2011-10-06T10:12:16-05:00 2010-12-31 RSM MCGLADREY INC 400 LOCUST ST STE 640 DES MOINES IA 503092354 990 2010-01-01 410855367 OLMSTED MEDICAL CENTER OLMS 5072883443 210 NINTH STREET SE ROCHESTER MN 55904 TIM WEIR 5072883443 2011-10-06 1 VIRGINIA M STRIEGEL 5155586600 2010 2016-03-07 17:11:31Z TIM WEIR 210 NINTH STREET SE ROCHESTER MN 55904 149656678 0 X HTTP://WWW.OLMMED.ORG X 1949 MN THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY AND SERVICE. 16 10 1136 80 0 0 565772 1086174 142684997 146157471 812869 1100758 100585 436012 144164223 148780415 229230 571070 0 0 85073908 88288949 0 0 204927 46517794 47475721 131820932 136335740 12343291 12444675 110190688 145694422 37326025 59838471 72864663 85855951 X THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY AND SERVICE. 0 0 123933982 497766 146288719 PATIENT CARE: OLMSTED MEDICAL CENTER (OMC) COMBINES A MULTI-SPECIALTY CLINIC PRACTICE WITH A COMMUNITY HOSPITAL. THE CLINIC PRACTICES ARE LOCATED THROUGHOUT SOUTHEASTERN MINNESOTA WITH A MAIN CLINIC LOCATED IN SE ROCHESTER PROVIDING PRIMARY CARE AND SPECIALTY CARE AND 10 BRANCH CLINICS PROVIDING PRIMARY CARE SERVICES TO THE FOLLOWING COMMUNITIES: BYRON, CHATFIELD, NW ROCHESTER, PINE ISLAND, PLAINVIEW, PRESTON, ST. CHARLES, SPRING VALLEY, STEWARTVILLE, AND WANAMINGO. IN 2010 OMC PROVIDED CARE TO 3,356 INPATIENTS FOR A TOTAL OF 7,901 PATIENT DAYS AND PROVIDED TREATMENT FOR 31,012 EMERGENCY/URGENT CARE CASES AND PROVIDED A TOTAL OF 283,896 CLINICAL ENCOUNTERS.OMC IS WELL KNOWN FOR EXCEPTIONAL PRIMARY HEALTHCARE. WE ALSO OFFER OUR 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 2010 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 SERVICES, FACILITIES, AND INFRASTRUCTURE UPGRADES IN OUR PATIENTS' BEST INTERESTS, AND WE PROUDLY CARRY ON OUR SUPPORT OF THE COMMUNITIES WE SERVE.IN 2010 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 ARE 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 ITS FOURTH ANNUAL "BUSINESS GIVES" AWARD FROM THE MINNESOTA GOVERNOR'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. 129557 73304 COMMUNITY OUTREACH AND SUPPORT ACTIVITIES: OMC WELCOMES ITS MANY OPPORTUNITIES TO BE AN ACTIVE, CONTRIBUTING PARTNER TO SOUTHEASTERN MINNESOTA'S HEALTH AND WELLNESS EFFORTS.OUR COMMUNITY INVESTMENT ACTIVITIES SUPPORTED 112 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 2010 EMPLOYEES VOLUNTEERED AN AVERAGE OF 11 HOURS OF PERSONAL TIME AND UP TO SEVEN HOURS A MONTH ENGAGED IN VOLUNTEER SERVICE. USING THE INDEPENDENT SECTOR'S ESTIMATED DOLLAR VALUE OF VOLUNTEER TIME ($21.36 PER HOUR FOR 2010, ACCORDING TO WWW.INDEPENDENT-SECTOR.ORG), THIS MEANS OMC EMPLOYEES WHO VOLUNTEER CONTRIBUTED $385 PER EMPLOYEE PER MONTH OR $4,620 PER EMPLOYEE PER YEAR. THE 250+ EMPLOYEES SURVEYED CONTRIBUTED OVER $1.1 MILLION DOLLARS IN VOLUNTEER TIME AND EFFORTS.OMC WAS ACTIVELY INVOLVED WITH MAYO CLINIC, OLMSTED COUNTY AND ROCHESTER PUBLIC SCHOOLS IN A FREE VACCINATION PROGRAM. WE HELD MULTIPLE WALK-IN VACCINATION CLINICS WORKING CLOSELY WITH LOCAL PARTNERS TO EDUCATE OUR COMMUNITIES. 1059460 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 THE 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 THE ROCHESTER EPIDEMIOLOGY PROJECT, 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. 125122999 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 190 0 1 1136 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 646278 0 46976 RANDY HEMANN MD 40.00 X 270445 0 43135 JAMES HOFFMANN MD 40.00 X 376065 0 45738 LINDA WILLIAMS MD 30.00 X 188391 0 27013 NORM DOTY 1.00 X 0 0 0 JOHN DOYLE 1.00 X X 0 0 0 DENNIS MCDONOUGH 1.00 X 0 0 0 SUSAN MADDEN 1.00 X 0 0 0 DON SUDOR 1.00 X 0 0 0 TOM WINKELS 1.00 X 0 0 0 ROY A YAWN MD 40.00 X X 396639 0 35463 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 403937 0 45799 TIM WEIR 40.00 X 408337 0 44223 KEVIN HIGGINS 40.00 X 255021 0 43410 DAVID WESTGARD MD 40.00 X 386214 0 41078 DR SRDAN BABOVIC 40.00 X 644919 0 35630 DR DAVID LOWE 40.00 X 602088 0 51170 DR VIDHAN CHANDRA 40.00 X 574212 0 34609 DR MARCO SANTAMARIA 40.00 X 538168 0 49553 DR JEFFERY BECKENBAUGH 40.00 X 585005 0 53052 DR KATHRYN LOMBARDO 40.00 X 406611 0 33583 DR THOMAS ERBACH 40.00 X 420216 0 43909 7102546 0 674341 129 1 1 0 WEIS BUILDERS INC 2227 7TH STREET NW ROCHESTER MN 55901 CONSTRUCTION 5230355 CONSTRUCTION COLLABORATIVE 320 SOUTH BROADWAY ROCHESTER MN 55904 CONSTRUCTION 2060311 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 1158534 THE AFFILIATED GROUP PO BOX 7739 ROCHESTER MN 55903 DEBT COLLECTION 592649 MCKESSON INFORMATION SYSTEMS PO BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 550269 33 116877 413398 555899 1086174 NET PATIENT SERVICES 621110 146157471 146157471 146157471 1153682 1153682 93781 93781 93781 93781 823339 826415 49848 -3076 -49848 -52924 -49848 -3076 CAFETERIA REVENUE 722210 161135 161135 181096 181096 342231 148780415 146288719 0 1405522 571070 571070 4166229 2771896 1394333 65048030 60748885 4138138 161007 5838125 5342950 478397 16778 8341199 7568986 756715 15498 4895366 4589925 293797 11644 112047 112047 103853 103853 115693 115693 114754 56630 58124 4254608 3545932 708676 262554 8603 253951 15986222 15552057 434165 407182 175285 231897 4144966 3728166 416800 54701 47421 7280 727741 555940 171801 980103 980103 4048511 4048511 655353 655353 PROVISION FOR BAD DEBTS 8185010 8185010 EQUIPMENT & SOFTWARE MA 2621131 1809349 811782 MINNESOTACARE TAX 2432883 2432883 MISCELLANEOUS 2268409 1748044 520365 136335740 125122999 11007814 204927 25585222 4449379 61172009 19826053 20221700 1306012 1205462 1043953 1503567 83500897 32378266 41530661 51122631 9558116 16449408 910937 110190688 145694422 2041254 4346489 34476 310228 13978068 28077043 480000 5673457 7448623 15598770 19176088 37326025 59838471 X 72864663 85855951 72864663 85855951 110190688 145694422 X 12444675 546613 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4390500 4390500 49451309 12566402 36884907 29496273 19682056 9814217 162815 129808 33007 51122631 PAYROLL LIABILITY 11882552 OTHER ACCRUED LIABILITY 4566700 ACCRUED INTEREST 736596 ACCRUED REAL ESTATE TAXES 543376 THIRD PARTY PAYOR SETTLEMENTS 1446864 19176088 148780415 136335740 12444675 546613 546613 12991288 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION AND THE 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, 2010 AND 2009. THE ORGANIZATION AND THE FOUNDATION ARE ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE MINNESOTA STATUTES. THE ORGANIZATION AND THE 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, 2005, AND PRIOR. 1 1 X 1 X 1 X 260.000000000000 1 1 1 0 1 1 880360 880360 0.00690 24403763 15041384 9362379 0.07310 2913698 388377 2525321 0.01970 28197821 15429761 12768060 0.09970 40329 40329 0.00030 789391 789391 0.00620 1059460 875333 184127 0.00140 571070 571070 0.00450 2460250 875333 1584917 0.01240 30658071 16305094 14352977 0.11210 0 4396882 257201 9710977 12244437 -2533460 X 1 1 1 1 OLMSTED MEDICAL CENTER-HOSPITAL

1650 4TH STREET SE ROCHESTER MN 55904

X X X X X URGENT CARE OLMSTED MEDICAL CENTER 1 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 7: THE ORGANIZATION CALCULATED THE COST AMOUNTS NOTED IN PART I, LINE 7 BY UTILIZING ITS CURRENT COST ACCOUNTING SYSTEM. IRS WORKSHEETS ARE UTILIZED TO REPORT AMOUNTS SHOWN. PART I, LINE 7G: AMOUNTS INCLUDED IN THIS LINE WERE ATTRIBUTABLE TO PHYSICIAN CLINICS. 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 $ 8185010. 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. THE ORGANIZATION USED A COST TO CHARGE RATIO TO DETERMINE THE COST AMOUNT OF THE BAD DEBT EXPENSE. WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, AS PROVIDED IN THE IRS INSTRUCTIONS WAS USED TO DETERMINE THE APPROPRIATE RATIO. 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 $10,483,348. 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 I, LINE 6A: THE MARKETING AND COMMUNICATION DEPARTMENTS PREPARE AN ANNUAL REPORT WHICH INCLUDES A SECTION ON COMMUNITY BENEFIT. THIS REPORT IS SENT TO SPECIFIC INDIVIDUALS WITHIN THE COMMUNITY AND IS AVAILABLE ON THE ORGANIZATIONS' WEBSITE.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.PART VI, LINE 7: NOT PROVIDED TO STATE. 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 6: 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 7: N/A 1 OLMSTED MEDICAL CENTER REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 501(C)(3) 497766 PROVIDE FUNDING TO OMC REGIONAL FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES. ROCHESTER AREA CHAMBER OF COMMERCE 220 SOUTH BROADWAY 100 ROCHESTER MN 55904 400506950 501(C)(6) 6450 MUSEUM, GOLD/SILVER SPONSORSHIP, MLK BREAKFAST, GOLF OUTINGS AMERICAN NATIONAL RED CROSS 2025 E STREET NW WASHINGTON DC 20006 530196605 501(C)(3) 6000 PROVIDE RELIEF TO VICTIMS OF DISASTER, HEROES CAMPAIGN AND STORE OF HOPE 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. FOR OTHER DONATIONS, LETTERS ARE RECEIVED FROM THE BENEFACTORS INDICATING USE OF FUNDS AND THANKING US FOR OUR GENEROUS DONATIONS. X X X X X 0 1 0 0 0 1 0 0 0 CHARLES BRANCH MD 645278 0 0 0 1000 0 26950 0 20026 0 693254 0 0 0 RANDY HEMANN MD 259798 0 9647 0 1000 0 26950 0 16185 0 313580 0 0 0 JAMES HOFFMANN MD 370310 0 5255 0 500 0 26950 0 18788 0 421803 0 0 0 LINDA WILLIAMS MD 181839 0 5752 0 800 0 20528 0 6485 0 215404 0 0 0 ROY A YAWN MD 342951 0 52788 0 900 0 26950 0 8513 0 432102 0 0 0 JAY MYERS 397991 0 5946 0 0 0 26950 0 18849 0 449736 0 0 0 TIM WEIR 325937 0 82400 0 0 0 26950 0 17273 0 452560 0 0 0 KEVIN HIGGINS 211288 0 37079 0 6654 0 26950 0 16460 0 298431 0 0 0 DAVID WESTGARD MD 310766 0 75448 0 0 0 26950 0 14128 0 427292 0 0 0 DR SRDAN BABOVIC 644844 0 75 0 0 0 26950 0 8680 0 680549 0 0 0 DR DAVID LOWE 602013 0 75 0 0 0 26950 0 24220 0 653258 0 0 0 DR VIDHAN CHANDRA 574137 0 75 0 0 0 26950 0 7659 0 608821 0 0 0 DR MARCO SANTAMARIA 537093 0 75 0 1000 0 26950 0 22603 0 587721 0 0 0 DR JEFFERY BECKENBAUGH 584930 0 75 0 0 0 26950 0 26102 0 638057 0 0 0 DR KATHRYN LOMBARDO 406036 0 75 0 500 0 26950 0 6633 0 440194 0 0 0 DR THOMAS ERBACH 419141 0 75 0 1000 0 26950 0 16959 0 464125 0 0 0 PART I, LINE 4B THE ORGANIZATION FORMERLY HAD A NONQUALIFIED DEFERRED COMPENSATION PLAN FOR THE BENEFIT OF CERTAIN EMPLOYEES WHO MET QUALIFICATION REQUIREMENTS AS DEFINED IN THE PLAN. THE BENEFIT AVAILABLE TO A PARTICIPANT UPON MEETING THE VESTING REQUIREMENTS WAS THE AMOUNT THAT WAS ALLOCATED TO THE PARTICIPANT'S ACCOUNT. ANY AMOUNTS ACCUMULATED IN THE PLAN THAT WERE FORFEITED BY A PARTICIPANT REVERTED TO THE ORGANIZATION. IN OCTOBER 2008, THE BOARD OF TRUSTEES VOTED TO TERMINATE THE PLAN. ONE-HALF OF THE AMOUNT DUE TO PLAN PARTICIPANTS WAS PAID OUT, IN ACCORDANCE WITH THE PROVISIONS OF THE TERMINATION, DURING 2009. THE REMAINING AMOUNT WAS PAID OUT IN 2010. PART I, LINE 6 THE RETIREMENT SAVINGS PLAN CONTRIBUTION, WHICH IS A DEFERRED COMPENSATION PLAN, IS BASED ON THE PROFITABILITY OF THE ORGANIZATION SUBJECT TO IRS LIMITATIONS AND SUBJECT TO BOARD OF GOVERNORS DISCRETION. 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 20202546 CLINIC CONSTRUCTION 0 0 0 8000000 753700 160000 7086300 2005 0 0 1 1 2651915 51915 2600000 2006 0 0 1 1 20202546 1709215 403128 6727649 11351225 0 0 0 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 0.00000 0.00000 0.00000 1 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 480000 0 1 1 480000 JULIE WINKELS FAMILY MEMBER OF THOMAS WINKELS, TRUSTEE 40412 EMPLOYEE OF ORGANIZATION 0 DR LOUIS WAGNER FAMILY MEMBER OF DR. LINDA WILLIAMS, TRUSTEE 514072 EMPLOYEE OF ORGANIZATION 0 DR BARBARA YAWN FAMILY MEMBER OF DR. ROY YAWN, PRESIDENT 156529 EMPLOYEE OF ORGANIZATION 0 MERCHANTS BANK JOHN DOYLE, BOARD CHAIR, SERVES AS PRESIDENT OF MERCHANTS BANK 531412 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, TRUSTEE, IS PRESIDENT OF BANK. FORM 990, PART IV, LINE 20B: THE AUDITED FINANCIAL STATEMENTS HAVE NOT BEEN ATTACHED TO THIS RETURN IN COMPLIANCE WITH IRS INSTRUCTIONS FOR TAX YEARS BEGINNING BEFORE MARCH 23, 2010. 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 2010, 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 GOVENORS. 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. THESE DISCUSSIONS ARE NOTED IN MINUTES OF THIS 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, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ANNUAL FORM 990 REPORT IS AVAILABLE FOR PUBLIC VIEWING BY APPOINTMENT. 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 EMPLOYED PHYSICIANS OF THE ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 546,613. FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE FINANCE COMMITTEE MEETS WITH MANAGEMENT BI-MONTHLY TO REVIEW FINANCIAL PERFORMANCE AS WELL AS KEY FINANCIAL ISSUES. IN ADDITION, THEY REVIEW THE RFP SUMMARIES WHEN A NEW INDEPENDENT AUDIT TEAM IS BEING SELECTED. 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 11A, I 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 497766 GAAP OLMSTED MEDICAL CENTER REGIONAL FOUNDATION C 110342 GAAP OLMSTED MEDICAL CENTER REGIONAL FOUNDATION N 196271 GAAP OLMSTED MEDICAL CENTER AUXILIARY C 6535 GAAP