2025-07-24T10:28:35-05:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2024-01-01 411949230 GLENCOE REGIONAL HEALTH SERVICES GLEN 3208643121 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 ANGELA ERICKSON CFO 3208643121 2025-07-22 1 0 RYAN STRUSZ P01604381 6123764500 2025-07-21 2024 2025-03-06 01:10:19Z GLENCOE REGIONAL HEALTH ANGELA ERICKSON 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 105804914 0 X WWW.GLENCOEHEALTH.ORG X 1999 MN TO IMPROVE EVERY LIFE BY OFFERING HIGH-QUALITY, SAFE, AND ACCESSIBLE HEALTHCARE. 7 4 789 54 0 0 556757 1311869 78118002 87237783 1353688 4975978 375589 447564 80404036 93973194 48774 52620 0 0 51125312 57751487 0 0 0 27661786 30180147 78835872 87984254 1568164 5988940 126997568 130963775 31812581 29406804 95184987 101556971 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 66688833 52620 73428888 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. 11977548 0 13188086 NURSING HOME - THE LONG-TERM CARE UNIT IS A 108-BED SKILLED NURSING FACILITY, WITH ALL BEDS MEDICARE AND MEDICAID CERTIFIED. 563825 0 620809 INDEPENDENT SENIOR LIVING - ORCHARD ESTATES IS A 40-UNIT SENIOR HOUSING COMPLEX COMPRISED OF ONE- AND TWO-BEDROOM APARTMENTS. 79230206 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 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 58 0 1 789 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 1 0 MN X ANGELA ERICKSON 3208647797 1805 HENNEPIN AVENUE NORTH GLENCOE MN 55336 SCOTT KUEHN CHAIR 0.50 0.00 X X 0 0 0 MARY STOLTENBURG VICE CHAIR 0.50 0.00 X X 0 0 0 HEATHER PEIRCE SECRETARY 0.50 0.00 X X 0 0 0 SEAN TRITABAUGH DIRECTOR 0.50 0.00 X 0 0 0 DR BRYAN FRITSCH DIRECTOR & PHYSICIAN 40.50 0.00 X 372529 0 47071 DR BRYAN PETERSEN DIRECTOR & PHYSICIAN 40.50 0.00 X 454007 0 49560 DR KRISTEN BUDAHN DIRECTOR & PHYSICIAN 40.00 0.00 X 577530 0 41658 ANGELA ERICKSON CFO 40.00 0.00 X 206319 0 43255 BENJAMIN DAVIS PRESIDENT AND CEO 40.00 0.00 X 363365 0 55922 DR CHAD ROBBINS PHYSICIAN 40.00 0.00 X 497491 0 47333 DR ELIZABETH COLSEN PHYSICIAN 40.00 0.00 X 520475 0 38723 DR KEN SMITH PHYSICIAN 40.00 0.00 X 608273 0 13662 JOSLIN THIEMANN APRN ADVANCED PRACTICE PROV. 40.00 0.00 X 664284 0 50057 DR MATTHEW COPPLE PHYSICIAN 40.00 0.00 X 880423 0 32373 5144696 0 419614 97 0 1 0 MA MORTENSON COMPANY 700 MEADOW LANE NORTH MINNEAPOLIS MN 55422 CONSTRUCTION MANAGEMENT 5630029 PREMIER STAFFING INC 243 WINKLER TRAIL COLOGNE MN 55322 PHYSICIAN SERVICES 756676 AYA HEALTHCARE INC PO BBOX 123519 DALLAS TX 75312 POOL LABOR 625364 FOSTER MECHANICAL INC 9455TH AVENUE SE UNIT 12 HUTCHINSON MN 55350 CONSTRUCTION MANAGEMENT 590169 ALLINA HEALTH LABORATORY PO BOX 77008 MINNEAPOLIS MN 55480 REFERENCE LAB 450113 17 40587 1271282 1311869 HOSPITAL 623000 73428888 73428888 NURSING HOME 623000 13188086 13188086 SENIOR LIVING 623990 620809 620809 87237783 1958928 1958928 48652 0 48652 48652 48652 14846810 820 11830580 0 3016230 820 3017050 3017050 100 0 100 100 6436 1140 5296 5296 MISCELLANEOUS 900099 336814 336814 CAFETERIA REVENUE 722210 52071 52071 INVESTMENT IN JOINT VENTURES 900099 4631 4631 393516 93973194 87237783 0 5423542 7673 7673 44947 44947 2211214 1526932 684282 45793892 43159611 2634281 1621962 1536086 85876 5190688 4902172 288516 2933731 2736092 197639 184167 184167 4670 4670 4938061 3399795 1538266 276277 276277 1187139 717348 469791 578677 578677 1710096 1710096 142553 89746 52807 94678 21738 72940 736827 736827 4255775 4255775 917632 314444 603188 DRUGS 5904718 5896658 8060 MEDICAL EXPENSES 5619158 5614658 4500 LICENSES AND TAXES 1503318 1503318 BAD DEBT EXPENSE 919191 919191 1207210 1061740 145470 87984254 79230206 8754048 0 13924068 7165317 13432512 15645792 12501696 13330746 697393 625607 1048654 1119822 119714715 72627655 42142034 47087060 41093084 43628218 0 4631 2158127 2356582 126997568 130963775 6748154 7320621 1051350 319919 21019935 19384861 40558 24821 2952584 2356582 31812581 29406804 X 95184987 101556971 95184987 101556971 126997568 130963775 5988940 383044 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4670 4670 0 PART II-B, LINE 1: LOBBYING PORTION OF ASSOCIATION DUES PAID TO AHA AND MHA. 0 1 X 1306705 1306705 55392383 35756561 19635822 2772120 2001861 770259 52866794 34869233 17997561 7376713 7376713 47087060 DEFERRED COMPENSATION 2356582 2356582 X 93438187 383044 1140 384184 93054003 919191 919191 93973194 87066203 1140 1140 87065063 919191 919191 87984254 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 1,140. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 919,191. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 1,140. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 919,191. 1 1 X 1 X 1 X 0 1 1 0 0 1277178 1277178 0.01450 10500087 7423766 3076321 0.03500 11777265 7423766 4353499 0.04950 238627 7114 231513 0.00260 363173 27715 335458 0.00380 78302 78302 0.00090 680102 34829 645273 0.00730 12457367 7458595 4998772 0.05680 207490 207490 0.00240 207490 207490 0.00240 0 919191 20011728 20308736 -297008 X 1 1 1 1 GLENCOE REGIONAL HEALTH SERVICES 1805 HENNEPIN AVENUE NORTH GLENCOE MN 55336 WWW.GLENCOEHEALTH.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 22 1 0 1 1 X SEE PART V, SECTION B, LINE 7D X X 1 22 1 SEE PART V, SECTION B, LINE 7D 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X HTTPS://GLENCOEHEALTH.ORG/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE/ X HTTPS://GLENCOEHEALTH.ORG/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE/ X HTTPS://GLENCOEHEALTH.ORG/BILLING-AND-INSURANCE/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: DURING 2024, GLENCOE REGIONAL HEALTH (GRH) IMPLEMENTED A VARIETY OF INITIATIVES TO ADDRESS THE IDENTIFIED COMMUNITY HEALTH NEEDS (OBESITY AND MENTAL HEALTH). TO PROMOTE PHYSICAL ACTIVITY AND HEALTHY LIFESTYLES, GRH HOSTED ANNUAL EVENTS LIKE THE FUN RUN (CANCELLED IN 2024 DUE TO WEATHER) AND SCARECROW STROLL, ENHANCED THE PRAIRIE TRAIL WITH A LITTLE FREE LIBRARY, AND LAUNCHED THE COMMUNITY CARES VOLUNTEER PROGRAM TO ENCOURAGE MOVEMENT AND ENGAGEMENT. WE ALSO SUPPORTED HEALTHY HABITS THROUGH EDUCATIONAL BLOG POSTS, SOCIAL MEDIA, AND RADIO INTERVIEWS. FOR MENTAL HEALTH, GRH EXPANDED SERVICES, IMPLEMENTED DEPRESSION SCREENINGS, AND SUPPORTED COMMUNITY CONNECTION THROUGH EVENTS, VOLUNTEER ROLES, AND PARTNERSHIPS LIKE 2B CONTINUED. WE ALSO PROVIDED MENTAL HEALTH EDUCATION VIA NEWSLETTERS, INTERVIEWS, AND ONLINE CONTENT, REINFORCING THEIR COMMITMENT TO HOLISTIC COMMUNITY WELLNESS. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 6B: THE NON-HOSPITAL ORGANIZATIONS INVOLVED IN THE ASSESSMENT PROCESS INCLUDED REPRESENTATIVES FROM MCLEOD COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, CITY OF GLENCOE, CITY OF STEWART, GLENCOE SCHOOL DISTRICT, GLENCOE POLICE DEPARTMENT, GLENCOE CHAMBER OF COMMERCE, LORENZ CLINIC, SECURITY BANK & TRUST, ALLINA HEALTH (AMBULANCE SERVICES), AND INTEGRATIONS WELLNESS & RECOVERY CENTER, AS WELL AS UNAFFILIATED COMMUNITY MEMBERS. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 7D: THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://GLENCOEHEALTH.ORG/WP-CONTENT/UPLOADS/2024/12/2022-GRH-CHNA.PDF GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 11: GLENCOE REGIONAL HEALTH CONDUCTED THIS CHNA TO BETTER UNDERSTAND OUR COMMUNITY AND THE INDIVIDUALS WE SERVE. GRH DEVELOPED A STRATEGY TO RESPOND TO THE SIGNIFICANT COMMUNITY HEALTH NEEDS AND CREATED AN IMPLEMENTATION STRATEGY TO FORMALIZE THOSE RESPONSES. THAT IMPLEMENTATION STRATEGY WAS APPROVED BY GLENCOE REGIONAL HEALTH'S BOARD OF DIRECTORS ON NOVEMBER 28TH, 2022 AND IS BEING USED BY THE ORGANIZATION AS A GUIDE FOR THOUGHTFUL, IMPACTFUL DECISIONS AND ACTIONS. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 16J: EACH SELF-PAY EMERGENCY DEPARTMENT PATIENT RECEIVES A LIST OF MNSURE NAVIGATORS AND ARE ASKED TO SIGN A SELF-PAY DISCLAIMER. WITHIN 30 DAYS OF THEIR VISIT OR DISCHARGE GRH STAFF WILL CALL SELF-PAY PATIENTS TO ENSURE THEY ARE AWARE OF THE DISCOUNTS AVAILABLE TO THEM. IN ADDITION, THE FINANCIAL ASSISTANCE APPLICATION WILL BE MAILED TO THEIR ADDRESS ON FILE. 4 1 - GLENFIELDS LIVING WITH CARE 2015 HENNEPIN AVENUE NORTH GLENCOE MN 55336 NURSING HOME 2 - GLENCOE REGIONAL HEALTH SERVICES 1024 CENTRAL AVENUE LESTER PRAIRIE MN 55354 CLINIC 3 - GLENCOE REGIONAL HEALTH SERVICES 300 BOWMAN STREET STEWART MN 55385 CLINIC 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 $919,191 FOR 2024. 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, GRH 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 FINANCIALLY 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 AND ALLOWANCE FOR CREDIT LOSSES" PARAGRAPH IN NOTE 1 ON PAGES 8-9 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: ALL PATIENTS WILL RECEIVE MONTHLY STATEMENTS FOR ALL OUTSTANDING BALANCES. EACH STATEMENT WILL INCLUDE A SUMMARY OF CHARGES, PAYMENTS, ADJUSTMENTS, AND THE CURRENT BALANCE DUE. IF NO PAYMENTS ARE MADE AFTER THE SECOND STATEMENT HAS BEEN SENT, THE PATIENT WILL BE CALLED. IF NO RESPONSE, A FINAL LETTER IS SENT NOTIFYING THE PATIENT THE ACCOUNT WILL BE SENT TO COLLECTIONS IN 30 DAYS. 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 WEBSITE 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 BY CALLING EACH SELF-PAY PATIENT WITHIN 30 DAYS OF THEIR VISIT. IN ADDITION, THE INFORMATION IS POSTED THROUGHOUT OUR FACILITY, AVAILABLE ON THE GRHS WEBSITE AND ON EACH MONTHLY BILLING STATEMENT. ANNUALLY, WE PROVIDE A REPORT BACK TO THE COMMUNITY ABOUT OUR FINANCES AND CHARITY CARE AMOUNTS. THIS REPORT IS SENT TO ALL OF OUR PATIENTS, AS WELL AS THE RESIDENTS IN THE COMMUNITY 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 33,035 IN 2020, AN INCREASE OF 13.3% SINCE 2000. THE REPORTED POPULATION OF THE CITY OF GLENCOE FOR THE YEAR 2010 AND 2020 WERE 5,631 AND 5,744 RESPECTIVELY, AN INCREASE OF 2%. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 2B CONTINUED 21092 451ST AVENUE ARLINGTON MN 55307 842398238 501(C)3 7500 0 GENERAL SUPPORT 1 0 EMPLOYEE SCHOLARSHIPS 9 12442 NAR TESTING 49 32505 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. THE ORGANIZATION PROVIDES A NAR TRAINING PROGRAM WHERE THE ORGANIZATION WILL PAY FOR ALL TRAINING AND TESTING FOR CANDIDATES TO RECEIVE A NAR CERTIFICATION WHICH IS MANAGED BY AN EDUCATION SPECIALIST. CANDIDATES ARE INTERVIEWED AND HIRED INTO THE PROGRAM WHERE THEY COMPLETE ALL NECESSARY TRAINING. ONCE ALL TRAINING IS COMPLETED THE EDUCATION SPECIALIST COORDINATES THE TESTING THROUGH QUALIFIED INSTITUTIONS AND APPROVES THE PAYMENTS TO THESE INSTITUTIONS AS THE EMPLOYEES COMPLETE THE TESTING. ANY DONATION GREATER OR EQUAL TO $5,000 MUST BE REVIEWED AND APPROVED BY THE CHIEF DEVELOPMENT OFFICER. X X X 0 0 0 0 0 0 0 0 0 DR MATTHEW COPPLE PHYSICIAN 807015 0 29501 0 43907 0 9400 0 22973 0 912796 0 0 0 JOSLIN THIEMANN APRN ADVANCED PRACTICE PROV. 625026 0 28547 0 10711 0 17250 0 32807 0 714341 0 0 0 DR KEN SMITH PHYSICIAN 575294 0 18697 0 14282 0 13446 0 216 0 621935 0 0 0 DR KRISTEN BUDAHN DIRECTOR & PHYSICIAN 549635 0 27895 0 0 0 16842 0 24816 0 619188 0 0 0 DR ELIZABETH COLSEN PHYSICIAN 490400 0 16686 0 13389 0 17250 0 21473 0 559198 0 0 0 DR CHAD ROBBINS PHYSICIAN 475849 0 21642 0 0 0 17250 0 30083 0 544824 0 0 0 DR BRYAN PETERSEN DIRECTOR & PHYSICIAN 433070 0 20937 0 0 0 17250 0 32310 0 503567 0 0 0 DR BRYAN FRITSCH DIRECTOR & PHYSICIAN 354335 0 18194 0 0 0 33170 0 13901 0 419600 0 0 0 BENJAMIN DAVIS PRESIDENT AND CEO 307044 0 56321 0 0 0 17250 0 38672 0 419287 0 0 0 ANGELA ERICKSON CFO 189725 0 16594 0 0 0 32471 0 10784 0 249574 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 11770000 23087781 1737800 388068 20961913 2013 1 0 1 1 B 1880000 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 0 0 1 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: 01/11/2023 ISSUER NAME: CITY OF PLATO, MINNESOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/11/2023 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 OF 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 BY THE BOARD OF DIRECTORS. THE BOARD USES FORM 990 INFORMATION FROM OTHER COMPARABLE ORGANIZATIONS ALONG WITH COMPENSATION BENCHMARKING DATA FROM THE MINNESOTA HOSPITAL ASSOCIATION, THE MEDICAL GROUP MANAGEMENT ASSOCIATION MARKET DATA, AND THE HEALTHCARE HUMAN RESOURCES ASSOCIATION OF MINNESOTA TO GATHER COMPARISON DATA. ANNUALLY, THIS DATA AND THE PERFORMANCE REVIEW DONE BY THE BOARD OF DIRECTORS ARE USED TO SET THE CEO'S COMPENSATION. THE MOST RECENT YEAR THIS PROCESS WAS CONDUCTED WAS IN 2024. 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. GLENCOE REGIONAL HEALTH SERVICES FOUNDATION INC 1805 HENNEPIN AVE N GLENCOE MN 55336 411625505 FUNDRAISING MN 501(C)(3) LINE 12C, III-FI GLENCOE REGIONAL HEALTH SERVICES 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0