2023-11-13T13:07:20-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 410837659 MINNESOTA VALLEY HEALTH CENTER INC MINN 5076653375 621 SOUTH 4TH STREET LE SUEUR MN 56058 AARON BLOOMQUIST CFO 5076653375 2023-11-13 1 AARON BLOOMQUIST XXX-XX-XXXX 1 KURT BENNION CPA P01469618 4252506100 2023-11-13 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z RIDGEVIEW LE SUEUR MEDICAL CENTER MICHAEL PHELPS 500 SOUTH MAPLE ST WACONIA MN 55387 15307099 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1959 MN RIDGEVIEW LE SUEUR MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF THE PEOPLE WE SERVE WITH A CULTURE THAT NURTURES THE WHOLE PERSONMIND, BODY AND SPIRIT. 7 6 157 6 0 0 2059652 883428 13235751 14146423 66552 9551 414009 267697 15775964 15307099 0 0 0 0 6849731 6489192 0 0 0 6351498 8016147 13201229 14505339 2574735 801760 20327367 20693444 10056374 9788391 10270993 10905053 RIDGEVIEW LE SUEUR MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF PEOPLE IT SERVES WITH A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. 0 0 9323977 0 14146423 RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED & ORGANIZED EXCLUSIVELY FOR CHARITABLE PURPOSES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES. RIDGEVIEW LE SUEUR MEDICAL CENTER INCLUDES A HOSPITAL, OUTPATIENT SPECIALTY CLINICS, COMPLETE LAB AND RADIOLOGY DEPARTMENTS, A COMPREHENSIVE PHYSICAL OCCUPATIONAL AND SPEECH THERAPY DEPARTMENT, EXTENDED CARE NURSING FACILITIES, AND INDEPENDENT LIVING SENIOR HOUSING. 9323977 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 157 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X AARON BLOOMQUIST 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 MICHAEL PHELPS PRESIDENT/CEO 0.50 49.50 X 0 1274183 64040 GORDON GABLENZ CIO 0.50 49.50 X 0 794145 89439 AARON BLOOMQUIST CFO 0.50 49.50 X 0 490798 61669 BENJAMIN NIELSEN COO & TREASURER 0.50 49.50 X X 0 363774 18024 JEFF NELSON BOARD MEMBER 0.40 2.40 X 1200 6200 0 ROBERT BROEDER BOARD CHAIR 0.40 0.00 X X 1800 0 0 KAY KING SECRETARY 0.40 0.00 X X 1200 0 0 MARK AMUNDSON BOARD MEMBER 0.40 0.00 X 1200 0 0 DAVID BRAUN BOARD MEMBER 0.40 0.00 X 1200 0 0 SHAWN KIRBY BOARD MEMBER 0.40 0.00 X 1200 0 0 7800 2929100 233172 0 0 1 0 EMPAC 500 S MAPLE STREET WACONIA MN 55387 EMERGENCY DEPARTMENT PHYSICIAN SERVICES 1126464 CONNECTED HEALTH CARE LLC 1121 E SE LOOP 323 SUITE 102 TYLER TX 75701 STAFFING SERVICES 532518 AEGIS THERAPIES INC 2601 NETWORK BLVD SUITE 102 FIRSCO TX 75034 THERAPY SERVICES 322934 PRIME TIME HEALTHCARE LLC 15380 WEIR STREET OMAHA NE 68137 STAFFING SERVICES 222509 PREMIER STAFFING INC 243 WINKLER TRAIL COLOGNE MN 55322 STAFFING SERVICES 212171 6 57913 556803 268712 883428 PATIENT/RESIDENT REV. 621110 13836235 13836235 APARTMENT PROJECT REV. 623000 290091 290091 PHARMACY 621110 20097 20097 14146423 9551 9551 224418 0 224418 224418 224418 MISCELLANEOUS INCOME 900099 43279 43279 43279 15307099 14146423 0 277248 X 7800 7800 5436473 3806815 1629658 165440 115681 49759 489920 342568 147352 389559 272392 117167 633 633 17889 17889 3346154 2060438 1285716 16919 16919 31501 15475 16026 27964 17451 10513 447718 279396 168322 9670 6035 3635 12870 8031 4839 266518 266518 1408781 385392 1023389 48258 30115 18143 SUPPLIES 878715 878715 REPAIRS AND MAINTENANCE 673926 420560 253366 BAD DEBT 332553 332553 DUES AND SUBSCRIPTIONS 260311 162446 97865 235767 189914 45853 14505339 9323977 5181362 0 268511 1274945 7681376 6468801 3646404 2594765 175317 203617 142783 155307 15490945 10324026 7429984 5166919 107029 982992 4722061 20327367 20693444 376845 630509 627920 441565 16381 16751 298896 213755 8736332 8485811 10056374 9788391 X 9288001 10089761 982992 815292 10270993 10905053 20327367 20693444 X 801760 -167700 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 233 233 0 PART II-B, LINE 1: RIDGEVIEW LE SUEUR MEDICAL CENTER PAY DUES TO A CERTAIN ORGANIZATION RELATED TO THE INDUSTRY WHICH HAS LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 0 1 X 982992 -167700 815292 955773 27219 982992 793116 162657 955773 722130 111628 30050 10592 793116 794693 -32850 29405 10308 722130 0.00000 1.00000 0.00000 1 0 46482 46482 2753695 5089301 -2335606 127009 106908 20101 12320493 5127817 7192676 243266 243266 5166919 BENEFICIAL INTEREST IN MINNESOTA FOUNDATION 815292 RIGHT-OF-USE LEASE ASSETS 3906769 4722061 DUE TO AFFILIATE 1324980 RIGHT-OF-USE LEASE LIABILITIES 5359826 THIRD PARTY PAYOR SETTLEMENTS 1801005 8485811 X 11532348 0 11532348 3774751 3774751 15307099 9910263 0 9910263 4595076 4595076 14505339 PART IV, LINE 2B: RIDGEVIEW LE SUEUR MEDICAL CENTER ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. THE ORGANIZATION ALSO HOLDS SECURITY DEPOSITS FOR TENANTS LEASING SPACE WITHIN OUR FACILITIES. EACH SECURITY DEPOSIT WILL BE REFUNDED, LESS ANY REPAIRS FOR DAMAGES, WHEN THE LEASE IS TERMINATED. PART V, LINE 4: RIDGEVIEW LE SUEUR MEDICAL CENTER'S INTENDED USE OF ITS ENDOWMENT FUNDS IS FOR CAPITAL AND OTHER IMPROVEMENTS THAT FURTHER RIDGEVIEW LE SUEUR MEDICAL CENTER'S MISSION. PART X, LINE 2: THE HEALTH CENTER IS OPERATED AS A TAX-EXEMPT CORPORATION UNDER SECTION 501(C)(3) OF THE IRC AND IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAX RELATED TO BUSINESS INCOME. THE HEALTH CENTER FOLLOWS THE ACCOUNTING STANDARD FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HEALTH CENTER'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 9,551. FOUNDATION CONTRIBUTIONS 49,150. BAD DEBT EXPENSE 332,553. CAPITAL GRANTS AND CONTRIBUTIONS 268,712. REVENUE FROM DISCONTINUED OPERATIONS 3,114,785. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 332,553. EXPENSES FROM DISCONTINUED OPERATIONS 4,262,523. 1 1 X 1 X 1 X 1 1 0 1 1 146401 146401 0.01030 1921755 765622 1156133 0.08160 2068156 765622 1302534 0.09190 1 750 750 0.00010 1 750 750 0.00010 1 2068906 765622 1303284 0.09200 1 332553 103067 4086943 4325131 -238188 X 1 1 1 1 RIDGEVIEW LE SUEUR MEDICAL CENTER 621 SOUTH 4TH STREET LE SUEUR MN 56058 WWW.RIDGEVIEWMEDICAL.ORG HFID-00336 X X X X RIDGEVIEW LE SUEUR MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 0 1 X WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ X 1 22 1 WWW.RIDGEVEIWMEDICAL.ORG/ABOUT-US/ 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 RIDGEVIEW LE SUEUR MEDICAL CENTER PART V, SECTION B, LINE 5: RIDGEVIEW COLLECTED ITS OWN PRIMARY DATA FOR THE 2022 CHNA, USING ITS ELECTRONIC AND OTHER HEALTH RECORDS. THIS INCLUDED DATA ANALYSIS, VALIDATION AND PRIORITIZATION, AND ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS. TO SPECIFICALLY IDENTIFY NEEDS IN RIDGEVIEW'S MOST RURAL COUNTIES, COMMUNITY INPUT WAS PROVIDED IN AUGUST 2022 BY FOCUS GROUPS COMPOSED OF RESIDENTS OF LE SUEUR AND SIBLEY COUNTIES. RIDGEVIEW LE SUEUR MEDICAL CENTER PART V, SECTION B, LINE 6A: THE 2022 CHNA WAS CONDUCTED WITH RIDGEVIEW MEDICAL CENTER AND RIDGEVIEW SIBLEY MEDICAL CENTER. RIDGEVIEW LE SUEUR MEDICAL CENTER PART V, SECTION B, LINE 11: RIDGEVIEW LE SUEUR MEDICAL CENTER CONTINUES TO DEVELOP BROAD COMMUNITY STRATEGIES THAT FOCUS ON THREE HEALTH ISSUES THAT WERE IDENTIFIED AND PRIORITIZED IN THE CHNA AND IMPLEMENTATION PLAN: 1) PREVENTION, CLINICAL CARE, AND DISEASE MANAGEMENT (PREVENTATIVE SCREENINGS, TOBACCO CESSATION, OBESITY), 2) ACCESS TO CARE (PRIMARY AND URGENT CARE, RURAL SERVICE AREA), AND 3) MENTAL AND BEHAVIORAL HEALTH (EMERGENCY SERVICES, ADULT BEHAVIORAL HEALTH).RIDGEVIEW WILL CONTINUE TO OFFER CARE AND SERVICES TO ADDRESS THESE PRIORITY HEALTH ISSUES. THE INFORMATION FROM THE CHNA WILL FURTHER INFORM ORGANIZATIONAL LEADERSHIP IN DECISION-MAKING PROCESSES TO EXPAND, REFINE, AND DIRECT SERVICES, COMMUNICATION, COLLABORATION, EDUCATION AND OUTREACH ACTIVITIES. ADDRESSING THE PRIORITY HEALTH ISSUES INVOLVES MANY FACTORS OUTSIDE THE CLINICAL SETTING. RIDGEVIEW WILL CONTINUE TO WORK TO ENHANCE THE IMPACT OF BROADER COMMUNITY HEALTH EFFORTS TO ADDRESS THESE ISSUES. BY FACILITATING SYSTEM-WIDE AND CROSS-COMMUNITY COMMUNICATION AND COLLABORATION, EXISTING EFFORTS WILL RESULT IN IMPROVED SUCCESS AND IMPACT. WHILE EMPHASIS IS PLACED ON THE THREE HEALTH ISSUES DETAILED IN THE CHNA REPORT DOCUMENT, RIDGEVIEW AS A COMMUNITY HEALTH PROVIDER, WILL CONTINUE TO FOCUS RESOURCES ON OTHER LONG-STANDING INITIATIVES AND SERVICES THAT HELP IMPROVE OVERALL HEALTH. RIDGEVIEW LE SUEUR MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT WWW.RIDGEVIEWMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL/. 3 1 - RIDGEVIEW LE SUEUR LONG-TERM CARE 621 SOUTH 4TH STREET LE SUEUR MN 56058 SKILLED NURSING FACILITY 2 - SUNRIZE PLAZA 600 SOUTH 5TH STREET LE SUEUR MN 56058 SENIOR APARTMENTS 3 - RIDGEVIEW LE SUEUR CLINIC 621 SOUTH 4TH STREET LE SUEUR MN 56058 CLINIC PART I, LINE 3C: TO QUALIFY FOR FINANCIAL ASSISTANCE, THE FOLLOWING CONDITIONS MUST BE MET:(A) THE MEDICAL CARE PROVIDED BY RIDGEVIEW LE SUEUR MEDICAL CENTER IS MEDICALLY NECESSARY;(B) THE INDIVIDUAL SUBMITS A COMPLETED APPLICATION;(C) THE INDIVIDUAL COOPERATES WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE, IF NECESSARY (INCLUDING SSI, DISABILITY, MEDICARE AND MEDICAID); AND(D) THE INDIVIDUAL'S FAMILY INCOME IS LESS THAN 250% OF FEDERAL POVERTY GUIDELINES ("FPG"). FREE CARE IS OFFERED FOR FEDERAL ADJUSTED GROSS INCOME UP TO 200% OF FPG. 75% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 200% AND 225% FPG. 56% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 225% AND 250% OF FPG.IN ADDITION, PATIENTS SEEKING FINANCIAL ASSISTANCE MAY BE ASKED FIRST TO APLY FOR OTHER EXTERNAL PROGRAMS (SUCH AS MEDICAID OR INSURANCE THROUGH THE PUBLIC MARKETPLACE).RIDGEVIEW MAY RELY ON EXTERNAL SOURCES TO DETERMINE ELIGIBILITY WHEN:(A) THE PATIENT IS HOMELESS;(B) THE PATIENT IS ELIGIBLE FOR OTHER UNFUNDED STATE OR LOCAL ASSISTANCE PROGRAMS;(C) THE PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH;(D) THE PATIENT IS ELIGIBLE FOR STATE-FUNDED PRESCRIPTION MEDICATION;(E) THE PATIENT'S VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING; OR(F) THE PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL FOR FURTHER TREATMENT.RIDGEVIEW LE SUEUR MEDICAL CENTER ALSO USES CHANGE HEALTHCARE, AN ELIGIBILITY VENDOR, TO HELP IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE COSTING METHODOLOGY USED BY RIDGEVIEW LE SUEUR MEDICAL CENTER TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON MVHC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. 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 $ 332,553. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS CALCULATED BY RIDGEVIEW AS FOLLOWS: PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF THE INVOICE OR CLAIM SUBMITTED. PATIENT ACCOUNTS THAT ARE MORE THAN 90 DAYS PAST DUE ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE ORGANIZATION. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE. PART III, LINE 3: RIDGEVIEW LE SUEUR MEDICAL CENTER ESTIMATES THAT APPROXIMATELY 25% OF ITS TOTAL COST OF CHARITY CARE IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE BUT DID NOT COMPLETE AN APPLICATION AND WERE ULTIMATELY INCLUDED IN BAD DEBT EXPENSE REPORTED IN PART III, LINE 2. PART III, LINE 4: SEE NOTE 2, "PATIENT AND RESIDENT SERVICE REVENUE", ON PAGES 13-17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF RIDGEVIEW LE SUEUR MEDICAL CENTER'S BAD DEBT EXPENSE. PART III, LINE 8: RIDGEVIEW LE SUEUR MEDICAL CENTER INCORPORATED THE FULL VALUE OF THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. THE RATIONALE FOR THE ORGANIZATION'S OPINION IS PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE AND IT IS LIKELY TO GET WORSE. MANY MEDICARE BENEFICIARIES ARE POOR AND ARE ELIGIBLE FOR MEDICAID IN ADDITION TO MEDICARE. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL AND NURSING HOME IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY. PART III, LINE 9B: RIDGEVIEW'S CHARITY PROGRAM ALLOWS FOR ACCOUNTS IN BAD DEBT STATUS TO COMPLETE A CHARITY CARE APPLICATION. IF APPROVED, THE ACCOUNT WILL BE RETURNED FROM BAD DEBT AND APPLIED TO OUR CHARITY CARE PROGRAM. ALL PATIENTS ARE ADVISED OF OUR CHARITY CARE PROGRAM THROUGH OUR MONTHLY BILLING PROCESS. RIDGEVIEW MEDICAL CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING PATIENT ACCOUNT BALANCES. PART VI, LINE 2: RIDGEVIEW LE SUEUR MEDICAL CENTER ASSESSES THE CURRENT HEALTH STATUS, HEALTH OUTCOMES, AND UNMET NEEDS IN THE COMMUNITIES IT SERVES THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS. COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND PUBLIC REPORTING ENSURES THAT RIDGEVIEW LE SUEUR MEDICAL CENTER IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH COMMUNITY HEALTH PRIORITIES.RIDGEVIEW LE SUEUR MEDICAL CENTER HAS AND WILL CONTINUE TO USE A CHNA AND OTHER INTERNAL AND EXTERNAL INFORMATION (INCLUDING DISCHARGE, QUALITY MEASURES, PREDICTIVE, AND POPULATION DATA) TO AID STRATEGIC PLANNING PROCESSES AND ALIGN ORGANIZATIONAL SERVICES/RESOURCES ACCORDINGLY. PART VI, LINE 3: AT THE TIME OF SCHEDULING, PRE-REGISTRATION, REGISTRATION, OR DISCHARGE (WHICHEVER IS APPLICABLE), THE PATIENT WILL BE ASKED FOR INSURANCE COVERAGE, AND THE PATIENT WILL BE INFORMED OF ANY CO-PAYMENTS THAT WILL BE EXPECTED AT THE TIME OF PAYMENT. IF THE PATIENT WISHES TO APPLY FOR COMMUNITY CARE, HE OR SHE WILL BE GIVEN OR MAILED AN APPLICATION; THE APPLICATION IS ALSO AVAILABLE FOR DOWNLOAD FROM THE WEBSITE. A PATIENT MAY NOT QUALIFY FOR COMMUNITY CARE UNTIL HE OR SHE HAS COMPLETED THE APPLICATION.AFTER COMPLETING THE COMMUNITY CARE APPLICATION (INCLUDING SUPPORTING DOCUMENTATION), THE ACCOUNT REPRESENTATIVE WILL ASSESS THE APPLICATION AND DETERMINE WHETHER THE PATIENT QUALIFIES FOR COMMUNITY CARE OR ANY OTHER GOVERNMENTAL HEALTH CARE COVERAGE. IF THE PATIENT IS LIKELY TO QUALIFY FOR THE HOSPITAL PRESUMPTIVE ELIGIBILITY PROGRAM OTHER GOVERNMENTAL HEALTH CARE COVERAGE, THE ACCOUNT REPRESENTATIVE WILL DETERMINE APPROPRIATE COVERAGE AND REFER THE PATIENT AS APPROPRIATE.IF AN UNINSURED PATIENT IS UNLIKELY TO QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE, OR DENIED HOSPITAL PRESUMPTIVE ELIGIBILITY, AND THE PATIENT DOES NOT QUALIFY FOR COMMUNITY CARE, APPROPRIATE PAYMENT ARRANGEMENTS MUST BE MADE WITH THE ACCOUNT REPRESENTATIVE BASED UPON RIDGEVIEW LE SUEUR MEDICAL CENTER'S UNINSURED PAYMENT POLICY.SHOULD THE PATIENT SUBSEQUENTLY QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE OR ANY OTHER HEALTH INSURANCE, ANY PAYMENTS RECEIVED WILL BE REFUNDED LESS ANY CO-PAYMENTS DUE.THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT WWW.RIDGEVIEWMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL/. PART VI, LINE 4: RIDGEVIEW LE SUEUR MEDICAL CENTER) IS LOCATED IN LE SUEUR, MN. RIDGEVIEW LE SUEUR MEDICAL CENTER OPERATES A CRITICAL ACCESS HOSPITAL, A LONG-TERM CARE FACILITY, AND A 37-UNIT HUD-SUBSIDIZED LOW INCOME HOUSING FOR SENIORS THAT SERVE THE COMMUNITIES OF LE SUEUR, NICOLLET AND SIBLEY COUNTIES. THE OVERALL COMMUNITY IS CLASSIFIED AS RURAL. RIDGEVIEW LE SUEUR MEDICAL CENTER AND ITS RELATED FACILITIES COVER A SERVICE REGION OF APPROXIMATELY 29,000 PEOPLE. THE SERVICE REGION AGE DISTRIBUTION IS 29% UNDER THE AGE OF 18, 52% BETWEEN THE AGES OF 18 AND 65, AND 19% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE REGION IS 90% WHITE, 7% HISPANIC OR LATINO, 1% BLACK OR AFRICAN AMERICAN, 1% AMERICAN INDIAN AND 1% ASIAN. THE GENDER SPLIT RATIO IS 49% WOMEN AND 51% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $80,425. APPROXIMATELY 6.7% OF THE POPULATION FALLS BELOW THE FEDERAL POVERTY GUIDELINES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS COMMITTED TO SERVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. RIDGEVIEW LE SUEUR MEDICAL CENTER HAS AN OUTREACH PROGRAM THAT BRINGS SPECIALISTS LIKE CARDIOLOGISTS, GASTROENTEROLOGY, ORTHOPEDICS AND OTHERS INTO ITS SMALLER COMMUNITY. THIS ELIMINATES BARRIERS TO CARE FOR MANY PATIENTS, PARTICULARLY THOSE WHO ARE ELDERLY, LIVING ON LOW INCOMES, OR ARE FACED WITH OTHER CHALLENGES THAT MAKE IT DIFFICULT TO TRAVEL LONG DISTANCES FOR CARE. RIDGEVIEW LE SUEUR MEDICAL CENTER IS PART OF THE RIDGEVIEW HEALTH SYSTEM, WHICH SERVES APPROXIMATELY 310,000 PEOPLE IN CARVER, SIBLEY, SOUTHERN WRIGHT, WESTERN HENNEPIN, AND EASTERN MCLEOD, LE SUEUR, AND SCOTT COUNTIES. PART VI, LINE 5: RIDGEVIEW LE SUEUR MEDICAL CENTER'S BOARD OF DIRECTORS IS A BOARD CONSISTING OF LOCAL COMMUNITY MEMBERS WITH A CROSS SECTION OF OCCUPATIONS. ONE OF THE REPRESENTATIVES IS APPOINTED BY THE LE SUEUR CITY COUNCIL AND ANOTHER BOARD MEMBER IS FROM RIDGEVIEW'S CORPORATE BOARD. NONE OF THE BOARD MEMBERS ARE EMPLOYEES, ARE RELATED TO EMPLOYEES, OR ARE INDEPENDENT CONTRACTORS OF THE ORGANIZATION. GIVEN THAT WE ARE A SMALL COMMUNITY, IF A VOTE COMES UP FOR SOMETHING THAT COULD APPEAR TO BE A CONFLICT OF INTEREST THE BOARD MEMBER WILL ABSTAIN FROM VOTING. ANY SURPLUS CASH IS USED TO UPDATE MEDICAL EQUIPMENT FOR BOTH THE HOSPITAL AND NURSING HOME. ANY AND ALL EMERGENCY REPAIRS OR EQUIPMENT NEEDS THAT ARISE ARE TAKEN CARE OF IMMEDIATELY. RIDGEVIEW LE SUEUR MEDICAL CENTER OFFERS A MEALS ON WHEELS PROGRAM FOR HOME-BOUND RESIDENTS AND MOST OF THOSE MEALS ARE PAID FOR THROUGH AN ELDERLY WAIVER PROGRAM THROUGH THE COUNTY, WHICH JUST COVERS THE COST OF THE FOOD. VOLUNTEERS DELIVER MEALS TO HOME-BOUND CLIENTS MONDAYS - FRIDAYS. THIS PAST YEAR, 2,594 MEALS WERE PREPARED AND DELIVERED. WITH THE IMPLEMENTATION OF COVID SAFETY PRECAUTIONS, WE WERE ABLE TO CONTINUE TAKING NURSING HOME RESIDENTS. THE OUTPATIENT CLINIC WING PROVIDES SPACE FOR VISITING SPECIALISTS (CARDIOLOGY, ORTHOPEDICS, UROLOGY, GENERAL SURGERY) FROM OTHER HEALTH CARE SYSTEMS TO SEE PATIENTS LOCALLY AND TO PERFORM OUTPATIENT PROCEDURES LOCALLY. MOST OF OUR POPULATION IS ELDERLY AND ARE UNABLE TO DRIVE GREAT DISTANCES SO THEY ARE ABLE TO RECEIVE CARE FROM SPECIALISTS LOCALLY. WE STRIVE TO PROVIDE HIGH-QUALITY, PATIENT-CENTERED CARE CLOSE TO HOME FOR THE COMMUNITIES WE SERVE. WE CONTINUE TO UPGRADE FACILITIES AND TECHNOLOGY TO ENSURE PATIENTS IN RURAL COMMUNITIES HAVE NEARBY ACCESS TO THESE SERVICES. WE ALSO WERE ABLE TO IMPLEMENT TELE-VISITS FOR OUR PATIENTS WITH THE SPECIALISTS DURING 2020. PART VI, LINE 6: RIDGEVIEW LE SUEUR MEDICAL CENTER IS A SUBSIDIARY OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW MEDICAL CENTER IS A 120-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE: RIDGEVIEW CLINICS PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA. TWO CRITICAL ACCESS HOSPITALS, SIBLEY MEDICAL CENTER AND RIDGEVIEW LE SUEUR MEDICAL CENTER. CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST. IT OPERATES AN AMBULATORY SURGICAL CENTER. MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST. WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS. RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS. RIDGEVIEW COMMUNITY NETWORK OPERATES A AN ACCOUNTABLE CARE ORGANIZATION. RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW FOUNDATION OPERATES FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS PRESIDENT/CEO 0 1270809 0 0 0 3374 0 26074 0 37966 0 1338223 0 0 GORDON GABLENZ CIO 0 789842 0 0 0 4303 0 28440 0 60999 0 883584 0 0 AARON BLOOMQUIST CFO 0 488856 0 0 0 1942 0 14169 0 47500 0 552467 0 0 BENJAMIN NIELSEN COO & TREASURER 0 338638 0 0 0 25136 0 17240 0 784 0 381798 0 0 PART I, LINE 3 THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICIAL CENTER TO DETERMINE THE PRESIDENT/CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYEMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) PART I, LINE 4B MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $397,642 WAS CONTRIBUTED TO THE PLAN, $68,254 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $395,053 WAS CONTRIBUTED TO THE PLAN, $50,590 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. AARON BLOOMQUIST PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $125,556 WAS CONTRIBUTED TO THE PLAN, $0 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. PART I, LINE 6 THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2022 AND PAID IN 2023. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW LE SUEUR MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A RIDGEVIEW LE SUEUR MEDICAL CENTER'S BOARD CONSISTS TWO PERSONS APPOINTED BY THE SOLE MEMBER. OTHER MEMBERS OF RIDGEVIEW LE SUEUR MEDICAL CENTER'S BOARD ARE SELECTED BY A NOMINATING COMMITTEE AND MUST BE APPROVED BY THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS PROVIDE THE SOLE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES & BYLAWS AND GENERAL OPERATION DECISIONS. FORM 990, PART VI, SECTION A, LINE 8B RIDGEVIEW LE SUEUR MEDICAL CENTER HAS NO EXECUTIVE COMMITTEE OR SIMILAR COMMITTEE WITH BOARD-DELEGATED AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANY COMPENSATION RECEIVED BY OFFICERS OR BOARD MEMBERS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING & OTHER PROFESSIONAL FEE: PROGRAM SERVICE EXPENSES 2,060,438. MANAGEMENT AND GENERAL EXPENSES 1,241,306. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,301,744. ER MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 44,410. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,410. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION -167,700. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. MINNESOTA VALLEY MEMORIAL HOSPITAL FOUNDATION 621 SOUTH FOURTH STREET LE SUEUR MN 56058 411754182 RAISING FUNDS FOR RIDGEVIEW LE SUEUR MEDICAL CENTER. MN 501(C)(3) LINE 12A, I N/A 0 RIDGEVIEW MEDICAL CENTER 500 S MAPLE ST WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 RIDGEVIEW FOUNDATION 500 S MAPLE ST WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW CLINICS 500 S MAPLE ST WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW INSURANCE CO 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 SIBLEY MEDICAL CENTER 601 W CHANDLER ST ARLINGTON MN 55307 411801967 CRITICAL ACCESS HOSPITAL MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC 500 S MAPLE ST WACONIA MN 55387 205785920 CARDIOLOGY MN N/A 0 0 CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A 0 0 EXECUTIVE HEALTH MANAGEMENT SERVICES 500 SOUTH MAPLE ST WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1