2012-11-14T08:02:28-06:00 2011-12-31 420714325 MCGLADREY LLP 400 LOCUST ST STE 640 DES MOINES IA 503092354 990 2011-01-01 410855367 OLMSTED MEDICAL CENTER OLMS 5072883443 210 NINTH STREET SE ROCHESTER MN 55904 TIM WEIR 5072883443 2012-11-12 1 VIRGINIA M STRIEGEL P00436877 5155586600 2011 2016-02-24 21:20:13Z ROY YAWN 210 NINTH STREET SE ROCHESTER MN 55904 165048777 0 X HTTP://WWW.OLMMED.ORG X 1949 MN THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY AND SERVICE. 16 10 1185 88 0 0 1086174 2330720 146157471 157809553 1100758 1885878 436012 733162 148780415 162759313 571070 471938 0 0 88288949 92827255 0 0 257841 47475721 50516373 136335740 143815566 12444675 18943747 145694422 163081129 59838471 58805266 85855951 104275863 X THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY AND SERVICE. 0 0 129078439 409411 158775354 PATIENT CARE: PERSONAL APPROACH TO CARE THROUGH MORE THAN 25 SPECIALTIES. ALL OF OUR SPECIALTY SERVICES COMPLIMENT PRIMARY CARE AND OFFER PATIENTS GREATER CONVENIENCE AND PEACE OF MIND. OUR TARGETED GROWTH HAS BEEN BASED ON A STRATEGIC PLANNING PROCESS THAT INVOLVES MORE STAFF THAN EVER BEFORE. AND, WE SAW POSITIVE RESULTS IN OUR PATIENT SATISFACTION AND CARE QUALITY REPORTS AS A RESULT OF OUR EFFORTS.IN 2011 WE TOOK STEPS TOWARD A MUCH LARGER PLAN TO POSITION OMC AS A PREFERRED HEALTHCARE PROVIDER FOR PRIMARY AND SECONDARY CARE AMONG SOUTHEASTERN MINNESOTA RESIDENTS. SOME IMPORTANT NEXT STEPS INCLUDE INCREASING THE AMOUNT OF DIRECT PATIENT INPUT IN IMPROVING EXPERIENCES AT OMC THROUGH PATIENT ADVISORY GROUPS. THIS INPUT SUPPORTS OMC'S ON-GOING CUSTOMER SERVICE EXCELLENCE INIATIVE, WHICH INCREASINGLY GUIDES THE WAY OUR EMPLOYEES ARE EVALUATED FOR THEIR WORK. WE CONTINUE TO MAKE CLINICAL SERVICE, FACILITIES,AND INFRASTRUCTURE UPGRADES IN OUR PATIENTS' BEST INTERESTS, AND WE PROUDLY CARRY ON OUR SUPPORT OF THE COMMUNITIES WE SERVE.IN 2011 WE RECEIVED THE NATIONAL HEALTHGRADES AWARD FROM THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS. OUR PATIENT SURVEY RANKED HIGHER THAN 14 OF 15 HOSPITALS IN THE REGION.WE WERE RECOGNIZED BY THE MINNESOTA HOSPITAL ASSOCIATION FOR OUR CONTINUED SUCCESSFUL PARTICIPATION IN THE PATIENT SAFETY CAMPAIGNS.WE ARE PARTICIPATING IN THE BEACON GRANT AIMED AT IMPROVING THE CARE OF DIABETIC AND ASTHMATIC PATIENTS.OMC RECEIVED IT FIFTH ANNUAL "BUSINESS GIVES" AWARD FROM THE MINNESOTA GOVERNER'S OFFICE AND THE ROCHESTER AREA CHAMBER OF COMMERCE IN RECOGNITION OF OUR COMMITMENT TO BE AN ACTIVE, CONTRIBUTING PARTNER IN THE COMMUNITIES WE SERVE.OMC VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING THE CHARITY CARE PROGRAM. ADDITIONALY, THE MINNESOTA ATTORNEY GENERAL REVIEWED AND APPROVED THE HOSPITAL'S BILLING AND COLLECTION POLICIES AND PRACTICES. 255550 62527 COMMUNITY OUTREACH AND SUPPORT ACTIVIITES: OMC WELCOMES ITS MANY OPPORTUNITIES TO BE AN ACTIVE, CONTRIBUTING PARTNER TO SOUTHEASTERN MINNESOTA'S HEALTH AND WELLNESS EFFORTS.OUR COMMUNITY INVESTMENT ACTIVITIES SUPPORTED 88 LOCAL AND REGIONAL ORGANIZATIONS. OUR SUPPORT FOR THOSE ORGANIZATIONS IS CONSISTENT WITH THE PEOPLE, PLACES AND INITIATIVES OUR EMPLOYEES SERVE IN THEIR OWN VOLUNTEER WORK. IN 2011 EMPLOYEES VOLUNTEERED AN AVERAGE OF 11 HOURS OF PERSONAL TIME. USING THE INDEPENDENT SECTOR'S ESTIMATED DOLLAR VALUE OF VOLUNTEER TIME ($21.79 PER HOUR FOR 2011, ACCORDING TO WWW.INDEPENDENT-SECTOR.ORG), THIS MEANS OMC EMPLOYEES WHO VOLUNTEER CONTRIBUTED $240 PER EMPLOYEE PER MONTH OR $2,880 PER EMPLOYEE PER YEAR. THE 346 EMPLOYEES SURVEYED CONTRIBUTED OVER $996,000 DOLLARS IN PERSONAL AND PROFESSIONAL VOLUNTEER TIME AND EFFORTS.OMC WAS ACTIVELY INVOLVED WITH THE MAYO CLINIC, OLMSTED COUNTY AND THE ROCHESTER PUBLIC SCHOOLS IN A FREE VACCINATION PROGRAM. WE HELD MULTIPLE WALK-IN VACCINATION CLINICS WORKING CLOSELY WITH LOCAL PARTNERS TO EDUCATE OUR COMMUNITIES. 2333226 2193556 RESEARCH: AT OLMSTED MEDICAL CENTER, WE HAVE STUDIED SCREENING FOR ASTHMA, SCOLIOSIS, NEAR-SIGHTEDNESS, AND COPD. WE HAVE LEARNED HOW TO IMPROVE CHILDHOOD IMMUNIZATION RATES, DEVELOPED WAYS TO FIND AND TREAT POSTPARTUM DEPRESSION, CREATED NEW TOOLS TO IMPROVE ASTHMA CARE, LOOKED AT TWO TYPES OF SURGERY FOR CARPAL TUNNEL PROBLEMS, AND STUDIED SHINGLES. RESEARCH USING MEDICAL RECORDS IS VERY IMPORTANT TO MEDICAL SCIENCE AND MEDICAL CARE. USE OF ANONYMOUS INFORMATION IN MEDICAL RECORDS HAS HELPED RESEARCHERS FIND BETTER WAYS TO TREAT HEART ATTACKS, LEARN ABOUT SIDE EFFECTS OF SEVERAL DRUGS, AND FIND RISK FACTORS FOR COMMON PROBLEMS SUCH AS STROKES, HEART ATTACKS, AND CANCER. THE ROCHESTER EPIDEMIOLOGY PROJECT (REP) - THE ROCHESTER EPIDEMIOLOGY PROJECT IS AN INITIATIVE TO COLLECT, ARCHIVE, AND LINK MEDICAL INFORMATION FOR THE APPROXIMATELY 120,000 PEOPLE LIVING IN OLMSTED COUNTY, MN. THIS PROJECT ALLOWS MEDICAL RESEARCHERS TO STUDY HEALTH AND ILLNESSES IN THE PEOPLE LIVING IN THIS COMMUNITY. WE USE THE ACRONYM REP FOR BREVITY. OLMSTED MEDICAL CENTER, THE MAYO CLINIC, THE ROCHESTER FAMILY MEDICINE CLINIC, AND OTHER MEDICAL CARE PROVIDERS IN OLMSTED COUNTY, MN, HAVE AGREED TO WORK TOGETHER AND SHARE THEIR MEDICAL RECORDS WITH RESEARCHERS TO BETTER UNDERSTAND THE CAUSES AND OUTCOMES OF DIFFERENT ILLNESSES AND TO IMPROVE THE HEALTH AND HEALTH CARE OF THE ENTIRE COUNTY. THIS COLLARBORATION AND SHARING OF MEDICAL INFORMATION MAKES OLMSTED COUNTY ONE OF THE FEW PLACES IN THE UNITED STATES, AND ONE OF THE FEW PLACES IN THE WORLD, WHERE "POPULATION-BASED" RESEARCH CAN BE ACCOMPLISHED. THIS IS VERY IMPORTANT BECAUSE HEALTH RESEARCH BASED ON PEOPLE WHO ARE SEEN BY A SINGLE DOCTOR OR AT A SINGLE CLINIC HAS LIMITATIONS AND CANNOT BE GENERALIZED. USING REP, WE CAN FIGURE OUT THE TRUE FREQUENCY OF CERTAIN CONDITIONS (E.G. HOW MANY NEW PATIENTS DEVELOP HEART DISEASE EACH YEAR AMONG 100 PERSONS AGED 70 TO 79 YEARS) AND THE TRUE SUCCESS OF TREATMENTS (E.G. HOW MANY PERSONS WILL RESPOND POSITIVELY TO A NEW ANTI-DEPRESSANT MEDICATION). THIS PROJECT HAS BEEN SUPPORTED BY FUNDS FROM THE NATIONAL INSTITUTES OF HEALTH FOR OVER 40 YEARS.BEACON COMMUNITY PROJECT - OMC ASSUMED A LEADERSHIP ROLE IN THE FEDERALLY FUNDED $12.2 MILLION SOUTHEAST MINNESOTA REGION BEACON COMMUNITY PROJECT AND ITS GOAL OF CREATING A NATIONAL MODEL FOR THE SECURE EXCHANGE OF PATIENTS' HEALTH INFORMATION AT ANY POINT OF CLINICAL SERVICE. 131667215 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 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 216 0 1 1185 1 0 0 0 0 0 0 0 0 0 0 X 16 10 0 0 0 0 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X KEVIN HIGGINS 5075296600 210 9TH STREET SE ROCHESTER MN 55904 X CHARLES BRANCH MD 40.00 X 527304 0 50766 RANDY HEMANN MD 40.00 X 247828 0 52565 JAMES HOFFMANN MD 40.00 X 388485 0 51970 LINDA WILLIAMS MD 30.00 X 209036 0 35512 JOHN DOYLE 1.00 X X 0 0 0 ROY A YAWN MD 40.00 X X 413065 0 37364 WENDY SHANNON 1.00 X 0 0 0 JIM GANDER 1.00 X 0 0 0 JAY HESLEY 1.00 X 0 0 0 KATIE RYAN 1.00 X 0 0 0 JUSTIN MCNEILUS 1.00 X 0 0 0 JAMES MCPEAK JR 1.00 X 0 0 0 JULIE ANDERSON 1.00 X 0 0 0 MARY BENIKE KISILEWSKI 1.00 X 0 0 0 JAY MYERS 40.00 X X 471768 0 51357 MELISSA BRINKMAN 1.00 X 0 0 0 TOM SLIGHTAM 1.00 X 0 0 0 TIM WEIR 40.00 X 421626 0 52509 KEVIN HIGGINS 40.00 X 265703 0 52410 DAVID WESTGARD MD 40.00 X 400307 0 48027 DR SRDAN BABOVIC 40.00 X 673536 0 30693 DR VIDHAN CHANDRA 40.00 X 658681 0 33344 DR JEFFREY BECKENBAUGH 40.00 X 585335 0 53679 DR DAVID LOWE 40.00 X 552824 0 52132 DR MARIO POTVIN 40.00 X 539336 0 51799 DR KATHRYN LOMBARDO 40.00 X 411595 0 31933 DR THOMAS ERBACH 40.00 X 375053 0 43494 7141482 0 729554 142 1 1 0 WEIS BUILDERS INC 2227 7TH STREET NW ROCHESTER MN 55901 CONSTRUCTION 4919294 MAYO COLLABORATIVE SERVICES 200 1ST STREET SW ROCHESTER MN 55905 LAB SERVICES 1118264 MCKESSON INFORMATION SYSTEMS PO BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 874172 GE HEALTHCARE 2984 COLLECTION CTR DR CHICAGO IL 60693 SOFTWARE SUPPORT 660858 CONSTRUCTION COLLABORATIVE 320 SOUTH BROADWAY ROCHESTER MN 55904 CONSTRUCTION 650167 22 137164 1648569 544987 2330720 NET PATIENT SERVICES 621110 157809553 157809553 157809553 1138604 1138604 96453 0 96453 96453 96453 1687550 1349188 1427076 862388 260474 486800 747274 486800 260474 CAFETERIA REVENUE 722210 157708 157708 479001 479001 636709 162759313 158775354 0 1653239 471938 471938 3745466 2294734 1450732 68963899 64609095 4147018 207786 6117231 5594164 504974 18093 8604383 7841494 745808 17081 5396276 4842027 539368 14881 213130 139648 73482 200059 200059 138504 138504 18887 5250 13637 5660690 4879244 781446 204992 14683 190309 3349646 2899999 449647 629642 357846 271796 4150316 3745728 404588 60553 54322 6231 766733 583370 183363 1067268 1067268 4470934 4470934 778890 778890 MEDICAL SUPPLIES 13411572 13411572 PROVISION FOR BAD DEBTS 7202874 7202874 EQUIPMENT & SOFTWARE MA 3028535 2041094 987441 MINNESOTACARE TAX 2591305 2591305 2571843 1769736 802107 143815566 131667215 11890510 257841 61172009 64577957 20221700 24394812 1205462 1263932 1503567 1616650 95404885 34266874 51122631 61138011 9558116 9231207 910937 858560 145694422 163081129 4346489 3105695 310228 673586 28077043 26503775 480000 320000 7448623 7000933 19176088 21201277 59838471 58805266 X 85855951 104275863 85855951 104275863 145694422 163081129 X 18943747 -523835 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5285183 5285183 58304056 14415481 43888575 31652831 19713001 11939830 162815 138392 24423 61138011 PAYROLL LIABILITY 12961879 OTHER ACCRUED LIABILITY 5616580 ACCRUED INTEREST 739845 ACCRUED REAL ESTATE TAXES 678948 THIRD PARTY PAYOR SETTLEMENTS 1204025 21201277 162759313 143815566 18943747 -523835 -523835 18419912 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: OLMSTED MEDICAL CENTER AND THE OMC REGIONAL FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES AS TAX-EXEMPT ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT FOR INCOME ON CERTAIN UNRELATED BUSINESS INCOME. THERE IS NO MATERIAL UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2011 AND 2010. THE MEDICAL CENTER AND FOUNDATION ARE ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE MINNESOTA STATUTES. THE MEDICAL CENTER AND FOUNDATION FILE FEDERAL AND STATE INCOME TAX RETURNS. GENERALLY, THE ORGANIZATION AND THE FOUNDATION ARE NO LONGER SUBJECT TO STATE AND FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEAR ENDED DECEMBER 31, 2007, AND PRIOR. 1 1 X 1 X 230.000000000000 1 X 260.000000000000 1 1 1 0 1 1 1990276 1990276 0.01460 25704900 17242801 8462099 0.06190 3154900 408195 2746705 0.02010 30850076 17650996 13199080 0.09660 620807 620807 0.00450 626662 626662 0.00460 2333226 2193556 139670 0.00100 471938 471938 0.00350 4052633 2193556 1859077 0.01360 34902709 19844552 15058157 0.11020 0 7202874 659490 10714222 14685721 -3971499 X 1 1 1 1 OLMSTED MEDICAL CENTER-HOSPITAL

1650 4TH STREET SE ROCHESTER MN 55904

X X X X URGENT CARE OLMSTED MEDICAL CENTER 1 0 1 1 260.000000000000 1 260.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 16 OLMSTED MEDICAL CENTER - MAIN CLINIC

210 NINTH STREET SE ROCHESTER MN 55904

MAIN CLINIC - OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - BYRON CLINIC

846 HIGH POINT DR NE BYRON MN 55920

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - CHATFIELD CLINI

207 TWIFORD STREET SW CHATFIELD MN 55923

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - NORTHWEST CLINIC

4303 HIGHWAY 52N ROCHESTER MN 55901

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PINE ISLAND CLINIC

111 COUNTY ROAD 11 NW PINE ISLAND MN 55963

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PLAINVIEW CLINIC

20 2ND AVENUE NE PLAINVIEW MN 55964

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PRESTON CLINIC

405 KANSAS STREET NW PRESTON MN 55965

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - ST CHARLES CLINIC

403 W FOURTH STREET ST CHARLES MN 55972

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - SPRING VALLEY CLINIC

302 WEST TRACY ROAD SPRING VALLEY MN 55975

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - STEWARTVILLE CLINIC

208 CENTERTOWN PLAZA STEWARTVILLE MN 55976

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - WANAMINGO CLINIC

217 MAIN STREET STE B WANAMINGO MN 55983

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - FASTCARE NORTH CLINIC

3708 HIGHWAY 63N ROCHESTER MN 55906

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - FASTCARE SOUTH CLINIC

2820 S BROADWAY ROCHESTER MN 55904

OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - CENTER FOR WELLNESS

821 THIRD AVENUE SE ROCHESTER MN 55904

WELLNESS CENTER OLMSTED MEDICAL - PHYSICAL THERAPY

102 ELTON HILLS DRIVE ROCHESTER MN 55901

PHYSICAL THERAPY CENTER OLMSTED MEDICAL - RESEARCH DEPT

829 3RD AVE SE KINGS ROW ROCHESTER MN 55904

RESEARCH FACILITY PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED FOR DETERMINING FINANCIAL ASSISTANCE. PART I, LINE 7: LINE 7A-7C: AMOUNTS SHOWN ARE BASED UPON A COST-TO-CHRAGE RATIO FROM IRS WORKSHEET 2.LINE 7E-7I: AMOUNTS SHOWN ARE BASED UPON THE ORGANIZATIONS COST ACCOUNTING SYSTEM. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 7202874. PART I, LINE 6A: THE OLMSTED MEDICAL CENTER ANNUAL REPORT IS MADE WIDELY AVAILABLE AND IS AVAILABLE ON THE WEBSITE. PART III, LINE 4: THE FOOTNOTE FROM THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF PATIENT ACCOUNTS RECEIVABLE PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA.THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE: ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.AS REPORTED ON THE AUDITED FINANCIAL STATEMENTS, THE COMMUNITY BENEFIT OF COSTS IN EXCESS OF MEDICARE PAYMENTS WAS $10,617,532. PART III, LINE 9B: PATIENT FINANCIAL HARDSHIP POLICY: TO SUPPORT THE ORGANIZATION'S MISSION AND PHILOSOPHY IN THAT THE PATIENT COMES FIRST AND PROVIDE A GUIDELINE IN IDENTIFYING PATIENT'S WHO HAVE AN EXCEPTIONAL PERSONAL FINANCIAL HARDSHIP AND REQUIRED NEEDED AND NECESSARY MEDICAL CARE AND THERE IS REMOTE OR NEGLIBLE CHANCE THAT THE INDIVIDUAL WILL BE ABLE TO REPAY. PROCEDURE: FACTORS THAT MAY CONTRIBUTE TO EXCEPTIONAL FINANCIAL HARDSHIP INCLUDE:1) UNEMPLOYMENT OR UNDEREMPLOYMENT THROUGH NO FAULT OF THE PATIENT AND/OR FAMILY; 2) THREATENED LOSS OF SHELTER THROUGH FORECLOSURE, ETC; 3) LOSS OF INCOME FROM FEDERAL, STATE OR OTHER GOVERNMENT BENEFITS INCLUDING, BUT NOT LIMITED TO SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, PUBLIC ASSISTANCE, ETC; 4) LOSS OF INCOME DUE TO DEATH OR DISABILITY; 5) EXCEPTIONAL EXPENSES INCURRED BECAUSE OF UNINSURED PROPERTY DAMAGE OR COSTLY REPAIRS TO PRINCIPAL RESIDENCE; 6) EXCEPTIONAL EXPENSES DUE TO TEMPORARY OR CHRONIC ILLNESS; 7) EXCEPTIONAL EXPENSES DUE TO INCREASE IN LIVING EXPENSES BECAUSE OF A DIVORCE, ABANDONMENT OR SEPARATION FROM SPOUSE OR INCOME EARNER; 8) LOSS OF INCOME DUE TO DECLARATION OF INCOMPETENCE OR IN PROCESS OF BEING DECLARED INCOMPETENT; 9) PATIENT OR FAMILY MEMBER IS CONFINED TO A CONVALESCENT HOME OR OTHER RESIDENCE OTHER THAN THEIR PRINCIPAL RESIDENCE; 10) NATURAL DISASTERS SUCH AS FLOODS, FIRES, HURRICANES AND EARTHQUAKES; 11) EVICTION, HOMELESSNESS, LOSS OF OWNED RESIDENCE, ARSON, THEFT, ETC; 12) DISCONTINUANCE OF UTILITIES OR HEAT, OR UNSAFE OR UNHEALTHY LIVING CONDITIONS; 13) ANY OTHER CONDITION CONSIDERED LIFE THREATENING DUE TO EXCEPTIONAL FINANCIAL HARDSHIP.APPLICATION PROCESS: THE FINANCIAL HARDSHIP APPLICATION, UTILIZING OMC'S FINANCIAL ASSISTANCE APPLICATION, CONTAINS THE NECESSARY INFORMATION TO DETERMINE ELIGIBILITY FOR THE OMC FINANCIAL HARDSHIP PROGRAM. NO SEPARATE APPLICATION IS NECESSARY. SUPPORTING DOCUMENTATION REQUIRED TO MAKE AN ELIGIBILITY DETERMINATION ARE: 1) MOST RECENT TAX RETURNS, 2) CURRENT FAMILY PAYROLL STUB SHOWING YEAR-TO-DATE INCOME; 3) CURRENT TRANSUNION CREDIT REPORT AND OTHER FINANCIAL HARDSHIP DOCUMENTATION TO SUPPORT HARDSHIP; 4) EXPLANATION OF HARDSHIP SITUATION/NECESSITY AND RARE COMPLICATIONS.ELIGIBILITY DETERMINATION: BASED UPON PATIENT'S/FAMILY'S INCOME AND ASSETS AND COMPLETED FINANCIAL ASSISTANCE APPLICATION. BASED UPON TAKING INTO CONSIDERATION ALL PERSONAL FACTORS IN DETERMINING EXCEPTIONAL FINANCIAL HARDSHIP. THE BUSINESS SERVICES DEPARTMENT EVALUATES THE APPLICATIONS MEETING THE CRITERIA AND PRESENTS TO ADMINISTRATION FOR APPROVAL. OMC RESERVES THE RIGHT TO MAKE ADJUSTMENT DETERMINATIONS ON A CASE-BY-CASE BASIS. PART III, SECTION A, LINE 1: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 11H: OMC VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING THE CHARITY CARE PROGRAM. ADDITIONALY, OMC HAS SIGNED AN AGREEMENT WITH THE MINNESOTA STATE ATTORNEY GENERAL TO FOLLOW THE ATTORNEY GENERAL'S BILLING AND COLLECTION PRACTICES PER THE ATTORNEY GENERAL'S LETTER. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 19D: THERE WAS NO CAP ON THE AMOUNT OF PATIENT FAP. PART V, SECTION B, LINE 14: OMC VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING THE CHARITY CARE PROGRAM. ADDITIONALY, OMC HAS SIGNED AN AGREEMENT WITH THE MINNESOTA STATE ATTORNEY GENERAL TO FOLLOW THE ATTORNEY GENERAL'S BILLING AND COLLECTION PRACTICES PER THE ATTORNEY GENERAL'S LETTER. PART VI, LINE 2: OMC ACTIVELY WORKS WITH LOCAL GOVERNMENT IN ASSESSING AND ADDRESSING COMMUNITY NEEDS THROUGH MEETINGS, WORKSHOPS, AND COMMUNITY INPUT. IN ADDITION, OMC IS ACTIVELY INVOLVED WITH LOCAL GOVERNMENTS IN EMERGENCY PREPAREDNESS AND DISEASE MANAGEMENT. PART VI, LINE 3: OMC INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AND ASSISTS PATIENTS WHO INDICATE AN INABILITY TO PAY. OMC INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAMS BY PROVIDING THE FINANCIAL ASSISTANCE POLICY ON BROCHURES IN THE NEW PATIENT PACKET AND AT THE FRONT DESK FOR ALL PATIENTS. THE POLICY IS ALSO PROVIDED ON THE BACK OF THE HOSPITAL BILL STATEMENTS, ON THE HOSPITAL WEBSITE AND ON THE HOSPITAL'S ONLINE BILL-PAY SYSTEM. OMC PATIENT FINANCIAL COUNSELORS PROVIDE INFORMATION TO PATIENTS REGARDING AVAILABLE HEALTHCARE FINANCIAL COVERAGE OPTIONS, SUCH AS: 1) MEDICAL ASSISTANCE, 2) MINNESOTA CARE, 3) OTHER FINANCIAL SERVICES AVAILABLE FOR LOW INCOME FAMILIES IN THE COMMUNITY, 4) OMC'S FINANCIAL ASSISTANCE PROGRAM.THE PATIENT FINANCIAL COUNSELORS ASSIST OMC PATIENTS IN THE APPLICATION PROCESS. ALL APPLICATIONS ARE PROCESSED IN A TIMELY MANNER. PATIENT APPLICATIONS ARE CONSIDERED FOR CURRENT PATIENT RESPONSIBLE BALANCES, AS WELL AS NEAR FUTURE SCHEDULED MEDICAL SERVICES. PATIENTS MAY QUALIFY FOR FULL OR PARTIAL FINANCIAL ASSISTANCE. PATIENT FINANCIAL COUNSELORS NOTE PATIENT'S ACCOUNT VIA ON-LINE NOTES REGARDING APPLICATIONS SENT, APPLICATIONS IN PROCESS, AND WHETHER APPLICATIONS HAVE BEEN APPROVED, DENIED, OR ADDITIONAL INFORMATION IS REQUIRED. THE PATIENT FINANCIAL COUNSELORS INFORM THE PATIENT VIA A LETTER REGARDING THE DETERMINATION (APPROVED, DENIED, OR PARTIAL COVERAGE APPROVED) OF THE RECEIVED AND COMPLETED APPLICATION. PRIOR TO TURNING ACCOUNTS OVER THE THIRD PARTY COLLECTION, THE ACCOUNT WILL BE REVIEWED FOR POSSIBLE FINANCIAL ASSISTANCE PROGRAM QUALIFICATION THROUGH THE E-BUREAU PROCESS. PART VI, LINE 4: OMC IS A REGIONAL HEALTH CARE FACILITY SERVING PATIENTS WITHIN A FORTY FIVE MILE RADIUS OF ROCHESTER, MN. PART VI, LINE 5: THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE AREA.THE ORGANIZATION UTILIZES ITS SURPLUS FUNDS TO INCREASE THE SERVICES OFFERED TO ITS PATIENTS. THE ORGANIZATION HAS EXPANDED THE OPERATIONS AT FASTCARE FACILITIES AND ADDED CARDIOLOGY AND ENDOCRINOLOGY SERVICES FOR ITS PATIENTS. PART VI, LINE 6: N/A PART VI, LINE 7: THE ORGANIZATION DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF MINNESOTA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE MINNESOTA HOSPITAL ASSOCIATION WHICH IS THEN USED IN A STATEWIDE SUMMARY REPORT OF COMMUNITY BENEFITS PROVIDED BY MINNESOTA HOSPITALS. 1 OLMSTED MEDICAL CENTER REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 501(C)(3) 409411 PROVIDE FUNDING TO OMC REGIONAL FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES. ROCHESTER CIVIC THEATRE 20 CIVIC CENTER DR ROCHESTER MN 55904 410829271 501(C)(3) 5500 PROVIDE FUNDING TO UNDERWRITE CHILDREN'S PROGRAMPROVIDE FUNDING TO UNDERWRITE CHILDREN'S PROGRAM 2 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MOST OF GRANT EXPENDITURES ARE PROVIDED TO OLMSTED MEDICAL CENTER REGIONAL FOUNDATION, A RELATED ORGANIZATION. OMC PROVIDES FUNDS TO THE FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES AS NEEDED. THERE ARE NUMEROUS WAYS TO MONITOR THE USE OF THE GRANT FUNDS. MANY OF THE EVENTS ARE OPEN TO THE PUBLIC AND EASILY VERIFIABLE. STAFF OFTEN ASSIST AS VOLUNTEERS. THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE ITS MISSION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS COMMUNITY NEEDS IN THE HEALTH CARE AREA. NO ADDITIONAL MONITORING IS PERFORMED. X X X X X 0 0 0 0 0 0 0 0 0 CHARLES BRANCH MD 521948 0 0 0 5356 0 26950 0 23816 0 578070 0 0 0 RANDY HEMANN MD 236564 0 9662 0 1602 0 26950 0 25615 0 300393 0 0 0 JAMES HOFFMANN MD 380955 0 5630 0 1900 0 26950 0 25020 0 440455 0 0 0 LINDA WILLIAMS MD 200361 0 5884 0 2791 0 20528 0 14984 0 244548 0 0 0 ROY A YAWN MD 345627 0 59975 0 7463 0 26950 0 10414 0 450429 0 0 0 JAY MYERS 463740 0 6520 0 1508 0 26950 0 24407 0 523125 0 0 0 TIM WEIR 333767 0 87043 0 816 0 26950 0 25559 0 474135 0 0 0 KEVIN HIGGINS 225715 0 39652 0 336 0 26950 0 25460 0 318113 0 0 0 DAVID WESTGARD MD 312117 0 81735 0 6455 0 26950 0 21077 0 448334 0 0 0 DR SRDAN BABOVIC 671943 0 75 0 1518 0 26950 0 3743 0 704229 0 0 0 DR VIDHAN CHANDRA 657616 0 75 0 990 0 26950 0 6394 0 692025 0 0 0 DR JEFFREY BECKENBAUGH 584270 0 75 0 990 0 26950 0 26729 0 639014 0 0 0 DR DAVID LOWE 551759 0 75 0 990 0 26950 0 25182 0 604956 0 0 0 DR MARIO POTVIN 537743 0 75 0 1518 0 26950 0 24849 0 591135 0 0 0 DR KATHRYN LOMBARDO 396951 0 12840 0 1804 0 26950 0 4983 0 443528 0 0 0 DR THOMAS ERBACH 362962 0 7386 0 4705 0 26950 0 16544 0 418547 0 0 0 SUPPLEMENTAL INFORMATION PART III COMPENSATION PAID TO PHYSICIAN TRUSTEES IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS EMPLOYED PHYSICIANS OF THE ORGANIZATION. SUPPLEMENTAL INFORMATION PART III SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED FOR DETERMINING COMPENSATION. CITY OF CHATFIELD MINNESOTA 416005045 161817CE9 2004-11-15 8000000 HOSPITAL CONSTRUCTION 0 0 0 CITY OF CHATFIELD MINNESOTA 416005045 2006-04-13 2651915 HOSPITAL CONSTRUCTION 0 0 0 CITY OF ROCHESTER MINESOTA 416005494 771902FY4 2010-07-07 20360000 CLINIC CONSTRUCTION 0 0 0 8000000 768104 160000 7071896 2005 0 0 1 1 2651915 51915 2600000 2006 0 0 1 1 20202546 1709215 1341963 407200 18243585 17968405 275180 2011 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 STERLING STATE BANK - SEE BELOW X 800000 320000 0 1 1 320000 JULIE WINKELS FAMILY MEMBER OF THOMAS WINKELS, FORMER TRUSTEE 45125 EMPLOYEE OF ORGANIZATION 0 DR LOUIS WAGNER FAMILY MEMBER OF DR. LINDA WILLIAMS, TRUSTEE 445099 EMPLOYEE OF ORGANIZATION 0 DR BARBARA YAWN FAMILY MEMBER OF DR. ROY YAWN, PRESIDENT 184270 EMPLOYEE OF ORGANIZATION 0 MERCHANTS BANK JOHN DOYLE, BOARD CHAIR, SERVES AS PRESIDENT OF MERCHANTS BANK 531640 OPERATING LEASE PAYMENTS ON RIS/PACS SYSTEM 0 PART II INTERESTED PERSON DESCRIPTION STERLING STATE BANK - JUSTIN MCNEILUS, TRUSTEE, IS FAMILY MEMBER OF MAJORITY OWNER OF BANK; ROY YAWN, PRESIDENT, IS BOARD MEMBER OF BANK; TOM WINKELS, FORMER TRUSTEE, IS PRESIDENT OF BANK. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF GOVERNORS IS ELECTED BY PHYSICIAN VOTE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE FINANCIAL SERVICES MANAGER, CONTROLLER AND CFO. ANY NECESSARY CORRECTIONS AND ADJUSTMENTS ARE MADE. THE FORM 990 IS REVIEWED BY THE CEO AND CFO AND PRESENTED TO THE COMPENSATION COMMITTEE. THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PER OMC POLICY THE BOARD OF TRUSTEES AND PRINCIPAL OFFICERS ANNUALLY SIGN CONFLICT OF INTEREST STATEMENTS. SIGNED CONFLICT OF INTEREST STATEMENTS ARE OBTAINED AND REVIEWED BY SENIOR MANAGEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 IN ORDER TO ENSURE THAT ALL OLMSTED MEDICAL CENTER (OMC) EXECUTIVE COMPENSATION DECISIONS ARE COMPETITIVE, EQUITABLE, UNIFORMLY ADMINISTERED, AND CONSISTENT WITH MARKET PRACTICES, OMC FOLLOWS RECOMMENDED BEST PRACTICES. THE GOALS OF EXECUTIVE COMPENSATION ARE TO ATTRACT AND RETAIN HIGHLY QUALIFIED PERSONNEL, TO MAINTAIN COMPENSATION LEVELS COMMENSURATE WITH THE SCOPE OF RESPONSIBILITIES FOR EACH POSITION, AND TO REWARD OUTSTANDING PERFORMANCE. OMC WILL SEEK MANAGEMENT TALENT BY CONDUCTING NATIONAL SEARCHES FOR QUALIFIED APPLICANTS FOR ANY VACANCIES AT THE CMO AND CEO POSITIONS IN ADDITION TO VICE PRESIDENT POSITIONS AS NECESSARY. THE SAME PHILOSOPHY IS APPLICABLE TO THE POSITION OF OMC PRESIDENT. PEER GROUPS FOR EXECUTIVE COMPENSATION, WHICH INCLUDES BASE SALARIES, INCENTIVE AND BENEFITS, WILL BE INTEGRATED HEALTH DELIVERY SYSTEMS WITH A MINIMUM OF A HOSPITAL AND AN EMPLOYED PHYSICIAN NETWORK AND NET REVENUES ROUGHLY SIMILAR TO THE REVENUES OF OLMSTED MEDICAL CENTER. OMC ENGAGES AN EXTERNAL CONSULTANT WHO COMPILES A PEER GROUP COMPENSATION AND BENEFIT ANALYSIS ON A TWO YEAR BASIS. MOST RECENTLY IN DECEMBER 2011, A COMPENSATION PEER REVIEW STUDY WAS COMPLETED FOR THE CEO, PRESIDENT AND CMO AND PRESENTED TO THE BOARD OF GOVERNORS. THE EXECUTIVE COMPENSATION COMMITTEE OF THE OLMSTED MEDICAL CENTER CONSISTS OF FIVE ELECTED MEMBER OF THE BOARD OF GOVERNORS. THE EXECUTIVE COMPENSATION COMMITTEE WILL SET THE COMPENSATION OF THE PRESIDENT, CEO AND CMO AND MINUTES ARE KEPT OF THESE DISCUSSIONS. THE BOARD OF TRUSTEES, ACTING THROUGH THE BOARD OF TRUSTEES COMPENSATION COMMITTEE, MUST APPROVE THE EXECUTIVE COMPENSATION POLICY AND PROCESS OF DETERMINING EXECUTIVE COMPENSATION AND BENEFITS. IN ADDITION, THE PHYSICIAN SALARIES ARE CALCULATED ANNUALLY, USING REGIONAL PHYSICIAN SALARY COMPARISON GUIDES FACTORING IN PRODUCTIVITY AND QUALITY MEASURES, AND REVIEWED ON AN ANNUAL BASIS FOR MARKET REASONABLENESS BY MCGLADREY. THE PHYSICIANS RECEIVE NO COMPENSATION AS ATTENDING BOARD MEMBERS. THESE DISCUSSIONS ARE NOTED IN THE MINUTES OF THE BOARD OF TRUSTEES COMPENSATION COMMITTEE ANNUAL MEETING. THE BOARD OF TRUSTEES COMPENSATION COMMITTEE REPORTS TO THE FULL BOARD OF TRUSTEES ON AN ANNUAL BASIS THE COMPLETION OF SUCH DUTIES AND ARE ALSO NOTED IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ANNUAL FORM 990 & ATTACHED AUDITED FINANCIAL STATEMENT REPORT IS AVAILABLE IN ACCORDANCE WITH THE PUBLIC INSPECTION OF THE RETURN REQUIREMENTS. FORM 990, PART VII, SECTION A BOARD MEMBERS ARE NOT COMPENSATED FOR THEIR SERVICES TO THE ORGANIZATION. COMPENSATION SHOWN FOR PHYSICIAN TRUSTEES IS RELATED TO THEIR POSITION AS AN EMPLOYED PHYSICIAN OF THE ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -523,835. OLMSTED MEDICAL CENTER REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 HEALTHCARE EDUCATION AND COMMUNITY PURPOSES MN 501(C)(3) LINE 11A, I OLMSTED MEDICAL CENTER 1 OLMSTED MEDICAL CENTER AUXILIARY 1650 4TH STREET SE ROCHESTER MN 55904 363382873 SUPPORT OLMSTED MEDICAL CENTER MN 501(C)(3) LINE 11C, III-FI OLMSTED MEDICAL CENTER 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 OLMSTED MEDICAL CENTER REGIONAL FOUNDATION B 667252 GAAP OLMSTED MEDICAL CENTER REGIONAL FOUNDATION C 128737 GAAP OLMSTED MEDICAL CENTER AUXILIARY C 8427 GAAP OLMSTED MEDICAL CENTER REGIONAL FOUNDATION N 257841 GAAP