2012-11-15T09:08:19-06:00 2011-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST STE 2300 MINNEAPOLIS MN 55402 990 2011-01-01 410729979 NORTH MEMORIAL HEALTH CARE NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 PATRICK BORAN 7635814562 2012-11-01 0 LAWRENCE H MOHR CPA P00447603 6128764500 2011 2016-02-24 21:20:13Z PATRICK BORAN 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 911537994 0 X WWW.NORTHMEMORIAL.COM X 1954 MN GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. 13 10 5490 975 10664153 102716 1348772 1036554 593451178 617110561 11126827 54576333 -2680145 -2308164 603246632 670415284 0 0 0 0 372951709 372718647 0 0 0 252198769 252459977 625150478 625178624 -21903846 45236660 638765423 557564309 335267433 241051561 303497990 316512748 X INSPRIRING EACH OTHER TO GIVE OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. 0 0 553186756 599239344 NORTH MEMORIAL MEDICAL CENTER IS A GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL - SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NMMC ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST).IN FURTHERANCE OF ITS CHARITABLE PURPOSE, NORTH MEMORIAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED PROGRAMS, SUCH A HEALTH SCREENINGS, SUPPORT COUNSELING FOR PARENTS 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, UNREIMBURSED COSTS OF MEDICAL EDUCATION, TELEPHONE INFORMATION SERVICES, AND COST RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. NORTH MEMORIAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH: (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES; AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, NORTH MEMORIAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE. 553186756 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 578 0 1 5490 1 1 1 1 BD 0 0 0 0 0 0 X 13 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X PATRICK BORAN 7635814562 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 ROBERT POTTS 1.00 X 4500 0 0 TIMOTHY BAYLOR 1.00 X 4500 0 0 YVONNE CHEUNG-HO 1.00 X 4500 0 0 WARREN MACK 1.00 X 4500 0 0 PAT MCHALE 1.00 X 0 0 0 JON NIELSON MD 1.00 X 122191 0 0 ROBERT PRENTISS 1.00 X 4500 0 0 KAREN RAUENHORST 1.00 X 4500 0 0 MIKE STEINHAUSER 1.00 X 0 0 0 BILL TOBIN 1.00 X 4500 0 0 MICHAEL WOOTEN MD 1.00 X 46000 0 0 LOREN TAYLOR 50.00 X X 807651 0 22052 BETTY PAKZAK MD 1.00 X 2700 0 0 PATRICK BORAN 50.00 X 464704 0 38809 DAVID ABRAMS 50.00 X 304147 0 53058 JOHN ALLEN 50.00 X 260057 0 21781 JOSEPH BOSTON 50.00 X 172437 0 12803 ANDREW COCHRANE 50.00 X 382446 0 19967 KEVIN CROSTON 50.00 X 582065 0 16652 VIRGINIA MALONE 50.00 X 260962 0 7591 MICHAEL PARRISH 50.00 X 310666 0 20738 PATRICK TAFFE 50.00 X 299987 0 20710 TOM TIMMONS 50.00 X 862402 0 21659 STEVEN ROH 50.00 X 758118 0 25045 THOMAS ROSSINI 50.00 X 842258 0 24960 GEORGE TADROS 50.00 X 690048 0 27952 PAMELA PAULSEN 50.00 X 644980 0 27387 ALOK MAHESHWARI 50.00 X 661083 0 24006 PAMELA LINDEMOEN 50.00 X 498750 0 707 JERRY MOEN 50.00 X 536826 0 2972 9541978 0 388849 388 1 1 0 ACCRETIVE HEALTH 39918 TREASURY CENTER CHICAGO IL 606949900 REVENUE CYCLE SUPPORT 9520912 NORTH CLINIC 3366 OAKDALE AVE N 601 ROBBINSDALE MN 55422 PHYSICIAN SERVICES 7160558 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 MANAGEMENT SUPPORT FOR DIETARY 3219754 RESPIRATORY CONSULTANTS PA 3366 OAKDALE AVE N 605 ROBBINSDALE MN 55422 INTENSIVISTS STAFFING 2451608 REVENUE CYCLE SOLUTIONS 4524 SOUTHLAKE PARKWAY 15 HOOVER AL 35244 A/R MANAGEMENT SERVICES 1499351 66 510908 525646 453093 1036554 HOSPITAL PATIENT REVEN 621500 612211661 601547508 10664153 PARKING 900099 1751949 1751949 CAFETERIA 900099 1035384 1035384 TRANSCRIPTION SERVICES 900099 884357 884357 COFFEE SHOP 900099 709740 709740 517470 517470 617110561 5455768 5455768 1648064 1648064 11816374 14124538 -2308164 -2308164 -2308164 274366193 104480 226419950 578222 47946243 -473742 47472501 47472501 670415284 599239344 10664153 59475233 5295645 5295645 291510261 260958074 30552187 22886949 20270213 2616736 32735148 28908356 3826792 20290644 17855767 2434877 1470333 1293893 176440 326215 287069 39146 104919 104919 677772 677772 45953264 40438872 5514392 1656933 1546101 110832 7876927 6931696 945231 20510413 18049163 2461250 1441509 1268528 172981 5315562 4675284 640278 33294154 29242006 4052148 6287676 5533155 754521 SUPPLIES 83633042 73597077 10035965 BAD DEBT EXPENSE 20882330 20882330 GOVERNMENTAL TAXES 9828217 9828217 MAINTENANCE & REPAIRS 8726153 7679015 1047138 4474558 3941940 532618 625178624 553186756 71991868 0 4337 9381 27090465 15675164 127615 345991 85657938 86029544 4185088 5595194 5504738 5825134 576379505 346752629 246159391 229626876 171363493 134867799 54829269 49276441 43843089 30312785 638765423 557564309 70005790 64071117 431998 443845 199617262 124176381 17889970 23513623 47322413 28846595 335267433 241051561 X 303497990 316512748 303497990 316512748 638765423 557564309 X 45236660 -32221902 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 40000 1 60000 0 0 100000 0 2251229 72500 71751 12813 2382667 1737891 513452 25341 24455 2252229 1537773 247046 17937 64865 1737891 1910328 -382648 19699 9606 1537773 0.98510 0.01490 0 1 1 15594663 15594663 218074551 96651930 121422621 14257915 7907097 6350818 318729615 236961266 81768349 9722761 5232336 4490425 229626876 RREEF AMERICA REIT II 18747140 F MELLON AGGREGATE BOND INDEX FUND 25019301 F CASH ON DEPOSIT WITH BOND TRUSTEE 5451111 F AGENCY ACCOUNT 58889 F 49276441 OHE - NORTH AMBULANCE DOUGLAS COUNTY 100000 ASSOCIATED HEALTH ASSURANCE, LTD 500000 INSTITUTE ATHLETIC MEDICINE 521294 NORTH RADIATION THERAPY CENTER 3643680 PREFERRED ADMINISTRATIVE SERVICES, INC. 10234144 NORTHPORT PROPERTIES 74067 PREFERRED ONE COMMUNITY HEALTH PLAN 328048 MCG CAA DEPOSIT RESERVE 176441 COVENANT NOT TO SELL (NET OF AMORTIZATION) 1155000 DEFERRED FINANCING COSTS 1794325 MINNESOTA DIAGNOSTIC IMAGING 1409941 MAPLE GROVE HOSPITAL 6174153 MONTICELLO CANCER CENTER 592522 VHA UPPER MIDWEST 200000 COLLATERAL SECURITY LENDING 2238554 MAPLE GROVE ASC 1170616 30312785 EXECUTIVE PENSION PLAN 5754618 RESTORATION PENSION PLAN 49311 PY PENSION LIABILITY 17784836 POST RETIREMENT HEALTH INSURANCE 2272554 SECURITIES LENDING 2808835 MCG CAA DEPOSIT RESERVE 176441 28846595 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ALL ENDOWMENT FUNDS ARE HELD BY A RELATED ENTITY: NORTH MEMORIAL FOUNDATION. 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWNMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD THE PAY IT FORWARD FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN. MICHELLE RECOGNIZED A NEED TO HELP WOMEN STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, UNITY AND MONTICELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE NORTH MEMORIAL FOUNDATION. 7) MEDICAL STAFF ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: NORTH MEMORIAL EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2011. NORTH MEMORIAL IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAX JURISDICTION. 1 1 1 X 1 X 1 1 1 0 1 1 12749158 12749158 0.02040 77061075 51904776 25156299 0.04020 89810233 51904776 37905457 0.06060 1929995 1929995 0.00310 5021049 3000994 2020055 0.00320 55373966 42234182 13139784 0.02100 464846 464846 0.00070 62789856 45235176 17554680 0.02800 152600089 97139952 55460137 0.08860 1 6884479 130526889 169355781 -38828892 X 1 1 1 MAPLE GROVE HOSPITAL HOSPITAL 0.75000 0.00000 0.00000 2 NM SURGERY CENTER MAPLE GROVE OUTPATIENT SURG CTR 0.50000 0.00000 0.50000 4 MN DIAGNOSTIC IMAGING PARTNERS OUTPATIENT IMAGING CTR 0.60000 0.00000 0.40000 5 PREFERRED ONE ADMINISTRATIVE SERVICES CLAIMS ADMINISTRATOR 0.25000 0.00000 0.25000 6 PREFERRED ONE COMMUNITY HEALTH PLAN INSURANCE COMPANY 0.50000 0.00000 0.00000 7 INSTITUTE OF ATHLETIC MEDICINE CLINIC 0.37000 0.00000 0.00000 10 MONTICELLO CANCER CENTER OPTNT CANCER CLINIC 0.40000 0.00000 0.00000 11 NORTH RADIATION ONCOLOGY OPTNT RADIATION ONC CLNC 0.50000 0.00000 0.00000 1 1 NORTH MEMORIAL MEDICAL CENTER

3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422

X X X X NORTH MEMORIAL MEDICAL CENTER 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 1 PART III, LINE 4: NORTH MEMORIAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT. PART III, LINE 8: THE SHORTFALL REPORTED REPRESENTS THE AMOUNT MEDICARE REIMBURSEMENT IS LESS THAN THE ESTIMATED COST OFPROVIDING SERVICES TO THOSE PATIENTS. THE METHOD USED TO ESTIMATE THOSE COSTS IS THE COST TO CHARGE RATIO APPROACH WHICH CALCULATES THE RATIO OF TOTAL HOSPITAL COSTS / TOTAL HOSPITAL GROSS REVENUE AND THEM APPLIES THAT RATIO TO TOTAL MEDICARE GROSS REVENUE. PART III, LINE 9B: NORTH MEMORIAL HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATIONS INTRANET AND PERTAIN TO ALL ENTITIES UNDER THE NORTH MEMORIAL CORPORATE UMBRELLA. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 19D: THE MINNESOTA ATTORNEY GENERAL'S OFFICE REQUIRES HOSPITALS TO RENDER SERVICES TO THOSE PATIENTS WHO DO NOT HAVE INSURANCE AT A REDUCED RATE EQUAL TO THE DISCOUNT INCURRED FROM THE HIGHEST VOLUME MANAGE CARE PLAN. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 21: PER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT, THIRD PARTY LIABILITY AND PROCEDURES THAT ARE NOT MEDICALLY NECESSARY ARE NOT COVERED UNDER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT AND THOSE PATIENTS CAN BE BILLED FULL CHARGES. PART VI, LINE 2: NORTH MEMORIAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF COMMUNITY BENEFITS AND CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE MANAGEMENT'S ESTIMATE OF THE COST TO PROVIDE CHARITY CARE, THE COST OF THE SERVICES AND SUPPLIES FURNISHED FOR COMMUNITY BENEFIT PROGRAMS AND PUBLIC PROGRAM PAYMENT DEFICITS. PART VI, LINE 3: NORTH MEMORIAL HEALTH CARE HAS A VERY PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE AN IMMEDIATE DISCOUNT TO UNINSURED MINNESOTA RESIDENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.OUR CHARITY CARE PROGRAM IS PUBLISHED IN THE CORPORATE POLICIES AND PROCEDURES AND PROVIDES FOR 100% COVERAGE OF MEDICAL BILLS FOR ANYONE WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND NEEDS ASSISTANCE IN RESOLVING THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. THERE IS A GRADUAL REDUCTION IN THE CHARITY COVERAGE BETWEEN THE 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES.IF WE ARE UNABLE TO MEET WITH THE PATIENT BEFORE DISCHARGE FROM NORTH MEMORIAL, THE PATIENT IS GIVEN A PAMPHLET THAT LISTS CONTACT NUMBERS TO OUR BUSINESS OFFICE CUSTOMER SERVICE AREA TO DISCUSS OPTIONS FOR ASSISTANCE WITH THEIR MEDICAL BILLS. THIS CONTACT INFORMATION IS ALSO PROVIDED ON EVERY STATEMENT THAT IS SENT TO OUR CUSTOMERS. IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE. PART VI, LINE 4: NORTH MEMORIAL SERVES A GEOGRAPHIC AREA THAT INCLUDES 42 ZIP CODES IN THE NORTHWEST QUADRANT OF THE TWIN CITIES METRO. THIS SERVICE AREA INCLUDES BOTH URBAN, SUBURBAN, EX-URBAN, AND RURAL AREAS. THIS SERVICE AREA INCLUDES A DIVERSE POPULATION OF MORE THAN 900,000 PEOPLE LIVING IN HENNEPIN, WRIGHT, SHERBURNE AND RAMSEY COUNTIES. PART VI, LINE 5: NORTH MEMORIAL HEALTH CARE IS A GENERAL ACUTE CARE HOSPITAL PROVIDING SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CARDIOVASULAR AND OPEN HEART SERVICES, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATIVE AND BEHAVIORAL SERVICES. NMHC ALSO PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO OUR COMMUNITY INCLUDING PRIMARY CARE, AMBULANCE TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. NORTH MEMORIAL IS GOVERNED BY A BOARD OF 15 REPRESENTATIVES CONSISTING OF PHYSICIANS AND VARIOUS LEADERS FROM THROUGHOUT THE COMMUNITY. BOARD MEMBERS ARE ELECTED TO SERVE THREE-YEAR TERMS FOR A TOTAL OF FIVE TERMS. THE MEDICAL CENTER ALSO SUPPORTS AN OPEN MEDICAL STAFF ORGANIZATION INCLUDING APPROXIMATELY 900 BOARD CERTIFIED PHYSICIANS AND 300 ALLIED HEALTH PROFESSIONSALS. THE NORTH MEMORIAL BOARD OF TRUSTEES ESTABLISHES AN ANNUAL MARGIN TARGET FOR MANAGEMENT. PER BOARD POLICY 75% OF ANY EXCESS AVAILABLE CASH FLOW IS REINVESTED IN THE FORM OF CAPITAL IMPROVEMENTS TO THE CENTER. THE REMAINING 25% IS REINVESTED TO SUPPORT LONG TERM OPERATIONS. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 LOREN TAYLOR 606008 0 0 0 201643 0 7653 0 14399 0 829703 0 0 0 PATRICK BORAN 341414 0 0 0 123290 0 30800 0 8009 0 503513 0 63278 0 DAVID ABRAMS 225000 0 0 0 79147 0 43124 0 9934 0 357205 0 72198 0 JOHN ALLEN 224980 0 0 0 35077 0 9373 0 12408 0 281838 0 0 0 JOSEPH BOSTON 148180 0 0 0 24257 0 5444 0 7359 0 185240 0 0 0 ANDREW COCHRANE 331154 0 0 0 51292 0 10402 0 9565 0 402413 0 0 0 KEVIN CROSTON 401954 0 0 0 180111 0 8063 0 8589 0 598717 0 0 0 VIRGINIA MALONE 260962 0 0 0 0 0 1246 0 6345 0 268553 0 0 0 MICHAEL PARRISH 261750 0 0 0 48916 0 10374 0 10364 0 331404 0 0 0 PATRICK TAFFE 256203 0 0 0 43784 0 10410 0 10300 0 320697 0 0 0 TOM TIMMONS 329930 0 0 0 532472 0 10495 0 11164 0 884061 0 0 0 STEVEN ROH 739800 0 0 0 18318 0 10691 0 14354 0 783163 0 0 0 THOMAS ROSSINI 748096 0 92136 0 2026 0 10508 0 14452 0 867218 0 0 0 GEORGE TADROS 688300 0 0 0 1748 0 10114 0 17838 0 718000 0 0 0 PAMELA PAULSEN 624731 0 0 0 20249 0 12768 0 14619 0 672367 0 0 0 ALOK MAHESHWARI 651050 0 0 0 10033 0 10691 0 13315 0 685089 0 0 0 PAMELA LINDEMOEN 0 0 0 0 498750 0 0 0 707 0 499457 0 61250 0 JERRY MOEN 22500 0 514326 0 0 0 1784 0 1188 0 539798 0 76769 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 1A: THE ORGANIZATION REIMBURSES ONE OF THE EXECUTIVE MEMBERS FOR THE MONTHLY SOCIAL DUES AT THE GOLDEN VALLEY COUNTRY CLUB. THE DUES FOR 2011 WERE $90 PER MONTH OR 1,080 PER YEAR. THE NORTH MEMORIAL COMMUNITY FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUND RAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORTS VARIOUS ACTIVITIES FOR NORTH MEMORIAL. SUPPLEMENTAL INFORMATION PART III PART I, LINE 2: ALL EXPENSES ARE REVIEWED PRIOR TO REIMBURSEMENT AND SIGNED OFF BY THE CEO. NORTH MEMORIAL REPORTS EXECUTIVE EXPENSE REIMBURSEMENT DATA TO THE BOARD OF TRUSTEES ON A PERIODIC BASIS. CITY OF MAPLE GROVE 410873250 56516TAD7 2005-09-22 55000000 CONSTRUCTION OF OUTPATIENT CENTER 0 1 0 CITY OF ROBBINSDALE 716005496 2011-06-07 60000000 REFUND SERIES 2008 BONDS 0 1 0 CITY OF ROBBINSDALE 716005496 2011-06-07 15000000 REFUND SERIES 2008 BONDS 0 1 0 54851782 4767980 1083801 49000001 2007 0 0 1 1 2263171 60000000 749350 58710650 2011 1 0 1 1 15000000 15000000 2011 1 0 1 1 0 1 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 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 ROBIN DRUG AND MERWIN PHARMACIES BOARD MEMBER IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES 705215 MICHAEL STEINHAUSER, A BOARD MEMBER, IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES, WHICH SUPPLY DRUGS AND PHARMACEUTICALS TO NORTH MEMORIAL HEALTH CARE. 0 OAKDALE OBGYN BOARD MEMBER IS AN OWNER OF OAKDALE OBGYN 526369 JON NIELSEN, A BOARD MEMBER, IS AN OWNER OF OAKDALE OBSTETRICS & GYNECOLOGY (A.K.A. OAKDALE OBGYN) WHICH PROVIDES GYNECOLOGICAL SERVICES TO NORTH MEMORIAL HEALTH CARE. 0 X 1 102662 FMV X FURNITURE 1 11568 FMV X EQUIPMENT 1 338863 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 LOREN TAYLOR AND BOB POTTS - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE REVIEWS THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEWS THE FORM 990 WITH THE FINANCE AND AUDIT COMMITTEE IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE FINANCE AND AUDIT COMMITTEE APPROVES THE FORM 990 AND FORWARDS IT TO THE FULL BOARD FOR ITS REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY POSITIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE SECRETARY OF THE STATE FILING WITH THE STATE OF MINNESOTA. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -15,015,163. CHANGE IN INTEREST RATE SWAP VALUATION -1,141,258. EQUITY TRANSFER -16,065,481. TOTAL TO FORM 990, PART XI, LINE 5: -32,221,902. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT WERE CHANGED DURING THE TAX YEAR. 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