2025-05-30T11:09:48-05:00 2024-09-30 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2023-10-01 410743546 COMMUNITY MEMORIAL HOSPITAL ASSOCIATION COMM 2188794641 512 SKYLINE BLVD CLOQUET MN 55720 KIRK JOHNSON CFO 2188794641 2025-05-29 1 0 JULIE BOYER P01278549 2187275025 2025-05-29 2023 2025-03-06 01:10:19Z RICK BREUER 512 SKYLINE BLVD CLOQUET MN 55720 72958205 0 X WWW.CLOQUETHOSPITAL.COM X 1954 MN THE MISSION OF COMMUNITY MEMORIAL HOSPITAL IS TO IMPROVE AND ENHANCE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND OUR COMMUNITY THROUGH EDUCATION, PREVENTION, TREATMENT AND INTERVENTION. 9 7 552 75 2450 0 263782 442580 64648476 71667289 616544 183997 511049 664339 66039851 72958205 21565 23595 0 0 43211852 41643592 0 0 0 29400905 33280690 72634322 74947877 -6594471 -1989672 48919345 47126932 33102579 33299838 15816766 13827094 X YOUR NEIGHBORS CARING FOR YOU. 0 0 67552376 23595 72042417 CMH IS A CRITICAL ACCESS HOSPITAL LOCATED IN CLOQUET, MN IN CARLTON COUNTY. CMH SERVES PRIMARILY AN ELEVEN ZIP-CODE AREA WITH A POPULATION OF APPROXIMATELY 35,000 RESIDENTS. CMH OFFERS THE COMMUNITY A ROBUST SERVICE LINE OFFERING WHICH INCLUDES INPATIENT & OUTPATIENT SERVICES. CMH PROVIDES A NEWLY CONSTRUCTED STATE OF THE ART INPATIENT FACILITY HOUSING MED/SURG, ICU, OB, AND SWING BED SERVICES. CMH PROVIDES A FULL ARRAY OF OUTPATIENT SERVICES WHICH INCLUDE: A 24-HOUR E/R, A FULL SPECTRUM OF IMAGING SERVICES, LABORATORY, SURGERY, CHEMO/INFUSION, PHARMACY, R.T., CARDIAC REHAB, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIABETIC EDUCATION, SLEEP STUDIES, AND OTHER MEDICAL SERVICES NEEDED BY OUR COMMUNITY. CMH ALSO EMPLOYS A NUMBER OF PHYSICIANS IN SPECIALTIES THAT ARE IN HIGH DEMAND IN OUR SERVICE AREA. THESE INCLUDE GENERAL SURGEONS, ENT SURGEONS, AND ORTHOPEDIC SURGEONS. CMH HAS GROWN AT A FAST PACE TO MEET THE NEEDS OF OUR COMMUNITY. IN THE TAX YEAR ENDING SEPTEMBER 30, 2024, CMH PROVIDED 2,865 INPATIENT DAYS, 2,384 SURGERIES, 8,430 EMERGENCY ROOM VISITS, AND 49,836 OUTPATIENT VISITS. IN ADDITION, CMH REACHES OUT TO THE COMMUNITY TO ENHANCE THE HEALTH AND WELLBEING OF OUR SERVICE AREA BY OFFERING NUMEROUS EDUCATIONAL OPPORTUNITIES, HEALTH SCREENINGS, AND SUPPORT GROUPS. 67552376 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 66 0 1 552 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X KIRK JOHNSON 2188794641 512 SKYLINE BLVD CLOQUET MN 55720 KARA UNDERWOOD MD PHYSICIAN / DIRECTOR 40.00 X 349130 0 19550 JOANNA ROBNIK MD PHYSICIAN / DIRECTOR 40.00 X 244874 0 36203 LES RIESS MD DIRECTOR (THROUGH 11/20/23) 2.00 X 0 0 0 RALPH HAMANN DIRECTOR 2.00 X 0 0 0 RAY HATINEN DIRECTOR 2.00 X 0 0 0 SAMUEL MOOSE DIRECTOR 2.00 X 0 0 0 JENNY BARTA TREASURER 2.00 X X 0 0 0 STEVE RISACHER SECRETARY 2.00 X X 0 0 0 LEE OLSEN CHAIR 2.00 X X 0 0 0 KELLY JOHNSON VICE CHAIR 2.00 X X 0 0 0 RICK BREUER CEO 40.00 4.00 X 450176 0 51512 KIRK JOHNSON CFO 40.00 2.00 X 20853 0 2555 BRAD ANDERSON COO 40.00 X 255243 0 45524 KYLE MENZEL MD PHYSICIAN 40.00 X 870180 0 39300 BRYAN HUNTER CRNA 40.00 X 396839 0 48033 KENNETH RIPP MD PHYSICIAN 40.00 X 382201 0 61218 JAMES RYAN MD PHYSICIAN 40.00 X 373592 0 40575 JOSEPH LEMKER MD PHYSICIAN 40.00 X 377582 0 16500 3720670 0 360970 78 0 1 0 VENTURA MEDSTAFF LLC 11420 BLONDO ST STE 103 OMAHA NE 68164 MEDICAL STAFFING AGENCY 1062484 CENTRAL MINNESOTA DIAGNOSTIC INC 525 10 ST NE MILACA MN 56353 IMAGING SERVICES 889790 HAYES LOCUMS LLC 5900 N ANDREWS AVE STE 900 FORT LAUDERDALE FL 33309 MEDICAL STAFFING AGENCY 879290 SISU MEDICAL SOLUTONS LLC 4960 MILLER TRUNK HWY STE 500 HERMANTOWN MN 55811 IT SERVICES 641156 BARTON ASSOCIATES INC 300 JUBILEE DR PEABODY MA 01960 MEDICAL STAFFING AGENCY 622850 15 98100 268565 75915 442580 PATIENT SERVICE REVENUE 621500 71349073 71349073 OTHER INCOME 621500 315766 315766 OUTSIDE LAB SALES 621500 2450 2450 71667289 175934 175934 193293 0 193293 193293 193293 8063 0 8063 8063 8063 EARNINGS IN CMDI 900099 375128 375128 MISCELLANEOUS REVENUE 900099 95918 95918 471046 72958205 72039967 2450 473208 23595 23595 1662089 644583 1017506 32214848 31024320 1190528 1287206 1229040 58166 4251266 3583306 667960 2228183 2088905 139278 97081 97081 168994 168994 4446 4446 7208533 7104880 103653 225167 225167 647790 501650 146140 1481115 1149880 331235 191585 176323 15262 1019575 1019575 2888243 2407420 480823 366073 42742 323331 UBI TAX 12633 12633 MEDICAL SUPPLIES 10119815 10119426 389 DRUGS 3551653 3551653 IMPLICIT PRICE CONCESSI 1851254 1851254 3446733 2053399 1393334 74947877 67552376 7395501 0 749277 186130 8343443 3901528 9241286 13298864 1898467 1937716 2196042 2143552 330777 470215 69416893 46952195 23123998 22464698 1806734 1726611 976902 820597 252419 177021 48919345 47126932 6604509 8540515 222397 202363 52499 8607 24811202 23927843 1411972 620510 33102579 33299838 X 15515347 13827094 301419 0 15816766 13827094 48919345 47126932 -1989672 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 4446 4446 0 PART II-B, LINE 1: COMMUNITY MEMORIAL HOSPITAL ASSOCIATION PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 0 1 X 301419 301419 296445 4974 301419 294869 1576 296445 292457 2588 176 294869 417785 4135 129463 292457 1.00000 0.00000 0.00000 0 0 659448 659448 50427497 33574483 16853014 16414852 11947456 4467396 1915096 1430256 484840 22464698 THIRD-PARTY PAYOR SETTLEMENTS 443855 LEASE LIABILITIES 176655 620510 X 71054074 -1851254 -1851254 72905328 52877 52877 72958205 73043746 -52877 -52877 73096623 1851254 1851254 74947877 PART IV, LINE 2B: THE HOSPITAL IS THE CUSTODIAN OF FUNDS BELONGING TO FORMER RESIDENTS OF THE NURSING HOME. THE HOSPITAL IS WORKING TO RETURN THESE FUNDS TO THE LEGAL OWNERS. PART V, LINE 4: THE FUNDS ARE TO BE USED ONLY FOR EQUIPMENT NEEDS IN SUNNYSIDE (SNF) OR ICU AND TO BRING DIALYSIS INTO THE COMMUNITY. PART X, LINE 2: NONPROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGE, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE ASSOCIATION HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE ASSOCIATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS -1,851,254. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN/LOSS ON SALE OF ASSETS 8,063. GRANT REVENUE NETTED WITH EXPENSE 44,976. LAB REVENUE ADJUSTMENT -162. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN/LOSS ON SALE OF ASSETS -8,063. GRANT REVENUE NETTED WITH EXPENSE -44,976. LAB REVENUE ADJUSTMENT 162. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 1,851,254. 1 1 X 1 X 1 X 1 1 1 0 0 910862 910862 0.01250 10602057 6637773 3964284 0.05420 89552 102783 0 0.00000 11602471 6740556 4875146 0.06670 227400 53640 173760 0.00240 56595 56595 0.00080 283995 53640 230355 0.00320 11886466 6794196 5105501 0.06990 1 1851254 24557512 24629827 -72315 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BLVD CLOQUET MN 55720 HTTPS://CLOQUETHOSPITAL.COM/ 410557 X X X X NONE COMMUNITY MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART V, PAGE 8 X 1 21 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 250.000000000000 X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: WE MET WITH OUR HEALTH PARTNERS AT CARLTON COUNTY PUBLIC HEALTH AND HUMAN SERVICES TO REVIEW EXISTING DATA AND CONCLUSIONS DRAWN FROM THE DATA. WE ALSO WORKED WITH THEM AND A LARGER GROUP OF PARTNERS TO DEVELOP ADDITIONAL DATA SOURCES, WHERE WE RECEIVED FEEDBACK AND INPUT FROM MEMBERS AS TO THE VALIDITY OF OUR ASSESSMENT. MEMBERS OF THAT COMMITTEE SPAN ACROSS VARIOUS AGENCIES OF PUBLIC HEALTH, AS WELL AS INVOLVING COMMUNITY VOLUNTEERS, SOCIAL SERVICES AGENCIES, AND HEALTH EDUCATION PERSONNEL FROM CLOQUET AND THE REGION. COMMUNITY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: BECAUSE WE WERE THE ONLY ENTITY REQUIRED TO COMPLETE A CHNA IN 2022 AND OUR PARTNERING ENTITIES ARE REQUIRED TO PERFORM A CHNA IN 2023, NONE OF THOSE ENTITIES HAD THE SAME TIMEFRAME FOR COMPLETING THE PROCESS AS US. THAT BEING SAID, WE OBTAINED DATA FROM THOSE GROUPS AND SOUGHT INPUT AND FEEDBACK ON THE FINDINGS WE COMPILED INTERNALLY AS PART OF OUR PROCESS. WE SPECIFICALLY FOCUSED ON A SHARED AGENDA THAT WOULD ANSWER OUR NEEDS AND GIVE THEM DATA THAT COULD BE USED WITHIN THEIR PROCESS. THOSE PARTNERS INCLUDE REPRESENTATIVES FROM THE FOLLOWING AGENCIES THAT WERE EITHER CONTACTED INDIVIDUALLY OR THROUGH GROUPS SUCH AS THE CARLTON COUNTY PUBLIC HEALTH ADVISORY COMMITTEE: CARLTON COUNTY PUBLIC HEALTH, CARLTON COUNTY CHILDREN & FAMILY SERVICES, FOND DU LAC TRIBAL & COMMUNITY COLLEGE, STATEWIDE HEALTH IMPROVEMENT PROGRAM (SHIP) COMMUNITY LEADERSHIP TEAM, ARROWHEAD AGENCY ON AGING, AND COMMUNITY HEALTH BOARD REPRESENTATIVES. COMMUNITY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: EACH OF THESE NEEDS REQUIRES WORK BEYOND THE WALLS OF CMH. WE HAVE BEEN PARTNERING WITH OTHER COUNTY GROUPS AND TASK FORCES ALREADY IN PLACE TO ADDRESS, OR IN SOME CASES CONTINUE TO ADDRESS THE NEEDS NOTED. MENTAL HEALTH - THESE EFFORTS FOCUS WITHIN THE SCHOOLS AND COMMUNITIES AT LARGE. WE PARTNER WITH OTHER AGENCIES TO IMPLEMENT SCHOOL CURRICULUM AND POLICIES THAT SUPPORT MENTAL WELLBEING. WE ALSO INCREASE TRAINING OPPORTUNITIES WITHIN THE COMMUNITY TO UNDERSTAND AND SUPPORT MENTAL HEALTH. WE PARTICIPATE IN TWO DIFFERENT COUNTYWIDE TASK FORCES WORKING ON DIFFERENT ELEMENTS OF MENTAL HEALTH NEEDS ACROSS THE REGION. WE WILL OFFER OUR SUPPORT IN THE FORMS MOST NEEDED BY THE GROUP TO ADVANCE ITS WORK. BEYOND OUR PARTICIPATION, THAT MAY INCLUDE MEETING SPACE, FINANCIAL CONTRIBUTIONS, STAFF TIME TO COMPLETE CERTAIN PROJECTS, AND PROMOTION OF THE OBJECTIVES OF THE GROUP. WE RECENTLY COMPLETED PARTICIPATING IN A VIDEO SERIES SHOWING LOCAL LEADERS AND HOW THEY PERSONALLY PRACTICE SELF-CARE AND FIGHT AGAINST BURNOUT.SUBSTANCE USE - MOST OF THIS WORK IS TAKING PLACE OUTSIDE OF CMH ITSELF. WE PROMOTE POSITIVE WELL-BEING RESOURCES AND MAKE IT EASIER FOR COMMUNITY MEMBERS TO SHARE RESOURCES. WE ARE PARTNERING WITH PUBLIC HEALTH AND OTHER AGENCIES TO EXPAND POSITIVE COMMUNITY NORMS AND STIGMA REDUCTION CAMPAIGNS THROUGH THE COUNTY ACROSS ALL AGES. WE ARE ALSO WORKING TO INCREASE COLLABORATION FOR DRUG DROP BOXES, GROWING THE PROGRAM BEYOND LOCAL POLICE DEPARTMENTS. OUR COUNTYWIDE GROUP WORKING ON THIS INITIATIVE HAS IDENTIFIED UP TO SIX ADDITIONAL DRUG DROP BOX LOCATIONS. THROUGHOUT THE NEXT YEAR, WE WILL BE SECURING COMMITMENTS FROM SEVERAL OF THESE LOCATIONS AND BEING TO INSTALL THE ADDITIONAL DRUG DROP BOXES.OBESITY - WE HAVE ESTABLISHED A WORK GROUP OF PHYSICIANS AND STAFF TO CREATE A NEW SERVICE LINE FOR OVERALL WELLNESS. AS A PART OF THIS, WE WILL HAVE SPECIFIC AREAS OF FOCUS AROUND WEIGHT LOSS, NUTRITION, AND LIFESTYLE. WE ARE ENVISIONING AN INTERDISCIPLINARY APPROACH THAT WILL TACKLE THE PHYSICAL AND BEHAVIORAL HEALTH NEEDS OF PATIENTS WE SERVE THROUGH CLINICAL EXAMS, COUNSELING, MEDICATION MANAGEMENT, AND SURGICAL & OTHER INTERVENTIONS, DEPENDING ON THE UNIQUE NEEDS OF EACH PATIENT. WE ARE ALSO WORKING TO CREATE A CULTURE OF HEALTHY BEHAVIORS - HEALTHY EATING, ACTIVE LIVING, ETC. ACROSS OUR COUNTY IN CONJUNCTION WITH OUR LOCAL PARTNERS.CMH WILL NOT BE ADDRESSING OTHER NEEDS IDENTIFIED IN THE FIELDS OF HOUSING AND AGING. THESE ARE BROAD TOPICS, AND OUR EFFORTS WILL BE FOCUSED IN THE AREAS ALREADY LISTED. OUR ONGOING OPERATIONS DO SUPPORT HEALTHY AGING THROUGH MANY OF THE SERVICES WE ALREADY OFFER, BUT WE SIMPLY DO NOT HAVE THE ORGANIZATIONAL BANDWIDTH TO TACKLE ANY OF THE OTHER PRIORITY AREAS IDENTIFIED AT THIS TIME. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE: HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2023/05/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FY2022.PDF PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE: HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2023/05/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FY2022.PDF PART V, LINE 16A, FAP WEBSITE: HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2025/01/COMMUNITY-CARE-POLICY-PROCEDURE-2025-WEB.PDF PART V, LINE 16B, FAP APPLICATION FORM WEBSITE: HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2025/01/COMMUNITY-CARE-APPLICATION-2025.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY: HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2022/06/FAP-PLAIN-LANGUAGE-SUMMARY-2022.PDF 2 1 - SUNNYSIDE HEALTH CARE CENTER 512 SKYLINE BLVD CLOQUET MN 55720 SKILLED NURSING FACILITY 2 - CMH RAITER FAMILY CLINIC 417 SKYLINE BLVD CLOQUET MN 55720 FAMILY MEDICINE CLINIC PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST-TO-CHARGE RATIO FROM THE AS-FILED 2024 MEDICARE COST REPORT (LINES 7A, 7B, 7C). LINE 7I IS LISTED AS ACTUAL WITH THE EXCEPTION OF AN ESTIMATE FOR SPACE UTILIZATION FOR VARIOUS COMMUNITY PROGRAMS. PART I, LN 7 COL(F): IMPLICIT PRICE CONCESSIONS FROM FINANCIAL STATEMENTS ARE $1,851,254. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: THE HOSPITAL GENERALLY ESTIMATES THE AMOUNT OF IMPLICIT PRICE CONCESSIONS FOR THE CURRENT YEAR BY USING THE PERCENTAGE OF REVENUE SHOWN AS IMPLICIT PRICE CONCESSIONS IN SUPPLEMENTAL INFORMATION TO THE AUDITED FINANCIAL STATEMENT FROM THE PRIOR YEAR. PART III, LINE 3: AT COMMUNITY MEMORIAL HOSPITAL, IMPLICIT PRICE CONCESSIONS ARE CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE REFLECT AN INABILITY TO PAY. PART III, LINE 4: SEE FOOTNOTE 1 ON PAGE 7-8 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6: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: COMMUNITY MEMORIAL HOSPITAL HAS BOTH SELF-PAY COLLECTIONS AND COMMUNITY CARE PROGRAM (CHARITY CARE) POLICIES THAT ARE UTILIZED AND APPLIED FLUIDLY. SELF-PAY (MINNESOTA ATTORNEY GENERAL) DISCOUNTS ARE APPLIED IMMEDIATELY TO A SELF-PAY PATIENTS' LIABILITY. ALL INPATIENT AND OUTPATIENT ACCOUNTS ARE ELIGIBLE FOR CHARITY CARE. ALL PATIENTS ARE ADVISED OF THIS PROGRAM AND APPLICATIONS ARE MADE READILY AVAILABLE. ELIGIBILITY IS DETERMINED BY THE APPLICANTS INCOME (FEDERAL TAX RETURN AND OTHER FINANCIAL DISCLOSURES) COMPARED TO THE FEDERAL POVERTY GUIDELINES. QUALIFYING PATIENTS CAN RECEIVE A PARTIAL SLIDING SCALE REDUCTION UP TO 100%. PATIENTS WHO MAY QUALIFY BUT DO NOT COMPLETE THE COMMUNITY CARE APPLICATION WOULD BE MOVED TO OUR SELF-PAY COLLECTION POLICY. THIS POLICY OUTLINES THE SERIES OF STATEMENT MAILINGS, 30-60-90 DAY LETTERS, COURTESY CALLS AS WELL AS THE AVAILABILITY OF COMMUNITY CARE. THIS CYCLE IS PURSUED RATHER THAN THE ACCOUNT BEING CONSIDERED FOR BAD DEBT COLLECTION.COMMUNITY MEMORIAL HOSPITAL ASSOCIATION'S BILLING AND COLLECTIONS POLICY STATES:I. PURPOSE: THE COLLECTION OF PATIENT BALANCES IS INTENDED TO PRESERVE A SOUND FINANCIAL BASIS FOR OPERATIONS IN ORDER THAT VITAL ESSENTIAL SERVICES CONTINUE TO BE PROVIDED.II. POLICY: SELF-PAY BALANCES ARE DUE UPON RECEIPT OF AN ITEMIZED BILL OR STATEMENT WHEN THE ACCOUNT BALANCE IS DETERMINED TO BE THE PATIENT'S RESPONSIBILITY (AFTER THIRD-PARTY BENEFITS ARE EXHAUSTED). CMH IS OBLIGATED TO COLLECT FOR SERVICES PROVIDED FROM PATIENTS THAT HAVE THE ABILITY TO PAY. PATIENTS UNABLE TO PAY BALANCES IN FULL MAY MAKE MINIMUM MONTHLY PAYMENTS. CMH WILL ASSIST PATIENTS IN OBTAINING PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE.PRIOR TO ASSIGNING AN ACCOUNT TO A COLLECTION AGENCY FOR NON-PAYMENT OR INSUFFICIENT PAYMENT, THE BILLING CYCLE WILL BE FOLLOWED AND THE EVENTS AND ALL PATIENT/GUARANTOR COMMUNICATION MUST BE CLEARLY DOCUMENTED IN THE ACCOUNT NOTES.III. DEFINITIONS/SPECIAL CONSIDERATIONSA BAD DEBT IS AN ACCOUNT RECEIVABLE BASED ON SERVICES FURNISHED TO A PATIENT THAT IS REGARDED AS UNCOLLECTABLE FOLLOWING REASONABLE COLLECTION EFFORTS. ACCOUNTS WILL BE TRANSFERRED TO A COLLECTION AGENCY AS AUTHORIZED BY ADMINISTRATION.A GUARANTOR IS THE PERSON RESPONSIBLE FOR THE PAYMENT OF THE MEDICAL DEBT. THE GUARANTOR IS TYPICALLY THE SAME AS THE ADULT PATIENT. THE GUARANTOR FOR A MINOR CHILD IS TYPICALLY THE PARENT OR LEGAL GUARDIAN THAT BRINGS THE CHILD IN FOR SERVICES.PAYMENTS MAY BE MADE BY CASH, CHECK OR CREDIT CARD (VISA, MASTERCARD OR DISCOVER). CHECKS RETURNED BY A FINANCIAL INSTITUTION WILL INCUR A $30 RETURN CHECK FEE.IV. PROCEDURE1. SELF-PAY/UNINSURED AT TIME OF SERVICE:A. SCHEDULED SURGICAL PROCEDURES REQUIRE A MINIMUM $500 PREPAYMENT ON OR BEFORE THE DATE OF SERVICE IF THE PATIENT/GUARANTOR DOES NOT QUALIFY FOR ANY OTHER PROGRAM. OTHER SCHEDULED OUTPATIENT SERVICES REQUIRE A MINIMUM 10% PREPAYMENT.B. AN ITEMIZED BILL IS MAILED APPROXIMATELY 7 - 10 DAYS AFTER SERVICE/DISCHARGE DATE ALONG WITH A SELF- PAY LETTER (NEWSP) REQUESTING ANY POSSIBLE HEALTH PLAN COVERAGE INFORMATION AND INFORMING THE GUARANTOR ABOUT THE SELF-PAY DISCOUNTS AND COMMUNITY CARE PROGRAM (POLICY BUS-2002). THE SELF PAY DISCOUNT FOR UNINSURED (POLICY BUS-2005) IS APPLIED TO THE ACCOUNT IF APPROPRIATE.C. FIRST STATEMENT PRINTS APPROXIMATELY 14 DAYS LATER. A PROMPT PAY DISCOUNT (10%) IS OFFERED ON BALANCES OVER $50 IF PAID IN FULL WITHIN 30 DAYS. A COMMUNITY CARE APPLICATION WILL BE MAILED FOR ACCOUNT BALANCES OVER $1,500.D. SECOND STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH PAST DUE MESSAGE IF THERE HAS BEEN NO PAYMENT MADE OR NO CONTRACT FOR PAYMENT ESTABLISHED.E. THIRD STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH FIRST COLLECTION LETTER (#55) IF NO PAYMENT OR CONTRACT.F. FOURTH STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH SECOND/LAST COLLECTION LETTER (#25) STATING THEY HAVE 1O DAYS TO RESPOND OR THE ACCOUNT WILL BE PLACED WITH A PROFESSIONAL COLLECTION AGENCY IF NO PAYMENT IS RECEIVED OR CONTRACT ESTABLISHED.G. APPROXIMATELY 10 -30 DAYS LATER THE ACCOUNT IS REVIEWED FOR PLACEMENT WITH AN AGENCY.A. ROUTINE REVIEWS INCLUDE BUT ARE NOT LIMITED TO:I. CHECKING MN-ITS FOR MEDICAID ELIGIBILITYII. CHECKING IF ALL THIRD PARTY PAYER PAYMENTS HAVE BEEN RECEIVED OR IF DENIED PENDING INFORMATION FROM PATIENT, INSURED OR PROVIDERIII. CHECKING FOR RECENT PAYMENTS ON ALL ACCOUNTS WITH THE SAME PATIENT/GUARANTORIV. DETERMINING IF PATIENT MAY QUALIFY FOR CONTRACT HEALTH SERVICE (PHS) COVERAGEV. CHECKING IF A COMMUNITY CARE APPLICATION IS PENDINGVI. NEWBORNS CHECKED IF THEY ARE ENROLLED ON PARENT(S) HEALTH PLAN OR STATE MEDICAIDVII. REVIEW ACCOUNT COMMENTS/NOTES FOR RECENT PATIENT COMMUNICATION2. SELF-PAY BALANCE AFTER THIRD PARTY PAYERS:A. FIRST SELF-PAY STATEMENT PRINTS APPROXIMATELY 3 DAYS AFTER FINAL THIRD PARTY PAYMENT IS POSTED TO ACCOUNT. PROMPT PAY DISCOUNT (10%) IS OFFERED ON BALANCES OVER $50 IF PAID IN FULL WITHIN 30 DAYS.B. SUBSEQUENT STATEMENTS AND LETTERS FOLLOW THE SAME PROCESS AS ABOVE IF NO PAYMENT OR CONTRACT IS ESTABLISHED.3. PLACEMENT OF BAD DEBT ACCOUNTS WITH AN AGENCY OR OTHER RESOLUTION:A. THE DECISION TO ADVANCE A DEBT TO AN AGENCY FOR COLLECTION WILL BE BASED ON SUCH FACTORS AS LACK OF PAYMENT, INSUFFICIENT PAYMENTS, FAILURE TO APPLY FOR AVAILABLE PROGRAMS, FAILURE TO RESPOND TO PROVIDER OR PAYER REQUESTS FOR INFORMATION, OR FAILURE TO CONTACT THE BUSINESS OFFICE AS REQUESTED.B. AN ACCOUNT MAY BE DETERMINED UNCOLLECTIBLE AND TRANSFERRED TO AN AGENCY IF MAIL HAS BEEN RETURNED FOR A BAD ADDRESS AND ATTEMPTS WERE UNSUCCESSFUL TO FIND A CURRENT ADDRESS FOLLOWING THE RETURNED MAIL PROCEDURE.C. MINIMUM PAYMENT GUIDELINES WERE ESTABLISHED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY THEIR ACCOUNT BALANCE IN FULL. A LETTER (INSUF) WILL BE SENT TO PATIENTS THAT ARE NOT MAKING MINIMUM PAYMENTS ACCORDING TO CMH GUIDELINES WHICH ARE PRINTED ON THE BACK OF STATEMENTS.A. IF MINIMUM PAYMENTS ARE NOT SUBSEQUENTLY RECEIVED, INFORMATION MUST BE PROVIDED JUSTIFYING WHY THE MINIMUM PAYMENT CANNOT BE MADE AND WHY THEY ARE NOT ELIGIBLE FOR OTHER PROGRAMS SUCH AS MEDICAID AND COMMUNITY CARE. IF A FINANCIAL HARDSHIP IS INDICATED, A REDUCED PAYMENT PLAN MAY BE ESTABLISHED WITH PERIODIC REVIEW IN SIX TO NINE MONTHS. FINANCIAL HARDSHIP WILL BE DETERMINED UPON REVIEW OF SUPPORTING DOCUMENTATION.B. IF THE PATIENT/GUARANTOR DOES NOT RESPOND TO THE INSUFFICIENT PAYMENT LETTER, CONTINUED COLLECTION ACTIVITY WILL BE PURSUED.C. IF THE PATIENT/GUARANTOR DOES NOT RESPOND TO ANY ATTEMPTS TO DISCUSS THE INSUFFICIENT PAYMENT PLAN, THE ACCOUNT MAY BE TURNED OVER TO AN AGENCY.D. TRANSFERRING SELF-PAY BALANCES ONTO ONE ACCOUNT MAY ONLY BE DONE IF THE MINIMUM PAYMENT IS MADE ON THE NEW COMBINED BALANCE.D. PATIENTS KNOWN OR REPORTED TO HAVE EXPIRED, WITHOUT AN ESTATE OR PROBATE FILED, WILL NOT BE TRANSFERRED TO AN AGENCY IF THERE IS NO INDICATION THAT THE ACCOUNT WILL BE PAID. BALANCES WILL BE A WRITE-OFF ADJUSTMENT WHEN DEEMED APPROPRIATE.E. ACCOUNT BALANCES LESS THAN $25 WILL FOLLOW NORMAL COLLECTION PROCEDURES BUT WILL NOT BE TRANSFERRED TO AN AGENCY. IF THERE IS NO OTHER PATIENT OR GUARANTOR ACCOUNT BALANCES TO COMBINE WITH, THE BALANCE MAY BE A WRITE-OFF ADJUSTMENT.F. SMALL BALANCE WRITE-OFF ADJUSTMENTS WILL BE DONE MONTHLY ON ACCOUNT BALANCES LESS THAN $4.99 IF THERE IS NOT OTHER SELF-PAY ACCOUNT BALANCES TO COMBINE WITH. STATEMENTS ARE NOT SENT OUT FOR BALANCES UNDER $3.00.G. COLLECTION AGENCIES ARE DIRECTED TO RETURN ANY UNCOLLECTIBLE ACCOUNTS WITHIN NINE MONTHS OF TRANSFER IF NO PAYMENTS HAVE BEEN MADE OR PROVIDE INFORMATION TO CMH THAT WARRANTS RETAINING SUCH ACCOUNTS. PART VI, LINE 2: NEEDS ASSESSMENT:WE ARE A SPONSOR OF THE BRIDGE TO HEALTH SURVEY INSTRUMENT. THE SURVEY IS DESIGNED TO GATHER POPULATION-BASED HEALTH STATUS DATA ON RESIDENTS IN A NINE-COUNTY REGION IN NORTHEASTERN MINNESOTA AND NORTHWESTERN WISCONSIN. THE SURVEY IS A COLLABORATIVE EFFORT INVOLVING REPRESENTATIVES FROM OVER 60 HEALTH-RELATED ORGANIZATIONS. WE UTILIZE THE INFORMATION GATHERED FROM THIS SURVEY BROKEN DOWN TO OUR SPECIFIC SERVICE AREA TO IDENTIFY UNMET NEEDS AND OPPORTUNITIES FOR COMMUNITY HEALTH IMPROVEMENT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:SELF PAY PATIENTS ARE INFORMED AT THE TIME OF SERVICE THAT WE CAN PROVIDE COMMUNITY CARE SERVICES AND PROVIDE A FORM. WE ADVISE THE PATIENT TO APPLY FOR MEDICAL ASSISTANCE TO THE MINNESOTA COUNTY HUMAN SERVICES OFFICE WHERE THEY RESIDE SO THAT THEY CAN APPLY FOR ASSISTANCE. COMMUNITY CARE (CHARITY CARE) APPLICATIONS ARE PROVIDED IN OUR REGISTRATION OFFICES, WAITING ROOMS AND ON OUR WEBSITE. THE ORGANIZATION ALSO SENDS INFORMATION TO PATIENTS WITH THEIR ITEMIZED BILLS. WE REQUEST THAT PATIENTS CALL US WITH QUESTIONS OR FOR HELP REGARDING MEDICAL ASSISTANCE OR OUR COMMUNITY CARE PROGRAM. PART VI, LINE 4: COMMUNITY INFORMATION:COMMUMITY MEMORIAL HOSPITAL (CMH) MEETS THE STATE OF MINNESOTA'S CRITERIA OF A RURAL HOSPITAL AND HAS BEEN GRANTED NECESSARY PROVIDER STATUS AS A CRITICAL ACCESS HOSPITAL. CMH IS LOCATED IN CLOQUET, MINNESOTA, WHICH IS IN CARLTON COUNTY, A NORTHEASTERN COUNTY IN MINNESOTA, APPROXIMATELY 25 MILES FROM DULUTH, MINNESOTA AND LAKE SUPERIOR. CMH SERVES PRIMARILY AN ELEVEN ZIP CODE AREA WITH 85% OF ITS PATIENTS RESIDING IN CARLTON COUNTY. CARLTON COUNTY'S 2020 CENSUS ESTIMATED THE POPULATION AT 36,207. GROWTH IS PROJECTED OVER THE NEXT FIVE PLUS YEARS. MEDIAN HOUSEHOLD INCOME FOR THE AREA IS $68,579 WHICH IS 12% LOWER THAN THE MINNESOTA AVERAGE. THE ECONOMY OF THE SERVICE AREA IS MIXED AND INCLUDES MANUFACTURING, EDUCATIONAL SERVICES, RECREATIONAL CASINO-RESORT AND HEALTHCARE SERVICES. THIS MIX HAS HAD A STABILIZING EFFECT ON UNEMPLOYMENT. WHILE BEING GENERALLY HIGHER THAN THE MINNESOTA AVERAGE, THIS MEASURE HAS NOT SEEN LARGE SWINGS THAT THE NATION HAS SEEN. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:COMMUNITY MEMORIAL HOSPITAL (CMH) CONTINUES TO HAVE A STRONG ECONOMIC IMPACT ON OUR SERVICE REGION. WE KNOW WE COULD NOT BE SUCCESSFUL WITHOUT THE SUPPORT OF OUR COMMUNITY. OUR BOARD OF DIRECTORS ARE COMPRISED OF COMMUNITY MEMBERS WITH DIVERSE BACKGROUNDS AND INTERESTS. WE HAVE AN OPEN MEDICAL STAFF POLICY THAT SHARES OUR INTEREST OF PROVIDING QUALITY HEALTH CARE LOCALLY. WE TAKE "COMMUNITY" IN OUR NAME SERIOUSLY. CMH REACHES OUT BY OFFERING SCREENINGS, EDUCATION GROUPS AND OTHER CONNECTIONS TO IMPROVE THE HEALTH OF OUR CITIZENS. EDUCATIONAL SEMINARS INCLUDE: DIZZINESS, DIABETES, CHILDBIRTH AND URINARY INCONTINENCE. ONGOING STROKE AND GRIEF SUPPORT GROUPS HELP FAMILIES DEALING WITH THESE ISSUES. CMH HOSTS EXERCISE PROGRAMS IN ARTHRITIS CARE AND PILATES. MANY CONSULTING SERVICES ARE OFFERED THROUGH OUR OCCUPATIONAL THERAPY DEPARTMENT. WE CAN ASSIST IN DESIGNING AND PERFORMING EMPLOYMENT SCREENINGS, FUNCTIONAL JOB DESCRIPTIONS, WORK-SITE EVALUATIONS, WORKER EDUCATION, ETC. COMMUNITY MEMORIAL HOSPITAL GOES OUT INTO THE AREA TO CONDUCT HEALTH FAIRS AND EXPOS PROVIDING SCREENINGS FOR VISION, BLOOD GLUCOSE, BLOOD PRESSURE, GRIP STRENGTH AS WELL AS BODY FAT ANALYSIS. COMMUNITY MEMORIAL HOSPITAL WILL CONTINUE TO GROW THE PROMOTION OF HEALTH IN THE COMMUNITY AND FURTHER ITS PURPOSE AS A EXEMPT ORGANIZATION. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 CLOQUET SCHOOLS 1000 18TH STREET CLOQUET MN 55720 416000450 GOVERNMENTAL 15040 0 ATHLETIC TRAINER 1 0 PART I, LINE 2: THE ORGANIZATION GIVES THE FUNDS DIRECTLY TO THE LOCAL SCHOOL. X X X 0 0 0 0 0 0 0 0 0 KYLE MENZEL MD PHYSICIAN 869766 0 0 0 414 0 16500 0 22800 0 909480 0 0 0 RICK BREUER CEO 449402 0 0 0 774 0 16500 0 35012 0 501688 0 0 0 BRYAN HUNTER CRNA 396065 0 0 0 774 0 16500 0 31533 0 444872 0 0 0 KENNETH RIPP MD PHYSICIAN 381427 0 0 0 774 0 16500 0 44718 0 443419 0 0 0 JAMES RYAN MD PHYSICIAN 372848 0 0 0 744 0 16500 0 24075 0 414167 0 0 0 JOSEPH LEMKER MD PHYSICIAN 376440 0 0 0 1142 0 16500 0 0 0 394082 0 0 0 KARA UNDERWOOD MD PHYSICIAN / DIRECTOR 348356 0 0 0 774 0 16500 0 3050 0 368680 0 0 0 BRAD ANDERSON COO 254469 0 0 0 774 0 13154 0 32370 0 300767 0 0 0 JOANNA ROBNIK MD PHYSICIAN / DIRECTOR 244694 0 0 0 180 0 12851 0 23352 0 281077 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY MEMORIAL HOSPITAL ASSOCIATION HAS MEMBERS WHO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A COMMUNITY MEMORIAL HOSPITAL ASSOCIATION HAS MEMBERS WHO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS COMPLETED BY AN INDEPENDENT CPA FIRM, REVIEWED BY ADMINISTRATION AND FINANCE FOR ACCURACY, AND PROVIDED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST INDIVIDUAL ANNUAL STATEMENTS WILL BE SIGNED ANNUALLY BY BOARD MEMBERS, CORPORATE OFFICERS, EXECUTIVES, MEDICAL STAFF, PHYSICIANS, AND DEPARTMENT DIRECTORS. EDUCATION IS DONE ON A YEARLY BASIS TO PHYSICIANS, DEPT DIRECTORS AND THE BOARD OF DIRECTORS. ITEMS LISTED ON THE STATEMENTS ARE REVIEWED BY THE CEO, COMPLIANCE OFFICER AND/OR THE CHAIRMAN OF THE BOARD TO SEE IF CONFLICTS EXIST. IF CONFLICTS EXIST, THE CEO, COMPLIANCE OFFICER AND/OR THE CHAIRMAN SHALL: 1. IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. 2. AFTER EXERCISING DUE DILIGENCE, THE BOARD SHALL DETERMINE WHETHER CMH CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 3. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE OR CEO OF CMH SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN CMH'S BEST INTEREST, IS FOR CMH'S OWN BENEFIT, AND IS FAIR AND REASONABLE TO CMH AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. FORM 990, PART VI, SECTION B, LINE 15 AN ORGANIZATIONAL POLICY "SALARY ADMINISTRATION POLICY - NON CONTRACT EMPLOYEES" IS FOLLOWED. ANNUALLY, AN INDUSTRY SALARY SURVEY IS COMPLETED AND RESULTS ARE USED TO SET WAGE SCALES FOR POSITIONS BY JOB CODE. ANY CHANGES TO WAGE SCALES ARE PRESENTED TO THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS WHICH REVIEWS AND MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT ON-SITE FOR REVIEW BY THE PUBLIC DURING NORMAL BUSINESS HOURS FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). CLOQUET COMMUNITY MEMORIAL HOSPITAL FOUNDATION 512 SKYLINE BLVD CLOQUET MN 55720 363588501 SUPPORT MN 501(C)(3) LINE 12C, III-FI N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0