2012-11-13T18:46:42-06:00 2011-12-31 450310328 BRADY MARTZ AND ASSOCIATES PC PO BOX 14296 GRAND FORKS ND 582084296 990 2011-01-01 450310462 ALTRU HEALTH SYSTEM ALTR 7017805200 1200 S COLUMBIA RD GRAND FORKS ND 582014036 DAVID MOLMEN 7017805200 2012-11-12 1 MARK MILLER P00014209 7017754685 2011 2016-02-24 21:20:13Z ALTRU HOSPITAL DAVID MOLMEN 1200 S COLUMBIA RD GRAND FORKS ND 582014036 484919481 0 X ALTRU.ORG X 1970 ND HEALTHCARE DELIVERY 11 6 4162 353 2329256 0 1769870 2217753 398290568 424145122 3874572 4921726 441490 423148 404376500 431707749 68673 106934 0 0 235908618 249507009 0 0 0 145094004 165196637 381071295 414810580 23305205 16897169 371999674 380667327 227020666 235692188 144979008 144975139 X IMPROVING HEALTH, ENRICHING LIFE.WHY WE SERVE: TO ACHIEVE OPTIMUM HEALTH FOR ALL RESIDENTS IN OUR REGION.HOW WE SERVE: BY PROVIDING HEALTH EDUCATION, PREVENTIVE SERVICES, EARLY INTERVENTION, AND APPROPRIATE CARE.WHOM WE SERVE: THE MORE THAN 200,000 RESIDENTS OF NORTHEAST NORTH DAKOTA AND NORTHWEST MINNESOTA.WHO WE ARE: A COMMUNITY OF OVER 3,000 HEALTH PROFESSIONALS AND SUPPORT STAFF COMMITTED TO SERVING THE REGION FOR MORE THAN 100 YEARS. 0 0 18652584 22086073 ORTHOPEDICS - ALTRU'S TEAM OF ORTHOPEDIC SURGEONS PROVIDE INPATIENT AND OUTPATIENT SURGICAL SERVICES TO PATIENTS WITH ISSUES RANGING FROM SIMPLE FRACTURES TO COMPLEX TRAUMATIC INJURIES. IN 2011 THERE WERE 1,658 HOSPITAL DISCHARGES. 16539952 18626589 CARDIOLOGY - ALTRU OFFERS COMPREHENSIVE SERVICES INCLUDING INTERVENTIONAL AND MEDICAL CARDIOLOGY. ADDITIONAL SERVICES INCLUDE ECHOCARDIOGRAPHY, CARDIAC STRESS TESTS, AND CARDIAC REHAB. ALTRU HAS BEEN RECOGNIZED THREE TIMES AS A "100 TOP HOSPITALS" FOR CARDIOVASCULAR CARE. OUR CARDIOLOGY TEAM ALSO PROVIDES OUTREACH CLINIC SERVICES TO COMMUNITIES THROUGHOUT OUR SERVICE AREA. IN 2011 THERE WERE 1,947 HOSPITAL DISCHARGES. 10324126 14155204 GENERAL SURGERY - ALTRU'S TEAM OF GENERAL SURGEONS PERFORM INPATIENT AND OUTPATIENT SURGERY FROM ELEVEN OPERATING ROOM SUITES IN ALTRU HOSPITAL. IN 2011 THERE WERE 920 GENERAL SURGERY HOSPITAL DISCHARGES. 332278022 366084337 OTHER PROGRAM SERVICES INCLUDE OTHER PATIENT CARE PROGRAMS AND GENERAL & ADMINISTRATIVE. 332278022 366084337 377794684 1 1 0 0 0 0 0 0 0 0 1 0 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 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 84 0 4162 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DWIGHT THOMPSON 7017805203 1200 SOUTH COLUMBIA ROAD GRAND FORKS ND 58201 LONNIE LAFFEN 1.00 X X 0 0 0 JOHN SNUSTAD 1.00 X X 0 0 0 DARRELL LARSON ESQ 1.00 X X 0 0 0 CASEY RYAN MD 40.00 X X 483208 0 39874 DAVID MOLMEN 40.00 X X 454107 0 42840 TIMOTHY P SAYLER 40.00 X X 132907 0 8823 BRADLEY WEHE 40.00 X X 254434 0 43599 BRADLEY BELLUK MD 40.00 X 489453 0 38971 KRIS COMPTON 1.00 X 0 0 0 PHILIP GISI 1.00 X 0 0 0 JAMES HARGREAVES DO 40.00 X 544925 0 38835 ALICE BREKKE 1.00 X 0 0 0 MATTHEW ROLLER MD 40.00 X 414091 0 38816 DWIGHT THOMPSON 40.00 X 328185 0 43505 JAMES VANLOOY MD 40.00 X 300787 0 33720 MARGARET REED RN 40.00 X 218830 0 17944 RENEE M AXTMAN RN 40.00 X 185825 0 32456 LELAND LINDQUIST 40.00 X 227847 0 30856 JACQUELYN WALSH 40.00 X 168318 0 27425 DENNIS REISNOUR 40.00 X 197687 0 19757 KENNETH VEIN 40.00 X 176390 0 33358 MARK WAIND 40.00 X 182006 0 25571 KERRY P CARLSON 40.00 X 162350 0 29470 KELLY HAGEN RN 40.00 X 153515 0 28548 MICKEY SYRQUIN 40.00 X 1045651 0 38979 IKECHUKWU ONYEKA 40.00 X 1036941 0 43179 ABDEL AHMED 40.00 X 1729448 0 43434 SRINIVAS PULAGAM 40.00 X 948687 0 42778 RANDALL SMITH 40.00 X 911015 0 38979 10746607 0 781717 263 0 1 0 DELPHI HEALTHCARE PARTNERS INC 170 SOUTHPORT DR MORRISVILLE NC 27560 LOCUM TENENS SERVICES 2272352 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 532880314 SERVICES 2235736 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 SERVICES 1475661 C & R CLEANERS AND LAUNDRY 1010 N 5TH ST GRAND FORKS ND 58203 SERVICES 1026783 CLARITY COVERDALE FURY ADV 120 S 6TH ST STE 1300 MINNEAPOLIS MN 55402 ADVERTISING 946289 53 980686 944504 292563 2217753 NET SERVICE TO PATIENT 621110 413564906 411658798 1906108 PROGRAM SERVICE REVENU 621110 10093300 8693209 1400091 RESEARCH GRANTS 621500 439030 439030 BIOMED SERVICES/SITE S 900099 47886 47886 424145122 4760560 4760560 53372898 52814160 397572 558738 -397572 161166 161166 FITNESS PROGRAM 621990 225311 225311 RENTAL OFFICE SPACE/PA 621300 185940 185940 TELECOMMUNICATIONS 517000 6007 6007 5890 5890 423148 431707749 420952203 2329256 6208537 103134 103134 3800 3800 5649233 1893533 3755700 200213171 184655319 15557852 13598355 12541675 1056680 17947711 16553058 1394653 12098539 10998318 1100221 1177189 1177189 2298299 2133144 165155 6549920 6549920 20250608 20250608 2040381 2040381 SUPPLIES 60465492 60074421 391071 BAD DEBTS 29028266 29028266 PURCHASED SERVICES 27288722 18284227 9004495 FEES 8438736 7630498 808238 7659024 3877193 3781831 414810580 377794684 37015896 0 11676 11444 23407475 19610998 67962023 67851679 489594 510795 6492670 6106238 325706 369785 354294532 216534357 130833330 137760175 113283975 131687609 29193225 16758604 371999674 380667327 39489667 40435950 347935 385635 166477752 158529275 20705312 36341328 227020666 235692188 X 144979008 144975139 144979008 144975139 371999674 380667327 X 16897169 -16901038 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11008382 11008382 160788584 94433854 66354730 5876380 4433430 1442950 165451163 117667073 47784090 11170023 11170023 137760175 DUE TO AFFILIATES 59052 POST RETIREMENT HEALTH BENEFIT 26588337 OTHER 5330707 ESTIMATED THIRD PARTY LIABILITY 4029513 SPECIAL ASSESSMENTS PAYABLE 333719 36341328 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES THE ORGANIZATION'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 ORGANIZATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURNS OF THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY INTERNAL REVENUE SERVICE GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. 1 1 X 1 X 1 X 1 1 0 1 1 2197074 0 2197074 0.00530 18530730 0 18530730 0.04470 921005 0 921005 0.00220 21648809 21648809 0.05220 698688 364790 45 364745 0.00090 4813 429378 0 429378 0.00100 399 203502 0 203502 0.00050 30139 188253 0 188253 0.00050 734039 1185923 45 1185878 0.00290 734039 22834732 45 22834687 0.05510 1 29028266 0 94054708 272945327 -178890619 X 1 1 2 1 ALTRU HOSPITAL

1200 S COLUMBIA RD GRAND FORKS ND 582066002

X X X 2 ALTRU REHABILITATION CENTER

1300 S COLUMBIA RD GRAND FORKS ND 582066002

X ALTRU HOSPITAL 1 1 1 150.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 X X X X 1 X X X X X X 1 X 0 1 ALTRU REHABILITATION CENTER 2 1 1 150.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 X X X X 1 X X X X X X 1 X 0 1 53 ALTRU MAIN CLINIC

1000 S COLUMBIA RD GRAND FORKS ND 582066003

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CANCER CENTER

960 S COLUMBIA RD GRAND FORKS ND 582066003

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC TRUYU AESTHETIC CENTER

3165 DEMERS AVE GRAND FORKS ND 582066003

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU FAMILY MEDICINE CENTER

1380 S COLUMBIA RD GRAND FORKS ND 582066003

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU FAMILY MEDICINE RESIDENCY

725 HAMLINE STREET GRAND FORKS ND 58203

OUTPATIENT CLINIC ALTRU FAMILY MEDICINE RESIDENCY PHARMACY

725 HAMLINE STREET GRAND FORKS ND 58203

OUTPATIENT PHARMACY ALTRU CLINIC - DRAYTON

1003 N MAIN DRAYTON ND 582254650

OUTPATIENT CLINIC/THERAPY ALTRU PSYCHIATRY CENTER

860 S COLUMBIA RD GRAND FORKS ND 582066002

OUTPATIENT DEPARTMENT - PSYCH SERVICES ALTRU HOSPITAL - CENTER COURT FITNESS

1600 32ND AVE S GRAND FORKS ND 58201

OUTPATIENT THERAPHY ALTRU OUTPATIENT CENTER

411 2ND ST NW EAST GRAND FORKS MN 56721

OUTPATIENT THERAPHY ALTRU CLINIC - CAVALIER

201 E 3RD AVE S CAVALIER ND 582200040

OUTPATIENT CLINIC ALTRU CLINIC - DEVILS LAKE

1001 7TH STREET NE DEVILS LAKE ND 583012719

OUTPATIENT CLINIC ALTRU CLINIC - CROOKSTON

400 SOUTH MINNESOTA CROOKSTON MN 567160606

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - RED LAKE FALLS

312 INTERNATIONAL DRIVE RED LAKE FALLS MN 567504662

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - ERSKINE

23076 347TH ST SE ERSKINE MN 565354201

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - FERTILE

MILL STREET MAIN FERTILE MN 565404215

OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - ROSEAU

711 DELMORE DRIVE ROSEAU MN 567511534

OUTPATIENT CLINIC ALTRU CLINIC - WARROAD

412 MAIN AVE NE WARROAD MN 567632342

OUTPATIENT CLINIC ALTRU CLINIC - GREENBUSH

19120 200TH ST GREENBUSH MN 567269280

OUTPATIENT CLINIC UNITY MEDICAL CENTER

164 WEST 13TH STREET GRAFTON ND 58237

HOME HEALTH/HOSPICE FIRST CARE HEALTH CENTER

PO BOX I PARK RIVER ND 58270

HOME HEALTH/HOSPICE/THERAPY NELSON COUNTY HEALTH SYSTEM

BOX 367 MCVILLE ND 58254

HOME HEALTH/HOSPICE CO CAVALIER CLINIC

201 E 3RD AVE S CAVALIER ND 58220

HOME HEALTH/HOSPICE ALTRU HOME SVCS-NORTH VALLEY HOME HEALTH

109 S MINNESOTA ST WARREN MN 56762

HOME HEALTH/HOSPICE ANETA PARKVIEW HEALTH CENTER

BOX 287 ANETA ND 58212

OUTREACH CLINIC CAVALIER COUNTY MEMORIAL

909 2ND ST LANGDON ND 58249

OUTREACH CLINIC CENTRAL BOILER

20502 160TH ST GREENBUSH MN 56726

OUTREACH CLINIC COOPERSTOWN MEDICAL CENTER

1200 ROBERTS ST COOPERSTOWN ND 58425

OUTREACH CLINIC DEVILS LAKE GOOD SAMARITAN

302 7TH AVE DEVILS LAKE ND 58301

OUTREACH CLINIC FIRST CARE HEALTH CENTER

115 VIVIAN ST PARK RIVER ND 58270

OUTREACH CLINIC FRIENDSHIP

554 W 12TH ST GRAFTON ND 58327

OUTREACH CLINIC 4TH CORP

120 11TH ST NEW ROCKFORD ND 58356

OUTREACH CLINIC GRIGGS COUNTY HOSPITAL

1200 ROBERTS AVE NE COOPERSTOWN ND 58425

OUTREACH CLINIC HATTON PRAIRIE VILLAGE

930 DAKOTA AVE HATTON ND 58240

OUTREACH CLINIC HEARTLAND CARE CENTER

620 14TH AVE NE DEVILS LAKE ND 58301

OUTREACH CLINIC KARLSTAD HEALTH CARE

304 WASHINGTON AVE W KARLSTAD MN 56732

OUTREACH CLINIC KITTSON MEMORIAL HEALTH CARE CENTER

1010 S BIRCH HALLOCK MN 56728

OUTREACH CLINIC KITTSON MEMORIAL CLINIC OF KARLSTAD

1ST AND ROOSEVELT KARLSTAD MN 56732

OUTREACH CLINIC LAKE REGION CORP

224 3TH ST NW DEVILS LAKE ND 583012908

OUTREACH CLINIC LAKOTA GOOD SAMARITAN

608 4TH AVE SW HWY 2 LAKOTA ND 583447500

OUTREACH CLINIC MAPLE MANOR CARE CENTER

1116 9TH AVE LANGDON ND 58249

OUTREACH CLINIC MCINTOSH MANOR NURSING HOME

600 RIVERSIDE AVE NE MCINTOSH MN 56556

OUTREACH CLINIC NELSON COUNTY CARE CENTER

108 E NYHUS AVE MCVILLE ND 58254

OUTREACH CLINIC NELSON COUNTY HEALTH SYSTEM

200 NORTH MAIN MCVILLE ND 58254

OUTREACH CLINIC NORTHWOOD DEACONESS

4 N PART ST NORTHWOOD ND 58267

OUTREACH CLINIC OAKLAND PARK COMMUNITIES INC

123 BAKEN STREET THIEF RIVER FALLS MN 56701

OUTREACH CLINIC PEMBILIER NURSING CENTER

500 DELANO AVE WALHALLA ND 58282

OUTREACH CLINIC PEMBINA COUNTY MEMORIAL HOSPITAL

301 MOUNTAIN STREET E CAVALIER ND 58220

OUTREACH CLINIC PIONEER MEMORIAL CARE CENTER

23028 347TH ST SE ERSKINE MN 565359466

OUTREACH CLINIC REM-GRAFTON

817 HILL AVE GRAFTON ND 58327

OUTREACH CLINIC VALLEY 4000

4004 24TH AVE SOUTH GRAND FORKS ND 58201

OUTREACH CLINIC VALLEY MEMORIAL HOMES

2900 14TH AVE SOUTH GRAND FORKS ND 58201

OUTREACH CLINIC WEDGEWOOD MANOR

804 MAIN STREET WEST CAVALIER ND 58220

OUTREACH CLINIC PART I, LINE 6A: PREPARATION OF ANNUAL COMMUNITY BENEFIT REPORT: ALTRU HEALTH SYSTEM PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT BASED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION. ONCE ALL REPORTING FORMS HAVE BEEN COMPILED FOR THE YEAR, THE CATHOLIC HEALTH ORGANIZATION'S REFERENCE GUIDE FROM "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT" IS USED TO DETERMINE WHAT ITEMS SHOULD BE REPORTED INTO WHAT CATEGORY. THE COMMUNITY BENEFIT REPORT IS PUBLISHED AS A PART OF THE CORPORATION'S ANNUAL REPORT, WHICH IS PLACED ON OUR WEB SITE FOR PUBLIC ACCESS. PART I, LINE 7: COLUMN (F) - PERCENT OF TOTAL EXPENSES: IN DETERMINING THE DENOMINATOR FOR THE PERCENT OF TOTAL EXPENSE CALCULATION, THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WAS REDUCED BY BAD DEBTS EXPENSE OF $26,028,266.CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE METHODOLOGY USED TO DETERMINE THE REPORTED AMOUNTS FOR THE CHARITY CARE IS A COST-TO-CHARGE RATIO BASED ON GROSS CHARGES WRITTEN OFF PURSUANT TO OUR CHARITY CARE AND MEANS-TESTED PROGRAMS ELIGIBILITY CRITERIA. OTHER COMMUNITY BENEFIT IS DETERMINED FROM INFORMATION THAT WAS COMPILED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION AND USING THEIR REFERENCE GUIDE, "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT," TO DETERMINE WHICH CATEGORY THE AMOUNTS ARE PROPERLY REPORTED UNDER. PART II: NONE DOCUMENTED ON FORM 990. PART III, LINE 4: FOOTNOTE DISCLOSURE REGARDING BAD DEBTS EXPENSE: NOTES 1 AND 13 TO THE AUDITED FINANCIAL STATEMENTS REPORT ON BAD DEBT EXPENSE. NOTE 1 - CHANGE IN ACCOUNTING PRINCIPLES: "ALTRU HEALTH SYSTEM EARLY ADOPTED THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE NO. 2011-07, HEALTHCARE ENTITIES (TOPIC 954) PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES IS ALLOWABLE. IN ACCORDANCE WITH THE IMPLEMENTATION GUIDANCE, ALTRU HEALTH SYSTEM APPLIED THE PRESENTATION REQUIREMENTS TO 2011 AND 2010. THE IMPACT ON 2011 WAS A DECREASE TO UNRESTRICTED OPERATING REVENUE OF $29,151,584 AND A DECREASE TO TOTAL EXPENSE OF $29,151,584. THE IMPACT OF 2010 WAS A DECREASE TO UNRESTRICTED OPERATING REVENUE OF $18,618,905 AND A DECREASE TO TOTAL EXPENSE OF $18,618,905. THERE WAS NO IMPACT ON OPERATING INCOME OR NET ASSETS." ACCOUNTS RECEIVABLE: "PATIENT RECEIVABLE ARE UNCOLLATERALIZED PATIENT AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS OF PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED IN THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM.PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ALTRU HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, ALTRU RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.ALTRU'S PROCESS FOR CALCULATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS HAS NOT SIGNIFICANTLY CHANGED FROM DECEMBER 31, 2010 TO DECEMBER 31, 2011. ALTRU DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYORS. ALTRU HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2010 OR 2011.NOTE 13 - "...NEITHER THE CHARITY CARE NOR THE UNCOMPENSATED CARE AMOUNTS INCLUDE BAD DEBTS AS SHOWN IN THE STATEMENT OF OPERATIONS." PART III, LINE 8: NONE OF THE SHORTFALL SHOWN ON PART III, LINE 7 OF $178,890,619 HAS BEEN TREATED AS COMMUNITY BENEFIT AS REPORTED ON SCHEDULE H. THE SOURCE OF THE AMOUNT SHOWN ON PART III, LINE 6 COMES FROM THE MEDICARE ALLOWABLE COSTS REPORTED IN ALTRU'S MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR ENDING DECEMBER 31, 2011, UTILIZING THE FOLLOWING WORKSHEETS: WORKSHEETS B PART I, H-7 PARTS 1&2, I-4, AND K-6. PART III, LINE 9B: PROVISION FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE FOUND IN ALTRU'S POLICIES 2611 "DEDUCTIONS FROM REVENUES" AND 2614 "CHARITY CARE." ALTRU'S COMMUNITY CARE PROGRAM IS DESIGNED TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO HAVE NO INSURANCE AND/OR LIMITED MEANS TO PAY FOR THEIR MEDICAL SERVICES AND DO NOT QUALIFY FOR OTHER PROGRAMS. IN ADDITION TO QUALITY HEALTHCARE, PATIENTS OF ALTRU HEALTH SYSTEM ARE PROVIDED FINANCIAL COUNSELING REGARDING THEIR MEDICAL BILLS, BY SOMEONE WHO CAN UNDERSTAND AND OFFER POSSIBLE SOLUTIONS FOR THOSE WHO CANNOT PAY IN FULL. PROGRAMS ARE ALSO AVAILABLE FOR UNINSURED PATIENTS, AND FOR THOSE FOUND TO BE IN MEDICAL HARDSHIP. ALTRU HOSPITAL PART V, SECTION B, LINE 19D: N/A - GROSS CHARGES ARE NOT ADJUSTED FOR UNINSURED PATIENTS IN ER UNLESS THEY APPLY FOR AND QUALIFY FOR CHARITY CARE. ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 19D: N/A - GROSS CHARGES ARE NOT ADJUSTED FOR UNINSURED PATIENTS IN ER UNLESS THEY APPLY FOR AND QUALIFY FOR CHARITY CARE. ALTRU HOSPITAL PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE GROSS CHARGE REGARDLESS OF INSURANCE STATUS. ADJUSTMENTS MAY BE APPLIED PROVIDING THE PATIENTS APPLY FOR AND QUALIFY FOR CHARITY CARE. ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE GROSS CHARGE REGARDLESS OF INSURANCE STATUS. ADJUSTMENTS MAY BE APPLIED PROVIDING THE PATIENTS APPLY FOR AND QUALIFY FOR CHARITY CARE. PART VI, LINE 2: NEEDS ASSESSMENT: ALTRU HEALTH SYSTEM'S MISSION - IMPROVING HEALTH, ENRICHING LIFE - CONFIRMS THAT OUR RESPONSIBILITY TO THE REGION GOES BEYOND PROVIDING QUALITY HEALTHCARE SERVICES. ALL OF OUR RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. AT ALTRU, GOOD HEALTH MEANS THAT EVERY INDIVIDUAL SHOULD ENJOY THE BEST ACHIEVABLE AND SO SHOULD OUR COMMUNITIES. MOVING FORWARD, BECAUSE OF STIPULATIONS DEFINED IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, ALTRU WILL DEVELOP A FORMAL PROCESS FOR PERFORMING A COMMUNITY HEALTH NEEDS ASSESSMENT BASED ON OUR MISSION. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:ALTRU HAS SEVERAL AVENUES IN WHICH INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS COMMUNICATED TO PATIENTS. UNINSURED AND SELF-PAY PATIENTS IN THE HOSPITAL RECEIVE A VISIT FROM PATIENT REPRESENTATIVES AFTER INTAKE. DURING THIS MEETING, THEY ARE INFORMED OF VARIOUS FEDERAL, STATE AND COMMUNITY-BASED PROGRAMS THAT MAY PROVIDE ASSISTANCE. UNINSURED OR SELF-PAY PATIENTS FROM OUTPATIENTS RECEIVE CONTACT FROM PATIENT REPRESENTATIVES BY PHONE OR EMAIL INFORMING THEM OF POTENTIAL SOURCES OF FINANCIAL ASSISTANCE. BOTH SETS OF PATIENTS ARE ALSO PROVIDED INFORMATION ON HOW TO MOVE FORWARD IN APPLYING FOR THE PROGRAMS. IF PATIENTS ARE FOUND TO BE STRUGGLING WITH MEDICAL EXPENSES, OUR CREDIT AND COLLECTIONS REPRESENTATIVES UTILIZE LETTERS AND PHONE CALLS TO INFORM THEM OF VARIOUS RESOURCES THAT MAY PROVIDE ASSISTANCE.FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE TO THE PUBLIC AS A WHOLE. ALTRU'S WEBSITE, ALTRU.ORG, INCLUDES FINANCIAL ASSISTANCE CONTACT INFORMATION AND ELIGIBILITY GUIDELINES. PATIENTS MAY REVIEW THIS ON THEIR OWN AND CONTACT AGENCIES THAT MAY PROVIDE ASSISTANCE BASED ON THEIR CIRCUMSTANCES. ALSO, ALTRU DISTRIBUTES BROCHURES FEATURING OUR COMMUNITY CARE PROGRAM AND OTHER FEDERAL AND STATE PROGRAMS. THESE BROCHURES ARE AVAILABLE TO BOTH PATIENTS AND VISITORS IN WAITING ROOMS OF OUR INPATIENT AND OUTPATIENT FACILITIES AS WELL AS IN ALL BUSINESS OFFICE LOCATIONS. PART VI, LINE 4: COMMUNITY INFORMATION:ALTRU HEALTH SYSTEM SERVES A 17-COUNTY AREA THAT IS DIVIDED INTO THREE DISTINCT SERVICE AREAS (PRIMARY, SECONDARY, AND REFERRAL) AND HAS A POPULATION OF 219,405 PERSONS (2011 ESTIMATE) WHO RESIDE IN A DIVERSE AREA OF AGRICULTURE AND INDUSTRY. THE SERVICE AREA STRETCHES 265 MILES EAST AND WEST AND 120 MILES NORTH AND SOUTH. GRAND FORKS SITS IN THE MIDDLE OF THE RED RIVER VALLEY, ONE OF THE WORLD'S RICHEST AGRICULTURAL AREAS. PRINCIPAL CROPS INCLUDE SUGAR BEETS, POTATOES, EDIBLE BEANS, AND SMALL GRAINS SUCH AS WHEAT AND BARLEY. MUCH OF THE INDUSTRY IN THE AREA IS RELATED TO AGRICULTURE AND FOOD PROCESSING.THE PRIMARY SERVICE AREA, COMPRISED OF GRAND FORKS COUNTY (NORTH DAKOTA) AND EAST GRAND FORKS (MINNESOTA), IS HOME TO 77,215 PEOPLE (2011 ESTIMATE). LOCATED IN THIS MARKET IS ALTRU HOSPITAL, ALTRU REHABILITATION CENTER, ALTRU CANCER CENTER, AND SIX OTHER LOCATIONS THAT ARE HOME TO OUR PROVIDERS' CLINIC PRACTICES AND OTHER SERVICES OFFERED BY ALTRU. ALTRU HOSPITAL SERVES AS THE MAJOR REFERRAL CENTER FOR THE PEOPLE OF THE REGION. AS SUCH, IT PROVIDES A BROAD SPECTRUM OF PROGRAMS AND SERVICES. A FULL RANGE OF SERVICES ARE AVAILABLE FOR PATIENTS SUFFERING FROM CANCER, HEART DISEASE, END-STAGE RENAL DISEASE, NEUROLOGICAL DISORDERS, ALCOHOL OR CHEMICAL DEPENDENCY, HIGH RISK OBSTETRICAL COMPLICATIONS, AND PSYCHIATRIC DISORDERS. ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN 2011 FOR OUR PRIMARY MARKET WAS 83 PERCENT BASED ON CLAIMS DATA FROM BLUE CROSS BLUE SHIELD OF NORTH DAKOTA. ABOUT 80 PERCENT OF THE PHYSICIANS IN THE PRIMARY AREA ARE EMPLOYED BY ALTRU HEALTH SYSTEM. ALSO LOCATED IN GRAND FORKS COUNTY IS NORTHWOOD COMMUNITY HEALTH CENTER (IN NORTHWOOD, ND). A COUPLE NOTABLE POPULATIONS ALTRU SERVES THAT ARE LOCATED IN OUR PRIMARY SERVICE AREA INCLUDE THE UNIVERSITY OF NORTH DAKOTA AND GRAND FORKS AIR FORCE BASE. THE UNIVERSITY OF NORTH DAKOTA IS THE STATE'S OLDEST INSTITUTION OF HIGHER LEARNING WITH AN ENROLLMENT OF ABOUT 14,100 STUDENTS (FALL 2011). THE NUMBER OF RESIDENTS AT GRAND FORKS AIR FORCE BASE WAS COUNTED AT 2,367 IN THE 2010 CENSUS.WITH A POPULATION OF 57,111 (2011 ESTIMATE), THE SECONDARY SERVICE AREA IS COMPRISED OF SIX COUNTIES TO THE WEST, NORTH, AND EAST OF GRAND FORKS COUNTY: NELSON, WALSH, AND PEMBINA COUNTIES IN NORTH DAKOTA, AND POLK, MARSHALL, AND KITTSON COUNTIES IN MINNESOTA; THIS AREA IS LARGELY RURAL AND AGRICULTURAL. WITHIN THIS AREA, ALTRU HAS FIVE REGIONAL CLINIC LOCATIONS; IT IS ALSO HOME TO SEVERAL SMALL HOSPITALS AS LISTED BELOW.SECONDARY SERVICE AREA HOSPITALS: LOCATIONUNITY MEDICAL CENTER: GRAFTON, NDFIRST CARE HEALTH CENTER: PARK RIVER, NDPEMBINA COUNTY MEMORIAL HOSPITAL: CAVALIER, NDNELSON COUNTY HEALTH SYSTEM: MCVILLE, NDKITTSON MEMORIAL HOSPITAL: HALLOCK, MNNORTH VALLEY HEALTH CENTER: WARREN, MNRIVERVIEW HOSPITAL: CROOKSTON, MNESSENTIA HEALTH: FOSSTON, MNIN 2011, ALTRU'S HOSPITAL INPATIENT MARKET SHARE IN THIS SERVICE AREA WAS AROUND 58 PERCENT ACCORDING TO CLAIMS PAID BY BLUE CROSS BLUE SHIELD OF NORTH DAKOTA. THE SYSTEM EMPLOYS MANY OF THE PHYSICIANS IN THE SECONDARY SERVICE AREA. ALL OF THESE PHYSICIANS ARE ON MEDICAL STAFFS OF COMMUNITY HOSPITALS THROUGHOUT THE REGION, AND REFER PATIENTS TO GRAND FORKS AND ELSEWHERE FOR SPECIALTY CARE.THE SYSTEM'S REFERRAL AREA IS COMPRISED OF TEN COUNTIES ENCIRCLING THE PRIMARY AND SECONDARY SERVICE AREAS (ROLETTE, TOWNER, BENSON, RAMSEY, CAVALIER, AND TRAILL COUNTIES IN NORTH DAKOTA AND ROSEAU, LAKE OF THE WOODS, PENNINGTON, AND RED LAKE COUNTIES IN MINNESOTA.) THIS REGION IS ALSO MOSTLY RURAL AND AGRICULTURAL AND INCLUDES SEVERAL SMALLER HOSPITALS AS LISTED SERVING THE PRIMARY CARE NEEDS OF THEIR COMMUNITIES. ALTRU HAS FIVE REGIONAL CLINICS IN THIS SERVICE AREA AND ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN THIS REGION IS ABOUT 25 PERCENT ACCORDING TO 2011 CLAIMS PAID BY BLUE CROSS BLUE SHIELD OF NORTH DAKOTA. ALTRU, ONCE AGAIN, EMPLOYS MANY OF THE PHYSICIANS IN THIS AREA, AND THESE PHYSICIANS HAVE PRACTICE PATTERNS SIMILAR TO THOSE OF THE PHYSICIANS IN OUR SECONDARY SERVICE AREA.REFERRAL SERVICE AREA HOSPITALS: LOCATIONCAVALIER COUNTY MEMORIAL HOSPITAL: LANGDON, NDHILLSBORO MEDICAL CENTER: HILLSBORO, NDLAKEWOOD HEALTH CENTER: BAUDETTE, MNMERCY HOSPITAL: DEVILS LAKE, NDSANFORD-THIEF RIVER FALLS MEDICAL CENTER: THIEF RIVER FALLS, MNPRESENTATION MEDICAL CENTER: ROLLA, NDTOWNER COUNTY MEDICAL CENTER: CANDO, NDSANFORD MAYVILLE MEDICAL CENTER: MAYVILLE, NDLIFECARE MEDICAL CENTER: ROSEAU, MNQUENTIN N. BURDICK MEMORIAL HOSPITAL: BELCOURT, NDAS PREVIOUSLY MENTIONED, ALTRU'S 17-COUNTY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 219,000. USING DATA FROM THOMSON REUTERS (A VENDOR SPECIALIZING IN HEALTH CARE PLANNING INFORMATION), THE INSURANCE COVERAGE FOR COMMUNITIES IN OUR SERVICE AREA IS ESTIMATED TO BE AS FOLLOWS: COVERAGE ESTIMATES AS A PERCENTMEDICAID 22,978 11%MEDICARE 31,437 15%DUAL ELIGIBLE 4,145 2%PRIVATE EMPLOYER SPONSORED 108,122 51%PRIVATE DIRECT 18,342 9%UNINSURED 28,749 13%A PERCENTAGE BREAKDOWN OF INPATIENT UTILIZATION FOR ALTRU HOSPITAL BASED ON DISCHARGES BY TYPE OF PAYER IN 2011 SHOWS APPROXIMATELY 11 PERCENT OF DISCHARGES WERE FOR MEDICAID AND 3 PERCENT WERE SELF PAY (UNINSURED). ALSO FROM THOMSON REUTERS, OUR TOTAL SERVICE AREA'S INCOME BY HOUSEHOLD IS AS FOLLOWS:INCOME RANGE 2011 HOUSEHOLDS$ 0 - $ 9,999 8,101$ 10,000 - $ 14,999 4,975$ 15,000 - $ 19,999 5,556$ 20,000 - $ 24,999 5,436$ 25,000 - $ 29,999 6,013$ 30,000 - $ 34,999 5,807$ 35,000 - $ 39,999 5,512$ 40,000 - $ 44,999 5,141$ 45,000 - $ 49,999 4,874$ 50,000 - $ 59,999 8,907$ 60,000 - $ 74,999 9,975$ 75,000 - $ 99,999 8,772$100,000 - $124,999 4,155$125,000 - $149,999 1,588$150,000 - $199,999 1,123$200,000 - $249,999 615$250,000 - $499,999 412$500,000 + 170ACCORDING TO THE WEBSITE FOR HEALTH RESOURCES AND SERVICES ADMINISTRATION, THE FOLLOWING AREAS IN OUR SERVICE AREA ARE MUA'S:NORTH DAKOTA:BENSON COUNTY: BENSON SERVICE AREACAVALIER COUNTY: CAVALIER SERVICE AREAGRAND FORKS COUNTY: NORTHWOOD SERVICE AREA, GRAND FORKS SERVICE AREANELSON COUNTY: NELSON SERVICE AREAPEMBINA COUNTY: WALHALLA SERVICE AREAROLETTE COUNTY: ROLETTE SERVICE AREATOWNER COUNTY: CANDO CITY SERVICE AREATRAILL COUNTY: TRAILL SERVICE AREAWALSH COUNTY: PARK RIVER CITY SERVICE AREAMINNESOTA:KITTSON COUNTY: KITTSON SERVICE AREAMARSHALL COUNTY: MARSHALL SERVICE AREAPOLK COUNTY: POLK SERVICE AREARED LAKE COUNTY: RED LAKE SERVICE AREAROSEAU COUNTY: ROSEAU SERVICE AREA PART VI, LINE 5: ALL OF ALTRU'S RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. TO DO SO, WE KNOW THAT NOT ALL MEDICAL SERVICES WILL COME FROM STAFF EMPLOYED BY ALTRU HEALTH SYSTEM. ALTRU EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR NEARLY ALL DEPARTMENTS. ALSO, OUR BOARD OF DIRECTORS IS MADE UP OF INDIVIDUALS FROM OUTSIDE ALTRU HEALTH SYSTEM. THESE PEOPLE ARE VOLUNTEERS WHO HAVE THE SAME DEDICATION AND FOCUS ON ALTRU'S MISSION AS OUR OWN STAFF. PART VI, LINE 6: ALTRU HEALTH SYSTEM IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. IN SEPTEMBER 2011, ALTRU HEALTH SYSTEM BECAME THE FIRST MEMBER OF THE MAYO CLINIC CARE NETWORK. THIS IS A NON-OWNERSHIP RELATIONSHIP THAT BENFITS THE ORGANIZATION'S PHYSICIANS AND PATIENTS FROM ENHANCED ACCESS TO MAYO PHYSICIANS AND CLINICAL RESOURCES. MORE SPECIFICALLY, PHYSICIANS HAVE ACCESS TO MAYO CLINIC'S EVIDENCE-BASED DISEASE MANAGEMENT PROTOCOLS, CLINIC CARE GUIDELINES, AND TREATMENT RECOMMENDATIONS AND REFERENCE MATERIALS FOR COMPLEX MEDICAL CONDITIONS.PART VI, LINE 7: ALTRU HEALTH SYSTEM IS NOT REQUIRED TO FILE OUR COMMUNITY BENEFIT REPORT WITH ANY OUTSIDE ORGANIZATIONS BUT HAS MADE OUR REPORT AVAILABLE TO ANYONE ON OUR WEB SITE. 1 COMMUNITY VIOLENCE INTERVENTION CENTER 211 S 4TH ST STE 207 GRAND FORKS ND 58201 450359167 501(C)(3) 10000 PLEDGE FOR DREAM MAKER SOCIETY NORTHLAND COMMUNITY & TECHNICAL COLLEGE FOUNDATION 1101 HWY 1 EAST THIEF RIVER FALLS MN 56701 411287038 501(C)(3) 10000 STUDENT SCHOLARSHIP FUND UNIVERSITY OF MINNESOTA FOUNDATION 200 OAK ST SE STE 500 MINNEAPOLIS MN 55455 416042488 501(C)(3) 10000 STUDENT SCHOLARSHIP FUND RE ARENA INC ONE RALPH ENGLESTAD DR GRAND FORKS ND 58203 113666663 10000 GAME DAY SPONSORSHIPS 3 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: NORTHLAND COMMUNITY & TECHNICAL COLLEGE FOUNDATION - SCHOLARSHIPS ARE DIRECTED BY THE NORTHLAND COMMUNITY & TECHNICAL COLLEGE FOUNDATION AS PART OF THE SCHOLARSHIP PROGRAM AND ALTRU DOES NOT DIRECTLY DESIGNATE SCHOLARSHIP RECIPIENTS. UNIVERSITY OF MINNESOTA FOUNDATION - SCHOLARSHIPS ARE DIRECTED BY THE UNIVERSITY OF MINNESOTA FOUNDATION AS PART OF THE SCHOLARSHIP PROGRAM AND ALTRU DOES NOT DIRECTLY DESIGNATE SCHOLARSHIP RECIPIENTS. COMMUNITY VIOLENCE INTERVENTION CENTER - FUNDS WERE GRANTED WITH THE DIRECTION THAT CVIC WAS ABLE TO USE FUNDS AS NEEDED. CVIC DETERMINES THE RECIPIENTS OF THE ASSISTANCE PROVIDED THROUGH THOSE FUNDS. RE ARENA, INC. - ALTRU REVIEWS THE SPONSORSHIPS WITH RE ARENA/UNIVERSITY OF NORTH DAKOTA OFFICIALS PRIOR TO THE EVENTS AND HAS REPRESENTATIVES ATTEND THE EVENTS TO ACKNOWLEDGE THE PROPRIETY OF THE ANNOUNCEMENTS MADE REGARDING THE SPONSORSHIP OF THE DAY'S EVENT. X X X X X X 0 0 0 0 0 0 0 0 0 CASEY RYAN MD 441698 0 0 0 41510 0 22387 0 17487 0 523082 0 0 0 DAVID MOLMEN 413765 0 0 0 40342 0 22387 0 20453 0 496947 0 0 0 BRADLEY WEHE 237597 0 0 0 16837 0 23242 0 20357 0 298033 0 0 0 BRADLEY BELLUK MD 472152 0 0 0 17301 0 22387 0 16584 0 528424 0 0 0 JAMES HARGREAVES DO 503623 0 0 0 41302 0 22387 0 16448 0 583760 0 0 0 MATTHEW ROLLER MD 380723 0 0 0 33368 0 22387 0 16429 0 452907 0 0 0 DWIGHT THOMPSON 288309 0 0 0 39876 0 22387 0 21118 0 371690 0 0 0 JAMES VANLOOY MD 276919 0 0 0 23868 0 22387 0 11333 0 334507 0 0 0 MARGARET REED RN 201917 0 0 0 16913 0 15189 0 2755 0 236774 0 0 0 RENEE M AXTMAN RN 176345 0 0 0 9480 0 13442 0 19014 0 218281 0 0 0 LELAND LINDQUIST 204423 0 0 0 23424 0 16225 0 14631 0 258703 0 0 0 JACQUELYN WALSH 160804 0 0 0 7514 0 12021 0 15404 0 195743 0 0 0 DENNIS REISNOUR 178302 0 0 0 19385 0 14009 0 5748 0 217444 0 0 0 KENNETH VEIN 155204 0 0 0 21186 0 12879 0 20479 0 209748 0 0 0 MARK WAIND 174245 0 0 0 7761 0 12956 0 12615 0 207577 0 0 0 KERRY P CARLSON 150826 0 0 0 11524 0 11687 0 17783 0 191820 0 0 0 KELLY HAGEN RN 152961 0 0 0 554 0 8251 0 20297 0 182063 0 0 0 MICKEY SYRQUIN 1022409 0 0 0 23242 0 22387 0 16592 0 1084630 0 0 0 IKECHUKWU ONYEKA 1003101 0 0 0 33840 0 22387 0 20792 0 1080120 0 0 0 ABDEL AHMED 1689706 0 0 0 39742 0 22387 0 21047 0 1772882 0 0 0 SRINIVAS PULAGAM 915201 0 0 0 33486 0 22387 0 20391 0 991465 0 0 0 RANDALL SMITH 887773 0 0 0 23242 0 22387 0 16592 0 949994 0 0 0 CITY OF GRAND FORKS 456002085 38546WAW0 2005-12-01 40000000 CAPITAL EXPENDITURES, FUND DEBT SERVICE FUND 0 0 0 CITY OF GRAND FORKS 456002085 38546WAZ3 2007-08-15 30755173 REFUND BONDS ISSUED JUNE 17, 1997 AND MARCH 23, 2000 0 0 0 CITY OF GRAND FORKS 456002085 2010-08-20 30000000 CAPITAL EXPENDITURES, FUND DEBT SERVICE FUND 0 0 0 CITY OF GRAND FORKS 456002085 2011-08-02 23620000 REFUND BONDS ISSUED MAY 19, 1994 AND JUNE 17, 1997 0 0 0 40000000 3530596 425000 1506870 34537534 2007 0 0 1 1 30755173 3075517 27283893 395763 2007 1 0 1 1 30000000 203750 29796250 0 0 0 1 23620000 23487901 103099 2011 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 DARRELL LARSON ESQ BOARD CHAIR 12338 PROFESSIONAL SERVICES PROVIDED TO THE ORGANIZATION THROUGH A BUSINESS RELATIONSHIP - LEGAL FILE #1187 0 DARRELL LARSON ESQ BOARD CHAIR 4618 PROFESSIONAL SERVICES PROVIDED TO THE ORGANIZATION THROUGH A BUSINESS RELATIONSHIP - LEGAL FILE #0676 0 DARRELL LARSON ESQ BOARD CHAIR 104593 PROFESSIONAL SERVICES PROVIDED TO THE ORGANIZATION THROUGH A BUSINESS RELATIONSHIP - LEGAL FILE #1183 0 NEW TOOLS TO AID IN DELIVERY OF PROGRAM SERVICES: FORM 990, PART III, ALTRU HEALTH SYSTEM BECAME THE INAUGURAL MEMBER OF THE MAYO CLINIC CARE NETWORK IN SEPTEMBER 2011, FORMALIZING A LONG-STANDING RELATIONSHIP WITH MAYO CLINIC AND GAINING ACCESS TO TOOLS THAT WILL HELP KEEP PATIENTS CLOSER TO HOME DURING TREATMENT. WE HAVE TWO WAYS TO CONNECT ALTRU PHYSICIANS TO MAYO CLINIC. THE FIRST, ECONSULTS, ALLOWS OUR PHYSICIANS TO CONSULT WITH A MAYO CLINIC SPECIALIST FOR INPUT ON A PATIENT'S CARE PLAN. THIS IS DONE THROUGH A SECURE ONLINE NETWORK, KEEPING INFORMATION SAFE AND CONFIDENTIAL. THE SECOND, ASKMAYOEXPERT, IS A STATE-OF-THE-ART ELECTRONIC TOOL THAT PROVIDES ACCESS TO MAYO CLINIC'S KNOWLEDGE IN DISEASE MANAGEMENT, CLINICAL CARE GUIDELINES, TREATMENT RECOMMENDATIONS AND REFERENCE MATERIALS FOR A VARIETY OF MEDICAL CONDITIONS. ALTRU PHYSICIANS CAN ACCESS THIS DATABASE OF INFORMATION AT ANY TIME. FORM 990, PART VI, SECTION A, LINE 2 CFO/TREASURER, DWIGHT THOMPSON, HAS A FAMILY RELATIONSHIP WITH KEY EMPLOYEE, ROBERT THOMPSON, MD MBA. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED FOR ACCURACY BY THE BOARD OF DIRECTORS AND APPROVED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY IS REVIEWED AND SIGNED OFF ANNUALLY BY ALL MEMBERS OF THE BOARD OF DIRECTORS. THESE FORMS ARE COLLECTED AND REVIEWED BY THE SECRETARY. FORM 990, PART VI, SECTION B, LINE 15 DETERMINATION OF THE COMPENSATION FOR THE PRESIDENT AND CEO ARE DETERMINED BY THE BOARD. SUBSTANTIATION OF THESE DISCUSSIONS APPEAR IN THE BOARD MINUTES. COMPENSATION OF KEY EMPLOYEES ARE DETERMINED BY A COMPENSATION COMMITTEE FORMED OF PHYSICIANS THAT REPORT TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATIONS 990 AND 990-T PUBLIC INSPECTION COPIES ARE AVAILABLE UPON REQUEST. FORM 1023 IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH PUBLISHED ANNUAL REPORTS AND VIA ITS WEB SITE. 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 LOSSES ON INVESTMENTS: -1,687,038. APPLICATION OF FASB ASC TOPIC 715 -15,214,000. TOTAL TO FORM 990, PART XI, LINE 5: -16,901,038. "DOING BUSINESS AS" CONTINUATION HEADING ITEM C ALTRU CLINIC-MAIN, ALTRU REHAB CENTER, ALTRU CANCER CENTER, ALTRU FAMILY MEDICINE CENTER, ALTRU FAMILY MEDICINE RESIDENCY, TRUYU AESTHETIC CENTER, ALTRU CLINIC-LAKE REGION, ALTRU CLINIC-CAVALIER, ALTRU CLINIC-DRAYTON, ALTRU CLINIC-CROOKSTON, ALTRU CLINIC-RED LAKE FALLS, ALTRU CLINIC-FERTILE, ALTRU CLINIC-ERSKINE, ALTRU CLINIC-ROSEAU, ALTRU CLINIC-WARROAD, ALTRU CLINIC-GREENBUSH, ALTRU CLINIC-KARLSTAD SCHEDULE 1 - PROGRAM SERVICE REVENUE DETAIL FORM 990, PART VIII, LINE 2B & 2D EXCLUSION AMOUNT BIOMED SERVICES $41,996 SITE SERVICE FEES $5,890 SUBTOTAL $47,886 CAFETERIA RECEIPTS $1,168,029 PHARMACY SALES TO EMPLOYEES $1,435 HOUSING/SPACE RENTALS $195,679 VENDING MACHINE INCOME $34,323 SALE OF SCRAP $625 SUBTOTAL $1,400,091 TOTAL EXCLUSION AMOUNT $1,447,977 RELATED OR EXEMPT FUNCTION INCOME CEPT REVENUE $127,890 HEARING CENTER $673,768 OCCUPATIONAL HEALTH $430,952 VHA SUPPLY CO - DISTRIBUTION $589,393 PURCHASE DISCOUNTS $66,486 REBATES $50,316 CONTRACT SERVICES, OUTREACH, EDUCATION $3,395,170 CPE FUND $5,477 MEDICAL RECORDS TRANSCRIPT FEES $236,642 AFFILIATED OTHER REVENUE $364,964 MISCELLANEOUS REVENUE $2,752,151 TOTAL RELATED/EXEMPT INCOME $8,693,209 SCHEDULE 2-PROGRAM SERVICE REVENUE DESCRIPTIONS FORM 990, PART VIII, LINE 2B & 2D 1. CAFETERIA RECEIPTS: REVENUE INCURRED THROUGH THE PROVISION OF MEALS FOR EMPLOYEES WHO HAVE TO BE IN THE BUILDING DURING THEIR REGULAR WORKDAY. PURPOSE: PROVIDE THESE EMPLOYEES WITH A PLACE TO ACQUIRE AND CONSUME THEIR MEALS; NO ALTERNATIVES ARE AVAILABLE. 2. BIOMED SERVICES: REVENUE EARNED THROUGH THE PROVISION OF SERVICES TO AREA HEALTH CARE FACILITIES NEEDING TO KEEP THEIR EQUIPMENT IN OPERATION IN ORDER TO PROVIDE THEIR PATIENTS WITH THEIR SERVICE. THE BIOMED PROGRAM PROVIDES SMALL REGIONAL HOSPITALS WITH A SERVICE OTHERWISE UNOBTAINABLE FROM ANYONE IN THE LOCAL AREA; IT IS OFTEN ON A PRIORITY BASIS. 3. PHARMACY SALES TO EMPLOYEES: REVENUE INCURRED IN SALES STRICTLY FOR THE CONVENIENCE OF EMPLOYEES. 4. HOUSING/SPACE RENTALS: INCOME INCURRED THROUGH THE RENTAL OF SPACE TO THE AREA HEALTH EDUCATION CENTER WHICH IS REQUIRED TO BE ON-SITE TO WORK WITH OUR PHYSICIANS PROVIDING HEALTH CARE TO PATIENTS. 5. CEPT REVENUE: REVENUE EARNED FROM THE EVALUATION AND TREATMENT OF ADOLESCENTS THROUGH A MULTI-DISCIPLINARY APPROACH INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, AND PSYCHOLOGY. 6. HEARING CENTER: REVENUE FROM THE PROVISION OF AUDIOLOGICAL SERVICES AND HEARING AIDS TO PATIENTS. 7. OCCUPATIONAL HEALTH: FEES FOR PROVIDING DRUG SCREENINGS FOR REGIONAL EMPLOYERS. 8. VHA SUPPLY DISTRIBUTION: REBATE RECEIVED BASED ON VOLUME OF SUPPLY PURCHASES. 9. PURCHASE DISCOUNTS: THIS FIGURE REPRESENTS COST SAVINGS ON PURCHASES FROM SUPPLIERS FOR GOODS USED IN THE PROVISION OF HEALTH CARE SERVICES. 10. REBATES: REBATES RECEIVED BASED ON VOLUME OF PHARMACY PURCHASES. 11. SITE SERVICE FEES: FEES CHARGED FOR PROVIDING GROUNDS AND MAINTENANCE FOR THE AREA SURROUNDING THE UNITED HOSPITAL, INCLUDING FEES FOR SUCH SERVICES AS MAINTENANCE OF HOSPITAL PARKING LOT, SNOW SHOVELING, AND SNOW REMOVAL. 12. VENDING MACHINE INCOME: INCOME EARNED THROUGH THE OPERATION OF VENDING MACHINES IN THE BUILDINGS. 13. CONTRACT SERVICES, OUTREACH, EDUCATION: REVENUES EARNED IN THE PROVISION OF COMMUNITY EDUCATION/WELLNESS PROGRAMS, PASTORAL COUNSELING SERVICES, AND CONTRACTED SERVICES WITH REGIONAL HEALTHCARE SYSTEMS TO BRING OUTREACH SERVICES INTO THEIR COMMUNITIES. 14. CPE FUND: CLINICAL PASTORAL EDUCATION INCOME FROM PASTORAL RESIDENTS. PROGRAM SPONSORED BY THE ASSOCIATION OF CLINICAL PASTORAL EDUCATION. 15. MEDICAL RECORD TRANSCRIPTION FEES: INCOME EARNED THROUGH THE CHARGING OF VARIOUS THIRD PARTY PAYERS FOR THE PHOTOCOPYING OF PATIENT RECORDS. INSURANCE COMPANIES AND PAYERS ARE CHARGED TO OFFSET THE COST OF COPYING. 16. SALE OF SCRAP: INCOME EARNED THROUGH THE SALE OF ITEMS THAT ARE NOT FIXED ASSETS AND ARE OF DIMINISHED USE TO THE ORGANIZATION. 17.OTHER REVENUE CHARGED TO AFFILIATED CORPORATIONS: REVENUE FROM THE PROVISION OF PATIENT SERVICES, SUCH AS PSYCH OR LABORATORY, TO THE PATIENTS OF OTHER CORPORATIONS, WHICH ARE AFFILIATED TO ALTRU HEALTH SYSTEM. 18. MISCELLANEOUS INCOME: INCLUDES PRINCIPALLY A RETURN OF EXPENSES FROM AN INSURANCE POOL. ALSO INCLUDES INCOME EARNED THROUGH THE PROVISION OF SERVICES THAT ARE OPERATING IN THE HOSPITAL IN NATURE, BUT HAVE NO SPECIFIC COST CENTER IDENTIFICATIONS. AN EXAMPLE OF THIS WOULD BE IF THE DIRECTOR OF THE COMMUNICATIONS DEPARTMENT RECEIVED A SMALL TOKEN AMOUNT FOR FILLING OUT A SURVEY FROM SOME HEALTH CARE ORGANIZATION. ALTRU HEALTH FOUNDATION 2501 DEMERS AVE GRAND FORKS ND 58201 450368330 FUNDRAISING ND 501(C)(3) LINE 11A, I N/A 0 ALTRU HEALTH RESOURCES 1200 S COLUMBIA RD GRAND FORKS ND 58201 450368332 CONGREGATE HOUSING, ASSISTED LIVING ND 501(C)(3) LINE 11A, I N/A 0 DAK-MINN BLOOD BANK 1200 S COLUMBIA RD GRAND FORKS ND 58201 363453164 BLOOD BANK ND 501(C)(3) LINE 11D, III-O N/A 0 ALTRU ALLIANCE 1200 S COLUMBIA RD GRAND FORKS ND 58201 237389089 SUPPORT HOSPITAL AND AFFILIATES ND 501(C)(3) LINE 11B, II N/A 0 ALTRU SPECIALTY SERVICES INC 1200 S COLUMBIA RD GRAND FORKS ND 58201 450395652 DME SALES, RETAIL PHARMACY ND N/A C 1 0 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 ALTRU HEALTH FOUNDATION C 914053 CASH DONATED ALTRU HEALTH RESOURCES D 124536 LOAN OUTSTANDING ALTRU SPECIALTY SERVICES A 185940 RENT PAYMENT RECEIVED DAK-MINN BLOOD BANK C 66633 CASH DONATED DAK-MINN BLOOD BANK N 393878 COMPENSATION TO RELATED ORG ALTRU ALLIANCE P 71234 AMOUNT REIMBURSED ALTRU HEALTH RESOURCES A 2795 INTEREST PAYMENT RECEIVED ALTRU HEALTH RESOURCES P 159677 AMOUNT REIMBURSED ALTRU HEALTH RESOURCES O 103943 AMOUNT REIMBURSED ALTRU HEALTH RESOURCES N 585686 COMPENSATION TO RELATED ORG