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 450226558 TRINITY HEALTH 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 117316539 0 X WWW.TRINITYHEALTH.ORG X 1929 ND PROVIDES HEALTH EDUCATION AND HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHWESTERN MONTANA. 14 11 3620 335 285187 41702 0 0 69340026 77122957 1943443 2766347 -46178 -79455 71237291 79809849 3877 4029 0 0 57836081 65844876 0 0 0 30194866 28539608 88034824 94388513 -16797533 -14578664 308801061 357232945 436894994 498252150 -128093933 -141019205 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 7079228 8877361 TRINITY HEALTH RADIOLOGISTS ARE HIGHLY TRAINED AND SKILLED AT ASSESSING AND INTERPRETING X-RAYS, CT, NUCLEAR MEDICINE, ULTRASOUND, MRI SCANS AND MAMMOGRAPHY IMAGES. THEIR INTERPRETATION IS USED BY REFERRING PHYSICIANS, WHO ARE LESS WELL-TRAINED TO PLAN AND MANAGE PATIENT CARE. 8985258 10524698 TRINITY HEALTH PROVIDES OPTOMETRY SERVICE FOR GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS; OPHTHALMOLOGY WHO PROVIDE COMPREHENSIVE EYE AND VISION CARE, INCLUDING SURGERY TO REPAIR AND ENHANCE VISION; OPTOMETRY WHO PROVIDES GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS AND OPTICAL SALE OF CONTACT LENS AND EYEGLASSES. 5259073 2502042 TRINITY HEALTH HOSPITALISTS PROVIDE AND COORDINATE ALL ASPECTS OF INPATIENT AND OBSERVATION CARE FOR TRINITY HOSPITALS. 61018360 4029 55218856 TRINITY HEALTH PROVIDES EDUCATION & HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 61018360 4029 55218856 82341919 1 0 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 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 242 0 1 3620 1 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 MARTIN ROTHBERG 40.00 X 938535 0 53938 BLAINE 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 JOHN M KUTCH 20.00 X X 363778 0 48150 KEVIN COLLINS 40.00 X 655219 0 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 249412 0 41884 RANDY SCHWAN 20.00 X 165842 0 37534 PAUL SIMONSON 20.00 X 222498 0 45486 THOMAS WARSOCKI 20.00 X 156688 0 36852 DAVID KOHLMAN 20.00 X 119905 0 31418 SAMIR M TURK 40.00 X 1156509 0 59710 RAVINDRA P JOSHI 40.00 X 1107775 0 59004 BRUCE B SWENSON 40.00 X 910927 0 56150 DAVID A BILLINGS 40.00 X 853319 0 55314 MICHAEL G MCMAHON 40.00 X 904988 0 56063 ERNEST SELLAND 2.00 X 0 0 0 JEFFREY VERHEY 40.00 X 532310 0 50660 JOHN SHEEHAN 40.00 X 141094 0 34331 JAMES JENSEN 2.00 X 0 0 0 CHESTER REITEN 2.00 X 0 0 0 TERRY HOFF 20.00 X 20095 0 6175 NANCY HOLMES 20.00 X 214674 0 35397 NICOLE ROED 20.00 X 101238 0 9581 JULIE WALDERA 20.00 X 30508 0 3473 8674806 0 732496 193 1 1 0 COMMUNITY AMBULANCE SERVICE OF MINOT PO BOX 2195 MINOT ND 587022195 AMBULANCE SERVICE 2325810 COMPHEALTH MEDICAL STAFFING PO BOX 972651 DALLAS TX 753972651 LOCUM PHYSICIAN SERVICE 2107823 UNITED BLOOD SERVICE PO BOX 53022 PHOENIX AZ 85072 BLOOD SERVICE 1781140 DELTA LOCUM TENENS LP PO BOX 678082 DALLAS TX 752678082 LOCUM PHYSICIAN SERVICE 1550896 CREATIVE RADIOLOGY SOLUTIONS PC 1724 13TH ST NW MINOT ND 587031166 LOCUM PHYSICIAN SERVICE 1200000 49 REVENUE 621110 46151338 46151338 NET PATIENT SERVICE 621110 30686432 30686432 OPTICAL SALES 446199 185187 185187 MAOPS & B&B/NORTHWEST 561000 100000 100000 77122957 497133 497133 378046 378046 288218 259894 28324 28324 28324 39137964 37246796 1891168 1891168 1891168 JOINT VENTURE INCOME / 900099 -107779 -107779 -107779 79809849 78649483 285187 875179 4029 4029 3229731 1711177 1518554 55183819 54852699 331120 3159054 3078212 80842 1917405 1658907 258498 2354867 2225919 128948 1248091 48058 1200033 122518 122518 900069 840483 59586 616240 598748 17492 101879 101879 1048300 1020421 27879 289417 289417 MEDICAL DIRECTOR 10108466 10105970 2496 ALLOCATION 4962280 4962280 SUPPLIES 3053464 2952696 100768 RENTAL/MAINTENANCE 2652988 1908310 744678 BAD DEBT EXPENSE 2199099 2199099 1236797 1046873 189924 94388513 82341919 12046594 0 414816 798817 353132 357323 264229495 303970913 1735549 5546734 366249 476764 45721 157398 41595467 24354792 15000380 17240675 7556389 7556389 1956022 2447036 17143308 18680896 308801061 357232945 349387089 415048080 87507905 83204070 436894994 498252150 X -128093933 -141019205 -128093933 -141019205 308801061 357232945 X -14578664 1653392 X 0 1 1 X 0 X 0 305323 0 0 305323 313288 -5031 2934 305323 6823304 6823304 7978552 5583601 2394951 1297489 1257086 40403 22285228 17054850 5230378 3210894 459255 2751639 17240675 FUNDS HELD BY TRUSTEE 6033507 FUNDS HELD BLDG & EQUIP 791494 PRINCIPAL MUTUAL 10600052 DEFERRED DEBT EXPENSE 1053913 ACCRUED INTEREST 201930 18680896 79809849 94388513 -14578664 541494 1111898 1653392 -12925272 82379272 541494 2027929 2569423 79809849 0 79809849 94648407 259894 259894 94388513 0 94388513 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: EARNINGS FROM AFFILIATES 491,013. ADJUSTMENT TO MARKET 620,885. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 259,894. CHANGES IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1,768,035. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 259,894. 1 1 X 1 X 125.000000000000 1 X 125.000000000000 1 0 1 0 272148 272148 0.00290 272148 272148 0.00290 7 1125 19263 19263 0.00020 7 1125 19263 19263 0.00020 7 1125 291411 291411 0.00310 1 1342276 1 1 2 1 TRINITY HEALTH CENTER MEDICAL ARTS

400 BURDICK EXPRESSWAY EAST 4TH FLOOR MINOT ND 58701

ASC 2 TRINITY COMMUNITY CLINIC-WESTERN DAKOTA

1102 MAIN STREET WILLISTON ND 58701

ASC 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. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 MARTIN ROTHBERG 688264 0 52084 0 198187 0 0 0 53938 0 992473 0 980085 0 JOHN M KUTCH 322087 0 0 0 41691 0 0 0 48150 0 411928 0 224237 0 KEVIN COLLINS 290462 0 355373 0 9384 0 0 0 52442 0 707661 0 781893 0 KEVIN SEEHAFER 245846 0 0 0 3566 0 0 0 41884 0 291296 0 285797 0 RANDY SCHWAN 162276 0 0 0 3566 0 0 0 37534 0 203376 0 197870 0 PAUL SIMONSON 220698 0 0 0 1800 0 0 0 45486 0 267984 0 262509 0 THOMAS WARSOCKI 153122 0 0 0 3566 0 0 0 36852 0 193540 0 181897 0 SAMIR M TURK 942956 0 163714 0 49839 0 0 0 59710 0 1216219 0 1268627 0 RAVINDRA P JOSHI 843876 0 243314 0 20585 0 0 0 59004 0 1166779 0 1358329 0 BRUCE B SWENSON 585911 0 320649 0 4367 0 0 0 56150 0 967077 0 954253 0 DAVID A BILLINGS 441067 0 407885 0 4367 0 0 0 55314 0 908633 0 896054 0 MICHAEL G MCMAHON 290264 0 610357 0 4367 0 0 0 56063 0 961051 0 0 0 JEFFREY VERHEY 293943 0 130000 0 108367 0 0 0 50660 0 582970 0 0 0 JOHN SHEEHAN 136727 0 0 0 4367 0 0 0 34331 0 175425 0 0 0 NANCY HOLMES 205638 0 0 0 9036 0 0 0 35397 0 250071 0 284303 0 NICOLE ROED 100310 0 0 0 928 0 0 0 9581 0 110819 0 0 0 COUNTY OF WARD ND HEALTH CARE FACILITIES REVENUE BONDS SERIES 2006 456002248 934023EMO 2006-11-01 88455263 SEE SCHEDULE O 0 0 0 78145000 6538606 712412 203858 0 0 0 0 0 1 1 0 0 0.01810 0.01810 0 0 0 0 0 0 0 RAVINDRA JOSHI RECRUITMENT & RETENTION X 100000 0 0 1 1 KEVIN B COLLINS RECRUITMENT & RETENTION X 150000 59327 0 1 1 CHARLES B STILLERMAN RECRUITMENT & RETENTION X 105000 105000 0 1 1 164327 FORM 990, PART VI, SECTION B, LINE 11 BEFORE THE FORM 990 IS FILED WITH THE IRS, THE GOVERNING BODY OF TRINITY HEALTH 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 TO 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 990-T AVAILABE 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 FINANCIAL 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: 541,494. EARNINGS FROM AFFILIATES 491,013. ADJUSTMENT TO MARKET 620,885. TOTAL TO FORM 990, PART XI, LINE 5: 1,653,392. FORM 990, SCHEDULE K, PART I, BOX (F) PROCEEDS OF THE SERIES 2006 BONDS WERE USED (I) TO CURRENTLY REFUND THE COUNTY OF WARD, NORTH DAKOTA, ADJUSTABLE RATE DEMAND HEALTH CARE REVENUE BONDS (TRINITY OBLIGATED GROUP) TAX-EXEMPT SERIES 2002A (THE "SERIES 2002 BONDS"), OUTSTANDING IN THE AMOUNT OF $58,615,000, (II) TO FUND A TERMINATION PAYMENT FOR THE INTEREST RATE SWAP ASSOCIATED WITH THE SERIES 2002 BONDS, (III) TO ADVANCE REFUND THE COUNTY OF WARD, NORTH DAKOT HEALTH CARE FACILITIES REVENUE REFUNDING BONDS (TRINITY OBLIGATED GROUP) SERIES 1996A (THE "SERIES 1996A BONDS" AND TOGETHER WITH THE SERIES 2002 BONDS, THE "REFUNDABLE BONDS"), OUTSTANDING IN THE AMOUNT OF $9,400,000, (IV) TO FINANCE OR REIMBURSE THE CORPORATION FOR THE COSTS OF CERTAIN RENOVATION, REMODELING, AND EQUIPPING OF ITS HEALTH CARE FACILITIES (THE "PROJECT"), (V) TO FUND A DEPOSIT TO A DEBT SERVICE RESERVE FUND, AND (VI) TO PAY CERTAIN EXPENSES RELATING TO THE ISSUANCE OF THE SERIES 2006 BONDS AND THE REFUNDING OF THE SERIES 2002 BONDS AND THE SERIES 1996A BONDS. COMMUNITY AMBULANDE SERVICE OF MINOT INC PO BOX 2195 MINOT ND 587022195 450363593 TO PROVIDE AMBULANCE SERVICE TO THE MINOT AREA ND 501(C)(3) YES TRINITY HEALTH 0 MOUNTRAIL COUNTY MEDICAL CTR PO BOX 399 STANLEY ND 587840399 450447670 PROVIDE MEDICAL SERVICE TO THE AREA ND 501(C)(3) YES TRINITY HEALTH & BETHEL HOME 0 ST ANDREW'S BOTTINEAU CLINIC LLC 316 OHMER STREET BOTTINEAU ND 58318 450451306 PHYSICIAN CLINIC ND ST ANDREW'S HEALTH CENTER INVESTMENT -140626 16350 0 0 B&B DRUG INC 20 BURDICK EXPRESSWAY WEST MINOT ND 58701 450260565 RETAIL DRUG STORY ND TRINITY HEALTH C 226202 1886113 1.00000 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 B&B DRUG A 28000 FMV B&B DRUG F 45367 FMV B&B DRUG G 705881 FMV B&B DRUG K 197500 FMV COMMUNITY AMBULANCE K 2325810 FMV ST ANDREW'S BOTTINEAU CLINIC LLC B 167608 FMV COMMUNITY AMBULANCE F 28129 FMV