2020-05-13T11:17:05-05:00 2019-06-30 420714325 RSM US LLP 801 NICOLLET MALL WEST TOWER STE 1100 MINNEAPOLIS MN 554022526 990 2018-07-01 411924645 CENTRACARE HEALTH SYSTEM - LONG PRAIRIE CENT 3207322141 50 CENTRACARE DRIVE LONG PRAIRIE MN 56347 CRAIG BROMAN CHIEF OPERATING OFFICER 3207322141 2020-05-08 1 KACIE MCEWEN P01599614 6123324300 2020-05-08 174.219.32.236 2020-05-08 12:27:53 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 2018 2021-01-29 14:40:06Z X CENTRACARE HEALTH - LONG PRAIRIE DR KENNETH D HOLMEN 50 CENTRACARE DRIVE LONG PRAIRIE MN 56347 38793626 0 X WWW.CENTRACARE.COM X 1999 MN WE'RE HERE FOR YOUR WHOLE LIFE TO LISTEN, THEN SERVE, TO GUIDE AND HEAL BECAUSE HEALTH MEANS EVERYTHING. 5 0 377 50 0 0 298257 1042102 34733987 35743201 958900 285589 1337188 1515012 37328332 38585904 79128 141176 0 0 20419652 21408161 0 0 0 17312768 18590640 37811548 40139977 -483216 -1554073 59961772 61531480 40539302 43789990 19422470 17741490 X WE'RE HERE FOR YOUR WHOLE LIFE TO LISTEN, THEN SERVE, TO GUIDE AND HEAL BECAUSE HEALTH MEANS EVERYTHING. 0 0 18220788 126594 23899911 CCH - LONG PRAIRIE IS PART OF A LARGER INTEGRATED HEALTH CARE DELIVERY SYSTEM KNOWN AS CENTRACARE HEALTH, A SYSTEM RECOGNIZED FOR BEING A LEADER IN PROVIDING HIGH-QUALITY, COMPREHENSIVE CARE THROUGHOUT THE REGION. CCH - LONG PRAIRIE IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE SERVICES IN THE AREAS OF MEDICAL, SURGICAL, DIAGNOSTIC, AND OBSTETRICS ALONG WITH OTHER SERVICES OF 24 HOUR EMERGENCY ROOM, IMAGING, LABORATORY, REHABILITATION, AND CHEMOTHERAPY TO THE COMMUNITY OF LONG PRAIRIE AND THE SURROUNDING AREA. THERE WERE 589 ADMISSIONS, 2,869 INPATIENT DAYS, AND 30,651 OUTPATIENT VISITS DURING FISCAL YEAR 2019. 5044661 0 5862044 CCH - LONG PRAIRIE OPERATES THE LONG PRAIRIE CLINIC WHICH IS CONVENIENTLY CONNECTED TO THE LONG PRAIRIE HOSPITAL FOR THE HEALTH CARE NEEDS OF THE COMMUNITY. LONG PRAIRIE CLINIC PROVIDES HEALTH CARE THROUGH A MIXTURE OF PHYSICIANS AND MIDLEVEL PROVIDERS. THERE WERE 19,222 CLINIC VISITS DURING FISCAL YEAR 2019. ALSO 120 SURGEON CLINIC VISITS.CCH - LONG PRAIRIE ALSO OPERATES THE EAGLE VALLEY CLINIC IN EAGLE BEND, MN WHICH PROVIDES HEALTH CARE FOR BOTH THE CLARISSA AND EAGLE BEND COMMUNITIES AND SURROUNDING AREAS. THE EAGLE VALLEY CLINIC PROVIDES HEALTH CARE THROUGH THE USE OF MIDLEVEL PROVIDERS WITH OVERSIGHT OF THE PHYSICIANS FROM THE LONG PRAIRIE CLINIC. THERE WERE 720 CLINIC VISITS DURING FISCAL YEAR 2019. 4997532 14582 5626065 THE CCH - LONG PRAIRIE CARE CENTER IS AN ATTACHED 70 BED SKILLED NURSING FACILITY THAT PROVIDES QUALITY, COMPASSIONATE CARE WITH AN EMPHASIS ON ENHANCING EACH RESIDENT'S PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL WELL-BEING. THERE WERE 20,062 RESIDENT DAYS DURING FISCAL YEAR 2019. 1802628 0 355181 CCH - LONG PRAIRIE BUILT AN ASSISTED LIVING BUILDING AND OPENED IT FOR SERVICES IN MID AUGUST 2017. THE BUILDING CONSISTS OF 24 ASSISTED LIVING APARTMENTS AND 16 MEMORY CARE APARTMENTS. THERE WERE 4,326 ASSISTED LIVING OCCUPIED UNIT DAYS AND 3,089 MEMORY CARE OCCUPIED UNIT DAYS FOR FISCAL YEAR 2019. THERE WERE 5,056 ASSISTED LIVING TENANT DAYS AND 3,089 MEMORY CARE TENANT DAYS FOR FISCAL YEAR 2019. 1802628 0 355181 30065609 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 59 0 1 377 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X LARRY KNUTSON 3207327240 50 CENTRACARE DRIVE LONG PRAIRIE MN 56347 KENNETH D HOLMEN MD CEO 1.00 39.00 X X 0 1455450 29053 CRAIG J BROMAN CHIEF OPERATING OFFICER 1.00 39.00 X X 0 1380622 36391 DAVID J TILSTRA MD CPE VICE PRESIDENT (UNTIL DEC 2018) 1.00 39.00 X X 0 642647 359224 THOMAS G SCHRUP MD VICE PRESIDENT (AS OF DEC 2018) 1.00 39.00 X X 0 457851 166715 PAUL R HARRIS ESQ CORPORATE SECRETARY 2.00 38.00 X X 0 573539 309499 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 1.00 39.00 X X 0 756425 33266 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 39.50 0.50 X 0 286660 119500 RENE ELDIDY MD PHYSICIAN 40.00 0.00 X 0 320235 42163 WINN H GREGORY MD PHYSICIAN 40.00 0.00 X 0 297883 12569 HARRISON H HANSON MD PHYSICIAN 40.00 0.00 X 0 253602 22177 DEBORAH P RASMUSSEN MD PHYSICIAN 40.00 0.00 X 0 264952 24073 PAUL E VAN GORP MD PHYSICIAN 40.00 0.00 X 0 243107 31069 0 6932973 1185699 23 0 1 0 WHITESELL MEDICAL STAFFING 360 LAKE DRIVE EAST ANNANDALE MN 55302 PHYSICIAN SERVICES 765713 CENTRAL MN DIAGNOSTIC INC 525 10TH ST NE MILACA MN 56353 MRI/CT SERVICES 704001 WEST CENTRAL ANESTHESIA PC 10382 AUGUSTA DRIVE SAUK CENTRE MN 56378 CRNA SERVICES 359594 JOHNSON CONTROLS INC 402 GREAT OAK DRIVE BLDG B WAITE PARK MN 56387 BUILDING EFFICIENCY 183788 HOSPITAL LAUNDRY SERVICE 405 BENSON AVE SE WILLMAR MN 56201 LAUNDRY SERVICES 120051 5 142770 851665 47667 1042102 PATIENT AND RESIDENT SERVICE REVE 621110 35362045 35362045 OTHER PROGRAM REVENUE 621110 381156 381156 35743201 285589 285589 806994 0 806994 806994 806994 905492 207722 697770 697770 EXPENSE REIMBURSEMENT 900099 10248 10248 10248 38585904 35743201 0 1800601 X 126594 126594 14582 14582 15839291 12098758 3740533 663856 44171 619685 3976144 3463214 512930 928870 810642 118228 8338 8338 13103 13103 1255 1255 37022 37022 5607622 4152520 1455102 49020 1392 47628 126921 49364 77557 56515 42370 14145 909161 38474 870687 46501 30925 15576 1249548 661 1248887 3529472 3238783 290689 142829 78577 64252 MEDICAL SUPPLIES/DRUGS 4554502 4355806 198696 BAD DEBT 886170 886170 MEDICAID/MN CARE 694463 53695 640768 MEDICAL EQUIPMENT RENTA 383188 383188 295010 194468 100542 40139977 30065609 10074368 0 2879374 2337801 5626171 5888202 385306 275282 34999 64099 66892910 16962804 48075782 49930106 2420087 2525827 452053 510163 88000 0 59961772 61531480 2698406 3714247 6488 10376 37834408 40065367 40539302 43789990 X 19359196 17673670 63274 67820 19422470 17741490 59961772 61531480 -1554073 -126907 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 1255 1255 0 PART II-B, LINE 1: CENTRACARE - LONG PRAIRIE PAID $1,255 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 0 0 297762 297762 51990670 7805786 44184884 1923562 1562878 360684 12680916 7594140 5086776 49930106 ASSET RETIREMENT OBLIGATION 524198 BOND PREMIUM 32549484 CAPITAL LEASES 1639 DUE TO AFFILIATES 6191046 THIRD PARTY SETTLEMENTS 799000 40065367 X PART X, LINE 2: CENTRACARE, THE CORPORATION, THE CLINIC, CCH-MELROSE, CCH-LONG PRAIRIE, CCH-SAUK CENTRE AND THE FOUNDATION HAVE BEEN DETERMINED TO QUALIFY AS TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CCH-MONTICELLO, CCH-PAYNESVILLE AND CARRIS HEALTH, AS DISREGARDED LIMITED LIABILITY COMPANIES (LLCS) UNDER INTERNAL REVENUE SERVICE REGULATIONS, ACHIEVE TAX-EXEMPT TREATMENT BASED ON THE EXEMPT STATUS OF THEIR PARENT, CENTRACARE HEALTH SYSTEM. AT JUNE 30, 2019 AND 2018, THERE WERE NO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 389606 389606 0.00990 10582179 8166555 2415624 0.06150 10971785 8166555 2805230 0.07140 27004 27004 0.00070 27004 27004 0.00070 10998789 8166555 2832234 0.07210 1313 1313 0.00000 1313 1313 0.00000 1 886170 9449747 9452506 -2759 X 1 1 1 1 CENTRACARE HEALTH - LONG PRAIRIE 50 CENTRACARE DRIVE LONG PRAIRIE MN 56347 WWW.CENTRACARE.COM/LOCATIONS/CENTRACAR 389422 X X X X RURAL HEALTH CLINIC, NURSING HOME CENTRACARE HEALTH - LONG PRAIRIE 1 0 0 1 X X X X X X 15 1 1 0 1 X SEE SECTION C SUPPLEMENTAL INFORMATION FOR PART V, SECTION B X 1 15 1 SEE SECTION C SUPPLEMENTAL INFORMATION FOR PART V, SECTION B 0 1 X 175.000000000000 250.000000000000 X X 1 1 X X X 1 X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X CENTRACARE.COM/PRICING-FINANCIAL-ASSISTANCE X X X X X X X 1 X X 1 X X X X X X X 1 X 0 0 CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 3J: CENTRACARE HEALTH'S (CCH) CHNA PRIMARY NEEDS WERE IDENTIFIED USING THE CENTER FOR DISEASE CONTROL'S COMMUNITY HEALTH STATUS INDICATORS (CHSI). THE PROCESS ALSO CONSIDERED SECONDARY DATA FROM THE DARTMOUTH ATLAS, ROBERT WOOD JOHNSON, MINNESOTA DEPARTMENT OF HEALTH, US CENSUS BUREAU, MINNESOTA HOSPITAL ASSOCIATION, AND PUBLIC HEALTH DEPARTMENTS FROM APPROPRIATE COUNTIES AND ADDITIONAL FEDERAL AND STATE ENTITIES. THE CHNA WAS INFORMED BY A COLLABORATIVE AND ONGOING COMMUNITY HEALTH SURVEY JOINTLY FUNDED AND MANAGED WITH A NUMBER OF AREA COUNTIES WHO WERE JOINTLY CONDUCTING COMMUNITY SURVEYS TO INFORM THEIR COMMUNITY HEALTH ASSESSMENTS IN SUPPORT OF DEVELOPMENT OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS.LACK OF CURRENT PUBLIC HEALTH DATA WAS A SIGNIFICANT INFORMATION GAP IN THE CHNA AS THE SURVEY COULD NOT BE COMPLETED IN TIME TO INCLUDE ITS DATA IN THE CCH CHNA. CCH HAS COMMITTED TO A CONTINUING EFFORT WITH PUBLIC HEALTH OFFICIALS TO JOINTLY DEVELOP PRIORITIES WITH THE COUNTIES AS A PART OF ITS ACTION PLANS. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 5: DATA WAS OBTAINED FROM LOCAL COUNTY PUBLIC HEALTH DEPARTMENTS, INCLUDING THEIR MOST RECENT HEALTH ASSESSMENTS AND COMMUNITY REPORTS. IN ADDITION, HEALTH-RELATED INFORMATION WAS COLLECTED FROM AREA NONPROFIT ORGANIZATIONS THAT REGULARLY CONDUCT ASSESSMENTS AND EVALUATIONS OF THE SERVICES THEY PROVIDE AND THEIR TARGETED DEMOGRAPHICS. USEFUL MATERIAL WAS GATHERED FROM THE LOCAL UNITED WAY, CATHOLIC CHARITIES, THE CENTRAL MINNESOTA COUNCIL ON AGING, AND THE TRI-COUNTY ACTION PROGRAM (TRI-CAP). THESE ORGANIZATIONS SUPPORT A BROAD RANGE OF CONSTITUENTS WITH DIVERSE HEALTH-RELATED NEEDS; THEY REPRESENT DEMOGRAPHICS THAT ARE STATISTICALLY MORE LIKELY TO ENCOUNTER HEALTH-RELATED BARRIERS. CCH ALSO CONDUCTED A SERIES OF FOCUS GROUPS THAT INFORMED ITS CHNA. SPECIFICALLY, THE FOCUS GROUPS REPRESENTED POPULATIONS OF COLOR, RECENT IMMIGRANT POPULATIONS, CULTURAL MINORITIES, THOSE WHO WERE AUDIBLY CHALLENGED AND OTHERS WHO WERE DEEMED TO BE UNDER-REPRESENTED OR UNDER-SERVED. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 6A: CCH CONDUCTED ITS CHNA JOINTLY WITH ALL OF ITS 501(C)(3) HOSPITALS AS OF THE BEGINNING OF ITS FISCAL 2016. THOSE FACILITIES INCLUDED ST. CLOUD HOSPITAL, CENTRACARE HEALTH - MELROSE, CENTRACARE HEALTH - LONG PRAIRIE, CENTRACARE HEALTH - SAUK CENTRE, CENTRACARE HEALTH - MONTICELLO AND CENTRACARE HEALTH - PAYNESVILLE.EACH HOSPITAL PREPARED INDIVIDUAL ACTION PLANS TO THE CHNA BASED ON SPECIFIC INPUT FROM THOSE COMMUNITIES. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 11: THE NEEDS IDENTIFIED BY THE CHNA ARE CURRENTLY IN ORGANIZATIONAL WORK PLANS AND ARE UNDER IMPLEMENTATION. TO PRIORITIZE IDENTIFIED NEEDS, CHNA ADVISORY TASK FORCE MEMBERS DEVISED A SET OF CRITERIA. THE CRITERIA USED WERE: COMMUNITY IMPACT, POTENTIAL FOR CHANGE, ECONOMIC FEASIBILITY, COMMUNITY ASSETS, AND VALUE AND MISSION. THE PRIORITIZATION PROCESS IDENTIFIED PROCESS IDENTIFIED THE FOLLOWING SIX, BROAD COMMUNITY HEALTH ISSUES: 1 - ADULT OBESITY2 - ADULT DIABETES3 - OLDER ADULT PREVENTABLE HOSPITALIZATIONS4 - STROKE DEATHS5 - CORONARY HEART DISEASE DEATHS6 - CANCER DEATHSST. CLOUD HOSPITAL WILL MAINTAIN ITS ENGAGEMENTS WITH THE CHNA ADVISORY TASK FORCE TO ENSURE EFFECTIVE COLLABORATION AND COMMUNICATION WITH THE OTHER CENTRACARE HOSPITALS. THE CHNA ADVISORY TASK FORCE WILL CONTINUE TO MEET DURING THE THREE-YEAR PERIOD IN WHICH THE IMPLEMENTATION STRATEGY WILL UNFOLD. DURING THIS TIME THE GROUP WILL:- IDENTIFY WHAT OTHER COMMUNITY ORGANIZATION ARE DOING IN REGARD TO HEALTH PRIORITY AREAS;- DEVELOP SPECIFIC GOALS AND METRICS TO MONITOR AND MEASURE PROGRESS AND OUTCOMES;- COMMUNICATE SHORT-TERM AND LONG-TERM RESULTS OF ACTION PLANS WITHIN THE COMMUNITY.BASED ON THE FINDINGS AND PRIORITIES ESTABLISHED BY THE CHNA, AND AFTER HAVING REVIEWED THE COMMUNITY BENEFITS ACTIVITIES THAT CURRENTLY EXIST, ST. CLOUD HOSPITAL WILL CONTINUE TO SUPPORT THE SYSTEM-WIDE INITIATIVES OUTLINED BELOW AND WILL PARTICIPATE IN LOCALIZED ADAPTATIONS (AS DESCRIBED IN THE ACTION STEPS) OF THESE PROGRAMS WITH REGARD TO THE SPECIFIC NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. TO SEE THE SPECIFIC ACTION PLAN FOR EACH OF THE SIX PRIORITY HEALTH AREAS SEE THE FULL IMPLEMENTATION STRATEGY FOR FISCAL YEAR 2016 - 2018 LOCATED ON THE WEBSITE AT WWW.CENTRACARE.COM/DOCUMENTS/ABOUT/2016-CENTRACARE-CHNA-AND-IMPELMENTATION-STRATEGIES.PDF.PER GUIDANCE FROM THE IRS, REGULATION 1.501(R)-3(C), THE CHNA FOR CCH ELECTED NOT TO DIRECTLY ADDRESS SEVERAL DETERMINANTS OF HEALTH THAT IT IDENTIFIED IN ITS PROCESS WHICH WERE NOT WITHIN THE ORGANIZATION'S CAPABILITIES OR CORE COMPETENCIES. EXAMPLES OF ISSUES NOT SPECIFICALLY ADDRESSED IN THE CHNA ACTION PLANS INCLUDE HIGH SCHOOL GRADUATION RATES, AFFORDABLE HOUSING OR SUPPORTED HOUSING. CCH DID SUPPORT AN EFFORT OF THE CITY OF ST. CLOUD TO CONDUCT A HOUSING ASSESSMENT AS A RESULT OF THE CHNA PROCESS AND IS ALREADY THE LARGEST AREA PROVIDER OF SUPPORTED HOUSING DUE TO ITS EXTENSIVE CHEMICAL DEPENDENCY PROGRAMS AND SENIOR HOUSING PROGRAMS. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 13H: A NON-CITIZEN CAN BE DENIED CARE IF THEY CAME TO THE US SPECIFICALLY TO RECEIVE FREE CARE. PRESUMPTIVE ELIGIBILITY - IF PATIENTS FAIL TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT FINANCIAL ASSISTANCE ELIGIBILITY, CENTRACARE HEALTH MAY REFER TO OR RELY ON EXTERNAL SOURCES AND/OR OTHER PROGRAM ENROLLMENT RESOURCES TO DETERMINE ELIGIBILITY WHEN:(A) PATIENT IS HOMELESS(B) PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS(C) PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM(D) PATIENT IS ELIGIBLE FOR A STATE-FUNDED PRESCRIPTION MEDICATION PROGRAM(E) PATIENT'S VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING(F) PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO HOSPITAL FOR FURTHER TREATMENT CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 16J: PATIENTS WHO ARE AT A SELF PAY STATUS RECEIVE FINANCIAL ASSISTANCE INFORMATION EITHER VIA A TELEPHONE CALL OR ON BILLING STATEMENTS. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 18E: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE GARNISHMENTS & LAWSUITS AS WELL. ALL LEGAL ACTIONS ARE REVIEWED & APPROVED BY CCH MANAMGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 19E: THE ORGANIZATION EMPLOYS THE USE OF COLLECTION AGENCIES TO COLLECT A PATIENT'S BALANCE. AFTER THOSE EFFORTS ARE EXHAUSTED, THE ORGANIZATION DOES UTILIZE GARNISHMENTS & LAWSUITS AS WELL. ALL LEGAL ACTIONS ARE REVIEWED & APPROVED BY CCH MANAMGEMENT PRIOR TO INITIATING. CENTRACARE HEALTH - LONG PRAIRIE PART V, SECTION B, LINE 20E: OUR CREDIT COLLECTION AGENCIES ARE REQUIRED TO PROVIDE CHARITY INFORMATION AS PART OF THEIR COLLECTION PROCESS PRIOR TO ANY CONSIDERATION OF LEGAL ACTION AGAINST THE PATIENT. CENTRACARE HEALTH - LONG PRAIRIE: PART V, SECTION B, LINES 7A AND 10A: THE HOSPITAL'S CHNA AND STRATEGY AND IMPLEMENTATION PLAN CAN BE FOUND ON ITS WEBSITE AT WWW.CENTRACARE.COM/DOCUMENTS/ABOUT/2016-CENTRACARE-CHNA-AND-IMPELMENTATION-STRATEGIES.PDF. 4 1 - LONG PRAIRIE CARE CENTER 20 NINTH STREET SE LONG PRAIRIE MN 56347 NURSING HOME 2 - LONG PRAIRIE CLINIC 50 CENTRACARE DRIVE LONG PRAIRIE MN 56347 CLINIC 3 - EAGLE VALLEY CLINIC 815 HWY 71 SOUTH EAGLE BEND MN 56446 CLINIC 4 - LONG PRAIRIE MEADOW PLACE 220 CENTRACARE DRIVE LONG PRAIRIE MN 56347 ASSISTED LIVING PART I, LINE 6A: CENTRACARE HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT INCLUDES ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE ORGANIZATIONS TOTAL EXPENSES WERE REDUCED BY THEIR NON-OPERATING REVENUE, MEDICAID SURCHARGE AND MN CARE TAX. THE NET TOTAL EXPENSES WERE THEN DIVIDED BY GROSS CHARGES TO DETERMINE THE COST TO CHARGE RATIO. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 886,170. PART III, LINE 2: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PART III, LINE 4: THE FOLLOWING IS FROM THE "ACCOUNTS RECEIVABLE" PARAGRAPH INCLUDED IN NOTE 2 OF THE ORGANIZATION'S AUDITED FINANCIALS."CENTRACARE REPORTS PATIENT AND RESIDENT SERVICE REVENUE AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH CENTRACARE EXPECTS TO BE ENTITLED TO IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS AND THIRD-PARTY PAYORS (INCLUDING MEDICARE, MEDICAID, BLUE CROSS AND OTHER THIRD-PARTY PAYORS). CERTAIN REIMBURSEMENT ARRANGEMENTS INCLUDE VARIABLE CONSIDERATION FOR AMOUNTS SUBJECT TO RETROACTIVE AUDIT AND ADJUSTMENT. DIFFERENCES BETWEEN AMOUNTS ORIGINALLY RECORDED AND FINALLY SETTLED ARE INCLUDED IN OPERATIONS IN THE YEAR IN WHICH THE DIFFERENCES ARE KNOWN. REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED." PART III, LINE 8: THE SHORTFALL OF $2,759 OF TREATING MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT IN ITS ENTIRETY. THE HOSPITAL PROVIDES AN EXCELLENT LEVEL OF CARE TO THE PEOPLE IN THE COMMUNITY. DESPITE THE SHORTFALL IN EIMBURSEMENT FROM MEDICARE, THE HOSPITAL CONTINUES TO PROVIDE ESSENTIAL HEALTHCARE SERVICES TO THE POPULATION. THE AMOUNT ON LINE 7 OF PART III WAS DETERMINED BY UTILIZING THE MEDICARE COST REPORT UTILIZING KEY SECTION OF THAT REPORT, PRIMARILY THE D SERIES AND E SERIES. PART III, LINE 9B: THE COLLECTION POLICIES AT THE ORGANIZATION REQUIRE COLLECTION STAFF TO OFFER CHARITY TO PATIENTS WHO INDICATE THAT PAYMENT MAY BE AN ISSUE. IF A PATIENT DOES QUALIFY FOR FULL CHARITY, ALL OTHER COLLECTION EFFORTS MUST CEASE. IF A PATIENT QUALIFIES FOR PARTIAL CHARITY, COLLECTION EFFORTS WILL CONTINUE ON THE BALANCE OF THE ACCOUNT. THESE PROVISIONS APPLY TO BOTH HOSPITAL EMPLOYED COLLECTION STAFF AND COLLECTION AGENCY STAFF. NO PATIENTS, WHETHER THEY QUALIFY FOR CHARITY OR NOT, ARE REPORTED TO CREDIT REPORTING AGENCIES. PART VI, LINE 2: THE ORGANIZATIONS' STRATEGIC PLANNING ASSESSES THE NEEDS OF THE COMMUNITY AND PATIENTS THROUGH PATIENT SATISFACTION SURVEYS, COMMENT CARDS, COMMUNITY ASSESSMENTS AND A DIVERSE OPERATING COMMITTEE THAT REPRESENTS THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS AND RECOMMENDATIONS FOR HEALTH CARE SERVICES. PART VI, LINE 3: INPATIENTS WHO ARE SELF PAY ARE IDENTIFIED, AND A REPRESENTATIVE OF THE ORGANIZATION'S BILLING DEPARTMENT EXPLAINS THE CHARITY CARE POLICY TO PATIENTS. THEY ALSO EXPLAIN THE SELF PAY DISCOUNT AND SCREENS THE PATIENT FOR ELIGIBILITY FOR ANY STATE OR FEDERAL PROGRAMS. THEY ALSO ASSIST THE PATIENT WITH ANY PAPERWORK REQUIRED TO APPLY FOR SUCH PROGRAMS. OUTPATIENTS WHO ARE SELF PAY RECEIVE AN AUTOMATIC SELF PAY DISCOUNT. IF THE PATIENT DOES NOT REMIT PAYMENT, COLLECTION STAFF ATTEMPT TO REACH THE PATIENT BY PHONE. PATIENTS ARE TOLD ABOUT THE CHARITY PROGRAM. FOR BOTH INPATIENTS AND OUTPATIENTS, ALL STATEMENTS CONTAIN A LETTER REGARDING THE AVAILABILITY OF CHARITY CARE. ALSO ALL PRECOLLECTION LETTERS HAVE THIS SAME LANGUAGE INDICATING THE AVAILABILITY AND PROCESS OF OBTAINING CHARITY CARE. PART VI, LINE 4: LONG PRAIRIE IS LOCATED IN TODD COUNTY, MINNESOTA. THE ESTIMATED 2019 POPULATION SHOWS 6,734 RESIDENTS WITH AN ESTIMATED SLIGHT INCREASE TO 6,765 BY 2024. THIS AREA HAS SEEN DECLINES IN ITS POPULATION. THE PROJECTED GROWTH BY AGE BRACKET FROM 2019 TO 2024 IS AS FOLLOWS: 0-17: 2.19%, 18-44: 2.29%, 45-64: -8.66%, 65+: 7.02%. THE ESTIMATED 2019 ETHNIC MIX IS AS FOLLOWS: CAUCASIAN: 77.22%, AFRICAN AMERICAN: .65%, ASIAN: 1.66%, HISPANIC: 18.50%, OTHER: 1.96%. PART VI, LINE 5: THE ORGANIZATION HAS A COMMUNITY BASED OPERATING COMMITTEE THAT MEETS ON A MONTHLY BASIS TO REVIEW VARIOUS ASPECTS OF THE FACILITY AND PROVIDE INPUT ON THOSE ASPECTS FROM A COMMUNITY PERSPECTIVE. THE ORGANIZATION PARTICIPATES IN THE COMMUNITY BLOOD DRIVES BY PROVIDING FOOD AND SUPPLIES FOR BOTH THE WORKERS AND BLOOD DONORS. THE FACILITY ALSO SPONSORS A HEALTH FAIR ON AN ANNUAL BASIS FOR THE LOCAL AND SURROUNDING COMMUNITIES. PART VI, LINE 6: THE ORGANIZATION IS PART OF CENTRACARE HEALTH SYSTEM (CCHS) WHICH PROVIDES A BROAD RANGE OF HEALTH CARE SERVICES TO THE PATIENTS OF CENTRAL MINNESOTA. CCHS IS DEDICATED TO IMPROVING THE HEALTH OF PEOPLE LIVING AND WORKING IN THE COMMUNITIES IT SERVES. TO ACCOMPLISH ITS GOALS IT WORKS ACTIVELY WITH ITS AFFILIATE HEALTH CARE ORGANIZATIONS. CCHS CONTINUES TO FOCUS ON PROVIDING THE BEST CARE POSSIBLE AND IN REINVESTING INTO THE COMMUNITY. CCHS ALSO PROMOTES WELLNESS BY SPONSORING PROGRAMS AND EVENTS IN LOCAL COMMUNITIES THAT FOCUS ON HEALTHY EATING AND EXERCISE, AND BY CONDUCTING SCREENINGS FOR CONDITIONS SUCH AS HIGH BLOOD PRESSURE. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 501(C)(3) 116970 PROGRAM SUPPORT 1 0 EDUCATION SCHOLARSHIPS 11 14582 1 1 0 0 0 0 1 0 0 KENNETH D HOLMEN MD CEO 0 1173232 0 262499 0 19719 0 11687 0 18207 0 1485344 0 0 CRAIG J BROMAN CHIEF OPERATING OFFICER 0 843549 0 165926 0 371147 0 20625 0 16564 0 1417811 0 93908 DAVID J TILSTRA MD CPE VICE PRESIDENT (UNTIL DEC 2018) 0 440886 0 97979 0 103782 0 124551 0 235471 0 1002669 0 81758 THOMAS G SCHRUP MD VICE PRESIDENT (AS OF DEC 2018) 0 368446 0 82829 0 6576 0 63495 0 105928 0 627274 0 0 PAUL R HARRIS ESQ CORPORATE SECRETARY 0 390662 0 85223 0 97654 0 105471 0 204905 0 883915 0 66403 GREGORY R KLUGHERZ TREASURER/CFO, CCHS 0 622849 0 113782 0 19794 0 16500 0 17607 0 790532 0 0 DANIEL J SWENSON ADMINISTRATOR - LONG PRAIRIE 0 217284 0 34858 0 34518 0 41825 0 78552 0 407037 0 25842 RENE ELDIDY MD PHYSICIAN 0 244005 0 53240 0 22990 0 19103 0 25178 0 364516 0 0 WINN H GREGORY MD PHYSICIAN 0 178471 0 0 0 119412 0 5297 0 8654 0 311834 0 0 HARRISON H HANSON MD PHYSICIAN 0 195304 0 31567 0 26731 0 5822 0 17951 0 277375 0 0 DEBORAH P RASMUSSEN MD PHYSICIAN 0 220690 0 36193 0 8069 0 17066 0 9203 0 291221 0 0 PAUL E VAN GORP MD PHYSICIAN 0 209062 0 25411 0 8634 0 17198 0 14954 0 275259 0 0 PART I, LINE 3 THE COMPENSATION PAID TO THE PRESIDENT AND VICE-PRESIDENTS (NON-MEDICAL PROVIDERS) IS DETERMINED BY CENTRACARE HEALTH SYSTEM, A RELATED ORGANIZATION. CENTRACARE HEALTH SYSTEM USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B WINN H GREGORY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $117,000. THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED NON-QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO FORM 990, THE AMOUNTS LISTED IN PART VII AND SCHEDULE J, PART II, COLUMN C, REFLECT TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON FORM 990 - ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF AND WHEN IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: KENNETH D HOLMEN - PAID $0; ACCRUED $0 CRAIG J BROMAN - PAID $152,547; ACCRUED $0 DAVID J TILSTRA - PAID $81,758; ACCRUED $103,926 PAUL R HARRIS - PAID $66,403; ACCRUED $88,628 GREGORY R KLUGHERZ - PAID $0; ACCRUED $0 DANIEL J SWENSON - PAID $25,842; ACCRUED $27,159 THOMAS G SCHRUP - PAID $0; ACCRUED $42,705 PART I, LINE 6 THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: STEWARDSHIP, THROUGH A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR SAINT CLOUD HOSPITAL AND/OR CENTRACARE HEALTH SYSTEM AS WELL THROUGH ACHIEVING METRICS FOR AN IDENTIFIED COST REDUCTION PROGRAM; QUALITY, THROUGH ACHIEVING SAINT CLOUD HOSPITAL AND SYSTEM QUALITY METRICS; PATIENT EXPERIENCE, THROUGH ACHIEVEMENT OF PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; AND PEOPLE/EMPLOYEES, THROUGH ACHIEVEMENT OF SPECIFIED EMPLOYMENT SATISFACTION GOALS AND HIRING AND/OR RETENTION GOALS. THE INCENTIVE COMPENSATION PAID OUT IS NOT A PORTION OR PERCENTAGE OF ACTUAL NET EARNINGS OF ANY CENTRACARE HEALTH SYSTEM AFFILIATE, HOWEVER NET EARNINGS GOALS ARE REQUIRED TO BE MET BEFORE THE INCENTIVE COMPENSATION IS PAID. FORM 990, PART VI, SECTION A, LINE 6 CENTRACARE HEALTH SYSTEM, A MINNESOTA NONPROFIT ASSOCIATION, IS THE SOLE MEMBER OF CENTRACARE HEALTH SYSTEM - LONG PRAIRIE. FORM 990, PART VI, SECTION A, LINE 7A ALL BOARD MEMBERS ARE APPOINTED BY CENTRACARE HEALTH SYSTEM, THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MATTERS ARE RESERVED FOR ACTION BY CENTRACARE HEALTH SYSTEM, THE SOLE MEMBER: 1. ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. 2. APPOINTMENT OF DIRECTORS AND OFFICERS. 3. APPROVAL OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY DEBTS TO BE INCURRED. 4. APPROVAL OF ALL STRATEGIC PLANS. 5. DETERMINATION OF THE DISSOLUTION OF OR THE DISCONTINUATION OF THE BUSINESS OF THE CORPORATION. 6. APPROVAL OF ANY TRANSACTION WHICH MAY AFFECT THE CORPORATION'S STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS HAS DELEGATED THE APPROVAL AUTHORITY OF THE FORM 990 TO THE AUDIT COMMITTEE. ANNUALLY, AT THE AUDIT COMMITTEE MEETING, PRIOR TO FILING WITH THE IRS, THE AUDIT COMMITTEE REVIEWS AND APPROVES FORM 990. A COPY OF FORM 990 IS THEN PROVIDED FOR THE FULL BOARD TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE TWICE A YEAR. ALL STAFF SIGN CONFLICTS OF INTEREST FORMS ON AN ANNUAL BASIS. THE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AS WELL AS THE CORPORATE COMPLIANCE GROUP (A COMPLIANCE COMMITTEE WHICH INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRES ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD. THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTERESTS RELATED TO BOARD AND STAFF AND TO ALERT AFFECTED PARTIES WHEN A CONFLICT ARISES. WHEN AN ACTUAL CONFLICT ARISES, THE AFFECTED PARTY IS ASKED TO RECUSE HIM/HER SELF FROM THE DECISION MAKING PROCESS. THE CORPORATE COMPLIANCE OFFICER ATTENDS BOARD MEETINGS AND SPECIFIED BOARD COMMITTEE MEETINGS WHERE CONFLICT ISSUES MAY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION AND BENEFITS OF THE PRESIDENT ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS DONE MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. COULD HOSPITAL TO PERFORM SERVICES. FORM 990, PART VI, QUESTION 15B: THE COMPENSATION AND BENEFITS OF THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS COMPLETED IN MAY 2017. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. CLOUD HOSPITAL TO PERFORM THESE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE HOSPITAL/CENTRACARE HEALTH SYSTEM DOES DO AN ANNUAL REPORT TO THE COMMUNITY IN WHICH FINANCIAL RESULTS ARE REPORTED TO AND DISCUSSED WITH THE PUBLIC. THIS REPORT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE. FORM 990, PART IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 3,271,993. MANAGEMENT AND GENERAL EXPENSES 308,381. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,580,374. CONTRACTED/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 880,527. MANAGEMENT AND GENERAL EXPENSES 1,146,721. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,027,248. CENTRACARE HEALTH SYSTEM 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411813221 INTEGRATED HEALTH SYSTEM MN 501(C)(3) LINE 3 N/A 0 ST CLOUD HOSPITAL 1406 6TH AVE N ST CLOUD MN 56303 410695596 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH-MELROSE 11 NORTH 5TH AVE WEST MELROSE MN 56352 411865315 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRACARE HEALTH-SAUK CENTRE 425 ELM STREET NORTH SAUK CENTRE MN 56378 452438973 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRACARE CLINIC 1200 6TH AVE NORTH ST CLOUD MN 56303 411806657 MULTI-SPECIALTY MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 1 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 FUNDRAISING MN 501(C)(3) LINE 7 CENTRACARE HEALTH SYSTEM 0 CUSHMAN ALBERT RICE TRUST 1100 WEST ST GERMAIN STREET ST CLOUD MN 56303 416019335 SUPPORT FOR RICE MEMORIAL HOSPITAL MN 501(C)(3) N/A 0 RICE HEALTH FOUNDATION 301 BECKER AVE SW WILLMAR MN 56303 411611555 SUPPORT FOR RICE MEMORIAL HOSPITAL MN 501(C)(3) LINE 7 N/A 0 MONTICELLO CANCER CENTER 1001 HART BLVD STE 50 MONTICELLO MN 55362 261909519 RADIATION & ONCOLOGY SERVICES MN N/A MONTICELLO SURGERY CENTER 1013 HART BLVD MONTICELLO MN 55362 813593057 AMBULATORY SURGERY CENTER MN N/A BENSON MEDICAL LLC 1228 ATLANTIC AVENUE BENSON MN 56215 203149203 HEALTHCARE MN N/A CENTRACARE HOLDINGS INC 1406 6TH AVE N ST CLOUD MN 56303 472688595 HOLDING COMPANY/PHARMACY MN N/A C 0 AFFILIATED COMMUNITY MEDICAL CENTERS PA 301 BECKER AVE SW WILLMAR MN 56201 410850702 HEALTH CARE SYSTEM MN N/A C 0 AFFILIATED COMMUNITY HEALTH NETWORK INC 101 WILLMAR AVE SW WILLMAR MN 56201 HEALTH NETWORK MN N/A C 0 0 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 1 1 1 CENTRACARE HEALTH - SAUK CENTRE O 77772 ACTUAL AMOUNT CENTRACARE CLINIC O 2878634 ACTUAL AMOUNT