2022-08-26T12:50:48-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-01-01 411949230 GLENCOE REGIONAL HEALTH SERVICES GLEN 3208643121 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 ANGELA ERICKSON CFO 3208643121 2022-08-02 1 ANGELA ERICKSON 999009999 ROBERT E SCHILE P00369682 6123764500 2022-08-02 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z GLENCOE REGIONAL HEALTH ANGELA ERICKSON 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 89419342 0 X WWW.GRHSONLINE.ORG X 1999 MN TO IMPROVE EVERY LIFE BY OFFERING HIGH-QUALITY, SAFE, AND ACCESSIBLE HEALTHCARE. 7 4 733 84 0 0 5776061 4049756 60822871 70570171 1237547 2808115 261445 245461 68097924 77673503 10412 27948 0 0 40293098 43436875 0 0 0 23893191 24586769 64196701 68051592 3901223 9621911 119374284 129617347 35566777 35338672 83807507 94278675 X GLENCOE REGIONAL HEALTH SERVICES EXISTS TO IMPROVE EVERY LIFE BY OFFERING HIGH-QUALITY, SAFE, AND ACCESSIBLE HEALTHCARE. WE ARE DEDICATED TO STRENGTHENING HEALTHCARE BY CONNECTING OUR COMMUNITIES, ENHANCING THE PATIENT EXPERIENCE, ELEVATING EMPLOYEE ENGAGEMENT, AND DELIVERING ON CLINICAL EXCELLENCE. 0 0 51683933 27948 59545177 HOSPITAL - THE FACILITY IS LICENSED FOR 49 BEDS. MEDICAL/SURGICAL SERVICES ARE PROVIDED FOR ACUTE AND SWING BED PATIENTS. MAJOR SERVICES PROVIDED INCLUDE ER, MEDICAL IMAGING, SURGERY, LABORATORY, REHABILITATION THERAPY AND CLINIC SERVICES. 9128946 0 10517479 NURSING HOME - THE LONG-TERM CARE UNIT IS A 108-BED SKILLED NURSING FACILITY, WITH ALL BEDS MEDICARE AND MEDICAID CERTIFIED. 440512 0 507515 INDEPENDENT SENIOR LIVING - ORCHARD ESTATES IS A 40-UNIT SENIOR HOUSING COMPLEX COMPRISED OF ONE- AND TWO-BEDROOM APARTMENTS. 61253391 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 1 733 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 MN X SUE ANN HAHN-GABRELCIK 3208647858 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 DR BRYAN PETERSEN DIRECTOR & PHYSICIAN 40.50 0.00 X 435371 0 43862 DR KRISTINE KNUDTEN DIRECTOR & PHYSICIAN 40.50 0.00 X 340723 0 43316 JAN BRATSCH VICE CHAIR 0.50 0.00 X X 0 0 0 SCOTT KUEHN CHAIR 0.50 0.00 X X 0 0 0 MARY STOLTENBURG SECRETARY 0.50 0.00 X X 0 0 0 HEATHER PEIRCE DIRECTOR 0.50 0.00 X 0 0 0 DR BRYAN FRITSCH DIRECTOR & PHYSICIAN 40.50 0.00 X 273462 0 43198 PATRICIA HENDERSON PRESIDENT & CEO 40.00 0.00 X 256882 0 36410 ANGELA ERICKSON CFO 40.00 0.00 X 150450 0 36339 DR CHAD ROBBINS PHYSICIAN 40.00 0.00 X 471818 0 40949 DR KRISTEN BUDAHN PHYSICIAN 40.00 0.00 X 483812 0 36384 DR JOHN MARK JOHNSON PHYSICIAN 40.00 0.00 X 422233 0 43420 DR LIBAN HIRED PHYSICIAN 40.00 0.00 X 401835 0 43361 DR CODY WENDLANDT PHYSICIAN 40.00 0.00 X 433962 0 16267 3670548 0 383506 54 0 1 0 PREMIER STAFFING INC 243 WINKLER TRAIL COLOGNE MN 55322 PHYSICIAN SERVICES 918000 PARK NICOLLETMETHODIST HOSPITAL PO BOX 16300 ST LOUIS PARK MN 55416 MANAGEMENT & PHYSICIAN SERVICES 734779 ALLINA HEALTH LABORATORY PO BOX 342 MINNEAPOLIS MN 55440 REFERENCE LAB 429060 HEALOGICS WOUND CARE 28525 NETWORK PLACE CHICAGO IL 60673 WOUND CENTER MANAGEMENT 358663 CLIFTONLARSONALLEN LLP PO BOX 776376 CHICAGO IL 60677 FINANCIAL SERVICES 255418 11 2938353 1111403 4049756 HOSPITAL 623000 59545177 59545177 NURSING HOME 623000 10517479 10517479 SENIOR LIVING 623990 507515 507515 70570171 833332 833332 47795 0 47795 47795 47795 13711661 890 11735435 2333 1976226 -1443 1974783 1974783 9291 7686 1605 1605 1350 385 965 965 CAFETERIA REVENUE 722210 113495 113495 MISCELLANEOUS 900099 81601 81601 195096 77673503 70570171 0 3053576 27948 27948 1660013 1168134 491879 34445469 32625660 1819809 1147627 1094464 53163 4124244 3913763 210481 2059522 1932492 127030 76923 76923 3597 3597 3793719 2379553 1414166 261992 4842 257150 953620 563820 389800 551824 551824 1591981 1591981 85501 70527 14974 75948 16110 59838 909378 909378 4577896 4577896 602064 214132 387932 MEDICAL EXPENSES 4132319 4106454 25865 DRUGS 4129134 4117660 11474 LICENSES AND TAXES 1330150 1330150 BAD DEBT EXPENSE 584247 584247 926476 802506 123970 68051592 61253391 6798201 0 12706849 15389302 13703685 15076809 8771755 10561558 588428 719464 1033103 1217051 111842855 67291767 47897040 44551088 32294779 39486642 2378645 2615433 119374284 129617347 5903480 6032139 1256668 1200000 25575573 24115294 29809 32843 2801247 3958396 35566777 35338672 X 83807507 94278675 83807507 94278675 119374284 129617347 9621911 849257 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3597 3597 0 PART II-B, LINE 1: LOBBYING PORTION OF ASSOCIATION DUES PAID TO AHA AND MHA. 0 1 X 1306705 1306705 54334453 30746925 23587528 2518228 1627572 890656 53591948 34917270 18674678 91521 91521 44551088 DEFERRED COMPENSATION 2615433 ESTIMATED THIRD PARTY PAYABLE 1342963 3958396 X 77946584 849257 8071 857328 77089256 584247 584247 77673503 67475416 8071 8071 67467345 584247 584247 68051592 PART IV, LINE 2B: INDEPENDENT SENIOR LIVING TENANTS MAKE SECURITY DEPOSITS WHEN THEY MOVE IN TO THE FACILITY. DEPOSITS, WITH INTEREST, LESS ANY COSTS OF REPAIRS, ARE RETURNED TO TENANTS OR THEIR ESTATES WHEN THE TENANT LEAVES THE FACILITY. THE ORGANIZATION HOLDS SMALL AMOUNTS DEPOSITED BY RESIDENTS OF THE NURSING HOME ON THEIR BEHALF. RESIDENTS MAY MAKE DEPOSITS OR WITHDRAWALS AT ANY TIME. PART X, LINE 2: THE FACILITY QUALIFIES AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE FACILITY IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE FACILITY FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 385. FUNDRAISING EXPENSES 7,686. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 584,247. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 385. FUNDRAISING EXPENSES 7,686. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 584,247. 1 1 X 1 X 1 X 0 1 1 0 1 1 1241829 1241829 0.01840 9337800 7032889 2304911 0.03420 10579629 7032889 3546740 0.05260 249286 10933 238353 0.00350 496750 496750 0.00740 105064 92862 12202 0.00020 49802 49802 0.00070 900902 103795 797107 0.01180 11480531 7136684 4343847 0.06440 62100 62100 0.00090 62100 62100 0.00090 0 584247 11584751 15589276 -4004525 X 1 1 1 1 GLENCOE REGIONAL HEALTH SERVICES 1805 HENNEPIN AVENUE NORTH GLENCOE MN 55336 WWW.GRHSONLINE.ORG 360844 X X X X NURSING HOME/SNF GLENCOE REGIONAL HEALTH SERVICES 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE PART V, SECTION B, LINE 7D X X 1 19 1 SEE PART V, SECTION B, LINE 7D 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X HTTPS://GRHSONLINE.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/ X HTTPS://GRHSONLINE.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/ X HTTPS://GRHSONLINE.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X 1 X 0 0 GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 5: IN MARCH 2018, GRHS STAFF MEMBERS BEGAN MEETING WITH REPRESENTATIVES FROM HUTCHINSON HEALTH, RIDGEVIEW SIBLEY MEDICAL CENTER, MEEKER MEMORIAL HOSPITAL, AND MEEKER-MCLEOD-SIBLEY PUBLIC HEALTH (MMS) TO IDENTIFY STRATEGIES AND TACTICS FOR THE NEXT COMMUNITY HEALTH NEEDS ASSESSMENTS REQUIRED BY EACH ORGANIZATION. THIS WAS A COLLABORATIVE PROCESS INVOLVING OUR LOCAL HOSPITALS AND PUBLIC HEALTH. THROUGH REGULAR MEETINGS AND DISCUSSIONS, A COMMUNITY BEHAVIORAL HEALTH SURVEY WAS DEPLOYED, SIMILAR TO ONE THAT OCCURRED IN 2014. WORK CONTINUED THROUGHOUT 2018 AND 2019, WITH STRATEGIC EFFORTS IDENTIFIED AND IMPLEMENTED TO GAIN COMMUNITY INPUT INTO THE HEALTH ISSUES FACING OUR COMMUNITIES. INFORMATION WAS SHARED AMONG THE ORGANIZATIONS AS IT RELATED TO INDIVIDUAL EFFORTS OCCURRING BY EACH GROUP. THROUGH THIS WORK AND THE REVIEW OF AVAILABLE DATA, PRIORITY AREAS EMERGED. ADDITIONALLY, WE PARTNERED WITH STUDENTS FROM RIDGEWATER COLLEGE'S MINNESOTA ALLIANCE FOR NURSING EDUCATION (MANE) NURSING PROGRAM TO ASSIST US IN OUR CHNA PROCESS. THROUGH THIS PARTNERSHIP DATA TRENDS WERE ANALYZED, ADDITIONAL KEY COMMUNITY STAKEHOLDERS WERE IDENTIFIED AND SURVEYED, PRIORITY AREAS WERE REAFFIRMED, AND RECOMMENDATIONS EMERGED ON OUR IMPLEMENTATION STRATEGY. SIMILAR TO OUR PAST CHNAS, THE HIGHEST-PRIORITY HEALTH NEEDS FOR THE COMMUNITY SERVED BY GLENCOE REGIONAL HEALTH WERE IDENTIFIED AS ACCESS TO NEEDED SERVICES (SPECIFICALLY MENTAL HEALTH) AND OBESITY TRENDS (ESPECIALLY IN OUR FEMALE POPULATION). RESPONDING TO THOSE OBESITY TRENDS WILL CALL FOR US TO POSITIVELY IMPACT INDIVIDUAL BEHAVIORAL CHOICES RELATED TO HEALTHY EATING AND BEING ACTIVE. AN ADDITIONAL EMERGING AREA OF CONCERN WAS IDENTIFIED LATE IN OUR PROCESS RELATED TO VAPING LUNG DISEASE. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 6A: HUTCHINSON HEALTH, MEEKER MEMORIAL HOSPITAL AND RIDGEVIEW SIBLEY MEDICAL CENTER GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 6B: THE NON-HOSPITAL ORGANIZATIONS INVOLVED IN THE ASSESSMENT PROCESS INCLUDED REPRESENTATIVES FROM MEEKER-MCLEOD-SIBLEY PUBLIC HEALTH (MMS) AND RIDGEWATER COLLEGE'S MINNESOTA ALLIANCE FOR NURSING EDUCATION (MANE), AS WELL AS UNAFFILIATED COMMUNITY MEMBERS. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 7D: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://GRHSONLINE.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 11: THE GLENCOE REGIONAL HEALTH SERVICES BOARD OF DIRECTORS REVIEWED THE CHNA ON NOVEMBER 25, 2019. BASED UPON AN ANALYSIS OF GRHS'S CAPABILITIES AND CAPACITY, IT WAS DECIDED TO CONTINUE OUR EFFORTS TO FOCUS UPON MENTAL HEALTH DURING THE NEXT THREE YEARS. IT WAS ALSO DETERMINED THAT WE NEED TO INCREASE EFFORTS TO IMPACT OBESITY AND PHYSICAL ACTIVITY, BEING MINDFUL TO FOCUS ON EFFORTS THAT IMPACT WOMEN WHEN POSSIBLE.AN EMERGING ISSUE WAS IDENTIFIED LATE IN OUR ASSESSMENT AS VAPING LUNG DISEASE WAS MAKING HEADLINES ACROSS MINNESOTA AND THE NATION. TO ADDRESS THIS ISSUE, RIDGEWATER NURSING STUDENTS CONDUCTED SEVERAL KEY INFORMANT INTERVIEWS WITH LOCAL LEADERS TO GAIN ADDITIONAL INSIGHT. THEY ALSO LOOKED FOR ADDITIONAL DATA THAT WAS NOT INCLUDED IN THE MMS INDICATOR DATA. AFTER REVIEWING THE SURVEY RESULTS AND ADDITIONAL LIMITED DATA THEY WERE ABLE TO FIND, IT WAS CONCLUDED THIS WAS NOT A PRIORITY AT THIS TIME, BUT AN ISSUE WE NEEDED TO KEEP ON OUR RADAR. THE NURSING STUDENTS HAVE PROVIDED STRATEGIES TO ADDRESS VAPING AS MORE DATA BECOMES AVAILABLE IN THE FUTURE. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 13H: BANKRUPTCY ACCOUNTS WILL BE CONSIDERED CHARITY CARE AND THE GUARANTOR WILL NOT BE REQUIRED TO COMPLETE THE CHARITY CARE APPLICATION. BANKRUPTCY ACCOUNTS WILL BE ADJUSTED OFF ONCE GRHS RECEIVES THE BANKRUPTCY DISCHARGE OF DEBTOR INFORMATION. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 16J: A COPY OF THE FIANCIAL ASSISTANCE POLICY WAS GIVEN TO EACH SELF-PAY EMERGENCY ROOM PATIENT WHEN LEAVING OUR FACILITY. 4 1 - GLENCOE REGIONAL HEALTH SERVICES 1024 CENTRAL AVENUE LESTER PRAIRIE MN 55354 CLINIC 2 - GLENCOE REGIONAL HEALTH SERVICES 300 BOWMAN STREET STEWART MN 55385 CLINIC 3 - GLENFIELDS LIVING WITH CARE 2015 HENNEPIN AVENUE NORTH GLENCOE MN 55336 NURSING HOME 4 - ORCHARD ESTATES 1900 FORD AVENUE NORTH GLENCOE MN 55336 SENIOR APARTMENTS PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON ANNUAL HOUSEHOLD INCOME AND INSURANCE STATUS. INDIVIDUALS MUST ALSO APPLY FOR GOVERNMENT MEDICAL ASSISTANCE BEFORE QUALIFYING FOR FINANCIAL ASSISTANCE FROM GRHS. PART I, LINE 7: THE AMOUNTS IN PART I, LINE 7 WERE CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990, SCHEDULE H. PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN ITS SUBSIDIZED HEALTH SERVICES IN SCHEDULE H, PART I, LINE 7G. PART I, LN 7 COL(F): BAD DEBT EXPENSE - REPORTED IN FORM 990, PART IX, LINE 24 - IS SUBTRACTED FROM THE TOTAL FUNCTIONAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7, COLUMN F. BAD DEBT EXPENSE SUBTRACTED IN THIS WAY WAS $584,247 FOR 2021. PART II, COMMUNITY BUILDING ACTIVITIES: OUR COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH DISASTER PREPAREDNESS EFFORTS, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PATIENTS, FINANCIAL AND IN-KIND SUPPORT, AND EDUCATION. FIRST, THROUGH DISASTER PREPAREDNESS TRAINING, WE SUPPORT AND PROTECT THE HEALTH OF OUR COMMUNITIES BY WORKING TO INSURE THAT THOSE NEEDING MEDICAL ATTENTION CAN ACCESS QUALITY CARE IN A SAFE AND TIMELY MANNER. DISASTER PREPAREDNESS EFFORTS ARE A YEAR-ROUND ACTIVITY, AS DISASTERS CAN INCLUDE PANDEMICS, NATURAL DISASTERS AND MASS CASUALTY SITUATIONS. SECOND, BY PROVIDING CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PATIENTS, WE WORK TO HELP PATIENTS RETURN HOME AND REGAIN THEIR INDEPENDENCE AFTER AN ILLNESS, INJURY OR SURGERY. IN CASES WHERE IT IS NOT POSSIBLE FOR SOMEONE TO RETURN HOME, WE WORK TO MAKE SURE THEY HAVE ACCESS TO THE CARE AND RESOURCES THEY NEED TO CONTINUE THEIR RECOVERY OR LIVE WITH DIGNITY. THROUGH HELPING OUR PATIENTS OBTAIN FINANCIAL SUPPORT, AS WELL AS OBTAIN ACCESS TO COMMUNITY SUPPORT SYSTEMS, WE WORK TO ENSURE THAT THEY GET ADDITIONAL SERVICES THAT MAY BE NEEDED TO ASSIST IN THEIR RECOVERY. THIS PROMOTES THE HEALTH OF THE COMMUNITY BY ENSURING THAT PATIENTS HAVE THE SUPPORT AND RESOURCES THEY NEED TO RETURN TO THE COMMUNITY AS PRODUCTIVE CITIZENS, AS WELL AS HELPING TO CREATE A COMMUNITY IN WHICH PEOPLE ARE VALUED AND TREATED WITH RESPECT.THIRD, BY PROVIDING FINANCIAL AND IN-KIND SUPPORT TO THE GLENCOE AREA CHAMBER OF COMMERCE, WE SUPPORT THE ECONOMIC HEALTH OF OUR REGION. A STRONG LOCAL ECONOMY CONTRIBUTES TO THE OVERALL HEALTH AND WELL-BEING OF ALL ITS RESIDENTS. BY PROVIDING FINANCIAL AND IN-KIND SUPPORT FOR COMMUNITY ACTIVITIES, SUCH AS THE MCLEOD COUNTY FOOD DRIVE CHALLENGE, WE ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY.FINALLY, BY PROVIDING EDUCATIONAL PRESENTATIONS AND TOURS TO OUR AREA SCHOOLS, WE ARE INVESTING IN A FUTURE GENERATION OF HEALTH CARE WORKERS WHO MAY PROVIDE DIRECT CARE TO OUR PATIENTS AND OTHERS IN THE COMMUNITIES WE SERVE. WE ARE ALSO EDUCATING INDIVIDUALS ABOUT THE WORK WE DO, WHY WE DO IT, AND HOW OUR EFFORTS AFFECT THEIR LIVES AND THE LIVES OF OTHERS. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, GRHS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, GRHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, GRHS RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY FOR THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIAL RESPONSIBLE. PART III, LINE 3: GRHS IS UNABLE TO REASONABLY CALCULATE THE AMOUNT OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF THEY APPLIED. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH IN NOTE 1 (PAGE 9) TO THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION USES A COST-TO-CHARGE RATIO TO CALCULATE THE MEDICARE ALLOWABLE COSTS REPORTED IN ITS MEDICARE COST REPORT. THE ORGANIZATION USES THE MEDICARE REIMBURSEMENT PROVIDER MANUAL 15-2 TO DETERMINE ACCEPTABLE METHODOLOGIES. PART III, LINE 9B: OUR GENERAL DEBT COLLECTION POLICY FOR ALL PATIENTS IS AS FOLLOWS: TWO BILLING STATEMENTS ARE SENT OUT TO THE PATIENT. ACCOUNTS WITH NO SELF-PAY ACTIVITY WITHIN TWO MONTHS RECEIVE A REMINDER LETTER. IF NO PAYMENT IS MADE WITHIN THREE WEEKS OF THE FIRST LETTER BEING SENT, A PHONE CALL IS PLACED TO THE PATIENT IN ORDER TO SET UP PAYMENT ARRANGEMENTS. IF AN AGREEMENT IS NOT MET, THE ACCOUNT IS SENT TO COLLECTIONS. IN ALL, PATIENTS RECEIVE THREE STATEMENTS, ONE LETTER AND A PHONE CALL BEFORE AN ACCOUNT IS SENT TO COLLECTIONS.PAYMENT PLANS ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE OR FINANCIAL SITUATION. WE DO NOT CHARGE INTEREST OR FEES ON PAYMENT PLANS. IF PATIENTS CONTACT US ABOUT THEIR BILL, WE WILL REFER THEM TO FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE OR DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE PROGRAMS OR UNINSURED DISCOUNT PROGRAMS. INFORMATION ABOUT THE DISCOUNTS AND PROGRAMS THAT ARE AVAILABLE TO PATIENTS CAN ALSO BE FOUND ON THE BACK OF EACH MONTHLY STATEMENT, ON GRHS WEB-SITE AND ON EACH PAYMENT REMINDER LETTER THAT IS SENT. WHEN INSURANCE COMPANIES NEED MORE INFORMATION FROM THE PATIENT TO PROCESS THE CLAIM, WE WILL CALL THE PATIENT AND SEND THE PATIENT A REMINDER LETTER ASKING THE PATIENT TO CONTACT THEIR INSURANCE COMPANY. PART VI, LINE 2: GHRS HAS CONDUCTED COMMUNITY-BASED RESEARCH ON SEVERAL OCCASIONS, INCLUDING USE OF FOCUS GROUPS AND STATISTICALLY VALID TELEPHONIC SURVEYS. DURING STRATEGIC PLANNING PROCESSES, DEMOGRAPHIC AND UTILIZATION TRENDS ARE REVIEWED, ALONG WITH THE RESULTS OF ANY COMMUNITY-BASED RESEARCH. FEEDBACK FROM MEDICAL STAFF MEMBERS IS SOLICITED REGARDING TRENDS AND ISSUES THEY SEE. PATIENT FEEDBACK FROM PATIENT SURVEYS IS ALSO REVIEWED. PART VI, LINE 3: GRHS EDUCATES AND INFORMS PATIENTS ABOUT FINANCIAL ASSISTANCE, CHARITY CARE AND UNINSURED DISCOUNT PROGRAMS IN ALL BILLING INVOICES SENT. THE INFORMATION IS LISTED ON THE BACK OF THE BILLING STATEMENT. WE ALSO POST THE INFORMATION IN OUR FACILITY AND INCLUDE IT ON OUR WEB SITE, WWW.GRHSONLINE.ORG. IN ADDITION, WE PROVIDE A REPORT BACK TO THE COMMUNITY ANNUALLY ABOUT OUR FINANCES AND CHARITY CARE AMOUNTS. THIS REPORT IS SENT TO ALL OF OUR PATIENTS, AS WELL AS THE RESIDENTS IN THE COMMUNITIES WE SERVE. PART VI, LINE 4: PATIENTS CARED FOR BY GRHS RESIDE, PRIMARILY, IN AN AREA WITHIN A RADIUS OF TWENTY MILES OF THE CITY OF GLENCOE, WHICH IS APPROXIMATELY 55 MILES WEST OF MINNEAPOLIS. THE POPULATION OF GRHS'S PRIMARY SERVICE AREA WAS PROJECTED TO BE 35,873 IN 2018, A DECREASE OF 2% SINCE 2010. THE REPORTED POPULATION OF THE CITY OF GLENCOE FOR THE YEAR 2010 AND 2018 WERE 5,631 AND 5,467 RESPECTIVELY, A DECREASE OF 2%. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 EMPLOYEE SCHOLARSHIPS 14 16890 NAR TESTING 27 9846 PART I, LINE 2: THE ORGANIZATION PROVIDES TUITION REIMBURSEMENT ASSISTANCE TO EMPLOYEES. EMPLOYEES ARE REQUIRED TO COMPLETE THE REIMBURSEMENT REQUEST FORM, WHICH IS TO BE SIGNED BY THEIR SUPERVISOR, PRIOR TO BEGINNING THEIR COURSE(S) TO RESERVE FUNDS. THEY ARE TO INCLUDE A DESCRIPTION OF THE COURSE(S) THEY PLAN TO TAKE, AND RECEIPTS FOR TUITION AND BOOKS, (FEES ARE NOT ELIGIBLE FOR REIMBURSEMENT), WITH THEIR REQUEST. EMPLOYEES ARE REQUIRED TO COMPLETE THEIR COURSE WITH A GRADE OF C OR BETTER TO BE ELIGIBLE FOR REIMBURSEMENT. EMPLOYEES ARE RESPONSIBLE FOR ALL UP-FRONT COSTS. X X X X 0 0 0 0 0 0 0 0 0 DR KRISTEN BUDAHN PHYSICIAN 471844 0 11968 0 0 0 14500 0 21884 0 520196 0 0 0 DR CHAD ROBBINS PHYSICIAN 460764 0 11054 0 0 0 14500 0 26449 0 512767 0 0 0 DR BRYAN PETERSEN DIRECTOR & PHYSICIAN 424559 0 10812 0 0 0 14500 0 29362 0 479233 0 0 0 DR JOHN MARK JOHNSON PHYSICIAN 422233 0 0 0 0 0 14500 0 28920 0 465653 0 0 0 DR CODY WENDLANDT PHYSICIAN 389045 0 14350 0 30567 0 6844 0 9423 0 450229 0 0 0 DR LIBAN HIRED PHYSICIAN 371763 0 11872 0 18200 0 14500 0 28861 0 445196 0 0 0 DR KRISTINE KNUDTEN DIRECTOR & PHYSICIAN 327034 0 13689 0 0 0 14500 0 28816 0 384039 0 0 0 DR BRYAN FRITSCH DIRECTOR & PHYSICIAN 260095 0 6867 0 6500 0 14076 0 29122 0 316660 0 0 0 PATRICIA HENDERSON PRESIDENT & CEO 217857 0 19525 0 19500 0 13238 0 23172 0 293292 0 0 0 ANGELA ERICKSON CFO 143125 0 7325 0 0 0 7916 0 28423 0 186789 0 0 0 A CITY OF GLENCOE MINNESOTA 416005185 378160BW4 2013-02-27 23087781 DEFEASE SERIES 2005 BONDS 0 0 0 B CITY OF PLATO MINNESOTA 416005465 72766SAM3 2017-05-18 10938562 PROVIDE FUNDING FOR THE CONSTRUCTION OF THE EXPANSION OF THE NURSING HOME 0 0 0 A 8100000 23087781 1737800 388068 20961913 2013 1 0 1 1 B 900000 10938562 716513 218771 10003278 2017 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF GLENCOE, MINNESOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 11/11/2019 FORM 990, PART VI, SECTION A, LINE 1A THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WHICH SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS, THE VICE CHAIRPERSON OF THE BOARD OF DIRECTORS, THE PRESIDENT AND THE SECRETARY OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL ADVISE WITH AND AID THE OFFICERS OF THE CORPORATION IN ALL MATTERS CONCERNING THE MANAGEMENT OF ITS BUSINESS; AND BETWEEN MEETINGS OF THE BOARD OF DIRECTORS THE EXECUTIVE COMMITTEE SHALL POSSESS AND MAY EXERCISE ALL THE POWERS OF THE BOARD OF DIRECTORS EXCEPT WITH REFERENCE TO MAKING OR AMENDING THE BYLAWS FOR THE BOARD OF DIRECTORS, REMOVING ANY MEMBER OF THE BOARD OF DIRECTORS OR FILLING VACANCIES IN THEIR OWN MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAD A CONTRACTUAL ARRANGEMENT WITH PARK NICOLLET HEALTH SERVICES THROUGH 2019, UNDER WHICH PARK NICOLLET HEALTH SERVICES (PNHS) PROVIDED A CHIEF EXECUTIVE OFFICER, MANAGEMENT CONSULTATION, AND OTHER SERVICES TO THE FACILITY. THE ARRANGEMENT DID NOT ALTER THE AUTHORITY OR RESPONSIBILITY OF THE BOARD OF DIRECTORS OF GLENCOE REGIONAL HEALTH SERVICES. STARTING IN 2020, THE CONTRACTUAL AGREEMENT WITH PHNS WAS AMENDED WHERE THE CEO IS EMPLOYED DIRECTLY BY THE ORGANIZATION, AND PNHS WILL PROVIDE MANAGEMENT AND OTHER SERVICES TO THE FACILITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED WITH THE BOARD MEMBERS AT A REGULARLY SCHEDULED BOARD MEETING. THE BOARD WAS ASKED TO APPROVE THE DOCUMENT PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C GLENCOE REGIONAL HEALTH SERVICES HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF A COMMITTEE OF THE BOARD OF DIRECTORS, AND SENIOR MANAGEMENT. ANNUALLY, THE BOARD MEMBERS AND SENIOR MANAGEMENT ARE ASKED TO COMPLETE A CONFLICT OF INTEREST DECLARATION. ANY INDIVIDUAL HAVING A CONFLICT OF INTEREST IS REQUIRED TO INFORM THE BOARD OR COMMITTEE. THE INDIVIDUAL ABSTAINS FROM VOTING ON THE MATTER, BUT IS PERMITTED TO BRIEFLY STATE THEIR POSITION AND ANSWER PERTINENT QUESTIONS. THE MINUTES OF THE MEETING REFLECT THAT THE DISCLOSURE WAS MADE AND THAT THE PERSON ABSTAINED FROM VOTING. THE PRESIDENT AND CEO IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION REVIEW PROCESS IS PERFORMED UNDER THE DIRECTION OF PARK NICOLLET. INDEPENDENT COMPARISON DATA IS USED TO ESTABLISH COMPENSATION. THE BOARD OF DIRECTORS FINALIZES THE REVIEW AND COMPENSATION. THE CFO'S COMPENSATION REVIEW IS CONDUCTED BY THE CEO AND COMPENSATION IS DETERMINED USING INDEPENDENT COMPARISON DATA. THE MOST RECENT YEAR THIS PROCESS WAS CONDUCTED WAS IN 2021. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.