 315395 0.02670 2518747 1833922 684825 0.05800 19326 24229 -4903 0.00000 19326 24229 -4903 0 120381 7704 2975155 2857975 117180 X 1 1 1 1 KITTSON MEMORIAL HEALTHCARE CENTER

1010 SOUTH BIRCH AVENUE HALLOCK MN 56728

X X X X NA 1 1 KITTSON MEMORIAL CLINIC OF KARLSTAD

FIRST AND ROOSEVELT KARLSTAD MN 56372

RURAL HEALTH CLINIC PART I, LINE 3C: ALTHOUGH EACH APPLICATION WILL BE DEALT WITH ON AN INDIVIDUAL BASIS, THE FOLLOWING FEDERAL GUIDELINES AS TO ANNUAL INCOME WILL SIGNIFY A STARTING POINT IN THE ELIGIBILITY PROCESS:POVERTY GUIDELINES = CHARGES REDUCED TO ZERO150% POVERTY GUIDELINES = 75% REDUCTION IN CHARGES200% POVERTY GUIDELINES = 50% REDUCTION IN CHARGES250% POVERTY GUIDELINES = 25% REDUCTION IN CHARGES PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT IS MADE AVAILABLE UPON REQUEST. PART I, LINE 7: THE ORGANIZATION USED THE FOLLOWING METHODS TO DETERMINE THE COSTS FOR PART I, LINE 7:LINE A - CHARITY CARE WAS CONVERTED TO COST USING THE COST TO CHARGE RATIO FROM THE IRS WORKSHEET 2.LINE B - MEDICAID WAS DERIVED FROM INTERNAL REPORTS AND THEN COSTS WERE CALCULATED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2. LINE E - COMMUNITY HEALTH IMPROVEMENT SERVICES ARE BASED ON THE ACTUAL DOLLARS SPENT FOR THESE ACTIVITIES. LINE G - SUBSIDIZED HEALTH SERVICES ARE DERIVED FROM THE 2011 MEDICARE COST REPORT. PART I, L7 COL(F): $158,535 OF BAD DEBT EXPENSE WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE COMMUNITY BENEFIT EXPENSE PERCENTAGE FOR FY 2011. PART II: IN COMPLIANCE WITH KITTSON MEMORIAL HEALTHCARE CENTER'S MISSION TO PROVIDE COMMUNITY SERVICES TO KITTSON COUNTY AND IT'S SURROUNDING COMMUNITIES, FREE CHECK-UPS ARE PROVIDED TO PATIENTS WHO CANNOT AFFORD TO PAY, CHARITY CARE APPLICATIONS ARE AVAILABLE AND APPROVED, AND PUBLIC HEALTH EDUCATION IS PROVIDED. PART III, LINE 4: BAD DEBT EXPENSE F/S FOOTNOTE IS AS FOLLOWS:PATIENT AND RESIDENT RECEIVABLES ARE UNCOLLATERALIZED CUSTOMER AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS OF PATIENT AND RESIDENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED ON THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM.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 AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 WAS DERIVED BY APPLYING THE COST TO CHARGE RATIO CALCULATED USING IRS WORKSHEET 2.THE ORGANIZATION ESTIMATES THAT 6.4% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS WHO WOULD BE ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. APPROXIMATELY 6.4% OF THE POPULATION WHICH THE ORGANIZATION SERVICES IS BELOW FEDERAL POVERTY LEVELS AND SO IT IS REASONABLE TO ASSUME THAT 6.4% OF THE BAD DEBT COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD BE ELIGIBLE FOR CHARITY CARE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: COLLECTION EFFORTS ARE MADE BY CONTACTING THE PATIENT THROUGH WRITTEN CORRESPONDENCE AND PHONE CALLS. IF THROUGHOUT THESE CONVERSATIONS, THE COLLECTOR AND PATIENT DISCUSS THAT THE PATIENT IS NOT ABLE TO AFFORD PAYMENTS AS REQUIRED BY OUR POLICY, THE PATIENT IS ENCOURAGED TO APPLY FOR CHARITY CARE. AN APPLICATION AND POLICY IS SENT TO THE PATIENT TO COMPLETE. ACCORDING TO FEDERAL POVERTY GUIDELINES, THE PATIENT MAY QUALIFY FOR ALL OR A PERCENT OF CHARGES WRITTEN OFF THEIR ACCOUNT. PATIENTS MUST APPLY FOR MEDICAID PRIOR TO QUALIFYING FOR CHARITY CARE. ADDITIONAL INFORMATION IS OFFERED TO HELP THEM APPLY FOR STATE FUNDED PROGRAMS. PART VI, LINE 2: PUBLIC HEALTH CONDUCTS A COMMUNITY HEALTHCARE NEEDS ASSESSMENT (CHNA). THIS INFORMATION IS THEN SHARED WITH FACILITY MANAGEMENT AND THE BOARD OF DIRECTORS. GOING FORWARD, A CNHA WILL BE CONDUCTED EVERY THREE YEARS TO MAKE THIS ASSESSMENT. PART VI, LINE 3: IF A PATIENT IS UNABLE TO PAY THEIR BILL, A CHARITY CARE APPLICATION IS SENT TO THEM TO COMPLETE (A NOTICE IS INCLUDED IN THEIR MONTHLY STATEMENT TO CONTACT US REGARDIN CHARITY CARE IF THEY ARE UNABLE TO PAY THEIR BILL). A PREREQUISITE TO QUALIFY FOR CHARITY CARE IS THAT THEY HAVE TO HAVE BEEN DENIED BY MEDICAL ASSISTANCE. WE ARE ABLE TO OFFER THEM CONTACT INFORMATION AT THE COUNTY FOR QUALIFICATION/APPLICATION INFORMATION. INFORMATION REGARDING CHARITY CARE IS ALSO AVAILABLE IN THE ADMISSION AREA OF THE CLINIC. PART VI, LINE 4: KMHC PRIMARILY SERVES THE RESIDENTS OF KITTSON COUNTY, WHICH IS LOCATED IN NORTHWEST MINNESOTA, WITH A POPULATION OF APPROXIMATELY 4,550. THIS IS A VERY RURAL AREA WITH 4.1 PERSONS PER SQUARE MILE. THE MEDIAN HOUSEHOLD INCOME IS $47,568 WITH 6.4% OF THE POPULATION BELOW POVERTY LEVELS. PART VI, LINE 6: PROVIDE MANAGERS TO DELIVER COMMUNITY MEALS ON WHEELS FOR A MONTH; SPONSOR A TEAM AND FINANCIALLY SUPPORT LOCAL CANCER "RELAY FOR LIFE" EVENT; PROVIDE AMBULANCE STAND-BY SERVICES AT LOCAL PUBLIC HIGH SCHOOL SPORTING VENTS; PROVIDE FREE BLOOD PRESSURE CHECKS AT VARIOUS AREA EVENTS THROUGHOUT THE YEAR; PROVIDE FINANCIAL CONTRIBUTIONS TO HELP FUND TWO AREA PUBLIC SCHOOLS "AFTER PROM PARTY' EVENTS; PROVIDE TO AREA CHARITIES FOR THEIR FUNDRAISING EVENTS, LAB TESTING CERTIFICATES AS DOOR OR RAFFLE PRIZES; FREE AND REDUCED CARE; EVENING MEDICAL CLINIC; HEALTH INFOMRATION BOOTH AT FOUR DAY COUNTY FAIR. ALSO, WE PROVIDE SERVICES THAT NO OTHER PRIVATE ENTITY WOULD LIKELY CONSIDER PROVIDING SUCH AS ASSISTED LIVING SERVICES, NURSING HOME SERVICES, COMMUNITY FITNESS, OR AMBULANCE SERVICES AS THERE IS LITTLE VOLUME AND NOT CURRENTLY FINANCIALLY VIABLE SERVICES. HOWEVER, KITTSON MEMORIAL'S BOARD VIEWS THESE SERVICES AS ESSENTIAL IN METING TH NEEDS OF THE SERVICE AREA'S POPULATION. PART VI, LINE 7: N/A 1 SCHOLARSHIPS/EDUCATIONAL ASSISTANCE 10 15955 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FOUR SCHOLARSHIPS PER YEAR ARE GIVEN TO ONE SENIOR IN EACH OF THE SCHOOLS LOCATED IN KITTSON COUNTY. EDUCATIONAL ASSISTANCE IS PROVIDED FOR EMPLOYEES WHO CHOOSE TO FURTHER THEIR EDUCATION IN A FIELD THAT IS NEEDED BY KITTSON MEMORIAL. THIS ELIGIBILITY IS DETERMINED ON A CASE BY CASE BASIS. X X X 0 0 0 0 0 0 0 0 0 DR THOMAS LOHSTRETER 323624 0 0 0 0 0 0 0 6360 0 329984 0 0 0 PAUL ANDERSON 147798 0 0 0 0 0 0 0 17482 0 165280 0 0 0 CHERYL GUSTAFSON SPOUSE OF BOARD MEMBER 24681 WAGES AND BENEFITS 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE (COMPRISED OF THE BOARD OFFICERS) CAN ACT ON BEHALF OF THE FULL BOARD IN CERTAIN CIRCUMSTANCES. FORM 990, PART VI, SECTION A, LINE 2 JON BLOMQUIST - BUSINESS RELATIONSHIP TODD JOHNSON - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IN THE ASSOCIATION SHALL BE ANY NATURAL PERSON OF LEGAL AGE PURCHASING ONE OR MORE MEMBERSHIP SHARES OF THE CORPORATION FOR THE SUM OF $50.00 EACH. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS ARE ALLOWED TO VOTE FOR MEMBERS OF THE BOARD AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED WITH THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE BOARD'S POLICY TO AVOID ANY POSSIBLE APPEARANCE OF IMPROPRIETY OR BREACH OF THE MEMBER'S FIDUCIARY RESPONSIBILITY BY HAVING BOARD MEMBERS ANNUALLY ACKNOWLEDGE ANY POTENTIAL BUSINESS OR PERSONAL CONFLICTS IN REGARDS TO KITTSON MEMORIAL'S BUSINESS AFFAIRS. IT IS NOT THE INTENTION OF THIS POLICY TO PRECLUDE A BOARD MEMBER FROM BEING INVOLVED IN THE DISCUSSION OF A SUBJECT WHERE THE BOARD MEMBER HAS A CONFLICT OF INTEREST. HOWEVER, DISCRETION SHOULD BE EXERCISED AND THE BOARD MEMBER IS EXPECTED TO ABSTAIN FROM VOTING ON THE MATTER. THE CONFLICT OF INTEREST POLICY WILL BE SIGNED ANNUALLY AT THE BOARD'S REGULAR MEETING IN JANUARY. THIS STATEMENT WILL BE RETAINED BY THE PRESIDENT AND A COPY FILED IN THE CEO'S OFFICE. THE PRESIDENT WILL BE RESPONSIBLE TO CALL INTO QUESTION A POSSIBLE CONFLICT OF INTEREST OF A PARTICULAR BOARD MEMBER WHEN APPLICABLE IN THE EVENT THE BOARD MEMBER DOES NOT DECLARE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CEO COMPENSATION IS DETERMINED BY STATE SALARY SURVEY DATA AND IS SUBJECT TO BOARD APPROVAL. THE CEO'S CONTRACT WAS REVIEWED IN 2010 AND COMPARED TO THE COMPENSATION DATA FROM MHA, WHICH RESULTED IN AN INCREASE MADE EFFECTIVE OCTOBER 2010. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -24,450.