2020-10-06T16:32:48-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-01-01 410855367 OLMSTED MEDICAL CENTER OLMS 5072883443 210 NINTH STREET SE ROCHESTER MN 55904 TIM WEIR CHIEF EXECUTIVE OFFICER 5072883443 2020-09-24 1 ROBERT E SCHILE P00369682 6123764500 66.188.188.148 2020-09-24 15:34:11 CD P 556679616493003E6E17937C0791D09847FC9451 8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4C 2019 2021-01-29 14:40:06Z JAMES HOFFMANN 210 NINTH STREET SE ROCHESTER MN 55904 285499753 0 X WWW.OLMMED.ORG X 1949 MN THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY, AND SERVICE. 11 7 1543 86 0 -12996 61044 154658 213507780 219441670 2990658 7815982 862833 695933 217422315 228108243 251414 237448 0 0 127150186 133342971 0 0 813678 78756564 84924855 206158164 218505274 11264151 9602969 278992681 278629440 72518565 64529241 206474116 214100199 X THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY, AND SERVICE. 0 0 189262622 237448 219441670 PERSONAL APPROACH TO CARE THROUGH MORE THAN 25 SPECIALTIES. ALL OF OUR SPECIALTY SERVICES COMPLIMENT PRIMARY CARE AND OFFER PATIENTS GREATER CONVENIENCE AND PEACE OF MIND. WE CONTINUE TO WORK TO POSITION OMC AS A PREFERRED HEALTHCARE PROVIDER FOR PRIMARY AND SECONDARY CARE AMONG SOUTHEASTERN MINNESOTA RESIDENTS. OMC'S 186 CLINICIANS AND 1,000 HEALTHCARE PROFESSIONALS SERVE AT 25 LOCATIONS, INCLUDING PHYSICAL/OCCUPATIONAL THERAPY, TWO MULTI-SPECIALTY CLINICS, SPORTS MEDICINE FACILITIES, A LEVEL IV TRAUMA HOSPITAL WITH 24-HOUR EMERGENCY ROOM AND BIRTHCENTER, TWO WALK-IN FASTCARE RETAIL CLINICS, A WALK-IN SKYWAY CLINIC IN DOWNTOWN ROCHESTER, AND 11 COMMUNITY BRANCH CLINICS. IN 2019, OMC HAD 334,485 PATIENT VISITS SERVING 79,968 UNIQUE PATIENTS. THE HOSPITAL PROVIDED CARE FOR 2,829 PATIENT ADMISSIONS RESULTING IN 6,672 PATIENT DAYS INCLUDING 949 BIRTHS. 164172 0 0 OMC WELCOMES ITS MANY OPPORTUNITIES TO BE AN ACTIVE, CONTRIBUTING PARTNER TO SOUTHEASTERN MINNESOTA'S HEALTH AND WELLNESS EFFORTS. AS A 501(C)(3) NON-PROFIT ORGANIZATION, OMC ACTIVELY SUPPORTS SOUTHEASTERN MINNESOTA'S HEALTH AND WELLNESS EFFORTS THROUGH THE CONTRIBUTION OF STAFF TIME/TALENT, IN-KIND RESOURCES, AND FINANCIAL ASSISTANCE. IN 2019, OUR COMMUNITY CONTRIBUTIONS MADE UP 29.54% OF OUR ANNUAL OPERATING EXPENSE - MORE THAN $62,256,000 IN SUPPORT OF OUR COMMITMENT TO BE AN ACTIVE, CONTRIBUTING PARTNER IN THE COMMUNITIES WE SERVE. ANOTHER WAY OMC ACTIVELY SUPPORTS COMMUNITY HEALTH IS THROUGH ITS PARTNERSHIP WITH MAYO CLINIC, OLMSTED COUNTY PUBLIC HEALTH, AND SEVERAL OTHER COMMUNITY-SERVICE ORGANIZATIONS AS TOGETHER WE IMPLEMENTED THE YEAR-THREE ACTION PLAN BASED ON OUR COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IN 2019, OMC CONTINUED ITS TRADITION OF WELCOMING HUNDREDS OF SCHOOL-AGED CHILDREN AND COLLEGE STUDENTS FOR ON-SITE SCIENCE, TECHNOLOGY, ENGINEERING, AND MATH (STEM) EDUCATION EXPERIENCES DESIGNED TO CULTIVATE THE NEXT GENERATION OF CAREGIVERS. OUR CAREGIVERS ALSO EXTENDED THEIR COMMUNITY OUTREACH DURING THE YEAR, REPRESENTING OMC AT MORE THAN 50 COMMUNITY HEALTH FAIR EVENTS IN SOUTHEASTERN MINNESOTA. OVER THE PAST YEAR, WE CONTINUED TO MAKE IT EASIER FOR COMMUNITY MEMBERS TO DONATE THEIR TIME AND TALENT TO OMC. IN ADDITION TO ADDING AN ONLINE VOLUNTEER APPLICATION FORM TO OUR WEBSITE, WE EXPANDED OUR VOLUNTEERS IN PATIENT CARE OPPORTUNITIES LIKE CANINE COMPANIONS AND ESCORT/GREETER ROLES TO HELP PATIENTS NAVIGATE OUR EXPANDING HOSPITAL CAMPUS. 189426794 1 1 0 0 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 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 178 0 1543 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X KEVIN HIGGINS 5072883443 210 NINTH STREET SE ROCHESTER MN 55904 VIDHAN CHANDRA MD PHYSICIAN 36.00 0.00 X 961698 0 29643 MATTHEW KIRSCH MD PHYSICIAN 40.00 0.00 X 956545 0 51020 MARK HERR MD PHYSICIAN 40.00 0.00 X 824051 0 23367 SAMER ABDEL-AZIZ MD PHYSICIAN 40.00 0.00 X 757335 0 27597 DAVID LOWE MD PHYSICIAN 40.00 1.00 X 749083 0 50054 TIM WEIR CEO 40.00 1.00 X 747562 0 53810 KATHRYN LOMBARDO MD PRESIDENT (THROUGH JUNE 2019) 40.00 1.00 X X 561677 0 25836 JAMES HOFFMANN DO VICE PRESIDENT & PRESIDENT (JULY 2019) 36.00 0.00 X X 536064 0 39412 KEVIN HIGGINS CFO/TREASURER/SECRETARY 40.00 1.00 X 463078 0 52795 RANDY HEMANN MD CHIEF MEDICAL OFFICER 40.00 0.00 X 442786 0 39315 JOSEPH TRICARICO MD CLINIC TRUSTEE (THROUGH MAR 2019) 36.00 0.00 X 423129 0 48279 TAMARA ALEXANDROV MD CLINIC TRUSTEE 36.00 0.00 X 407160 0 0 MARK WILBUR MD CLINIC TRUSTEE 34.00 0.00 X 299131 0 25212 CAROLE NISTLER MD CLINIC TRUSTEE 36.00 0.00 X 277778 0 35087 KEN BROWN BOARD CHAIR 1.00 1.00 X X 0 0 0 STEVE BORCHARDT PUBLIC TRUSTEE 1.00 0.00 X 0 0 0 DAN CHRISTIANSON PUBLIC TRUSTEE 1.00 0.00 X 0 0 0 ELAINE GARRY PUBLIC TRUSTEE (THROUGH OCT 2019) 1.00 0.00 X 0 0 0 HAL HENDERSON PUBLIC TRUSTEE 1.00 0.00 X 0 0 0 CASSIE HARRINGTON PUBLIC TRUSTEE (STARTING NOV 2019) 1.00 0.00 X 0 0 0 JAY HESLEY PUBLIC TRUSTEE 1.00 0.00 X 0 0 0 JACK PRIGGEN PUBLIC TRUSTEE 1.00 0.00 X 0 0 0 8407077 0 501427 218 0 1 0 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 COMPUTER SUPPORT 3037125 EPIC HOSTING LLC 1979 MILKY WAY VERONA WI 53593 COMPUTER SUPPORT 1561464 CONSTRUCTION COLLABORATIVE 2212 SECOND STREET SW ROCHESTER MN 55902 CONSTRUCTION SERVICES 1259194 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 1178743 THE CMI GROUP PO BOX 7799 ROCHESTER MN 55903 COLLECTION SERVICES 1146033 141 102599 52059 154658 NET PATIENT SERVICES 621110 217034694 217034694 PHARMACY 446110 2406976 2406976 219441670 2471282 2471282 78498 0 78498 78498 78498 62725795 57357113 23982 5368682 -23982 5344700 5344700 53366 10415 42951 42951 CAFETERIA 621990 301533 301533 MISCELLANEOUS 621990 270408 270408 EHR INCENTIVE 621990 2543 2543 574484 228108243 219444213 0 8509372 237448 237448 4068252 2349590 1718662 103989265 91049438 12600274 339553 5547174 4970800 553441 22933 13115397 11457085 1561723 96589 6622883 5749014 850734 23135 794518 465748 328770 214024 214024 89453 89453 121581 121581 13918683 9670426 4236585 11672 440173 440012 161 1675152 1413874 223086 38192 842062 434438 407624 10219202 8118756 2087145 13301 112123 97341 13536 1246 992483 784909 189342 18232 1932347 1789735 142612 9408556 9408556 916047 916047 MEDICAL SUPPLIES 23455953 23452553 2961 439 BAD DEBT 7748995 7748995 EQUIP/SOFTWARE MAINT 7120852 5003954 2011490 105408 MN CARE TAX 4206276 4206276 716375 101811 471747 142817 218505274 189426794 28264802 813678 78819467 74376261 36811197 35735893 1999254 2134632 1596646 2077276 194914062 88456349 103568205 106457713 56197912 57847665 278992681 278629440 32318500 32214492 10000 37005 30011080 28341216 4338867 2517447 5547922 1277857 292196 141224 72518565 64529241 X 206474116 214100199 206474116 214100199 278992681 278629440 9602969 -1976886 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6181760 6181760 96741981 36387855 60354126 86963031 52068494 34894537 5027290 5027290 106457713 THIRD PARTY PAYOR SETTLEMENTS 141224 141224 X PART X, LINE 2: THE MEDICAL CENTER AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES AS TAX EXEMPT ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT FOR INCOME ON CERTAIN UNRELATED BUSINESS INCOME. THERE IS NO MATERIAL UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018. THE MEDICAL CENTER AND THE FOUNDATION ARE ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE MINNESOTA STATUTES. THE MEDICAL CENTER AND THE FOUNDATION FILE FEDERAL AND STATE INCOME TAX RETURNS. GENERALLY, THE MEDICAL CENTER AND THE FOUNDATION ARE NO LONGER SUBJECT TO STATE AND FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEAR ENDED DECEMBER 31, 2016, AND PRIOR. OMC RETAIL SERVICES, LLC IS A DISREGARDED LLC UNDER IRS REGULATIONS, AND IT ACHIEVES TAX-EXEMPT TREATMENT BASED ON THE EXEMPT STATUS OF ITS PARENT, OLMSTED MEDICAL CENTER. AT DECEMBER 31, 2019, THERE WERE NO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 1711800 1711800 0.00810 47520270 24719359 22800911 0.10820 3122680 3122680 0.01480 52354750 24719359 27635391 0.13110 25427 25427 0.00010 6016885 4105058 1911827 0.00910 104516 104516 0.00050 138745 138745 0.00070 6285573 4105058 2180515 0.01040 58640323 28824417 29815906 0.14150 1 7748995 0 17862430 24235296 -6372866 X 1 1 1 1 OLMSTED MEDICAL CENTER - HOSPITAL 1650 4TH ST SE ROCHESTER MN 55904 HTTP://WWW.OLMMED.ORG 376238 X X X OLMSTED MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE LINE 7D X SEE LINE 7D X X 1 19 1 HTTP://WWW.OLMMED.ORG/ABOUT/COMMUNITY-INVOLVEMENT/ 0 1 X 300.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.OLMMED.ORG/PATIENTS-VISITORS/ACCOUNTS/PAYMENT-ASSISTANCE/ X HTTPS://WWW.OLMMED.ORG/PATIENTS-VISITORS/ACCOUNTS/PAYMENT-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 5: OLMSTED MEDICAL CENTER LAUNCHED A COLLABORATIVE EFFORT WITH OLMSTED COUNTY, MAYO CLINIC, MANY OF THE COMMUNITY BENEFIT NON-PROFIT ORGANIZATIONS, AND THE PUBLIC TO IDENTIFY THE COMMUNITY NEEDS. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 6A: OLMSTED MEDICAL CENTER COLLABORATED WITH MAYO CLINIC. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 6B: OLMSTED MEDICAL CENTER COLLABORATED WITH OLMSTED COUNTY HEALTH SERVICES TO PRODUCE THE COMMUNITY HEALTH NEEDS ASSESSMENT. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON OUR WEBSITE AT:HTTPS://WWW.OLMMED.ORG/ABOUT/COMMUNITY-INVOLVEMENT/AND ON THE COUNTY'S WEBSITE AT:HTTPS://WWW.CO.OLMSTED.MN.US/OCPHS/REPORTS/NEEDS%20ASSESSMENT/PAGES/2019- COMMUNITY-HEALTH-NEEDS-ASSESSMENT-PLAN.ASPX. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 11: A PRIORITIZATION PROCESS CONDUCTED BY OLMSTED COUNTY PUBLIC HEALTH ALLOWED MAYO CLINIC, OLMSTED MEDICAL CENTER, THE CHNA CORE GROUP, THE CHIP MEMBERS, AND OTHER COMMUNITY AGENCY GROUPS RESULTED IN THE LIST OF TOP FIVE COMMUNITY HEALTH NEEDS: OBESITY, MENTAL HEALTH, IMMUNIZATIONS, INJURY PREVENTION, AND HOMELESSNESS/FINANCIAL STRESS.OMC REMAINS COMMITTED TO WORKING WITH THE CHNA CORE GROUP AND ITS COLLABORATING PARTNERS TO DEVELOP AND IMPLEMENT A COMMUNITY HEALTH IMPROVEMENT PLAN. THE CHNA CORE GROUP WILL CONTINUE TO COORDINATE THE EFFORTS OF ALL OF THE INVOLVED HEALTH PROVIDERS AND AGENCIES IN THEIR WORK ON THE FIVE MAJOR COMMUNITY HEALTH PRIORITIES AS DETERMINED BY THE HEALTH NEEDS ASSESSMENT. A KEY GOAL WILL BE TO INTEGRATE MENTAL HEALTH, MEDICAL CARE, AND SOCIAL SERVICES FOR THOSE PARTICULARLY NEEDY INDIVIDUALS WHO HAVE MULTIPLE CHRONIC MEDICAL AND MENTAL HEALTH PROBLEMS AND WHO ARE FREQUENT AND HIGH-COST VISITORS TO EMERGENCY DEPARTMENTS, HOSPITALS, AND CLINICS.OMC'S COMMUNITY HEALTH NEEDS ASSESSMENT STEERING GROUP COMPRISED OF CLINICIANS, NURSES, DIETITIANS, AND ADMINISTRATORS HAS COMMITTED TO CONTINUING TO ENGAGE OUR STAFF IN THE VARIOUS COMMUNITY-LED EFFORTS THROUGH CHNA AND CHIP. IN ADDITION, THIS STEERING GROUP HAS DEVELOPED AN ACTION PLAN SPECIFIC TO OUR PATIENT BASE TO ADDRESS THESE SAME PRIORITIES. WHILE HOMELESSNESS AND FINANCIAL STRESS IS AN ISSUE BEYOND THE SCOPE OF OMC'S MISSION AND RESOURCES, OMC HAS ESTABLISHED SOME GOALS FOR THIS ISSUE AND INTENDS TO PARTICIPATE IN ANY COMMUNITY-WIDE EFFORTS TO ADDRESS THIS MOST DIFFICULT ISSUE. FOR ALL OF THE GOALS THAT FOLLOW, THE SPECIFIC NEEDS OF OMC PATIENTS, FEASIBILITY AND POTENTIAL IMPACT OF THE PLANS, FINANCIAL IMPLICATIONS, AND OPPORTUNITIES TO WORK WITH COMMUNITY ORGANIZATIONS WILL CONTINUE TO BE EVALUATED.OMC IS ELIGIBLE FOR AND ARE RELYING ON THE RELIEF PROVIDED DUE TO COVID-19 AND SHOULD NOT BE TREATED AS FAILING TO MEET THE REQUIREMENTS OF SECTION 501(R)(3) PRIOR TO DEC. 31, 2020. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 13H: OMC UTILIZES A THIRD PARTY TO CONDUCT AN ELECTRONIC REVIEW FOR PRESUMPTIVE ELIGIBILITY OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED THROUGH TRANSUNION / EBUREAU. ACCOUNTS THAT HAVE BEEN APPROVED UNDER THIS PROCESS WILL BE APPLIED TO THE FINANCIAL ASSISTANCE PROGRAM AND FURTHER COLLECTION ACTION WILL NOT TAKE PLACE. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 20E: MEETING WITH PATIENTS UPON THEIR REQUEST. 22 1 - OMC - MAIN CLINIC 210 9TH ST SE ROCHESTER MN 55904 OUTPATIENT PHYSICIAN CLINIC 2 - OMC - BYRON CLINIC 846 HIGH POINT DR NE BYRON MN 55920 OUTPATIENT PHYSICIAN CLINIC 3 - OMC - CHATFIELD CLINIC 207 TWIFORD ST SW CHATFIELD MN 55923 OUTPATIENT PHYSICIAN CLINIC 4 - OMC - CANNON FALLS CLINIC 1705 HIGHWAY 200 CANNON FALLS MN 55009 OUTPATIENT PHYSICIAN CLINIC 5 - OMC - PINE ISLAND CLINIC 111 COUNTY RD 11 NW PINE ISLAND MN 55963 OUTPATIENT PHYSICIAN CLINIC 6 - OMC - PLAINVIEW CLINIC 20 2ND AVE NE PLAINVIEW MN 55964 OUTPATIENT PHYSICIAN CLINIC 7 - OMC - PRESTON CLINIC 405 KANSAS ST NW PRESTON MN 55965 OUTPATIENT PHYSICIAN CLINIC 8 - OMC - ST CHARLES CLINIC 403 W FOURTH ST ST CHARLES MN 55972 OUTPATIENT PHYSICIAN CLINIC 9 - OMC - SPRING VALLEY CLINIC 802 MEMORIAL DR SPRING VALLEY MN 55975 OUTPATIENT PHYSICIAN CLINIC 10 - OMC - WANAMINGO CLINIC 217 MAIN ST SUITE B WANAMINGO MN 55983 OUTPATIENT PHYSICIAN CLINIC 11 - OMC - FASTCARE NORTH CLINIC 102 ELTON HILLS DR SUITE 200 ROCHESTER MN 55901 OUTPATIENT PHYSICIAN CLINIC 12 - OMC - FASTCARE SOUTH CLINIC 90 14TH STREET SW SUITE 200 ROCHESTER MN 55902 OUTPATIENT PHYSICIAN CLINIC 13 - OMC - NW CLINIC 5067 55TH ST NW ROCHESTER MN 55901 OUTPATIENT PHYSICIAN CLINIC 14 - OMC - SKYWAY CLINIC 318 1ST AVE SW SUITE 203 ROCHESTER MN 55902 OUTPATIENT PHYSICIAN CLINIC 15 - OMC - PHYSICAL THERAPY 102 ELTON HILLS DR ROCHESTER MN 55901 PHYSICAL THERAPY 17 - OMC - SPORTS MED & ATHLETIC PERFORMANCE 5155 55TH ST NW ROCHESTER MN 55901 PHYSICAL THERAPY/ATHLETIC PERFORMANCE 18 - OMC - STEWARTVILLE CLINIC 208 CENTERTOWN PLAZA STEWARTVILLE MN 55976 OUTPATIENT PHYSICIAN CLINIC 19 - OMC - NW RETAIL PHARMACY 5067 55TH ST NW ROCHESTER MN 55901 RETAIL PHARMACY 20 - OMC - SE RETAIL PHARMACY 210 9TH ST SE ROCHESTER MN 55904 RETAIL PHARMACY 21 - OMC - LAKE CITY CLINIC 507 W DOUGHTY ST LAKE CITY MN 55041 OUTPATIENT PHYSICIAN CLINIC 22 - OMC - GREENVIEW 1544 GREENVIEW DR SW ROCHESTER MN 55902 OUTPATIENT OPTICAL 23 - OMC- SLEEP MEDICINE 4303 HWY 52 NORTH ROCHESTER MN 55901 SLEEP CLINIC PART I, LINE 3C: ELIGIBILITY IS DETERMINED BY MEASURING INCOME, HOME EQUITY ASSETS BASED ON THE FEDERAL POVERTY GUIDELINES, AND PRESUMPTIVE DETERMINATION. BOTH INCOME AND ASSETS (SEPARATELY) HAVE TO FALL BELOW THE ANNUAL GROSS INCOME/ASSET MAXIMUM VALUES IN OMC'S FINANCIAL ASSISTANCE POLICY TO QUALIFY. PART I, LINE 6A: THE OLMSTED MEDICAL CENTER ANNUAL REPORT IS MADE WIDELY AVAILABLE AND IS AVAILABLE ON THE WEBSITE. PART I, LINE 7: THE AMOUNTS REPORTED ON PART I, LINES 7A-C ARE DERIVED USING THE COST-TO-CHARGE RATIO CALCULATION BASED ON WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE AMOUNTS REPORTED ON PART I, LINES 7E-7I ARE DERIVED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G INCLUDE ACTIVITIES FROM THREE OF OMC'S CLINIC LOCATIONS. PART I, LN 7 COL(F): $7,748,995 OF BAD DEBT EXPENSE WAS EXCLUDED IN CALCULATING THE PERCENTAGES REPORTED IN PART I, LINE 7, COLUMN F. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENTS ARE CARRIEDAT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVEREDBY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFULRECEIVABLES. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTSBY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIEDTO AN AGING OF ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF PATIENT ACCOUNTS RECEIVABLEPREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. PART III, LINE 3: THE ORGANIZATION HAS NOT IDENTIFIED A METHODOLOGY UNDER WHICH IT CAN REASONABLY ESTIMATE THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO INDIVIDUALS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT FAILED TO COMPLETE AN APPLICATION. PART III, LINE 1: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE NOTE ON PAGE 10 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THEMEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COSTREPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINEDTHROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICECENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THEINSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTOACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THETOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA.THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITARE: ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALSWOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENTPROGRAMS; BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THEBURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS;THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION INREIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESEINDIVIDUALS; AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. AS REPORTED ON THE AUDITED FINANCIAL STATEMENTS, THE COMMUNITY BENEFIT OF COSTS IN EXCESS OF MEDICARE PAYMENTS WAS $28,515,138 PART III, LINE 9B: PATIENT FINANCIAL HARDSHIP POLICY: TO SUPPORT THE ORGANIZATION'S MISSIONAND PHILOSOPHY IN THAT THE PATIENT COMES FIRST AND PROVIDE A GUIDELINE INIDENTIFYING PATIENTS WHO HAVE AN EXCEPTIONAL PERSONAL FINANCIAL HARDSHIPAND REQUIRED NEEDED AND NECESSARY MEDICAL CARE AND THERE IS REMOTE ORNEGLIBLE CHANCE THAT THE INDIVIDUAL WILL BE ABLE TO REPAY.PROCEDURE: FACTORS THAT MAY CONTRIBUTE TO EXCEPTIONAL FINANCIAL HARDSHIPINCLUDE:1) UNEMPLOYMENT OR UNDEREMPLOYMENT THROUGH NO FAULT OF THE PATIENT AND/ORFAMILY; 2) THREATENED LOSS OF SHELTER THROUGH FORECLOSURE, ETC; 3) LOSS OFINCOME FROM FEDERAL, STATE OR OTHER GOVERNMENT BENEFITS INCLUDING, BUT NOTLIMITED TO SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, PUBLICASSISTANCE, ETC; 4) LOSS OF INCOME DUE TO DEATH OR DISABILITY; 5)EXCEPTIONAL EXPENSES INCURRED BECAUSE OF UNINSURED PROPERTY DAMAGE ORCOSTLY REPAIRS TO PRINCIPAL RESIDENCE; 6) EXCEPTIONAL EXPENSES DUE TOTEMPORARY OR CHRONIC ILLNESS; 7) EXCEPTIONAL EXPENSES DUE TO INCREASE INLIVING EXPENSES BECAUSE OF A DIVORCE, ABANDONMENT OR SEPARATION FROMSPOUSE OR INCOME EARNER; 8) LOSS OF INCOME DUE TO DECLARATION OFINCOMPETENCE OR IN PROCESS OF BEING DECLARED INCOMPETENT; 9) PATIENT ORFAMILY MEMBER IS CONFINED TO A CONVALESCENT HOME OR OTHER RESIDENCE OTHERTHAN THEIR PRINCIPAL RESIDENCE; 10) NATURAL DISASTERS SUCH AS FLOODS,FIRES, HURRICANES AND EARTHQUAKES; 11) EVICTION, HOMELESSNESS, LOSS OFOWNED RESIDENCE, ARSON, THEFT, ETC; 12) DISCONTINUANCE OF UTILITIES ORHEAT, OR UNSAFE OR UNHEALTHY LIVING CONDITIONS; 13) ANY OTHER CONDITIONCONSIDERED LIFE THREATENING DUE TO EXCEPTIONAL FINANCIAL HARDSHIP.APPLICATION PROCESS: THE FINANCIAL HARDSHIP APPLICATION, UTILIZING OMC'S FINANCIAL ASSISTANCE APPLICATION, CONTAINS THE NECESSARY INFORMATION TODETERMINE ELIGIBILITY FOR THE OMC FINANCIAL HARDSHIP PROGRAM. NO SEPARATEAPPLICATION IS NECESSARY. SUPPORTING DOCUMENTATION REQUIRED TO MAKE ANELIGIBILITY DETERMINATION ARE: 1) MOST RECENT TAX RETURNS; 2) CURRENTFAMILY PAYROLL STUB SHOWING YEAR-TO-DATE INCOME; 3) CURRENT TRANSUNIONCREDIT REPORT AND OTHER FINANCIAL HARDSHIP DOCUMENTATION TO SUPPORTHARDSHIP; AND 4) EXPLANATION OF HARDSHIP SITUATION/NECESSITY AND RARECOMPLICATIONS.ELIGIBILITY DETERMINATION: BASED UPON PATIENT'S/FAMILY'S INCOME ANDASSETS AND COMPLETED FINANCIAL ASSISTANCE APPLICATION. BASED UPON TAKINGINTO CONSIDERATION ALL PERSONAL FACTORS IN DETERMINING EXCEPTIONALFINANCIAL HARDSHIP. THE BUSINESS SERVICES DEPARTMENT EVALUATES THEAPPLICATIONS MEETING THE CRITERIA AND PRESENTS TO ADMINISTRATION FORAPPROVAL. OMC RESERVES THE RIGHT TO MAKE ADJUSTMENT DETERMINATIONS ON ACASE-BY-CASE BASIS. PART VI, LINE 2: OMC ACTIVELY WORKS WITH LOCAL GOVERNMENT IN ASSESSING AND ADDRESSINGCOMMUNITY NEEDS THROUGH MEETINGS, WORKSHOPS, AND COMMUNITY INPUT. INADDITION, OMC IS ACTIVELY INVOLVED WITH LOCAL GOVERNMENTS IN EMERGENCYPREPAREDNESS AND DISEASE MANAGEMENT. PART VI, LINE 3: OMC INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE ANDASSISTS PATIENTS WHO INDICATE AN INABILITY TO PAY. OMC INFORMS PATIENTSOF THE FINANCIAL ASSISTANCE PROGRAMS BY PROVIDING THE FINANCIAL ASSISTANCEPOLICY ON BROCHURES IN THE NEW PATIENT PACKET AND AT THE FRONT DESK FORALL PATIENTS. THE POLICY IS ALSO PROVIDED ON THE BACK OF THE HOSPITALBILL STATEMENTS, ON THE HOSPITAL WEBSITE AND ON THE HOSPITAL'S ONLINEBILL-PAY SYSTEM.OMC PATIENT FINANCIAL COUNSELORS PROVIDE INFORMATION TO PATIENTS REGARDINGAVAILABLE HEALTHCARE FINANCIAL COVERAGE OPTIONS, SUCH AS: 1) MEDICALASSISTANCE, 2) MINNESOTA CARE, 3) OTHER FINANCIAL SERVICES AVAILABLE FORLOW INCOME FAMILIES IN THE COMMUNITY, 4) OMC'S FINANCIAL ASSISTANCEPROGRAM.THE PATIENT FINANCIAL COUNSELORS ASSIST OMC PATIENTS IN THE APPLICATION PROCESS. ALL APPLICATIONS ARE PROCESSED IN A TIMELY MANNER. PATIENT APPLICATIONS ARE CONSIDERED FOR CURRENT PATIENT RESPONSIBLE BALANCES, AS WELL AS NEAR FUTURE SCHEDULED MEDICAL SERVICES. PATIENTS MAY QUALIFY FOR FULL OR PARTIAL FINANCIAL ASSISTANCE. PATIENT FINANCIAL COUNSELORS NOTE PATIENT'S ACCOUNT VIA ON-LINE NOTES REGARDING APPLICATIONS SENT, APPLICATIONS IN PROCESS, AND WHETHER APPLICATIONS HAVE BEEN APPROVED, DENIED, OR ADDITIONAL INFORMATION IS REQUIRED. THE PATIENT FINANCIAL COUNSELORS INFORM THE PATIENT VIA A LETTER REGARDING THE DETERMINATION (APPROVED, DENIED, OR PARTIAL COVERAGE APPROVED) OF THE RECEIVED AND COMPLETED APPLICATION. PRIOR TO TURNING ACCOUNTS OVER THE THIRD PARTY COLLECTION, THE ACCOUNT WILL BE REVIEWED FOR POSSIBLE FINANCIAL ASSISTANCE PROGRAM QUALIFICATION THROUGH THE E-BUREAU PROCESS. PART VI, LINE 4: OMC IS A REGIONAL HEALTH CARE FACILITY SERVING PATIENTS WITHIN A SIXTYMILE RADIUS OF ROCHESTER, MN. PART VI, LINE 5: THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE ORGANIZATION UTILIZES ITS SURPLUS FUNDS TO INCREASE THE SERVICES OFFERED TO ITS PATIENTS. PART VI, LINE 6: N/A 1 OMC REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 501(C)(3) 237448 PROVIDE FUNDING TO OMC REGIONAL FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES. 1 0 PART I, LINE 2: MOST OF GRANT EXPENDITURES ARE PROVIDED TO OMC REGIONAL FOUNDATION, A RELATED ORGANIZATION. OMC PROVIDES FUNDS TO THE FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES AS NEEDED. THERE ARE NUMEROUS WAYS TO MONITOR THE USE OF THE GRANT FUNDS. MANY OF THE EVENTS ARE OPEN TO THE PUBLIC AND EASILY VERIFIABLE. STAFF OFTEN ASSIST AS VOLUNTEERS. THE FILING ORGANZATION CONSIDERS REQUESTS FOR FUNDING TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE ITS MISSION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS COMMUNITY NEEDS IN THE HEALTH CARE AREA. NO ADDITIONAL MONITORING IS PERFORMED. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 VIDHAN CHANDRA MD PHYSICIAN 959431 0 2067 0 200 0 22000 0 7643 0 991341 0 0 0 MATTHEW KIRSCH MD PHYSICIAN 952074 0 4471 0 0 0 22000 0 29020 0 1007565 0 0 0 MARK HERR MD PHYSICIAN 824051 0 0 0 0 0 22000 0 1367 0 847418 0 0 0 SAMER ABDEL-AZIZ MD PHYSICIAN 757335 0 0 0 0 0 22000 0 5597 0 784932 0 0 0 DAVID LOWE MD PHYSICIAN 746416 0 2067 0 600 0 22000 0 28054 0 799137 0 0 0 TIM WEIR CEO 617274 0 130288 0 0 0 22000 0 31810 0 801372 0 0 0 KATHRYN LOMBARDO MD PRESIDENT (THROUGH JUNE 2019) 495426 0 65251 0 1000 0 22000 0 3836 0 587513 0 0 0 JAMES HOFFMANN DO VICE PRESIDENT & PRESIDENT (JULY 2019) 472906 0 62158 0 1000 0 22000 0 17412 0 575476 0 0 0 KEVIN HIGGINS CFO/TREASURER/SECRETARY 377989 0 63744 0 21345 0 22000 0 30795 0 515873 0 0 0 RANDY HEMANN MD CHIEF MEDICAL OFFICER 401473 0 40313 0 1000 0 22000 0 17315 0 482101 0 0 0 JOSEPH TRICARICO MD CLINIC TRUSTEE (THROUGH MAR 2019) 422579 0 0 0 550 0 22000 0 26279 0 471408 0 0 0 TAMARA ALEXANDROV MD CLINIC TRUSTEE 407160 0 0 0 0 0 19600 0 3356 0 430116 0 0 0 MARK WILBUR MD CLINIC TRUSTEE 290363 0 8468 0 300 0 22000 0 3212 0 324343 0 0 0 CAROLE NISTLER MD CLINIC TRUSTEE 268761 0 9017 0 0 0 22000 0 13087 0 312865 0 0 0 PART I, LINE 1A KATHRYN LOMBARDO, $1,150, GROSS UP ON EMPLOYEE RECOGNITION PART I, LINE 4B THE ORGANIZATION HAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FOR CERTAIN INDIVIDUALS IN LEADERSHIP POSITIONS. DURING 2019, TIM WEIR BECAME ELIGIBLE FOR A $77,750.40 PAYMENT IN 2024, KEVIN HIGGINS BECAME ELIGIBLE FOR A $26,880 PAYMENT IN 2024, KATHRYN LOMBARDO BECAME ELIGIBLE FOR A $19,437.50 PAYMENT IN 2024, RANDY HEMANN BECAME ELIGIBLE FOR A $7,041.25 PAYMENT IN 2024, AND JAMES HOFFMANN BECAME ELIGIBLE FOR A $25,253 PAYMENT IN 2024. A CITY OF ROCHESTER MN 416005494 771902FY4 2010-07-07 20202546 NW CLINIC CONSTRUCTION 0 0 0 B CITY OF ROCHESTER MN 416005494 771902GK3 2013-04-24 19290018 WOMEN'S HEALTH PAVILLION CONSTRUCTION 0 0 0 A 6715000 20202546 1736608 1341608 407200 17968405 275180 2011 0 0 1 1 B 3180000 19290018 490226 286285 18513507 2014 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF ROCHESTER, MN DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2015 ISSUER NAME: CITY OF ROCHESTER, MN DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2017 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF FOUR (4) VOTING MEMBERS CONSISTING OF THE BOARD CHAIR, CHAIR OF THE FINANCE COMMITTEE, PRESIDENT AND CHIEF EXECUTIVE OFFICER, WHO WILL BE EX OFFICIO MEMBERS. EXCEPT AS PROVIDED BY THE BOARD OF TRUSTEES, THE EXECUTIVE COMMITTEE WILL HAVE THE AUTHORITY OF THE BOARD OF TRUSTEES IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION TO ACT IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE FINANCIAL SERVICES MANAGER, CONTROLLER AND CFO. ANY NECESSARY CORRECTIONS AND ADJUSTMENTS ARE MADE. THE FORM 990 IS REVIEWED BY THE CEO AND CFO AND PRESENTED TO THE COMPENSATION COMMITTEE. THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH CLINIC AND PUBLIC TRUSTEE AND PRINCIPAL OFFICER ("COVERED MEMBERS") OF THE CORPORATION ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT EACH PERSON HAS RECEIVED AND UNDERSTANDS THE CONFLICTS OF INTEREST POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. UNLESS A PREVIOUSLY DISCLOSED AND DOCUMENTED CONFLICT OF INTEREST IS KNOWN TO THE BOARD, ALL CONFLICTS OF INTEREST ARE DISCLOSED TO THE BOARD BY THE COVERED MEMBER WITH THE CONFLICT(S). A COVERED MEMBER HAS DISCLOSED A CONFLICT IF HE OR SHE PROMPTLY PROVIDES A DESCRIPTION OF THE MATERIAL FACTS COMPRISING THE CONFLICT OF INTEREST TO THE BOARD. IF A COVERED MEMBER HAS A CONFLICT OF INTEREST ON ANY MATTER CONSIDERED BY THE BOARD, SUCH MATTER IS APPROVED BY THE BOARD IN A MANNER THAT COMPLIES WITH THE REQUIREMENTS OF THE SEVENTH RESTATED BYLAWS OF OLMSTED MEDICAL CENTER AND MINNESOTA STATUE SECTION 317A.255. SUCH LAW CURRENTLY STATES THAT A MATTER INVOLVING A CONFLICT OF INTEREST WILL NOT BE VOID OR VOIDABLE IF APPROVED BY ONE OF THE FOLLOWING PROCEDURES: THE CONTRACT OR TRANSACTION WAS, AND THE PERSON ASSERTING THE VALIDITY OF THE CONTRACT OR TRANSACTION HAS THE BURDEN OF ESTABLISHING THAT THE CONTRACT OR TRANSACTION WAS, FAIR AND REASONABLE AS TO THE CORPORATION WHEN IT WAS AUTHORIZED, APPROVED, OR RATIFIED; THE MATERIAL FACTS AS TO THE CONTRACT OR TRANSACTION AND AS TO THE TRUSTEE'S INTEREST ARE FULLY DISCLOSED OR KNOWN TO THE MEMBERS AND THE CONTRACT OR TRANSACTION IS APPROVED IN GOOD FAITH BY TWO-THIRDS OF THE MEMBERS ENTITLED TO VOTE, NOT COUNTING ANY VOTE THAT THE INTERESTED TRUSTEE MIGHT OTHERWISE HAVE, OR THE UNANIMOUS AFFIRMATIVE VOTE OF ALL MEMBERS, WHETHER OR NOT ENTITLED TO VOTE; OR THE MATERIAL FACTS AS TO THE CONTRACT OR TRANSACTION AND AS TO THE TRUSTEE'S INTEREST ARE FULLY DISCLOSED OR KNOWN TO THE BOARD OR A COMMITTEE, AND THE BOARD OR COMMITTEE AUTHORIZES, APPROVES, OR RATIFIES THE CONTRACT OR TRANSACTION IN GOOD FAITH BY A MAJORITY OF THE BOARD OR COMMITTEE, NOT COUNTING ANY VOTE THAT THE INTERESTED TRUSTEE MIGHT OTHERWISE HAVE, AND NOT COUNTING THE TRUSTEE IN DETERMINING THE PRESENCE OF A QUORUM. FORM 990, PART VI, SECTION B, LINE 15A IN ORDER TO ENSURE THAT ALL OLMSTED MEDICAL CENTER (OMC) EXECUTIVE COMPENSATION DECISIONS ARE COMPETITIVE, EQUITABLE, UNIFORMLY ADMINISTERED, AND CONSISTENT WITH MARKET PRACTICES, OMC FOLLOWS RECOMMENDED BEST PRACTICES. THE GOALS OF EXECUTIVE COMPENSATION ARE TO ATTRACT AND RETAIN HIGHLY QUALIFIED PERSONNEL, TO MAINTAIN COMPENSATION LEVELS COMMENSURATE WITH THE SCOPE OF RESPONSIBILITIES FOR EACH POSITION, AND TO REWARD OUTSTANDING PERFORMANCE. OMC WILL SEEK MANAGEMENT TALENT BY CONDUCTING NATIONAL SEARCHES FOR QUALIFIED APPLICANTS FOR ANY VACANCIES AT THE CHIEF MEDICAL OFFICER, AND CEO POSITIONS IN ADDITION TO VICE PRESIDENT POSITIONS AS NECESSARY. THE SAME PHILOSOPHY IS APPLICABLE TO THE POSITION OF OMC PRESIDENT. OMC ENGAGES AN EXTERNAL CONSULTANT WHO ANNUALLY COMPILES A PEER GROUP COMPENSATION ANALYSIS AND ON A TWO YEAR BASIS COMPILES A PEER GROUP COMPENSATION AND BENEFITS ANALYSIS. PEER GROUPS FOR EXECUTIVE COMPENSATION, WHICH INCLUDES BASE SALARIES, INCENTIVE AND BENEFITS, WILL BE PROVIDED FOR HEALTH DELIVERY SYSTEMS WITH A MINIMUM OF A HOSPITAL AND AN EMPLOYED PHYSICIAN NETWORK AND NET REVENUES ROUGHLY SIMILAR TO THE REVENUES OF OLMSTED MEDICAL CENTER. MOST RECENTLY A COMPENSATION AND BENEFITS PEER REVIEW STUDY WAS COMPLETED FOR THE CEO, PRESIDENT, CHIEF MEDICAL OFFICER, AND VICE PRESIDENTS AND PRESENTED TO THE BOARD EXECUTIVE COMPENSATION COMMITTEE. THE EXECUTIVE COMPENSATION COMMITTEE RECEIVES A SUMMARY OF EVERYONE'S COMPENSATION TO ENSURE IT IS IN ALIGNMENT WITH THE SAME COMPENSATION METHODOLOGY AND AGREED UPON METHODOLOGY OF THE EXECUTIVE COMPENSATION SYSTEM OF OMC. THESE POSITIONS INCLUDE THE CHIEF MEDICAL OFFICER, AND VICE PRESIDENTS OF OMC. THE EXECUTIVE COMPENSATION COMMITTEE WILL SET THE COMPENSATION OF THE PRESIDENT, AND CEO, AND MINUTES ARE KEPT OF THESE DISCUSSIONS. THE BOARD OF TRUSTEES, ACTING THROUGH THE BOARD OF TRUSTEES COMPENSATION COMMITTEE, MUST APPROVE THE EXECUTIVE COMPENSATION POLICY AND PROCESS OF DETERMINING EXECUTIVE COMPENSATION AND BENEFITS. IN ADDITION, THE PHYSICIAN SALARIES ARE CALCULATED ANNUALLY, USING REGIONAL PHYSICIAN SALARY COMPARISON GUIDES FACTORING IN PRODUCTIVITY AND QUALITY MEASURES, AND REVIEWED ON AN ANNUAL BASIS FOR MARKET REASONABLENESS BY AN INDEPENDANT CONSULTING FIRM. THE PHYSICIANS RECEIVE NO COMPENSATION AS ATTENDING BOARD MEMBERS. THESE DISCUSSIONS ARE NOTED IN THE MINUTES OF THE BOARD OF TRUSTEES COMPENSATION COMMITTEE ANNUAL MEETING. THE BOARD OF TRUSTEES COMPENSATION COMMITTEE REPORTS TO THE FULL BOARD OF TRUSTEES ON AN ANNUAL BASIS THE COMPLETION OF SUCH DUTIES AND ARE ALSO NOTED IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ANNUAL FORM 990 & ATTACHED AUDITED FINANCIAL STATEMENT REPORT IS AVAILABLE IN ACCORDANCE WITH THE PUBLIC INSPECTION OF THE RETURN REQUIREMENTS. OMC RETAIL SERVICES LLC 210 9TH STREET SE ROCHESTER MN 55904 460960716 PHARMACY MN 2417559 1109966 OLMSTED MEDICAL CENTER OMC REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 HEALTHCARE EDUCATION AND COMMUNITY PURPOSES MN 501(C)(3) LINE 12A, I OLMSTED MEDICAL CENTER 1 0 1 1 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 OMC REGIONAL FOUNDATION B 237448 GAAP OMC REGIONAL FOUNDATION O 413516 GAAP OMC REGIONAL FOUNDATION C 102599 GAAP