2025-08-14T12:53:18-05:00 2024-09-30 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2023-10-01 410808719 ELY-BLOOMENSON COMMUNITY HOSPITAL ELY- 2183653271 328 WEST CONAN STREET ELY MN 55731 TIMOTHY BALTHAZOR CFO 2183653271 2025-08-13 1 1 JULIE BOYER P01278549 2187275025 2025-08-13 2023 2025-03-06 01:10:19Z PATTI BANKS 328 WEST CONAN STREET ELY MN 55731 34733877 0 X WWW.EBCH.ORG X 1956 MN ELY-BLOOMENSON COMMUNITY HOSPITAL IS COMMITTED TO CARING FOR AND ENHANCING THE HEALTH AND WELL BEING OF THE COMMUNITY IT SERVES. 9 9 151 15 4516241 0 903426 565000 29907971 32569536 293528 392472 90606 77466 31195531 33604474 85119 110579 0 0 11959980 13828592 0 0 0 18423113 19225515 30468212 33164686 727319 439788 29881505 29624244 12463218 10984652 17418287 18639592 X ELY-BLOOMENSON COMMUNITY HOSPITAL IS COMMITTED TO CARING FOR AND ENHANCING THE HEALTH AND WELL-BEING OF THE COMMUNITY IT SERVES. 0 0 28085702 110579 32622535 HOSPITAL SERVICES PROVIDED FOR THE ELY COMMUNITY AND SURROUNDING AREA. ELY-BLOOMENSON COMMUNITY HOSPITAL (EBCH), RECOGNIZED BY THE FEDERAL & STATE OF MINNESOTA GOVERNMENTS AS A CRITICAL ACCESS HOSPITAL, IS THE ONLY LOCAL HEALTHCARE CENTER SERVING ELY AND SURROUNDING COMMUNITIES BORDERING THE VAST ACREAGE OF BOUNDARY WATERS CANOE AREA WILDERNESS. UNDER ORIGINAL FEDERAL RULES EBCH WOULD HAVE BEEN ONLY ONE OUT OF SEVEN HOSPITALS IN MINNESOTA THAT WOULD HAVE QUALIFIED FOR CRITICAL ACCESS HOSPITAL STATUS. THE HOSPITAL BOASTS: IN AND OUTPATIENT HOSPITAL NURSING SERVICE, IN-HOUSE LABORATORY, AN ON-SITE RETAIL PHARMACY, PHYSICAL AND OCCUPATIONAL THERAPY, CHEMOTHERAPY, A FULLY-STAFFED 24-7 RADIOLOGY DEPARTMENT, A PROFESSIONAL ANESTHESIA TEAM, SWING BED CARE FOR PATIENTS WHO NO LONGER REQUIRE ACUTE CARE HOSPITALIZATION, AND A 24-7 EMERGENCY ROOM. DURING THE FY2024 EBCH PERFORMED 629 SURGICAL PROCEDURES, 27,460 LABORATORY TESTS, 7,233 RADIOLOGICAL EXAMS, AND 3,776 EMERGENCY ROOM VISITS. IN ADDITION, 224 PEOPLE WERE ADMITTED FOR INPATIENT CARE. 578 DAYS OF CARE WERE PROVIDED FOR INPATIENTS AND 398 DAYS OF CARE WERE PROVIDED TO SWING BED PATIENTS, 3,036 OUTPATIENTS WERE SEEN, 20,206 MODALITIES WERE PERFORMED IN OT AND PT, AND 1,241 MODALITIES WERE PERFORMED IN CARDIAC REHAB. 28085702 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 43 0 1 151 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MN X PATTI BANKS 2183653271 328 WEST CONAN STREET ELY MN 55731 RIANA HEGMAN DIRECTOR 1.00 0.50 X 0 0 0 STEPHEN PETERSON SR DIRECTOR 1.00 0.50 X 0 0 0 JOHN SAW DIRECTOR 1.00 0.50 X 0 0 0 MARY ANN SMITH DIRECTOR 1.00 0.50 X 0 0 0 ROBERT WILMUNEN DIRECTOR 1.00 0.50 X 0 0 0 JO LANGAN DIRECTOR UNTIL 12/31/23 1.00 0.50 X 0 0 0 TODD HEIMAN TREASURER 1.00 0.50 X X 0 0 0 KELLY KLUN SECRETARY UNTIL 12/31/23 1.00 0.50 X X 0 0 0 BARBARA SODERBERG SECRETARY 1.00 0.50 X X 0 0 0 TIM RILEY VICE PRESIDENT 1.00 0.50 X X 0 0 0 DEVON LUTHENS PRESIDENT 1.00 0.50 X X 0 0 0 PATTI BANKS CEO 39.50 0.50 X 248682 0 43202 BROCK URIE CMO/PHYSICIAN 40.00 0.00 X 418927 0 0 SAM RICE PHYSICIAN 40.00 0.00 X 195241 0 32641 KARLA GRIZZARD RN 40.00 0.00 X 182753 0 37293 JOHN SCHINDELE PHARMACIST 40.00 0.00 X 176080 0 43567 BETH HARTSHORN PHARMACIST 40.00 0.00 X 160086 0 16486 ABIGAIL SIREK PHARMACIST 40.00 0.00 X 150399 0 15992 1532168 0 189181 20 0 1 0 CENTRAL MINNESOTA DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 DIAGNOSTIC EQUIP SERVICE 1082970 ACUTE CARE INC 1609 N ANKENY BLVD STE 200 ANKENY IA 50023 EMERGENCY ROOM PHYSICIAN COVERAGE 981982 LAKE COUNTRY ANESTHESIA LLC 2760 BEAR ISLAND RIVER RD ELY MN 55731 ANESTHESIA SERVICES 955935 RSM US LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 ACCOUNTING, AUDITING & CONSULTING SERVIC 774870 ESSENTIA HEALTH SHARED SERVICES 502 EAST 2ND ST DULUTH MN 55805 EPIC SOFTWARE SERVICES 443291 15 425000 125000 15000 565000 PATIENT SERVICE 621400 27606327 27606327 RETAIL PHARMACY 456110 4516241 4516241 EQUITY IN EARNINGS OF AFFILIATES 900099 446968 446968 32569536 508202 508202 26448 1981 24467 24467 24467 1011692 1127422 -115730 -115730 -115730 OTHER OPERATING 621400 52999 52999 52999 33604474 28106294 4516241 416939 X 110579 110579 796529 450537 345992 9574090 8426166 1147924 318487 293303 25184 2416896 2297359 119537 722590 624759 97831 48653 48653 455423 455423 2210 2210 5202245 4159541 1042704 138885 67656 71229 232813 165875 66938 867831 490552 377279 231193 231193 89043 27763 61280 221557 221557 1021397 935711 85686 138313 138313 DRUGS 5715291 5715291 LEASE EXPENSE 1358133 1358133 MEDICAL SUPPLIES 1150524 1045722 104802 REPAIRS & MAINTENANCE 683882 669986 13896 1668122 1015576 652546 33164686 28085702 5078984 0 3010223 1968818 4047226 3678683 250000 62500 1136806 1000945 272281 362145 27836119 21972027 5937487 5864092 9702135 11246064 5525347 5440997 29881505 29624244 2305258 1979898 109154 68221 6235667 5486575 4528 0 3808611 3449958 12463218 10984652 X 17418287 18639592 17418287 18639592 29881505 29624244 439788 804517 -23000 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 2210 2210 0 PART II-B, LINE 1: THE HOSPITAL 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. 77500 56 56 77500 77500 9 9 77500 77500 2 2 77500 77500 462 462 77500 77500 1594 1594 77500 0.00000 1.00000 0.00000 0 1 1 76827 76827 16176821 14099652 2077169 9336454 6474879 2861575 2246017 1397496 848521 5864092 INTEREST RECEIVABLE 29 DIRECT FINANCING LEASE 961819 INVESTMENT IN AFFILIATES 1098926 OPERATING RIGHT-OF-USE LEASE ASSETS 2382658 FINANCE RIGHT-OF-USE LEASE ASSETS 752300 THIRD-PARTY PAYOR SETTLEMENTS 245265 5440997 OPERATING RIGHT-OF-USE LEASE LIABILITIES 2382658 THIRD-PARTY PAYOR SETTLEMENTS 315000 FINANCE RIGHT-OF-USE LEASE LIABILITIES 752300 3449958 X 33588114 804517 -820877 -16360 33604474 0 33604474 32366809 23000 23000 32343809 820877 820877 33164686 PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY ELY HEALTH AND HOSPITAL FOUNDATION. THE INCOME FROM THE ENDOWMENT FUNDS WILL BE USED FOR GRANTS AND CONTRIBUTIONS. PART X, LINE 2: THE HOSPITAL IS A NONPROFIT HOSPITAL AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. MANAGEMENT EVALUATED THE HOSPITAL'S TAX POSITIONS AND CONCLUDED THE HOSPITAL HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THE GUIDANCE. GENERALLY, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS -633,377. EXPENSE NETTED WITH REVENUE -187,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 633,377. EXPENSE NETTED WITH REVENUE 187,500. 1 1 X 1 X 125.000000000000 1 X 180.000000000000 1 1 1 0 0 339690 339690 0.01040 3360243 2215698 1144545 0.03520 3699933 2215698 1484235 0.04560 103398 103398 0.00320 149462 149462 0.00460 244894 244894 0.00750 497754 497754 0.01530 4197687 2215698 1981989 0.06090 15540 15540 0.00050 15540 15540 0.00050 1 633377 0 8832189 8705671 126518 X 1 1 1 1 ELY-BLOOMENSON COMMUNITY HOSPITAL 328 WEST CONAN STREET ELY MN 55731 410419 X X X X N/A ELY-BLOOMENSON COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V, PAGE 8 X 1 21 1 SEE PART V, PAGE 8 0 1 X 125.000000000000 180.000000000000 X X 1 1 X 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 ELY-BLOOMENSON COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: EBCH PROVIDED RHI WITH A COUNT OF INPATIENT ADMISSIONS BY ZIP CODE FROM THE PREVIOUS YEAR. ZIP CODES WITH THE GREATEST NUMBER OF ADMISSIONS AND UTILIZATION WERE STRATIFIED IN THE INITIAL SAMPLE SELECTION. EACH AREA WOULD BE REPRESENTED IN THE SAMPLING PROPORTIONATELY TO BOTH THE OVERALL SERVED POPULATION AND THE NUMBER OF PAST ADMISSIONS OR UTILIZATION. EIGHT HUNDRED ADDRESSES REPRESENTING THE SAMPLE AREA WERE SELECTED RANDOMLY FROM PRIMENET DATA SOURCE, A MARKETING ORGANIZATION. ALTHOUGH THE SURVEY SAMPLES WERE PROPORTIONATELY SELECTED, ACTUAL SURVEYS RETURNED FROM EACH POPULATION AREA VARIED. THIS MAY RESULT IN SLIGHTLY LESS PROPORTIONAL RESULTS. THE CHNA, A COVER LETTER ON EBCH'S LETTERHEAD, AND A POSTAGE PAID REPLY ENVELOPE WERE MAILED FIRST CLASS TO 800 RANDOMLY SELECTED RESIDENTS IN THE TARGETED REGION (SEVEN ZIP CODES). EBCH ANNOUNCED THE CHNA SURVEY IN A PRESS RELEASE IN THE ELY ECHO AND THE TIMBERJAY NEWSPAPERS THE WEEK OF OCTOBER 25, 2021. THE INFORMATION RAN IN THE TIMBERJAY ON OCTOBER 29, 2021, AND THE ELY ECHO ON OCTOBER 30, 2021. EBCH ALSO PROMOTED THE SURVEY ON SOCIAL MEDIA AND THE LOCAL RADIO STATION WELY. ELY-BLOOMENSON COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED THE FOLLOWING SIGNIFICANT NEEDS IN ITS MOST RECENTLY CONDUCTED CHNA: 1. ACCESS TO DENTAL SERVICES2. ACCESS TO CHILDCARE3. ACCESS TO SPECIALISTS4. DENTAL CARE5. AVAILABILITY OF SERVICES/ PROVIDERS6. MENTAL HEALTH SERVICESELY-BLOOMENSON COMMUNITY HOSPITAL (EBCH) AND ITS BOARD OF DIRECTORS IDENTIFIED THE FOLLOWING THREE SIGNIFICANT NEEDS. THE HOSPITAL IS ADDRESSING ALL OF THE SIGNIFICANT NEEDS IN SOME CAPACITY: 1.) INCREASE IN ACCESS TO SPECIALTY SERVICES2.) INCREASE IN COMMUNITY AWARENESS AND EDUCATION3.) INCREASE IN ACCESS TO CHILDCARESOME OF THE ONGOING COMMUNITY BENEFIT ACTIVITIES THAT EBCH IS PARTICIPATING IN FOR EACH OF THE SIGNIFICANT NEEDS INCLUDE: 1. WE CONTINUE TO WORK WITH OTHER HEALTHCARE PARTNERS TO INCREASE THE AVAILABILITY OF SERVICES AND PROVIDERS AT EBCH. EBCH HAS THE FOLLOWING SPECIALTIES: PODIATRY, ORTHOPEDICS, GENERAL SURGERY AND GASTROENTEROLOGY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, INFUSIONS, AND CARDIAC REHAB. CURRENTLY EBCH IS EXPLORING ADDING ADDITIONAL SPECIALTIES WITH LIMITED FINANCIAL RESOURCES. EBCH PARTNERS WITH LOCAL DENTAL OFFICES AND THE FREE CLINIC TO ADDRESS NEEDS WHEN APPROPRIATE.2. INCREASE IN ACCESS TO SPECIALTY SERVICES WAS IDENTIFIED BY THE BOARD OF DIRECTORS AND THE CHNA AS A SIGNIFICANT NEED. WE PROVIDE ONGOING PRINT AND RADIO ADS ADVERTISING THESE SPECIALTY SERVICES AND WHAT THEY CAN DO FOR THE COMMUNITY. EBCH HAS INCREASED ITS SOCIAL MEDIA PRESENCE REGARDING HEALTH TOPICS WITHIN THE COMMUNITY THROUGH ITS PARTNERSHIP WITH VARIOUS MARKETING COMPANY'S. EBCH ALSO CREATED MARKETING MATERIALS TO GIVE TO LARGE EMPLOYERS IN THE AREA. EBCH ALSO HAS EMPLOYEESSPEAK AT LOCAL MEETINS OF CIVIC GROUPS.3. THE CEO, PATTI BANKS, DURING TAX YEAR 2021, JOINED THE BOARD OF THE ELY AREA COMMUNITY FOUNDATION THAT IS WORKING ON A PROJECT TO PROVIDE AN AFFORDABLE BUILDING SPACE FOR A LOCAL DAY CARE FACILITY. THIS BUILDING IS ALSO HOME TO OTHER HEALTH AND WELNESS ORGANIZATIONS. EBCH CONTINUES TO EVALUATE AND DETERMINE THE BEST WAY TO PROVIDE CHILDCARE SERVICES TO THE COMMUNITY WITH LIMITED FINANCIAL RESOURCES.4. THE CHNA NOTES THAT THERE IS A GAP IN MENTAL HEALTH CARE SERVICES; WE CONTINUE TO PARTNER WITH MANY LOCAL ORGANIZATIONS SUCH AS BEHAVIORAL HEALTH NETWORK AND EPARC TO BRING AWARENESS TO MENTAL HEALTH AND ASSOCIATED SUBSTANCE ABUSE. EBCH IS ALSO PARTICIPATING IN THE MN PATH TO VALUES AND IS PART OF THE MENTAL HEALTH COMMUNITY CARE TEAM. EBCH IS DETERMINING THE BEST WAY TO PROVIDE MENTAL HEALTH SERVICES TO THE COMMUNITY WITH LIMITED FINANCIAL RESOURCES. EBCH IS ALSO CONSIDERING UTILIZING TELEHEALTH WHEN APPLICABLE.5. THE CHNA NOTES THAT ACCESS TO DENTAL SERVICES IS A SIGNIFICANT NEED IN THE COMMUNITY, EBCH DONATES TO THE ELY FREE CLINIC WHICH PROVIDES DENTAL SERVICES. EBCH IS DETERMINING THE BEST WAY TO PROVIDE DENTAL SERVICES TO THE COMMUNITY WITH LIMITED FINANCIAL RESOURCES. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE HTTPS://WWW.EBCH.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE HTTPS://WWW.EBCH.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, LINE 16A, FAP WEBSITE HTTPS://WWW.EBCH.ORG/WP-CONTENT/UPLOADS/2025/03/EBCH-FINANCIAL-ASSISTANCE-POLICY-2025-1.PDF PART V, LINE 16B, FAP APPLICATION WEBSITE HTTPS://WWW.EBCH.ORG/WP-CONTENT/UPLOADS/2025/03/EBCH-FINANCIAL-ASSISTANCE-APPLICATION-2025.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY: HTTPS://WWW.EBCH.ORG/WP-CONTENT/UPLOADS/2025/03/EBCH-FAP-PLAIN-LANGUAGE-SUMMARY-2025.PDF PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 9/30/2024 MEDICARE COST REPORT. PART I, LN 7 COL(F): IMPLICIT PRICE CONCESSIONS FROM THE FINANCIAL STATEMENTS IS $633,377. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT: COMMUNITY BUILDING ACTIVITIES PROMOTED HEALTH IN THE COMMUNITY BY ALLOWING THE COMMUNITY TO USE CONFERENCE ROOM SPACE FREE OF CHARGE TO DISCUSS AND PREPARE FOR HEALTH ISSUES OR EMERGENCIES. MOST OF THESE MEETINGS ARE TIED TO EMERGENCY PREPAREDNESS AND EMERGENCY MANAGEMENT. THERE WAS ALSO IP SPECIFIC EDUCATION, UNDER ONE ROOF CONFERENCE, MASS CASUALTY DRILL & DECONTAMINATION EQUIPMENT REVIEW. PART III, LINE 2: THE HOSPITAL DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACT AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. PART III, LINE 4: FROM FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS: WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THE HOSPITAL HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE HOSPITALS RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE HOSPITAL DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.THE PRIMARY COLLECTIONS RISKS RELATE TO UNINSURED PATIENT ACCOUNTS, INCLUDING PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT THE PATIENT RESPONSIBILITY AMOUNT (DEDUCTIBLES AND COPAYMENTS) REMAIN OUTSTANDING. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED.FROM FOOTNOTE 3 OF THE AUDITED FINANCIAL STATEMENTS: GENERALLY, PATIENTS WHO ARE COVERD BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJSUTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMNETS TO PATIENT SERVICES REVENUE IN THE PRIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD-DEBT EXPENSE. 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: AT LEAST 30 DAYS PRIOR TO TAKING ANY EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL TO OBTAIN PAYMENT FOR AN EPISODE OF CARE, EBCH OR ITS AGENT SHALL PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT INCLUDES THE FOLLOWING INFORMATION:I. CHARITY CARE - FINANCIAL ASSISTANCE PROGRAM (FAP) IS AVAILABLE FOR ELIGIBLE INDIVIDUALS.II. THE EXTRAORDINARY COLLECTION ACTIONS THAT EBCH INTENDS TO INITIATE FOR PAYMENT OF CARE.III. A DEADLINE AFTER WHICH EXTRAORDINARY COLLECTION ACTIONS MAY BE INITIATED.BEFORE SENDING AN ACCOUNT TO A COLLECTION AGENCY, EBCH MAY USE INFORMATION PROVIDED BY AN OUTSIDE AGENCY OR VENDOR TO DETERMINE ELIGIBILITY AND POTENTIAL FINANCIAL ASSISTANCE. THESE AGENCIES MAY USE PUBLICLY AVAILABLE AND PURCHASED TRANSACTION DATA TO ESTIMATE A GUARANTOR'S FINANCIAL PROFILE AND HOUSEHOLD SIZE. EXAMPLES OF SUCH DATA ARE CENSUS DATA, BIRTH CERTIFICATES, MARRIAGE LICENSES, LEGAL NOTICES, BANKRUPTCY FILINGS, AUTOMOBILE REGISTRATIONS, PROPERTY TAX RECORDS, AS WELL AS POINT-OF-SALES TRANSACTIONS DATA THAT RETAILERS AND CREDIT CARD COMPANIES MAKE AVAILABLE FOR PURCHASE TO PRESUMPTIVELY DETERMINE WHETHER THAT INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER EBCH'S FINANCIAL ASSISTANCE POLICY.IF THE INDIVIDUAL IS PRESUMPTIVELY DETERMINED TO BE ELIGIBLE FOR A 100% DISCOUNT (COMPLETE WRITE-OFF) UNDER EBCH'S FINANCIAL ASSISTANCE POLICY, EBCH SHALL INFORM THE INDIVIDUAL OF THAT DECISION AND NO FURTHER ACTIONS WILL BE TAKEN IN RELATION TO MEDICAL SERVICES TO WHICH THIS FINANCIAL ASSISTANCE APPLIES. PART VI, LINE 2: NEEDS ASSESSMENT:ELY BLOOMENSON UTILIZES THE BRIDGES TO HEALTH SURVEY FIRST CONDUCTED IN 1995 AND THUS COMPLETED EVERY FIVE YEARS: 2000, 2005, 2010, 2015, 2020. THE SURVEY, A COLLABORATIVE EFFORT AMONG REGIONAL HEALTH ORGANIZATIONS, IS A TRUSTED SOURCE OF POPULATION-BASED HEALTH STATUS INFORMATION USED TO IMPROVE THE HEALTH OF PEOPLE THROUGHOUT NORTHEASTERN MINNESOTA.THE HOSPITAL HELD THREE SESSIONS OF ITS COMMUNITY FORUM IN ELY, BABBITT, AND TOWER IN THE SPRING TO ENCOURAGE THE COMMUNITY TO GET AN UPDATE OF WHAT THEY ARE DOING AT THE HOSPITAL, AND THE HOSPITAL LISTENS TO QUESTIONS AND SUGGESTIONS FOR THE COMMUNITY. THE 2019 SESSIONS TOOK PLACE IN ELY ON 4/24/2019, BABBITT ON 5/23/2019, AND TOWER ON 6/27/2019.IN THE SUMMER OF 2021, EBCH PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SERVICES ADMINISTRATED BY RURAL HEALTH INNOVATIONS (RHI), A SUBSIDIARY OF THE NATIONAL RURAL HEALTH RESOURCE CENTER. RHI CONFERRED WITH LEADERS FROM EBCH TO DISCUSS THE OBJECTIVES OF A REGIONAL CHNA. A MAILED SURVEY INSTRUMENT WAS DEVELOPED TO ASSESS THE HEALTH CARE NEEDS AND PREFERENCES IN THE SERVICE AREA. THIS WAS COMPLETED IN NOVEMBER 2021.THE HOSPITAL ALSO RECEIVES QUESTIONS AND SUGGESTIONS FROM THE COMMUNITY THROUGH THE "CONTACT US" PAGE OF THEIR WEBSITE, THE EBCH FACEBOOK PAGE, AND AT VARIOUS SPEAKING ENGAGEMENTS FOR THEIR LOCAL SERVICE CLUBS AND ORGANIZATIONS, SUCH AS THE ROTARY, LIONS, AND KIWANIS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:THE ELY BLOOMENSON HOSPITAL STAFF ENCOURAGES ANY PATIENT WITH NO INSURANCE TO TALK TO ST. LOUIS COUNTY SOCIAL SERVICES TO FIND OUT ABOUT MEDICAL ASSISTANCE OR MN CARE ELIGIBILITY. ON ALL PATIENT STATEMENTS, THERE ARE DIRECTIONS ON HOW TO ACCESS THE CREDIT AND COLLECTION POLICY AS WELL AS THE FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY INFORMS PATIENTS THAT WE HAVE AN INCOME BASED CHARITY CARE POLICY AND THEY CAN CONTACT THE EBCH FINANCIAL COUNCILOR OR BUSINESS OFFICE FOR AN APPLICATION. APPLICATIONS AND POLICIES ARE AVAILABLE ON THE HOPITAL'S WEBSITE AT EBCH.ORG. WHEN AN ACCOUNT IS PAST DUE A SERIES OF COLLECTION LETTERS GO OUT WITH THE MESSAGE THAT THE ELY BLOOMENSON HOSPITAL HAS AN INCOME BASED CHARITY CARE POLICY AND IF ANYONE WOULD LIKE AN APPLICATION OR IF ANYONE HAS A QUESTION ABOUT IT THEY SHOULD CONTACT THE EBCH FINANCIAL COUNCILOR OR THE BUSINESS OFFICE. ALL PATIENTS SHOULD BE AWARE OF THE CHARITY CARE OPTION BEFORE THE ACCOUNT TURNS INTO BAD DEBT STATUS. PART VI, LINE 4: COMMUNITY INFORMATION:ELY, A CITY OF 2.7 SQUARE MILES, AND THE SURROUNDING COMMUNITIES OF WINTON, BABBITT, TOWER AND ISABELLA CONSTITUTES A LARGE RURAL DEMOGRAPHIC REGION IN NORTHEASTERN MINNESOTA BORDERING THE 1.5 MILLION ACRES OF THE BOUNDARY WATERS CANOE AREA WILDERNESS (BWCAW). THE CITY OF DULUTH, 120 MILES SOUTHWEST AND VIRGINIA, 50 MILES WEST, SERVE AS THE NEAREST HEALTH CARE CENTERS. THE HOSPITAL SERVES A YEAR ROUND POPULATION OF APPROXIMATELY 8,600. IN ADDITION, THE COMMUNITY ANNUALLY SERVES OVER 125,000 VISITORS SEEKING A WILDERNESS EXPERIENCE. ACCORDING TO THE 2020 CENSUS, ELY, MN HAD A POPULATION OF 3.34K PEOPLE WITH A MEDIAN AGE OF 52.4 AND A MEDIAN HOUSEHOLD INCOME OF $37,317. BETWEEN 2019 AND 2020 THE POPULATION OF ELY, MN DECLINED FROM 3,390 TO 3,338, A 1.53% DECREASE AND ITS MEDIAN HOUSEHOLD INCOME DECLINED FROM $40,946 TO $37,317, A 8.86% DECREASE.THE 5 LARGEST ETHNIC GROUPS IN ELY, MN ARE WHITE (NON-HISPANIC) (95.1%), TWO+ (HISPANIC) (1.98%), BLACK OR AFRICAN AMERICAN (NON-HISPANIC) (1.11%), AMERICAN INDIAN & ALASKA NATIVE (NON-HISPANIC) (0.989%), AND OTHER (HISPANIC) (0.33%). NONE OF THE HOUSEHOLDS IN ELY, MN REPORTED SPEAKING A NON-ENGLISH LANGUAGE AT HOME AS THEIR PRIMARY SHARED LANGUAGE. THIS DOES NOT CONSIDER THE POTENTIAL MULTI-LINGUAL NATURE OF HOUSEHOLDS, BUT ONLY THE PRIMARY SELF-REPORTED LANGUAGE SPOKEN BY ALL MEMBERS OF THE HOUSEHOLD. 99.6% OF THE RESIDENTS IN ELY, MN ARE U.S. CITIZENS. THE LARGEST UNIVERSITIES IN ELY, MN ARE VERMILION COMMUNITY COLLEGE (185 DEGREES AWARDED IN 2020).IN 2020, THE MEDIAN PROPERTY VALUE IN ELY, MN WAS $119,400, AND THE HOMEOWNERSHIP RATE WAS 58.2%. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:ELY BLOOMENSON DOES HAVE AN OPEN MEDICIAL STAFF ALLOWING A VARIETY OF PHYSICIANS TO PRACTICE BENEFITING THE COMMUNITY AND CITIZENS OF THE SURROUNDING AREA. THE COMMUNITY HEALTH COUNCIL, BRINGING HEALTH AND WELLNESS TO THE FOREFRONT IN ELY AND SURROUNDING COMMUNITIES THROUGH VARIOUS INITIATIVE AND SERVICES, MEETS AND IS PARTIALLY FUNDED THROUGH THE HOSPITAL. PROVIDES FUNDING FOR ELY, BABBITT, AND TOWER SOUDAN HIGH SCHOOL GRADUATION ACTIVITIES. FRUNDING PROVIDED FOR CHILDREN'S PROGRAMS SPONSORED BY THE ELY POLICE, ELY FIRE DEPARTMENTS, AND LOCAL SCHOOLD DISTRCT ISD# 696. THE HOSPITAL RECORDS DAILY RADIO SPOTS PROMOTING HEALTH AND WELLNESS. CONSULTATION SERVICES FOR THE MANY NON PROFIT ORGANIZATIONS SPECIFICALLY HOSPICE/RESPITE AND MENTAL ILLNESS PROGRAMS. TWO BLOOD DRIVES ARE ADMINISTERED ANNUALLY THROUGH ELY BLOOMENSON. ELY BLOOMENSON COMMUNITY HOSPITAL IS THE HEART OF THE CITY. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 ELY AREA AMBULANCE SERVICE 205 NORTH CENTRAL AVENUE ELY MN 55731 262472853 501(C)(3) 5928 0 OPERATIONS SUPPORT 1 0 PART I, LINE 2: ALL GRANTS ARE PAID DIRECTLY TO U.S. GRANT RECIPIENTS. THERE IS NO FURTHER MONITORING OF GRANT FUNDS. X X X X 0 0 0 0 0 0 0 0 0 BROCK URIE CMO/PHYSICIAN 418927 0 0 0 0 0 0 0 0 0 418927 0 0 0 PATTI BANKS CEO 248553 0 0 0 129 0 10255 0 32947 0 291884 0 0 0 SAM RICE PHYSICIAN 195241 0 0 0 0 0 8535 0 24106 0 227882 0 0 0 KARLA GRIZZARD RN 182555 0 0 0 198 0 7422 0 29871 0 220046 0 0 0 JOHN SCHINDELE PHARMACIST 157773 0 18178 0 129 0 6604 0 36963 0 219647 0 0 0 BETH HARTSHORN PHARMACIST 160059 0 0 0 27 0 6402 0 10084 0 176572 0 0 0 ABIGAIL SIREK PHARMACIST 150381 0 0 0 18 0 6015 0 9977 0 166391 0 0 0 A CITY OF ELY MINNESOTA 416005133 2015-03-23 7680415 SRS 2015A - REFUNDING OF 10/28/2008 NOTES 0 0 0 B CITY OF ELY MINNESOTA 416005133 2015-03-23 4287460 SRS 2015B - REFUNDING OF 10/28/2008 NOTES 0 0 0 A 2396672 7680415 153605 7526810 2009 1 0 1 1 B 4043470 4287460 85746 4201714 2009 1 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 PART IV, LINE 3 FOR NOTE A THE INTEREST RATE IS FIXED EXCEPT THAT ON THE SIXTY-FOURTH AND ONE HUNDRED TWENTY-EIGHTH PAYMENT DATES THE INTEREST RATE HEREON SHALL BE ADJUSTED TO A PER ANNUM INTEREST RATE EQUAL TO .67 TIMES THE SUM OF THE 5 YEAR LIBOR/SWAP RATE AND 2.65%, PROVIDED THAT THE ACTUAL INCREASE IN THE ANNUAL RATE HEREON ON ANY ADJUSTMENT DATE, MAY NOT EXCEED 1.5% AND THE ANNUAL RATE HEREON CAN NEVER BE LESS THAN 2.91%. FOR NOTE B THE INTEREST RATE IS FIXED EXCEPT THAT ON THE SIXTY-FOURTH PAYMENT DATE THE INTEREST RATE HEREON SHALL BE ADJUSTED TO A PER ANNUM INTEREST RATE EQUAL TO .67 TIMES THE SUM OF THE 5 YEAR LIBOR/SWAP RATE AND 2.65%, PROVIDED THAT THE ACTUAL INCREASE IN THE ANNUAL RATE HEREON ON ANY ADJUSTMENT DATE, MAY NOT EXCEED 1.5% AND THE ANNUAL RATE HEREON CAN NEVER BE LESS THAN 2.78%. FORM 990, PART VI, SECTION A, LINE 6 THE ELY HEATH AND HOSPITAL FOUNDATION IS THE SOLE MEMBER OF THE ELY-BLOOMENSON COMMUNITY HOSPITAL. THE ELY HEALTH AND HOSPITAL FOUNDATION HAS OVER 670 MEMBERS; ANY RESIDENT OF THE AREA SERVED BY THE HOSPITAL MAY BECOME A MEMBER WITH A PAYMENT OF $100. FORM 990, PART VI, SECTION A, LINE 7A ELY HEALTH AND HOSPITAL FOUNDATION (SOLE MEMBER OF EBCH) ELECTS ALL BOARD MEMBERS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THERE ARE CERTAIN ISSUES THAT MUST BE APPROVED BY ALL MEMBERS, SUCH AS BY-LAW CHANGES AND TRANSFER OF SUBSTANTIAL AMOUNTS OF ASSETS. ALL MEMBERS HAVE VOTING RIGHTS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE CFO AND PRESENTED TO THE BOARD MEMBERS AT A BOARD MEETING PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C DEFINITION OF CONFLICT: A CONFLICT OF INTEREST SHALL EXIST AT ANY TIME THAT A CONTRACT OR OTHER TRANSACTION EXISTS OR IS PROPOSED BETWEEN ELY-BLOOMENSON COMMUNITY HOSPITAL AND ONE OF ITS DIRECTORS OR BETWEEN ONE OF ITS DIRECTORS AND A RELATED ORGANIZATION, OR BETWEEN ELY-BLOOMENSON COMMUNITY AND AN ORGANIZATION IN OR OF WHICH A DIRECTOR OF ELY-BLOOMENSON COMMUNITY HOSPITAL IS ALSO A DIRECTOR, OFFICER OR LEGAL REPRESENTATIVE OR HAS MATERIAL FINANCIAL INTERESTS. A DIRECTOR OF ELY-BLOOMENSON COMMUNITY HOSPITAL HAS A MATERIAL FINANCIAL INTEREST IN AN ORGANIZATION WHICH THE DIRECTOR OR THE SPOUSE, PARENTS, CHILDREN AND SPOUSES OF CHILDREN, BROTHER AND SISTER AND SPOUSES OF BROTHERS AND SISTERS OF THE DIRECTOR, HAVE A MATERIAL FINANCIAL INTEREST. DECLARATION OF CONFLICT OF INTEREST: EACH DIRECTOR OF ELY-BLOOMENSON COMMUNITY HOSPITAL IS EXPECTED TO DECLARE A CONFLICT OF INTEREST AS SOON AS THE DIRECTOR IS AWARE OF SUCH CONFLICT. ONCE A CONFLICT OF INTEREST HAS BEEN DECLARED THE BOARD OF DIRECTORS SHALL FOLLOW THE PROCEDURE OUTLINED IN THE PROCEDURE PARAGRAPH OF THIS POLICY. DETERMINATION OF CONFLICT OF INTEREST: ANY OFFICER OR MEMBER OF THE BOARD OF DIRECTORS OF ELY-BLOOMENSON COMMUNITY HOSPITAL WHO BELIEVES THAT A BOARD MEMBER HAS A CONFLICT OF INTEREST SHALL STATE TO THE BOARD OF DIRECTORS THE BASIS FOR SUCH BELIEF. IF THE PERSON BELIEVED TO HAVE THE CONFLICT OF INTEREST DOES NOT AGREE THAT SUCH A CONFLICT EXISTS, SUCH PERSON SHALL BE GIVEN AN OPPORTUNITY TO RESPOND. IF IT IS NOT AGREED THAT A CONFLICT DOES EXIST THEN THE BOARD OF DIRECTORS SHALL VOTE TO DETERMINE WHETHER OR NOT SUCH CONFLICT EXISTS. ANY DIRECTOR WHO IS ENTITLED TO VOTE MAY REQUEST THAT THE VOTE BE BY CLOSED BALLOT AND UPON SUCH REQUEST THE CHAIRPERSON SHALL DECLARE THE VOTE BY CLOSED BALLOT. A SIMPLE MAJORITY OF THE MEMBERS PRESENT AND VOTING SHALL BE SUFFICIENT TO ESTABLISH THAT A CONFLICT OF INTEREST DOES EXIST. PROCEDURE UPON DETERMINATION OF CONFLICT: ONCE A CONFLICT OF INTEREST HAS BEEN DECLARED OR DETERMINED BY THE BOARD, THE INTERESTED PERSON OR PERSONS SHALL BE EXCUSED FROM THE MEETING UNTIL SUCH TIME AS A VOTE HAS BEEN TAKEN BY THE BOARD IN REGARD TO THE ISSUE IN WHICH THE INTERESTED MEMBER HAS A CONFLICT. ONCE A CONFLICT OF INTEREST HAS BEEN DECLARED OR DETERMINED, THE INTERESTED MEMBER SHALL NOT PARTICIPATE IN ANY DISCUSSION IN REGARD TO THE SUBJECT MATTER AND MAY ONLY RESPOND TO QUESTIONS DIRECTED TO HIM/HER BY ANY ONE OR MORE THE DIRECTORS. THE INTERESTED DIRECTOR SHALL NOT BE COUNTED IN THE QUORUM AND SHALL ABSTAIN FROM VOTING. THE STATEMENT REGARDING THE CONFLICT OF INTEREST MUST BE ENTERED INTO THE MINUTES. ONCE A DIRECTOR OR OFFICER HAS DECLARED OR BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST, SUCH CONFLICT SHALL BE DEEMED TO CONTINUE UNTIL THE FINAL VOTE HAS BEEN TAKEN BY THE BOARD OF DIRECTORS IN REGARD TO THE SUBJECT MATTER IN WHICH SUCH DIRECTOR HAS A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THERE IS A BOARD LEVEL COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT DIRECTORS, THAT MEETS ANNUALLY AND REVIEWS AND COMPARES THE COMPENSATION OF THE CEO, CFO, COO, CHRO & CNO WITH VARIOUS COMPENSATION STUDIES OF HOSPITALS OUR SIZE, SUCH AS THE MINNESOTA HOSPITAL ASSOCIATION ANNUAL SURVEY. THIS COMMITTEE IS APPRAISED OF 990 DISCLOSURE REQUIREMENTS. THE CEO MAKES RECOMMENDATIONS TO THE COMMITTEE REGARDING THE COMPENSATION OF THE CFO AND CNO BASED ON VARIOUS COMPENSATION STUDIES. THE COMPENSATION COMMITTEE THEN MAKES RECOMMENDATIONS TO THE FULL BOARD IN CLOSED SESSION AND MINUTES ARE KEPT OF SAID MEETING. THE MINUTES AND ALL MATERIALS RELATED TO THE COMPENSATION DECISIONS ARE KEPT ON FILE WITH THE HOSPITAL'S ATTORNEY'S OFFICE. OTHER POSITIONS RELY ON THE HEALTHCARE HUMAN RESOURCES ASSOCIATION OF MINNESOTA (HHRAM) SURVEY AND ANNUAL BUDGET REQUESTS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. ANNUAL FINANCIAL REPORTS ARE PROVIDED TO ALL SHAREHOLDERS WHO ATTEND THE ANNUAL MEETING OR UPON REQUEST. OTHER DOCUMENTS WILL BE PROVIDED TO MEMBERS UPON REQUEST. THE ANNUAL FINANCIAL REPORT WILL BE GIVEN TO THE GENERAL PUBLIC IF REQUESTED DURING THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,159,541. MANAGEMENT AND GENERAL EXPENSES 1,042,704. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,202,245. ELY HEALTH & HOSPITAL FOUNDATION 328 W CONAN STREET ELY MN 55731 412001411 TO PROVIDE SUPPORT TO ELY-BLOOMENSON COMMUNITY HOSPITAL FOR HEALTHCARE MN 501(C)(3) LINE 12B, II N/A 0 ELY HEALTH & HOSPITAL FUND 328 W CONAN STREET ELY MN 55731 461836177 TO PROVIDE SUPPORT TO ELY-BLOOMENSON COMMUNITY HOSPITAL FOR HEALTHCARE MN 501(C)(3) LINE 12B, II ELY HEALTH & HOSPITAL FOUNDATION 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0