2011-11-09T13:10:15-06:00 2010-12-31 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST STE 2300 MINNEAPOLIS MN 55402 990 2010-01-01 410729979 NORTH MEMORIAL HEALTH CARE NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 PAT BORAN 7635205200 2011-11-08 0 LAWRENCE H MOHR CPA 6128764500 2011-11-08 2010 2016-02-24 21:20:13Z PATRICK BORAN 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 675958899 0 X WWW.NORTHMEMORIAL.COM X 1954 MN GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. 14 9 5442 1053 9053122 -1205766 1816294 1348772 617578065 593451178 -11397159 11126827 -2481222 -2680145 605515978 603246632 41500 0 0 0 357563427 372951709 0 0 0 265297801 252198769 622902728 625150478 -17386750 -21903846 664144204 638765423 343635553 335267433 320508651 303497990 X GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE, ONCOLOGY, HIGH RISK MATERNITY & NEONATAL CARE. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NORTH MEMORIAL ALSO PROVIDES SEVERAL COMMUNITY BENEFITS (AT NO OR BELOW COST). 0 0 518854474 577243832 NORTH MEMORIAL MEDICAL CENTER IS A GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL - SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NMMC ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST).IN FURTHERANCE OF ITS CHARITABLE PURPOSE, NORTH MEMORIAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED PROGRAMS, SUCH A HEALTH SCREENINGS, SUPPORT COUNSELING FOR PARENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, UNREIMBURSED COSTS OF MEDICAL EDUCATION, TELEPHONE INFORMATION SERVICES, AND COST RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. NORTH MEMORIAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH: (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES; AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, NORTH MEMORIAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE. 518854474 1 1 0 1 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 698 0 1 5442 1 1 1 1 BD 0 0 0 0 0 0 X 14 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X PATRICK BORAN 7635205048 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 ROBERT POTTS 1.00 X 2700 0 0 TIMOTHY BAYLOR 1.00 X 2700 0 0 THOMAS BOLIN 1.00 X 2700 0 0 YVONNE CHEUNG-HO 1.00 X 2700 0 0 ANDREW HOULTON MD 1.00 X 52700 0 0 WARREN MACK 1.00 X 2700 0 0 PAT MCHALE 1.00 X 0 0 0 JON NIELSON MD 1.00 X 2700 0 0 ROBERT PRENTISS 1.00 X 2700 0 0 KAREN RAUENHORST 1.00 X 2700 0 0 MIKE STEINHAUSER 1.00 X 0 0 0 BILL TOBIN 1.00 X 2700 0 0 MICHAEL WOOTEN MD 1.00 X 17700 0 0 LOREN TAYLOR 50.00 X X 183782 0 19386 PATRICK BORAN 50.00 X 456191 0 51469 DAVID ABRAMS 50.00 X 278616 0 28325 JOHN ALLEN 50.00 X 263653 0 30268 JOSEPH BOSTON 50.00 X 169174 0 18185 ANDREW COCHRANE 50.00 X 344161 0 32834 KEVIN CROSTON 50.00 X 464424 0 15194 VIRGINIA MALONE 50.00 X 50962 0 3096 MICHAEL PARRISH 50.00 X 270009 0 29164 PATRICK TAFFE 50.00 X 284498 0 35952 TOM TIMMONS 50.00 X 400027 0 37185 CHRISTOPHER HECK 50.00 X 644351 0 37083 ROBERT KING 50.00 X 636459 0 39146 STEVEN ROH 50.00 X 723427 0 30952 THOMAS ROSSINI 50.00 X 706413 0 30059 GEORGE TADROS 50.00 X 717416 0 32501 DAVID CRESS 50.00 X 774908 0 52715 TOM HOLETS 50.00 X 881578 0 16663 PAM LINDEMOEN 50.00 X 434621 0 521466 JERRY MOEN 50.00 X 534430 0 7467 SUE PENQUE 50.00 X 221556 0 16650 9535356 0 1085760 474 1 1 0 NORTH CLINIC 3366 OAKDALE AVE N 601 ROBBINSDALE MN 55422 PHYSICIAN SERVICES 5077728 WELLSPRING PARTNERS 123 N WACKER DRIVE 900 CHICAGO IL 60606 CONSULTING SERVICES 3816684 RESPIRATORY CONSULTANTS 3366 OAKDALE AVE N 605 ROBBINSDALE MN 55422 PHYSICIAN SERVICES 2221372 HEALTH PARTNERS MEDICAL GROUP PO BOX 1309 MINNEAPOLIS MN 55440 PHYSICIAN SERVICES 1546479 NORTH PATHOLOGY ASSOCIATES 3300 OAKDALE AVE N ROBBINSDALE MN 55422 PHYSICIAN SERVICES 1029876 50 646639 702133 1348772 HOSPITAL PATIENT REVEN 621500 588977099 579923977 9053122 PARKING 900099 1652930 1652930 CAFETERIA 900099 931363 931363 COFFEE SHOP 900099 693926 693926 TRANSCRIPTION SERVICES 900099 665326 665326 530534 530534 593451178 5708490 5708490 204288 204288 10557633 13237778 -2680145 -2680145 -2680145 64671253 17285 58432890 1041599 6238363 -1024314 5214049 5214049 603246632 577243832 9053122 15600906 10621116 10621116 284444938 257661423 26783515 20589573 18265783 2323790 37103153 31185757 5917396 20192929 17491815 2701114 3178811 2575909 602902 337582 2800 334782 94835 94835 732415 732415 34153583 25972304 8181279 1412846 102865 1309981 7083741 788023 6295718 17803181 15986645 1816536 2279665 2141793 137872 7181655 54831 7126824 43762144 17503402 26258742 5450123 4769892 680231 SUPPLIES 85217199 83143216 2073983 BAD DEBT EXPENSE 21876353 21876353 MAINTENANCE & REPAIRS 8980079 8764869 215210 GOVERNMENTAL TAXES 7972113 7972113 EQUIPMENT RENTAL 2366424 1464041 902383 2316020 1130640 1185380 625150478 518854474 106296004 0 30164716 27090465 4337 4337 162484 127615 93653830 85657938 512547 4676026 4185088 4755468 5504738 563535657 317376266 270140803 246159391 148750631 171363493 50189828 54829269 61133534 43843089 664144204 638765423 70955052 70005790 414916 431998 199648900 199617262 18846632 17889970 53770053 47322413 343635553 335267433 X 320508651 303497990 320508651 303497990 664144204 638765423 X -21903846 4893185 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 40000 1 54835 0 0 94835 0 1737891 513452 25341 24455 2252229 1537773 247046 17937 64865 1737891 1910328 -382648 19699 9606 1537773 0.99140 0.00870 0 1 1 15594663 15594663 217625156 87187116 130438040 12845354 6523894 6321460 308188306 218798518 89389788 9282178 4866738 4415440 246159391 RREEF AMERICA REIT II 18717463 F MELLON AGGREGATE BOND INDEX FUND 30487350 F CASH ON DEPOSIT WITH BOND TRUSTEE 5541441 F CASH VALUE OF LIFE INSURANCE 10023 F AGENCY ACCOUNT 72992 F 54829269 OHE - NORTH AMBULANCE DOUGLAS COUNTY 100000 ASSOCIATED HEALTH ASSURANCE, LTD 500000 INSTITUTE ATHLETIC MEDICINE 800940 NORTH RADIATION THERAPY CENTER 3492928 PREFERRED ADMINISTRATIVE SERVICES, INC. 9449039 NORTHPORT PROPERTIES 74067 PREFERRED ONE COMMUNITY HEALTH PLAN 1328048 MCG CAA DEPOSIT RESERVE 499120 COVENANT NOT TO SELL (NET OF AMORTIZATION) 1347500 DEFERRED FINANCING COSTS 1790193 MINNESOTA DIAGNOSTIC IMAGING 1084717 MAPLE GROVE HOSPITAL 484074 MAPLE GROVE ENDOSCOPY 357988 NOW MEDICAL 15131530 MONTICELLO CANCER CENTER 1527922 VHA UPPER MIDWEST 200000 COLLATERAL SECURITY LENDING 5136097 MAPLE GROVE ASC 469067 WEST SUBURBAN HEALTH CAMPUS 69859 43843089 EXECUTIVE PENSION PLAN 5374974 RESTORATION PENSION PLAN 533607 PY PENSION LIABILITY 15381425 POST RETIREMENT HEALTH INSURANCE 2364174 SECURITIES LENDING 5784350 MCG CAA DEPOSIT RESERVE 499121 INTEREST RATE SWAP 17384762 47322413 603246632 625150478 -21903846 16334634 -11441449 4893185 -17010661 641103887 16334634 27880089 44214723 596889164 732415 5625053 6357468 603246632 653231871 30354154 30354154 622877717 732415 1540346 2272761 625150478 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ALL ENDOWMENT FUNDS ARE HELD BY A RELATED ENTITY: NORTH MEMORIAL FOUNDATION. 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWNMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILIITES AND EQUIPMENTAT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD THE PAY IT FORWARD FUND WAS ESTABLISHED BY BREAST CANVER SURVIVOR MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN. MICHELLE RECOGNIZED A NEED TO HELP WOMEN STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, UNITY AND MONTICELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE NORTH MEMORIAL FOUNDATION. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST RATE SWAP VALUATION -4,084,707. EQUITY TRANSFER ON 1/1/2010 -7,356,742. PART XII, LINE 2D - OTHER ADJUSTMENTS: FOUNDATION INCOME 1,595,697. ASSOCIATED HEALTH ASSURANCE LTD INCOME 726,657. OAKDALE HEALTH ENTERPRISES INCOME 3,042,453. RENTAL EXPENSES RECLASSED FROM EXPENSE 13,237,778. NOW MEDICAL CARE INCOME 8,253,190. GAIN ON SALE OF FIXED ASSETS RECLASSED FROM EXPENSE 1,024,314. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER OPERATING INCOME RECLASSED TO INTEREST EXPENSE 45,059. CONSOLIDATED ELIMINATION ENTRIES BETWEEN REVENUE AND EXPENSE 1,495,287. CHANGE IN INTEREST RATE SWAP VALUATION 4,084,707. PART XIII, LINE 2D - OTHER ADJUSTMENTS: OAKDALE HEALTH ENTERPRISES EXPENSE 3,105,741. RENTAL EXPENSE RECLASSED TO INCOME 13,237,778. FOUNDATION EXPENSES 895,967. NOW CARE MEDICAL CENTER EXPENSE 10,252,034. ASSOCIATED HEALTH ASSURANCE, LTD EXPENSE ADJUSTMENT 1,838,320. GAIN ON FIXED ASSET DISPOSAL RECLASSED TO INCOME 1,024,314. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSE RECLASSIFIED FROM OTHER INCOME 45,059. CONSOLIDATED ELIMINATION ENTRY BETWEEN REVENUE AND EXPENSE 1,495,287. 1 1 1 X 1 X 1 1 1 0 0 11974832 11974832 0.01920 78049367 50099040 27950327 0.04470 90024199 50099040 39925159 0.06390 1867031 49053 1817978 0.00290 3636193 2957667 678526 0.00110 53429630 42284136 11145494 0.01780 658472 571626 86846 0.00010 405123 405123 0.00060 59996449 45862482 14133967 0.02250 150020648 95961522 54059126 0.08640 1 8247385 115174679 126894987 -11720308 X 1 1 1 MAPLE GROVE HOSPIT HOSPITAL 0.75000 0.00000 0.00000 2 NM SURGERY CTR MG OUTPATIENT SURG CTR 0.50000 0.00000 0.50000 3 NM ENDO CTR MG OUTPATIENT GI CENTER 0.63000 0.00000 0.37000 4 MN DIAGNOSTIC IMAG OUTPATIENT IMAGING CTR 0.60000 0.00000 0.40000 5 PREFERREDONE ADMSVC CLAIMS ADMINISTRATOR 0.25000 0.00000 0.25000 6 PREFERREDONE COMHTH INSURANCE COMPANY 0.50000 0.00000 0.00000 7 INST ATHLETIC MED CLINIC 0.37000 0.00000 0.00000 8 WEST HEALTH AMBULATORY SURGERY CTR 0.50000 0.00000 0.00000 9 WEST SUBURBAN HLTH REAL ESTATE 0.50000 0.00000 0.00000 10 MONTICELLO CNCR CTR OPTNT CANCER CLINIC 0.40000 0.00000 0.00000 11 N RADIATION ONC OPTNT RADIATION ONC CLNC 0.50000 0.00000 0.00000 1 1 NORTH MEMORIAL MEDICAL CENTER

3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422

X X X X NORTH MEMORIAL MEDICAL CENTER 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 1 PART III, LINE 4: NORTH MEMORIAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT. PART III, LINE 8: NORTH MEMORIAL FEELS THE FULL AMOUNT OF THE SHORTFALL SHOULD BE INCLUDED SINCE THIS REPRESENTS AMOUNTS PAID TO NORTH MEMORIAL FOR SERVICES TO THESE PATIENTS AT RATES BELOW THE COST OF PROVIDING THE SERVICE. THE AMOUNT IS DETERMINED FOLLOWING COST FINDING PRINCIPLES PUT FORTH BY THE MEDICARE PROGRAM. PART III, LINE 9B: NORTH MEMORIAL HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATIONS INTRANET AND PERTAIN TO ALL ENTITIES UNDER THE NORTH MEMORIAL CORPORATE UMBRELLA. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 19D: THE MINNESOTA ATTORNEY GENERAL'S OFFICE REQUIRES HOSPITALS TO RENDER SERVICES TO THOSE PATIENTS WHO DO NOT HAVE INSURANCE AT A REDUCED RATE EQUAL TO THE DISCOUNT INCURRED FROM THE HIGHEST VOLUME MANAGE CARE PLAN. NORTH MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 21: PER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT, THIRD PARTY LIABILITY AND PROCEDURES THAT ARE NOT MEDICALLY NECESSARY ARE NOT COVEREDUNDER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT AND THOSE PATIENTS CAN BE BILLED FULL CHARGES. PART VI, LINE 2: NORTH MEMORIAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF COMMUNITY BENEFITS AND CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE MANAGEMENT'S ESTIMATE OF THE COST TO PROVIDE CHARITY CARE, THE COST OF THE SERVICES AND SUPPLIES FURNISHED FOR COMMUNITY BENEFIT PROGRAMS AND PUBLIC PROGRAM PAYMENT DEFICITS. PART VI, LINE 3: NORTH MEMORIAL HEALTH CARE HAS A VERY PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE AN IMMEDIATE DISCOUNT TO UNINSURED MINNESOTA RESIDENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.OUR CHARITY CARE PROGRAM IS PUBLISHED IN THE CORPORATE POLICIES AND PROCEDURES AND PROVIDES FOR 100% COVERAGE OF MEDICAL BILLS FOR ANYONE WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND NEEDS ASSISTANCE IN RESOLVING THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. THERE IS A GRADUAL REDUCTION IN THE CHARITY COVERAGE BETWEEN THE 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES.IF WE ARE UNABLE TO MEET WITH THE PATIENT BEFORE DISCHARGE FROM NORTH MEMORIAL, THE PATIENT IS GIVEN A PAMPHLET THAT LISTS CONTACT NUMBERS TO OUR BUSINESS OFFICE CUSTOMER SERVICE AREA TO DISCUSS OPTIONS FOR ASSISTANCE WITH THEIR MEDICAL BILLS. THIS CONTACT INFORMATION IS ALSO PROVIDED ON EVERY STATEMENT THAT IS SENT TO OUR CUSTOMERS. IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE. PART VI, LINE 4: NORTH MEMORIAL SERVES A GEOGRAPHIC AREA THAT INCLUDES 42 ZIP CODES IN THE NORTHWEST QUADRANT OF THE TWIN CITIES METRO. THIS SERVICE AREA INCLUDES BOTH URBAN, SUBURBAN, EX-URBAN, AND RURAL AREAS. THIS SERVICE AREA INCLUDES A DIVERSE POPULATION OF MORE THAN 900,000 PEOPLE LIVING IN HENNEPIN, WRIGHT, SHERBURNE AND RAMSEY COUNTIES. PART VI, LINE 6: NORTH MEMORIAL HEALTH CARE IS A GENERAL ACUTE CARE HOSPITAL PROVIDING SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CARDIOVASULAR AND OPEN HEART SERVICES, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATIVE AND BEHAVIORAL SERVICES. NMHC ALSO PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO OUR COMMUNITY INCLUDING PRIMARY CARE, AMBULANCE TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. NORTH MEMORIAL IS GOVERNED BY A BOARD OF 15 REPRESENTATIVES CONSISTING OF PHYSICIANS AND VARIOUS LEADERS FROM THROUGHOUT THE COMMUNITY. BOARD MEMBERS ARE ELECTED TO SERVE THREE-YEAR TERMS FOR A TOTAL OF FIVE TERMS. THE MEDICAL CENTER ALSO SUPPORTS AN OPEN MEDICAL STAFF ORGANIZATION INCLUDING APPROXIMATELY 900 BOARD CERTIFIED PHYSICIANS AND 300 ALLIED HEALTH PROFESSIONSALS. THE NORTH MEMORIAL BOARD OF TRUSTEES ESTABLISHES AN ANNUAL MARGIN TARGET FOR MANAGEMENT. PER BOARD POLICY 75% OF ANY EXCESS AVAILABLE CASH FLOW IS REINVESTED IN THE FORM OF CAPITAL IMPROVEMENTS TO THE CENTER. THE REMAINING 25% IS REINVESTED TO SUPPORT LONG TERM OPERATIONS. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 LOREN TAYLOR 182547 0 0 0 1235 0 12911 0 6475 0 203168 0 0 0 PATRICK BORAN 339192 0 0 0 116999 0 37718 0 13751 0 507660 0 62370 0 DAVID ABRAMS 221694 0 0 0 56922 0 16864 0 11461 0 306941 0 54563 0 JOHN ALLEN 220299 0 0 0 43354 0 15864 0 14404 0 293921 0 8005 0 JOSEPH BOSTON 141204 0 0 0 27970 0 9718 0 8467 0 187359 0 0 0 ANDREW COCHRANE 296599 0 0 0 47562 0 17464 0 15370 0 376995 0 0 0 KEVIN CROSTON 424488 0 0 0 39936 0 12563 0 2631 0 479618 0 0 0 MICHAEL PARRISH 232930 0 0 0 37079 0 16643 0 12521 0 299173 0 0 0 PATRICK TAFFE 256203 0 0 0 28295 0 17464 0 18488 0 320450 0 0 0 TOM TIMMONS 340814 0 0 0 59213 0 17464 0 19721 0 437212 0 0 0 CHRISTOPHER HECK 623694 0 0 0 20657 0 17464 0 19619 0 681434 0 0 0 ROBERT KING 623310 0 0 0 13149 0 17464 0 21682 0 675605 0 0 0 STEVEN ROH 711132 0 3000 0 9295 0 17464 0 13488 0 754379 0 0 0 THOMAS ROSSINI 592300 0 99342 0 14771 0 17464 0 12595 0 736472 0 0 0 GEORGE TADROS 707689 0 0 0 9727 0 16459 0 16042 0 749917 0 0 0 DAVID CRESS 424820 0 0 0 350088 0 17464 0 35251 0 827623 0 131470 0 TOM HOLETS 334089 0 0 0 547489 0 7350 0 9313 0 898241 0 0 0 PAM LINDEMOEN 335953 0 0 0 98668 0 515073 0 6393 0 956087 0 0 0 JERRY MOEN 26970 0 0 0 507460 0 1784 0 5683 0 541897 0 76769 0 SUE PENQUE 186129 0 0 0 35427 0 4746 0 11904 0 238206 0 0 0 SUPPLEMENTAL INFORMATION PART III THE ORGANIZATION REIMBURSES ONE OF THE EXECUTIVE MEMBERS FOR THE MONTHLY SOCIAL DUES AT THE GOLDEN VALLEY COUNTRY CLUB. THE DUES FOR 2010 WERE $90 PER MONTH OR 1,080 PER YEAR. THE NORTH MEMORIAL COMMUNITY FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUND RAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORTS VARIOUS ACTIVITIES FOR NORTH MEMORIAL. SUPPLEMENTAL INFORMATION PART III ALL EXPENSES ARE REVIEWED PRIOR TO REIMBURSEMENT AND SIGNED OFF BY THE CEO. NORTH MEMORIAL REPORTS EXECUTIVE EXPENSE REIMBURSEMENT DATA TO THE BOARD OF TRUSTEES ON AN ANNUAL BASIS. SUPPLEMENTAL INFORMATION PART III THE AMOUNTS REPORTED IN "OTHER REPORTABLE COMPENSATION" AND "RETIREMENT AND OTHER DEFERRED COMPENSATION" IN EXCESS OF $500,000 REFLECT PAYMENTS MADE IN 2010 OR 2011 PURSUANT TO SEVERANCE AGREEMENTS WITH THOSE INDIVIDUALS. CITY OF MAPLE GROVE 410873250 56516TAD7 2005-09-22 55000000 CONSTRUCTION OF OUTPATIENT CENTER 0 1 0 CITY OF ROBBINSDALE 716005496 2008-07-10 147190000 REFUND SERIES 2003 BONDS 0 1 0 54851782 4767980 1083801 2007 0 0 1 1 147190000 790017 2008 1 0 1 1 0 1 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 23.000000000000 1 AIG MATCHED FUNDING 1.750000000000 1 0 0 0 1 1 PIPER JAFFRAY 23.000000000000 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 LARRY TAYLOR AND BOB POTTS - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE REVIEWS THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEWS THE FORM 990 WITH THE FINANCE AND AUDIT COMMITTEE IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE FINANCE AND AUDIT COMMITTEE APPROVES THE FORM 990 AND FORWARDS IT TO THE FULL BOARD FOR ITS REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY POSITIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE SECRETARY OF THE STATE FILING WITH THE STATE OF MINNESOTA. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 16,334,634. CHANGE IN INTEREST RATE SWAP VALUATION -4,084,707. EQUITY TRANSFER ON 1/1/2010 -7,356,742. TOTAL TO FORM 990, PART XI, LINE 5: 4,893,185. FORM 990, PART XII, LINCE 2C: NEITHER THE OVERSIGHT PROCESS OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED IN THE CURRENT YEAR. OAKDALE MEDICAL CENTER 3300 OALDALE AVENUE NORTH ROBBINSDALE MN 55422 320022819 LEASE MEDICAL OFFICE SPACE MN NORTH MEMORIAL NORTH MEMORIAL COMMUNITY FOUNDATION 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411777966 FUNDRAISING MN 501(C)(3) 7 NORTH MEMORIAL 0 ASSOCIATED HEALTH ASSURANCE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 980343815 INSURANCE BD 501(C)(3) 11A NORTH MEMORIAL 0 MAPLE GROVE HOSPITAL CORPORATION 9875 HOSPITAL DRIVE MAPLE GROVE MN 55369 208316475 ACUTE CARE MN 501(C)(3) 3 NORTH MEMORIAL 0 WEST HEALTH INC 2805 CAMPUS DRIVE PLYMOUTH MN 55441 SURGERY CENTER MN 501(C)(3) 3 NORTH MEMORIAL 0 PREFERRED ONE COMMUNITY HEALTH PLAN 6105 GOLDEN HILLS DRIVE GOLDEN VALLEY MN 55416 HMO MN 501(C)(4) N/A 0 WEST SUBURBAN HEALTH 2805 CAMPUS DRIVE PLYMOUTH MN 55441 REAL ESTATE MN RELATED -58464 1084424 0 1 NORTH MEMORIAL SURGERY CENTER AT MAPLE GROVE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 OUTPATIENT SURGERY MN RELATED 399953 1684452 0 0 NORTH MEMORIAL ENDOSCOPY CENTER AT MAPLE GROVE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 OUTPATIENT SURGERY MN RELATED 60215 712836 0 0 MONTICELLO CANCER CENTER 1013 HARAT BLVD MONTICELLO MN 55362 CANCER CENTER MN RELATED -1068767 2120202 0 1 MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC 9855 HOSPITAL DRIVE MAPLE GROVE MN 55369 RADIOLOGY MN C 819652 1639372 0.60000 PREFERRED ONE ADMINISTRATIVE SERVICES INC 6105 GOLDEN HILLS DRIVE GOLDEN VALLEY MN 55416 TPA MN C 1237667 9793476 0.25000 OAKDALE HEALTH ENTERPRISES INC 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 411546422 AMBULANCE MN C -63288 803640 1.00000 NOW CARE INC 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 URGENT CARE MN C -452582 4843717 1.00000 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 1 0 1 NORTH MEMORIAL COMMUNITY FOUNDATION (CONTRIBUTIONS) C 705476 FMV NORTH MEMORIAL COMMUNITY FOUNDATION (LEASE PAYMENTS) I 98857 FMV MAPLE GROVE HOSPITAL CORPORATION (DEBT GUARANTEE) D 107704000 FMV MAPLE GROVE HOSPITAL CORPORATION (LEASE PAYMENTS) I 356905 FMV MAPLE GROVE HOSPITAL CORPORATION (MANAGEMENT FEES) P 3123672 FMV MAPLE GROVE HOSPITAL CORPORATION (SALARY REIMBURSEMENT) P 4067844 FMV ASSOCIATED HEALTH ASSURANCE (PREMIUMS) L 809000 FMV OAKDALE HEALTH ENTERPRISES (PAYROLL) B 1620652 FMV OAKDALE HEALTH ENTERPRISES (MANAGEMENT FEES) L 698898 FMV OAKDALE HEALTH ENTERPRISES (INTEREST ON LOAN) R 78095 FMV NOW MEDICAL (LOAN GUARANTEE) D 658141 FMV OAKDALE MEDICAL OFFICE BUILDING (LEASE PAYMENTS) J 446492 FMV OAKDALE MEDICAL OFFICE BUILDING (EXPENSE REIMBURSEMENT) P 391820 FMV WEST HEALTH (BOND DEBT GUARANTEE) D 11260000 FMV MINNEAPOLIS RADIATION ONCOLOGY (LOAN GUARANTEE) D 610099 FMV NORTH MEMORIAL AMBULATORY SURGERY CENTER (LOAN GUARANTEE) D 987000 FMV NORTH MEMORIAL AMBULATORY SURGERY CENTER (LEASE PAYMENTS) I 1359373 FMV NORTH MEMORIAL ENDOSCOPY CENTER (LOAN GUARANTEE) D 172000 FMV NORTH MEMORIAL ENDOSCOPY CENTER (LEASE PAYMENTS) I 691626 FMV MAPLE GROVE DIAGNOSTIC IMAGING CENTER (LOAN GUARANTEE) D 865000 FMV MAPLE GROVE DIAGNOSTIC IMAGING CENTER (LEASE PAYMENTS) I 1014542 FMV MINNEAPOLIS RADIATION ONCOLOGY (LEASE PAYMENTS) I 227371 FMV MINNEAPOLIS RADIATION ONCOLOGY (DIVIDEND) R 885000 FMV WEST HEALTH (MANAGEMENT FEE) L 782000 FMV WEST HEALTH (RENT) J 284275 FMV PREFERRED ON ADMINISTRATIVE SOURCES (CLAIMS PROCESSING) L 33346114 FMV PREFERRED ON ADMINISTRATIVE SOURCES (REIMBURSEMENT TO NMMC) R 22272431 FMV