2011-11-08T12:35:42-06:00 2010-12-31 RSM MCGLADREY INC 700 MISSABE BUILDING DULUTH MN 55802 990 2010-01-01 411293970 RANGE REGIONAL HEALTH SERVICES RANG 2183626657 750 EAST 34TH STREET HIBBING MN 55746 JOHN KRITZ 2183626657 2011-11-03 1 JENNIFER MILLER 2187278253 2010 2016-02-24 21:20:13Z JOHN KRITZ 750 EAST 34TH STREET HIBBING MN 55746 91533124 0 X WWW.RANGE.FAIRVIEW.ORG X 1998 MN TO PROVIDE A REGIONAL INTEGRATED NETWORK OF HEALTH CARE SERVICES THROUGH PHYSICIANS, AMBULATORY CARE, AND HOSPITAL FACILITIES. 15 8 1143 267 3943963 -1177922 927529 156153 88573041 90396482 84472 517611 524842 461035 90109884 91531281 0 0 0 0 55549280 58142233 0 0 0 35383737 36918640 90933017 95060873 -823133 -3529592 76629291 80410378 44829219 45500652 31800072 34909726 AN INTEGRATED HEALTH CARE SYSTEM MEETING THE NEEDS OF OUR PATIENTS IN AN EXEMPLARY MANNER. 0 0 85961600 90755324 MAINTAIN AND OPERATE A HOSPITAL TO PROVIDE MEDICAL AND SURGICAL CARE TO THE SICK, INFIRM, AGED, OR INJURED. 85961600 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 1 145 0 1 1143 1 1 1 0 0 0 0 0 0 0 0 0 X 15 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JOHN D KRITZ 2183626657 750 E 34TH STREET HIBBING MN 55746 DR SUSAN RUDBERG 1.00 X X 0 202670 47719 JOHN FORT 1.00 X X 0 0 0 EDIE CARR 1.00 X X 0 0 0 DAVE CLUSIAU 1.00 X 0 0 0 JIM WEIKUM 1.00 X X 0 0 0 ANDY MCCOY 1.00 X 0 255399 32472 CHARLIE CREP 1.00 X 0 0 0 JOHN DOHERTY 1.00 X 0 440771 53784 MIKE FAY 1.00 X 0 0 0 SCOTT MAKI 1.00 X 0 0 0 KATHY STERK 1.00 X 0 0 0 DR KRISTIN FREDRICKSON 1.00 X 0 570831 71666 DEBRA RUDQUIST 1.00 X 0 206576 23377 BETH GOHDES 1.00 X 0 165042 29507 DEBRA BOARDMAN 40.00 X X 0 256701 6400 JOHN KRITZ 40.00 X 183891 0 15270 JOHN BERLAND 40.00 X 195249 0 6701 RICHARD DINTER 54.50 X 248613 0 6744 JOHN STONEBURNER 40.00 X 190327 0 1370 MICHAEL PATREGNANI 40.00 X 199076 0 15025 GINA CLAUGHERTY 40.00 X 189203 0 15330 KENNETH KLOS 40.00 X 189243 0 6684 LARRY PFAFF 40.00 X 0 127567 -2768 1395602 2225557 329281 17 1 1 0 JOHNSON-WILSON CONSTRUCTORS 4431 W MICHIGAN STREET PO BOX 1600 DULUTH MN 55816 CONSTRUCTION COMPANY 1551455 RANGE MENTAL HEALTH CENTER 624 S 13TH STREET PO BOX 1188 VIRGINIA MN 55792 MANAGEMENT FEES 1388747 MAX GRAY CONSTRUCTION 2501 STH AVE W PO BOX 689 HIBBING MN 55746 CONSTRUCTION COMPANY 1385644 EMERGENCY PRACTICE ASSOCIATES 3840 W NINTH ST WATERLOO IA 50702 PROFESSIONAL FEES 1373486 CENTRAL MINNESOTA DIAGNOSTICS INC 150 10TH ST NW PO BOX 158 MILACA MN 56353 PURCHASED SERVICES 1003864 33 8542 21359 126252 156153 NET PATIENT SERVICE RE 621500 86056960 86056960 HEALTHLINE 900099 3203287 3203287 PHARMACY REVENUE 446110 740676 740676 CAFETERIA REVENUE 722210 395559 395559 90396482 499670 499670 102193 102193 102193 102193 19784 1843 17941 17941 17941 OTHER REVENUE 900099 358842 358842 358842 91531281 86811361 3943963 619804 401111 343323 57788 44104356 37750229 6354127 4083614 3495287 588327 6502076 5565319 936757 3051076 2611507 439569 4866095 4866095 15071389 15071389 722705 722705 4747920 4747920 FEES 3865205 3865205 BUILDING COSTS 2941412 2941412 BAD DEBTS 2370716 2370716 MN CARE TAX & SURCHARGE 1698868 1698868 EQUIPMENT RENTAL 634330 634330 95060873 85961600 9099273 0 2836701 4037863 6693630 7779398 13613994 13019283 2315980 1985220 1141175 1103646 91844064 52401651 34979185 39442413 385081 337013 14663545 12705542 76629291 80410378 26973822 22874677 4188 17578233 17855397 5043554 44829219 45500652 X 31800072 34909726 31800072 34909726 76629291 80410378 X -3529592 6639246 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 374539 374539 34440780 15069565 19371215 55468167 36197686 19270481 1560578 1134400 426178 39442413 ASSET LIMITED AS TO USE 11798065 DIAGNOSTIC, INC. 754491 DEFERRED DEBT ACQUISITION 152986 12705542 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THERE ARE NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONSOLIDATED BALANCE SHEETS. 1 1 1 X 120.000000000000 1 X 280.000000000000 1 1 1 0 1 1 2042307 2042307 0.02200 2953978 2953978 0.03190 4996285 4996285 0.05390 4154 1828838 34748 1794090 0.01940 1027 626130 3000 623130 0.00670 6914759 3508020 3406739 0.03680 1021 105401 105401 0.00110 6202 9475128 3545768 5929360 0.06400 6202 14471413 3545768 10925645 0.11790 1 2370716 19103049 25471193 -6368144 X 1 1 1 1 UNIVERSITY MEDICAL CENTER MESABI

750 E 34TH STREET HIBBING MN 55746

X X X UNIVERSITY MEDICAL CENTER MESABI 1 0 1 1 120.000000000000 1 280.000000000000 0 1 1 X X X X X X 1 X 1 X X X X X 1 X 0 1 2 HEALTHLINE HOMECARE

750 EAST 34TH STREET HIBBING MN 55746

HOME HEALTH NORTHSTAR HOSPICE

750 EAST 34TH STREET HIBBING MN 55746

HOSPICE 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 $ 2370716. PART II: N/A PART III, LINE 8: THE SHORTFALL REPORTED IS FROM THE INPATIENT, OUTPATIENT, AND HOSPICE PROGRAMS. IF THESE SERVICES WERE NOT PROVIDED BY THE HOSPITAL, THE NEED FOR THE SERVICES WOULD NOT BE MET IN THE COMMUNITY. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $698,325 AND ALLOWABLE COSTS OF $1,863,800 RESULTING IN A SHORTFALL OF $1,165,475. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE.THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: UNDER OUR COMMUNITY CARE PROGRAM ALL UNINSURED OR UNDERINSURED PATIENTS ARE OFFERED TO APPLY. IF A PERSON DOESN'T FULLY COMPLETE THE APPLICATION OR DOESN'T FOLLOW THROUGH WITH SOME OF THE REQUIRED STEPS, THEY MAY BE DEEMED UNCOOPERATIVE BUT, IF POSSIBLE, WILL STILL BE QUALIFIED AT A LOWER LEVEL OF DISCOUNT WITH MORE PATIENT RESPONSIBILITY. THIS DETERMINATION IS ONLY TO BE MADE BY THE SUPERVISOR OF PATIENT FINANCIAL SERVICES. UNIVERSITY MEDICAL CENTER MESABI PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED GROSS CHARGES UNIVERSITY MEDICAL CENTER MESABI PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED GROSS CHARGES PART VI, LINE 2: FAIRVIEW HEALTH SERVICES HAS BEEN ASSESSING THE NEEDS OF OUR LOCAL COMMUNITIES SINCE THE COMMUNITY HEALTH DEPARTMENT WAS CREATED IN 1992. THESE ASSESSMENTS ARE USED TO DRIVE COMMUNITY HEALTH OUTREACH PROGRAMMING AT EACH HOSPITAL. COMMUNITY HEALTH ASSESSMENTS ARE CONDUCTED BY THE FAIRVIEW CORPORATE COMMUNITY HEALTH DEPARTMENT ALONG WITH AN OUTSIDE CONSULTANT AND HOSPITAL-BASED COMMUNITY HEALTH STAFF EVERY THREE YEARS. IN ADDITION, EVERY THREE YEARS (FOLLOWING THE TIMING OF THE MDH ADMINISTRATION OF THE MN STUDENT SURVEYS) A TEEN AND ADOLESCENT ASSESSMENT FOR EACH HOSPITAL IS COMPLETED. COMMUNITY HEALTH STAFF STARTS WITH PREVIOUS ASSESSMENTS AND EXISTING COMMUNITY DOCUMENTS TO BUILD A BASELINE OF INFORMATION. INFORMATION MAY INCLUDE PATIENT DATA, EXISTING RECENT SOCIAL AND CULTURAL REPORTS, EDUCATION AND BUSINESS REPORTS, NEW DEMOGRAPHIC INFORMATION ABOUT INCOME, HOUSING, EMERGING HEALTH NEEDS AND MORE. NEXT, STAFF MAY CONDUCT KEY INTERVIEWS WITH COMMUNITY LEADERS FROM DIVERSE SECTORS - SOCIAL SERVICES, PHILANTHROPY, GOVERNMENT, HEALTH, EDUCATION, BUSINESS, MINORITY GROUPS, FAITH GROUPS. INTERVIEWS ALLOW ASSUMPTIONS TO BE VALIDATED AND NEW INFORMATION TO BE GATHERED.IN ADDITION, SITE COMMUNITY HEALTH STAFF WORK WITH LOCAL PUBLIC HEALTH DEPARTMENTS AND OTHER COMMUNITY GROUPS AS PART OF THEIR SUPPLEMENTAL ASSESSMENT OF COMMUNITY NEED AND/OR TO UTILIZE THE FINDINGS FROM THEIR GROUPS IN UNDERSTANDING THEIR COMMUNITIES. CORPORATE COMMUNITY HEALTH STAFF WORKS WITH THE OFFICE OF THE STATE DEMOGRAPHER, THE MINNESOTA DEPARTMENT OF HEALTH AND AN OUTSIDE CONSULTANT TO GATHER AND ANALYZE DEMOGRAPHIC INFORMATION. HOSPITAL BASED STAFF WORK WITH THEIR LOCAL PUBLIC HEALTH DEPARTMENT AS WELL AS COMMUNITY ORGANIZATIONS. AFTER DATA IS GATHERED FOR ALL OF THE HOSPITALS HOSPITAL-BASED COMMUNITY HEALTH STAFF REVIEWS THE DATA AND MEETS WITH COMMUNITY LEADERS TO ASK ABOUT THE HEALTH NEEDS THEY SEE IN THEIR COMMUNITY. THE RESULTS OF THE COMMUNITY REPORTED NEEDS ARE INCORPORATED INTO THE FINAL ASSESSMENT. ONCE THE DATA AND REPORTED NEEDS HAVE BEEN FINALIZED TOP NEEDS FOR EACH COMMUNITY ARE IDENTIFIED THROUGH A REVIEW OF THE DEMOGRAPHIC DATA BY CORPORATE COMMUNITY HEALTH STAFF. PART VI, LINE 3: PATIENTS THAT ARE ELIGIBLE FOR THE FAIRVIEW RANGE COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OF UP TO 100% OF TOTAL CHARGES BASED ON QUALIFYING FACTORS. FAIRVIEW RANGE SHALL INFORM PATIENTS ABOUT THE COMMUNITY CARE PROGRAM PRIOR TO DELIVERY OF SERVICE IF FEASIBLE AND AS APPROPRIATE AND DURING THE BILLING PROCESS.I. NOTICE TO PATIENTSCOMMUNITY CARE SHOULD ALWAYS BE OFFERED IF THE PATIENT/GUARANTOR INDICATES A FINANCIAL NEED. COMMUNITY CARE APPLIES TO UNIVERSITY MEDICAL CENTER-MESABI AND THE MESABA CLINICS. COMMUNITY CARE IS OFFERED TO BOTH UNINSURED AND UNDERINSURED IF THE PROPER STEPS ARE TAKEN. NON-COVERED AND ELECTIVE SERVICES ARE NOT APPROVED UNDER THE FAIRVIEW RANGE COMMUNITY CARE PROGRAM. REFER TO SECTION V FOR FURTHER EXPLANATION.COMMUNITY CARE APPLICATIONS ARE SENT OUT ON ALL ACCOUNTS THAT HAVE A BALANCE OVER $10,000. ALL UNINSURED (SELF PAY) PATIENTS RECEIVE AN ITEMIZED BILL ALONG WITH A CREDIT POLICY LETTER.II. MEDICAL ASSISTANCEPRIOR TO DETERMINING ELIGIBILITY FOR THE COMMUNITY CARE PROGRAM, THE PATIENT MUST APPLY FOR MEDICAL ASSISTANCE (MA) AND OTHER GOVERNMENTAL INSURANCE PROGRAMS. ADMISSION PROCEDURES FORASSISTING PATIENTS WITH MA APPLICATIONS SHALL BE FOLLOWED. III. COMMUNITY CARE PROGRAMEVERYONE HAS THE OPTION TO APPLY FOR OUR COMMUNITY CARE PROGRAM. THESE PROGRAMS ARE DESIGNED FOR PATIENTS IN FINANCIAL NEED AND MEET OUR GUIDELINES.A. DISCOUNT RATEPATIENTS THAT ARE ELIGIBLE FOR THE FAIRVIEW RANGE COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OF UP TO 100% OF TOTAL CHARGES BASED ON INCOME AND FAMILY SIZE ACCORDING TO THE FEDERAL POVERTY GUIDELINES.1. COOPERATION. BECAUSE THE COMMUNITY CARE PROGRAM IS NOT A SUBSTITUTE FOR PERSONAL RESPONSIBILITY, PERSONS SEEKING FINANCIAL ASSISTANCE THROUGH THE PROGRAM ARE EXPECTED TO COOPERATE WITH THE FAIRVIEW RANGE PROCEDURE FOR DETERMINING ELIGIBILITY AND TO CONTRIBUTE TO THE COST OF SERVICES TO THE EXTENT OF THEIR INDIVIDUAL ABILITY AND DETERMINED FINANCIAL RESPONSIBILITY. FAIRVIEW RANGE ENCOURAGES INDIVIDUALS WHO HAVE THE FINANCIAL ABILITY TO PURCHASE HEALTH INSURANCE IN ORDER TO ASSURE THEIR ONGOING ACCESS TO PREVENTATIVE HEALTH SERVICES AND TO PROTECT INDIVIDUAL ASSETS. ALL PATIENTS MUST APPLY FOR MEDICAID TO BE CONSIDERED COOPERATIVE.B. APPLICATION INFORMATION. COMMUNITY CARE APPLICANTS MUST PROVIDE THE FOLLOWING INFORMATION TO BE CONSIDERED COOPERATIVE:1. COMPLETED COMMUNITY CARE APPLICATION FORM. IT MUST BE SIGNED JOINTLY IF BOTH PARTIES ARE FILING2. COPY OF CURRENT YEAR FEDERAL INCOME TAX FORMS; INCLUDING ALL ATTACHMENTS AND SCHEDULES. IF MARRIED AND FILED TAXES SEPARATELY, BOTH PARTIES TAX INFORMATION MUST BE PROVIDED.3. DOCUMENTATION OF CURRENT INCOME FOR TWO CONSECUTIVE MONTHS. VALID DOCUMENTATION INCLUDES: RECENT PAYSTUBS, OR STUBS FROM UNEMPLOYMENT, DISABILITY, SOCIAL SECURITY, ETC.4. WRITTEN DOCUMENTATION FROM THE COUNTY OUTLINING IF THE PATIENT HAS BEEN APPROVED OR DENIED FROM MEDICAL ASSISTANCE. SERVICES PRIOR TO 3/1/07 DO NOT NEED A MA DENIAL.5. COPY OF CURRENT BANK STATEMENTS INCLUDING SAVINGS AND CHECKING.6. AN OPTIONAL LETTER OUTLINING ANY UNUSUAL CIRCUMSTANCES THAT MAY AFFECT THE ABILITY TO PAY.7. SPECIAL CIRCUMSTANCES MAY APPLY IF WE ARE ABLE TO DETERMINE INCOME FROM MA APPROVAL/DENIAL.8. FORMS MUST BE RETURNED WITHIN 30 DAYS. SPECIAL CIRCUMSTANCES MAY APPLY SUCH AS BACKLOG FROM THE COUNTY.9. PARTIAL APPLICATIONS WILL BE RETURNED TO THE PATIENT AND WILL NOT BE CONSIDERED.C. OTHER DISCOUNTS. UNINSURED DISCOUNT PROGRAM. A PROGRAM WHICH GIVES UNINSURED PATIENTS WITH A HOUSEHOLD INCOME EQUAL TO OR BELOW $125,000, AN UNINSURED DISCOUNT EQUIVALENT TO FAIRVIEW RANGE'S HIGHEST REVENUE PRIVATE PAYER CONTRACTED RATE FOR MEDICALLY NECESSARY SERVICES.D. MA OR GAMC PROGRAM IF A PATIENT HAS STRAIGHT MEDICAL ASSISTANCE OR GENERAL ASSISTANCE FOR TODAY'S DATE, THEIR PRIOR BALANCE(S) WILL BE WRITTEN OFF IN FULL.IV. INPATIENT SERVICESINPATIENT SERVICES ARE ADDRESSED MORE AGGRESSIVELY. IF A PATIENT IS SELF PAY AND IS AN INPATIENT, AN OUTREACH ADVOCATE WILL VISIT WITH THE PATIENT IN THEIR HOSPITAL ROOM. IF CONTACT IS NOT MADE WHILE AN INPATIENT, THE OUTREACH ADVOCATE WILL VISIT THE PATIENT IN THEIR HOME SETTING. THE ADVOCATE WILL PROVIDE AN MA APPLICATION AND ASSISTANCE IN FILLING IT OUT IF NEEDED. THE OUTREACH ADVOCATE WILL ALSO PROVIDE AND INFORM THE PATIENT ABOUT COMMUNITY CARE PROGRAM IN CASE MA IS DENIED. A FINANCIAL COUNSELORS WILL VISIT WITH THE PATIENT TO DISCUSS OPTIONS IF AN INPATIENT ACCOUNT HAS A HIGH DEDUCTIBLE OR COINSURANCE.A PROVIDER REQUEST FOR COVERAGE IS SENT TO THE COUNTY ON ALL SELF PAY ACCOUNTS AT THE TIME OF ADMISSION DUE TO THE COUNTY'S NEED TO BE NOTIFIED ON THE DAY OF ADMISSION.V. EXCLUSIONS. FAIRVIEW RANGE COMMUNITY CARE PROGRAM, DISCOUNT PROGRAM, AND OTHER CHARITY CARE PLANS DO NOT COVER THE FOLLOWING:THOSE PROCEDURES THAT ARE NOT MEDICALLY NECESSARY, COSMETIC, PHARMACY, HEARING AIDS, CHIROPRACTIC SERVICES, SERVICES NOT COVERED BY MINNESOTA MEDICAL ASSISTANCE AND OTHER INSURANCES, SERVICES WHICH YOU MAY BE RESPONSIBLE FOR IF YOU DO RECEIVE COUNTY ASSISTANCE, PROFESSIONAL SERVICES RENDERED AT OUR FACILITIES BY INDEPENDENT PHYSICIANS, OUT-OF-NETWORK SERVICES, HOSPICE, HOMECARE, DME, GREENVIEW ALZHEIMER'S, RETAIL STORE, FOREIGN OR OUT OF STATE SERVICES, SERVICES THAT WOULD HAVE QUALIFIED FOR INSURANCE COVERAGE IF RECEIVED AT ANOTHER FACILITY OR SERVICES NOT BILLED OR RECEIVED AT FAIRVIEW RANGE PART VI, LINE 4: RANGE REGIONAL HEALTH SERVICES IS A REGIONAL HEALTH CARE SYSTEM BASED OUT OF HIBBING AND IS COMPRISED OF FAIRVIEW UNIVERSITY MEDICAL CENTER - MESABI, FAIRVIEW MESABA CLINICS, AND FAIRVIEW HEALTHLINE. FAIRVIEW RANGE HAS CLINICS, MEDICAL SUPPLY STORES, AND PROVIDES HOME CARE/HOSPICE/TRANSPORTATION SERVICES THROUGHOUT THE REGION. RANGE REGIONAL HEALTH SERVICES IS LOCATED IN NORTHEASTERN MINNESOTA APPROXIMATELY 72 MILES NORTHWEST OF DULUTH AND 190 MILES DUE NORTH OF MINNEAPOLIS/ ST. PAUL MINNESOTA ON WHAT IS CALL MINNESOTA'S FAMED "IRON RANGE". FOR MANY OF ITS SERVICES, RANGE REGIONAL HEALTH SERVICES, SERVES A POPULATION BASE OF OVER 133,000 RESIDENTS. IT COVERS A GEOGRAPHIC RANGE OF 45 MILES TO THE WEST, 100 MILES TO THE NORTH AND 70 MILES TO THE EAST AND 30 MILES TO THE SOUTH. WE ARE A TRUE REGIONAL REFERRAL CENTER FOR RADIATION ONCOLOGY AND BEHAVIORAL HEALTH SERVICES WITH PATIENTS COMING FROM ALL ACROSS N.E. MINNESOTA. THE POPULATION WE SERVE IS MADE UP OF APPROXIMATELY 66,079 MALES AND 66,999 FEMALES WITH THE MEDIAN FAMILY ANNUAL INCOME RANGING FROM $33,500 TO $37,000. WE HAVE A DIVERSE POPULATION MADE UP OF A VARIETY OF RACES AND ETHNIC GROUPS. WITH MORE THAN 60 LOCAL PHYSICIANS AND OVER 1,000 EMPLOYEES, FAIRVIEW RANGE HAS THE LARGEST ACTIVE MEDICAL STAFF ON THE IRON RANGE AND IS THE AREA'S 2ND LARGEST EMPLOYER. RANGE REGIONAL HEALTH SERVICES OFFERS HIGHLY-ADVANCED INPATIENT AND OUTPATIENT MEDICAL SERVICES, AND ALONG WITH OUR PROFESSIONAL STAFF, PROVIDES THE MOST COMPREHENSIVE HEALTH CARE SERVICES ON THE IRON RANGE AND NORTH TO THE CANADIAN BORDER. RANGE REGIONAL HEALTH SERVICES UTILIZES TRUE STATE-OF-THE-ART TECHNOLOGY, WITH SOME OF THE NEWEST EQUIPMENT AND FACILITIES IN THE REGION. WITH THE INSTALLATION OF THE MOST ADVANCED CT SCANNER IN THE AREA, A NEWLY EXPANDED AND ENHANCED RADIATION ONCOLOGY CENTER, A NEW COMPREHENSIVE BREAST CENTER, AND A NEWLY CONSTRUCTED AND EXPANDED EMERGENCY AND URGENT CARE CENTER, FAIRVIEW RANGE TRULY PROVIDES THE LATEST IN HIGH QUALITY HEALTHCARE RIGHT IN, OR CLOSE BY, YOUR HOME COMMUNITY PART VI, LINE 6: RANGE REGIONAL HEALTH SERVICES IS GOVERNED BY AN UNPAID BOARD OF DIRECTORS. THE MAJORITY OF THE DIRECTORS ARE COMMUNITY MEMBERS WHO REPRESENT THE VARIOUS SERVICE AREAS AND ENTITIES WITHIN THE SYSTEM. AS A NONPROFIT HEALTH SYSTEM, RANGE REINVESTS ANY EXCESS REVENUES BEYOND EXPENSES INTO THE CORE OPERATIONS OF THE ORGANIZATION. IN 2009, RANGE STARTED A THREE-YEAR PROJECT TO IMPLEMENT AN INTEGRATED ELECTRONIC MEDICAL RECORD ACROSS THE CONTINUUM. THIS IS A SIGNIFICANT INVESTMENT IN CLINICAL QUALITY AND EFFICIENCY. RANGE PARTNERS WITH MYRIAD HIGHER EDUCATIONAL INSTITUTIONS TO PROVIDE CLINICAL HANDS-ON TRAINING FOR FUTURE NURSES, PHARMACISTS, LABORATORY PROFESSIONALS AND MORE. RANGE IS AN ACTIVE COMMUNITY MEMBER. LEADERS FROM RANGE HOSPITAL AND CLINICS ARE INVOLVED IN THEIR COMMUNITY THROUGH LEADERSHIP ON COMMUNITY BOARDS, LEGISLATIVE AND REGULATORY BOARDS AND MUCH MORE.WHEN SOMEONE IS SICK OR INJURED, THE EMERGENCY DEPARTMENTS (ED) AT RANGE SERVE AS FRONT DOOR FOR ALL INDIVIDUALS SEEKING MEDICAL CARE. THE EDS ARE PART OF A CRITICAL SAFETY NET OF SERVICES FOR UNINSURED INDIVIDUALS AND FAMILIES. FOR INDIVIDUALS WHO ARE UNABLE TO PAY FOR THEIR CARE, RANGE OFFERS CHARITY CARE ON A SLIDING FEE BASED ON INCOME. RANGE ALSO PROVIDES AN AUTOMATIC DISCOUNT ON ALL BILLS FOR UNINSURED INDIVIDUALS. THE DISCOUNT IS EQUAL TO THE DISCOUNT PROVIDED TO THE ORGANIZATION'S LARGEST COMMERCIAL INSURER. RANGE HOSPITAL AND CLINICS PARTICIPATE IN GOVERNMENT PROGRAMS SUCH AS MEDICARE, MEDICAID, GENERAL ASSISTANCE AND TRICARE. UMMC PROVIDES FOR A LARGE NUMBER OF INDIVIDUALS COVERED BY MEDICAID. THE AMOUNT OF MEDICAID VOLUME MAKES RANGE HOSPITAL A DISPROPORTIONATE SHARE RECIPIENT. PART VI, LINE 7: RANGE REGIONAL HEALTH SERVICES IS AN AFFILIATE OF FAIRVIEW HEALTH SERVICE, AN INTEGRATED HEALTH CARE SYSTEM HEADQUARTERED IN MINNEAPOLIS, MN. BASED ON THE HEALTH CARE NEEDS IN THAT SERVICE AREA, COMMUNITY BENEFIT ACTIVITY IS CARRIED OUT BY STAFF/LEADERSHIP AT THAT FACILITY. THE FAIRVIEW CORPORATE COMMUNITY HEALTH DEPARTMENT SUPPORTS THE LOCAL EFFORT BY SHARING BEST PRACTICES, FINDING EFFICIENCIES AMONG HOSPITAL COMMUNITY HEALTH LEADERS AS APPROPRIATE, COORDINATING THE FORMAL COMMUNITY NEEDS ASSESSMENTS AND MORE. THESE SAME EFFORTS TAKE PLACE AT RRHS. REPORTS FILED WITH STATES PART VI, LINE 7 MN X X X X 0 0 0 0 0 1 0 0 0 DR SUSAN RUDBERG 0 202670 0 0 0 0 0 23287 0 24432 0 250389 0 0 ANDY MCCOY 0 226429 0 28970 0 0 0 17150 0 15322 0 287871 0 0 JOHN DOHERTY 0 327180 0 113591 0 0 0 24508 0 29276 0 494555 0 0 DR KRISTIN FREDRICKSON 0 560831 0 10000 0 0 0 28175 0 43491 0 642497 0 0 DEBRA RUDQUIST 0 184943 0 21633 0 0 0 5615 0 17762 0 229953 0 0 BETH GOHDES 0 153329 0 11713 0 0 0 11767 0 17740 0 194549 0 0 DEBRA BOARDMAN 0 246701 0 10000 0 0 0 0 0 6400 0 263101 0 0 JOHN KRITZ 180391 0 0 0 3500 0 0 0 15270 0 199161 0 0 0 JOHN BERLAND 191749 0 0 0 3500 0 0 0 6701 0 201950 0 0 0 RICHARD DINTER 248613 0 0 0 0 0 0 0 6744 0 255357 0 0 0 JOHN STONEBURNER 190327 0 0 0 0 0 0 0 1370 0 191697 0 0 0 MICHAEL PATREGNANI 199076 0 0 0 0 0 0 0 15025 0 214101 0 0 0 GINA CLAUGHERTY 184203 0 5000 0 0 0 5741 0 9589 0 204533 0 0 0 KENNETH KLOS 184243 0 5000 0 0 0 5513 0 1171 0 195927 0 0 0 LARRY PFAFF 0 3962 0 66112 0 57493 0 -2768 0 0 0 124799 0 0 PART I, LINE 6 THE CEO HAS AN INCENTIVE PLAN BASED ON OVERALL COMPANY PERFORMANCE. CITY OF MINNEAPOLIS 616005375 60374VCH4 2008-11-12 8868000 REFUNDED 2005B REFUNDING 2000A ISSUE 0 0 0 CITY OF MINNEAPOLIS 616005375 60374VCH4 2008-10-29 7870000 AMBULATORY SERVICES CONSTRUCTION 0 0 0 8868000 919000 7821000 128000 8740000 0 0 0 0 7870000 69000 7801000 2010 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 1 MESABA CLINIC THE CEO AND 1 COMMUNITY BOARD MEMBER ARE ALSO ON THE BOARD OF MESABA CLINIC 7368006 FEES PAID TO MESABA CLINIC FOR SERVICES 0 MIKE FAY BOARD MEMBER 37809 INSURANCE COMMISSION 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD ANNUALLY COMPLETES A CONFLICT OF INTEREST STATEMENT. THE CFO DISCLOSES THE CONFLICTS TO THE ENTIRE BOARD. THE CFO MONITORS BOARD MOTIONS TO ENSURE DISCLOSURE OF POTENTIAL CONFLICTS WITH VOTES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS MARKET BASED AND BASED ON DATA COMPILED BY FAIRVIEW CORPORATE. FORM 990, PART VI, SECTION C, LINE 18 THE FORMS ARE AVAILABLE UPON REQUEST FORM 990, PART VI, SECTION C, LINE 19 THE DOCUMENTS ARE AVAILABLE UPON REQUEST IN THE ORGANIZATION'S ADMINISTRATION OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 967,928. ADDITIONAL LIABILITY ASSOCIATED WITH THE DEFINED BENEFIT PLAN 5,671,318. TOTAL TO FORM 990, PART XI, LINE 5: 6,639,246. FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. HEALTHLINE LLC 750 EAST 34TH STREET HIBBING MN 55746 HOSPICE HOME CARE DE 8616581 0 UNIVERSITY MEDICAL CENTER-MESABI AUXILIARY 750 EAST 34TH STREET HIBBING MN 55746 411452117 AUXILIARY MN 135499 105958 FAIRVIEW HEALTH SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 410991680 HEALTH CARE MN 501(C)(3) 170(B)(1)(A)(III) N/A 0 MESABA CLINIC 3605 MAYFAIR AVENUE HIBBING MN 55746 411805715 MEDICAL SERVICES MN N/A C 7368006 1000 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0