2019-11-14T10:37:28-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2018-01-01 410837659 MINNESOTA VALLEY HEALTH CENTER INC MINN 5076653375 621 SOUTH 4TH STREET LE SUEUR MN 56058 GORDON GABLENZ CFO & CIO 5076653375 2019-11-11 1 DARRYN MCGARVEY P00958683 5074347000 67.137.57.251 2019-11-11 06:21:33 CS P 37F149D8265E4E19AE85689D43BA006C0C485BA5 06C6282D018575128FE0891D0F3A4E057D2D2323 2018 2020-03-31 21:24:44Z RIDGEVIEW LE SUEUR MEDICAL CENTER MICHAEL PHELPS 621 SOUTH 4TH STREET LE SUEUR MN 56058 12897187 0 X WWW.RIDGEVIEWLESUEUR.ORG X 1959 MN PROVIDE COMMUNITY-BASED HEALTH CARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT & EXCELLENCE. 9 9 167 30 0 0 187598 56357 12619961 12617328 14589 12418 153577 211084 12975725 12897187 0 0 0 0 6336065 6320087 0 0 0 6386646 6323491 12722711 12643578 253014 253609 12329834 16335308 6808800 10633227 5521034 5702081 OUR MISSION IS TO PROVIDE COMMUNITY-BASED HEALTHCARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT, AND EXCELLENCE. 0 0 11259887 0 12704195 RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED & ORGANIZED EXCLUSIVELY FOR CHARITABLE AND EDUCATIONAL PURPOSES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES. RIDGEVIEW LE SUEUR MEDICAL CENTER INCLUDES A HOSPITAL, OUTPATIENT SPECIALTY CLINICS, COMPLETE LAB AND RADIOLOGY DEPARTMENTS, A COMPREHENSIVE PHYSICAL OCCUPATIONAL AND SPEECH THERAPY DEPARTMENT, EXTENDED CARE NURSING FACILITIES, AN ADULT DAY HEALTH CENTER, AND INDEPENDENT LIVING SENIOR HOUSING. 11259887 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 167 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X PATRICIA SCHLEGEL 5076658683 621 SOUTH 4TH STREET LE SUEUR MN 56058 RANDY BAUM BOARD PRESIDENT 10.00 0.00 X X 0 0 0 IRENE MANKE BOARD VICE-PRESIDENT 2.00 0.00 X X 0 0 0 ROBERT BROEDER BOARD SECRETARY/TREASURER 5.00 0.00 X X 0 0 0 STEVE SMITH BOARD DIRECTOR 2.00 0.00 X 0 0 0 DAVE JOHNSON BOARD DIRECTOR (THROUGH 12/31/18) 2.00 0.00 X 0 0 0 SHAWN KIRBY BOARD DIRECTOR 2.00 0.00 X 0 0 0 KAY KING BOARD DIRECTOR 2.00 0.00 X 0 0 0 DAVID BRAUN BOARD DIRECTOR 2.00 0.00 X 0 0 0 JEFF NELSON BOARD DIRECTOR 3.00 2.00 X 0 0 0 GORDON GABLENZ CFO 10.00 40.00 X X 0 351764 84068 PAMELA WILLIAMS VICE PRESIDENT 50.00 0.00 X 0 124695 40183 MICHAEL PHELPS CEO 0.50 49.50 X 0 564019 76156 0 1040478 200407 0 0 1 0 PREMIER STAFFING 243 WINKLER WAY COLOGNE MN 55322 ER PHYSICIAN SERVICES 1130714 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 471937 ESSENTIA CORPORATE 502 E SECOND STREET DULUTH MN 55805 SOFTWARE SUPPORT SERVICES 169529 3 36511 19846 56357 PATIENT/RESIDENT REVENUE 621110 12324726 12324726 APARTMENT PROJECT REVENUES 623000 292602 292602 12617328 12218 12218 124217 0 124217 124217 124217 200 0 200 200 200 MISCELLANEOUS INCOME 900099 77640 77640 DIETARY INCOME 900099 9227 9227 86867 12897187 12704195 0 136635 4982650 4144285 838365 996220 828599 167621 341217 283805 57412 10133 10133 80762 80762 160969 74196 86773 22038 22038 20549 20549 388926 388926 366940 366940 849631 849631 1150 1150 SUPPLIES 3468380 3460234 8146 BAD DEBT 625000 625000 REPAIRS AND MAINTENANCE 203650 202871 779 TAXES AND LICENSES 123871 13560 110311 1492 141 1351 12643578 11259887 1383691 0 163580 209155 3186092 4712106 2084580 2572652 41682 122419 19462 19792 17308999 9331945 5908558 7977054 925880 722130 12329834 16335308 987294 1987357 7545 4368 5270792 5059494 314882 2252636 228287 1329372 6808800 10633227 X 4726342 4979951 794692 722130 5521034 5702081 12329834 16335308 X 253609 -72562 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 116 116 0 PART II-B, LINE 1: RIDGEVIEW LE SUEUR MEDICAL CENTER PAY DUES TO A CERTAIN ORGANIZATION RELATED TO THE INDUSTRY WHICH HAS LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 0 1 X 794693 -32850 29405 10306 722132 711289 5050 115650 27879 9417 794693 704595 6694 711289 755050 -12834 28436 9185 704595 766834 24787 28393 8178 755050 0.00000 1.00000 0.00000 1 0 46482 46482 4493009 1666904 2826105 3608488 2177800 1430688 9138714 5487241 3651473 22306 22306 7977054 DUE TO RIDGEVIEW 1329372 1329372 X 12223258 0 12223258 673929 673929 12897187 12018578 0 12018578 625000 625000 12643578 PART IV, LINE 2B: RIDGEVIEW LE SUEUR MEDICAL CENTER ACTS AS CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. RESIDENT TRUST FUNDS TOTALED $4,368 AT DECEMBER 31, 2018. DURING THAT SAME TIME, RIDGEVIEW LE SUEUR MEDICAL CENTER HELD $16,653 IN A SEPARATE ACCOUNT FOR TENANT SECURITY DEPOSITS. PART V, LINE 4: RIDGEVIEW LE SUEUR MEDICAL CENTER INTENDED USE OF ITS ENDOWMENT FUNDS IS FOR CAPITAL AND OTHER IMPROVEMENTS THAT FURTHER RIDGEVIEW LE SUEUR MEDICAL CENTER'S MISSION. PART X, LINE 2: THE HEALTH CENTER IS OPERATED AS A TAX-EXEMPT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAX RELATED TO BUSINESS INCOME. THE HEALTH CENTER FOLLOWS THE ACCOUNTING STANDARD FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HEALTH CENTER'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 625,000. INVESTMENT INCOME 48,729. GAIN ON DISPOSAL OF ASSETS 200. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 625,000. 1 1 X 1 X 1 X 1 1 1 0 1 1 153214 153214 0.01270 1461688 1693392 0 0.00000 673524 78372 595152 0.04950 2288426 1771764 748366 0.06220 66271 31835 34436 0.00290 66271 31835 34436 0.00290 2354697 1803599 782802 0.06510 1 625000 156250 3236322 4123736 -887414 X 1 1 1 1 MINNESOTA VALLEY HEALTH CENTER INC 621 SOUTH 4TH STREET LE SUEUR MN 56058 WWW.MVHC.ORG 00336 X X X MINNESOTA VALLEY HEALTH CENTER 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X WWW.RIDGEVIEWLESUEUR.ORG X 1 15 1 WWW.RIDGEVIEWLESUEUR.ORG 1 1 50000 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X WWW.RIDGEVIEWLESUEUR.ORG X WWW.RIDGEVIEWLESUEUR.ORG X WWW.RIDGEVIEWLESUEUR.ORG X X X X X 1 X 0 X X X X 1 X 0 0 MINNESOTA VALLEY HEALTH CENTER PART V, SECTION B, LINE 5: IN SEPTEMBER-OCTOBER 2015, RIDGEVIEW LE SUEUR MEDICAL CENTER CONVENED A GROUP OF COMMUNITY MEMBERS AND PARTNERS TO 1) DEVELOP A VISION OF A HEALTHY COMMUNITY, 2) COME TO A COMMON UNDERSTANDING OF THE CURRENT HEALTH STATUS OF THE COMMUNITY, AND 3) IDENTIFY KEY OPPORTUNITIES TO HELP MOVE THE COMMUNITY FROM THE CURRENT STATUS TO THE VISION. ORGANIZATIONS THAT PARTICIPATED IN THE COMMUNITY MEETINGS: RIDGEVIEW LE SUEUR MEDICAL CENTER, PUBLIC HEALTH AGENCIES FROM LE SUEUR AND SIBLEY COUNTIES, AND MAYO CLINIC HEALTH SYSTEM - LE SUEUR CLINIC. ALSO INCLUDED IN THE PLANNING WORK WAS THE COMMUNITY CENTER AND SCHOOL DISTRICT. MINNESOTA VALLEY HEALTH CENTER PART V, SECTION B, LINE 11: AT THE TOP OF THE HEALTH IMPROVEMENT PRIORITIES WERE PHYSICAL ACTIVITY AND HEART HEALTH BASED ON NUMBER OF VOTES RECEIVED. THE COMMITTEE IMPLEMENTED THE STEP UP PROGRAM OVER THE SUMMER MONTHS. THIS PROGRAM ENCOURAGED COMMUNITY MEMBERS TO JOIN THE GROUP FOR AN EVENING WALK ON A PRE-SET COURSE. RESTING BENCHES WERE INSTALLED ALONG THE PAVED PATHWAY FOR THOSE THAT MIGHT NEED IT. LOCAL BUSINESSES TOOK TURNS TO DONATE A PRIZE FOR EACH NIGHT OF WALKING. THE PARTICIPANTS IN THE WALK WE ENCOURAGED TO ENTER THEIR NAME FOR THE DRAWING.EMOTIONAL SUPPORT FOR YOUTH AND CHILDREN AND NUTRITION WERE OTHER NEEDS IDENTIFED THAT MVHC IS NOT ADDRESSING AT THIS TIME DUE TO THE LACK OF PROFESSIONALS IN THE AREA TO HELP WITH THIS. THE SCHOOL WAS GOING TO RESEARCH THEIR RESOURCES FOR ASSISTANCE RELATED TO THESE NEEDS. 2 1 - MINNESOTA VALLEY CARE CENTER 621 SOUTH 4TH STREET LE SUEUR MN 56058 SKILLED NURSING FACILITY 2 - SUNRIZE PLAZA 600 SOUTH 5TH STREET LE SUEUR MN 56058 SENIOR APARTMENTS PART I, LINE 3C: ASSETS WILL BE CONSIDERED ALONG WITH THE PATIENT'S INCOME TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE PROGRAM. TO BE ELIGIBLE, REPORTABLE ASSETS MAY NOT EXCEED $15,000 FOR A HOUSEHOLD OF ONE (1), OR $25,000 FOR A HOUSEHOLD OF TWO (2) OR MORE. ASSETS MAY INCLUDE, BUT ARE NOT LIMITED TO, SUCH ITEMS AS CHECKING AND SAVINGS ACCOUNTS, IRAS, 401(K)S, VALUE OF ADDITIONAL CARS THAT EXCEED THE NUMBER OF WORKING MEMBERS IN THE HOUSEHOLD, EQUITY IN RECREATIONAL VEHICLES AND ADDITIONAL PROPERTY, ETC. PART I, LINE 7: THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS, RATIO OF PATIENT CARE COST-TO-CHARGES, WAS USED TO CALCULATE THE COSTS FOR THE FOLLOWING COMMUNITY BENEFITS: CHARITY CARE, UNREIMBURSED MEDICAID AND COSTS FROM OTHER MEANS-TESTED GOVERNMENT PROGRAMS. ACTUAL COSTS WERE USED FOR THE REMAINDER OF THE COMMUNITY BENEFITS REPORTED. 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 $ 625,000. PART III, LINE 2: DISCOUNTS, CHARITY CARE, AND BAD DEBT EXPENSE ARE ACCOUNTED FOR AS REDUCTIONS TO REVENUE. BAD DEBT EXPENSE ON PATIENT ACCOUNTS WOULD BE IDENTIFIED AS ANY BALANCE ON THE ACCOUNT, LESS ANY PREVIOUS PAYMENTS AND DISCOUNTS, THAT HAS AGED AND IS ABSENT OF ANY PAYMENTS. IF, DURING THE COLLECTION PROCESS, IT BECOMES KNOWN THAT THE PATIENT QUALIFIES FOR CHARITY CARE, THE AMOUNTS INCLUDED WITHIN THE BAD DEBT EXPENSE WOULD BE RECLASSIFIED TO CHARITY CARE. PART III, LINE 3: AS A TAX EXEMPT HOSPITAL, MEDICAL NECESSARY SERVICES ARE PROVIDED REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THAT CARE. RIDGEVIEW LE SUEUR MEDICAL CENTER APPLIED A HIGH-LEVEL CONSERVATIVE ANALYTIC REVIEW BY MULTIPLYING THE RATIO OF CHARITABLE ALLOWANCES TO GROSS PATIENT REVENUE AGAINST BAD DEBT EXPENSE TO ARRIVE AT AN APPROXIMATION OF CHARITY CARE THAT RESIDES IN BAD DEBT. PART III, LINE 4: REFER TO THE "PATIENT AND RESIDENT RECEIVABLES NOTE INCLUDED ON PAGE 7 OF THE CONSOLIDATED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 8: RIDGEVIEW LE SUEUR MEDICAL CENTER INCORPORATED THE FULL VALUE OF THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. THE RATIONALE FOR THE ORGANIZATION'S OPINION IS PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE AND IT IS LIKELY TO GET WORSE. MANY MEDICARE BENEFICIARIES ARE POOR AND ARE ELIGIBLE FOR MEDICAID IN ADDITION TO MEDICARE. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL AND NURSING HOME IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY. PART III, LINE 9B: THE POLICIES AND PROCEDRUES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE POLICY (FAP) AND FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE FROM RIDGEVIEW LE SUEUR MEDICAL CENTER, AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS. RIDGEVIEW LE SUEUR MEDICAL CENTER OFFERS EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS AND WILL NOT IMPOSE LIENS ON PRIMARY RESIDENCES NOR WILL WE REPORT PATIENTS TO A CREDIT RATING AGENCY FOR OUTSTANDING PATIENT BILLS. RIDGEVIEW LE SUEUR MEDICAL CENTER WILL NOT CHARGE A PATIENT GROSS AMOUNT OF CHARGES FOR ANY UNINSURED TREATMENT. UNINSURED DISCOUNTS WILL BE APPLIED TO THE GROSS CHARGES PRIOR TO ANY FAP OR OTHER DISCOUNTS. AT ANY TIME RIDGEVIEW LE SUEUR MEDICAL CENTER RECOGNIZES THAT A PATIENT MAY BE ELIGIBLE FOR STATE OF FEDERAL PROGRAMS, A REPRESENTATIVE WILL ASSIST THE PATIENT IN OBTAINING INFORMATION ABOUT THOSE PROGRAMS OR PROVIDE CONTACT INFORMATION FOR THOSE PROGRAMS. RIDGEVIEW LE SUEUR MEDICAL CENTER CONTRACTS WITH AN OUTSIDE PATIENT ADVOCACY AGENCY, WHICH MAY PROVIDE ASSISTANCE TO THE UNINSURED PATIENT IN APPLYING TO CERTAIN STATE AND FEDERAL PROGRAMS. AT ANY STAGE OF THE PATIENT EXPERIENCE AND UP THROUGH THE COLLECTION PROCESS, THE PATIENT MAY EXPRESS A CONCERN THAT THEY ARE UNABLE TO PAY THEIR BILL IN FULL OR MEET THE PAYMENT PLAN REQUIREMENTS. AT THAT TIME, THE PATIENT WILL BE GIVEN EVERY OPPORTUNITY TO COMPLETE AND SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. RIDGEVIEW LE SUEUR MEDICAL CENTER TRAINS ITS OUTSIDE DEBT COLLECTION AGENCIES AND ATTORNEYS ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW A PATIENT MAY OBTAIN MORE INFORMATION ABOUT THE FAP OR SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. RIDGEVIEW LE SUEUR MEDICAL CENTER REQUIRES ITS OUTSIDE COLLECTION AGENCIES AND ATTORNEYS TO REFER PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE TO RIDGEVIEW LE SUEUR MEDICAL CENTER. IF A PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, RIDGEVIEW LE SUEUR MEDICAL CENTER AND ITS OUTSIDE DEBT COLLECTION AGENCIES SUSPEND ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND RIDGEVIEW LE SUEUR MEDICAL CENTER HAS NOTIFIED THE PATIENT OF ITS DECISION. PART VI, LINE 2: RIDGEVIEW LE SUEUR MEDICAL CENTER IS A LICENSED 15 BED CRITICAL ACCESS HOSPITAL IN LE SUEUR, MN AND IS THE ONLY HOSPITAL IN LE SUEUR COUNTY. RIDGEVIEW LE SUEUR MEDICAL CENTER WORKS WITH THE ONLY LOCAL PRIMARY CARE PHYSICIAN CLINIC IN LE SUEUR, SIBLEY COUNTY PUBLIC HEALTH, NICOLLET COUNTY PUBLIC HEALTH, AND LE SUEUR COUNTY PUBLIC HEALTH AGENCIES FOR ASSESSING THE NEEDS OF THE RURAL COMMUNITIES IN OUR AREA. THESE NEEDS ARE DETERMINED BY SEVERAL DIFFERENT MENTHODS, BUT MOSTLY BASED ON WHAT THESE AGENCIES ARE ACTUALLY SEEING WHEN THEY ARE WORKING WITH THEIR CLIENTS. THIS COMMUNICATION IS ONGOING THROUGHOUT THE YEAR. RIDGEVIEW LE SUEUR MEDICAL CENTER IS A MEMBER OF A LOCAL NON-PROFIT GROUP CALLED COMMUNITY WELLNESS COLLABORATION. THE MISSION OF THIS GROUP IS TO ADDRESS DEPRESSION, BULLYING AND SUICIDE PREVENTION IN OUR COMMUNITY. OTHER MEMBERS OF THIS COLLABORATION ARE LE SUEUR COUNTY PUBLIC HEALTH AND SOCIAL SERVICES, A LOCAL FAMILY PRACTICE CLINIC, LAW ENFORCEMENT AGENCIES AND A LOCAL SCHOOL. THE COLLABORATION WAS FORMED IN THE LAST TWO YEARS AND IS BASED ON WHAT THESE AGENCIES WERE SEEING EITHER IN THE EMERGENCY ROOM, CLINIC VISITS, AMBULANCE CALLS, INCIDENTS AT SCHOOL AND CALLS TO LAW ENFORCEMENT. THE COLLABORATION WAS DEEMED NECESSARY AS THE NUMBER OF THESE EVENTS HAVE BEEN INCREASING. PART VI, LINE 3: RIDGEVIEW LE SUEUR MEDICAL CENTER MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO THE PATIENT. INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS, THAT WERE IN PLACE THROUGH DEC 31, 2018, IS AVAILABLE ON THE WEB SITE WWW.RIDGEVIEWLESUEUR.ORG, WHERE THE INFORMATION AND APPLICATION WERE EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED AND PRINTED AT NO CHARGE TO THE PATIENT. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS AND IN WAITING ROOMS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION, AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN ALL COLLECTION LETTERS AND PATIENT STATEMENTS. RIDGEVIEW LE SUEUR MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION. CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR BUSINESS OFFICE REPRESENTATIVE. REGISTRATION STAFF HAVE AN UNDERSTANDING OF THE POLICY, KNOWLEDGE OF WHERE THE RELATED DOCUMENTS ARE LOCATED AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING THAT THE PATIENT MAY BE ELIGIBLE FOR THIS PROGRAM. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. RIDGEVIEW LE SUEUR MEDICAL CENTER RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY. PART VI, LINE 4: RIDGEVIEW LE SUEUR MEDICAL CENTER IS LOCATED IN LE SUEUR, MN. RIDGEVIEW LE SUEUR MEDICAL CENTER OPERATES A CRITICAL ACCESS HOSPITAL, A LONG-TERM CARE FACILITY, AND A 37 UNIT HUD-SUBSIDIZED LOW INCOME HOUSING FOR SENIORS THAT SERVE THE COMMUNITIES OF LE SUEUR, NICOLLET AND SIBLEY COUNTIES. THE OVERALL COMMUNITY IS CLASSIFIED AS RURAL. RIDGEVIEW LE SUEUR MEDICAL CENTER AND ITS RELATED FACILITIES COVER A SERVICE REGION OF APPROXIMATELY 28,000 PEOPLE. THE SERVICE REGION AGE DISTRIBUTION IS 25% UNDER THE AGE OF 18, 54% BETWEEN THE AGES OF 18 AND 65, AND 16% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE REGION IS 91% WHITE, NON-HISPANIC, 6% HISPANIC OR LATINO, 1% BLACK OR AFRICAN AMERICAN, 1% AMERICAN INDIAN AND 1% ASIAN. THE GENDER SLPIT RATIO IS 50% WOMEN AND 50% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $60,632. APPROXIMATELY 8.5% OF THE POPULATION FALLS BELOW THE FEDERAL POVERTY GUIDELINES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS COMMITTED TO SERVING PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 28% NET REVENUE DOLLARS WERE FROM SELF-PAY PATIENTS. IN ADDITION, APPROXIMATELY 33% OF THEIR NET REVENUE DOLLARS WERE MEDICAID AND MEDICARE RECIPIENTS FOR THE HOSPITAL. APPROXIMATELY 64% NET REVENUE DOLLARS WERE FROM MEDICAL ASSISTANCE RESIDENTS IN THE NURSING HOME. RIDGEVIEW LE SUEUR MEDICAL CENTER HAS AN OUTREACH PROGRAM THAT BRINGS SPECIALISTS LIKE ONCOLOGISTS, CARDIOLOGISTS, NEUROLOGISTS, AND OTHERS INTO ITS SMALLER COMMUNITY. THIS ELIMINATES BARRIERS TO CARE FOR MANY PATIENTS, PARTICULARLY THOSE WHO ARE EDERLY, LIVING ON LOW INCOMES, OR ARE FACED WITH OTHER CHALLENGES THAT MAKE IT DIFFICULT TO TRAVEL LONG DISTANCES FOR CARE. PART VI, LINE 5: RIDGEVIEW LE SUEUR MEDICAL CENTER'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD CONSISTING OF LOCAL COMMUNITY MEMBERS WITH A CROSS SECTION OF OCCUPATIONS. ONE OF THE REPRESENTATIVES IS APPOINTED BY THE LE SUEUR CITY COUNCIL AND ONE BOARD MEMBER IS APPOINTED FROM RIDGEVIEW MEDICAL CENTER'S CORPORATE BOARD. NONE OF THE BOARD MEMBERS ARE EMPLOYEES, RELATED TO EMPLOYEES OR ARE INDEPENDENT CONTRACTORS OF THE ORGANIZATION. GIVEN THAT WE ARE A SMALL COMMUNITY, IF A VOTE COMES UP FOR SOMETHING THAT COULD APPEAR TO BE A CONFLICT OF INTEREST THE BOARD MEMBER WILL ABSTAIN FROM VOTING. OUR MEDICAL STAFF CONSISTS OF OUR EMERGENCY ROOM DIRECTOR AND THE PROVIDERS FROM THE MAYO CLINIC HEALTH SYSTEM - MANKATO. RIDGEVIEW MEDICAL CENTER OPENED A FAMILY PRACTICE CLINIC IN NOVEMBER 2018 AND THOSE PROVIDERS ARE ALSO PART OF THE MEDICAL STAFF. RIDGEVIEW LE SUEUR MEDICAL CENTER IS AN OPEN MEDICAL STAFF. THEREFORE, ANY QUALIFIED PHYSICAN OF THE COMMUNITY IS ALLOWED TO APPLY. ALL APPLICANTS THAT APPLY MUST MEET THE CREDENTIALING STANDARDS AND BE APPROVED BY OUR GOVERNING BOARD IN ORDER TO PROVIDE SERVICES IN OUR SYSTEM. ANY SURPLUS CASH IS USED TO UPDATE MEDICAL EQUIPMENT FOR BOTH THE HOSPITAL AND NURSING HOME. ANY AND ALL EMERGENCY REPAIRS OR EQUIPMENT NEEDS THAT ARISE ARE TAKEN CARE OF IMMEDIATELY. THE ADULT DAY HEALTH SERVICES PROGRAM IS ASSISTED BY THE HOSPITAL SERVICES. MOST OF THE CLIENTS IN THE ADULT DAY HEALTH SERVICES PROGRAM ARE ON THE ELDERLY WAIVER PROGRAM AND PAYMENT FROM THIS PROGRAM DOESN'T COVER ALL OF THE STAFF TIME OR THE COST TO TRANSPORT THE CLIENT FROM HOME TO OUR SITE AND BACK HOME AGAIN, YET IS IS A MUCH NEEDED SERVICE IN OUR COMMUNITY. WE OFFER A MEALS ON WHEELS PROGRAM FOR HOMEBOUND RESIDENTS AND MOST OF THOSE MEALS ARE PAID FOR THROUGH AN ELDERLY WAIVER PROGRAM THROUGH THE COUNTY, WHICH JUST COVERS THE COST OF THE FOOD. VOLUNTEERS DELIVER MEALS TO HOME BOUND CLIENTS MONDAYS - FRIDAYS. THIS PAST YEAR, 2,912 MEALS WERE PREPARED AND DELIVERED. WE HAVE EVENING EVENTS FOR THE COMMUNITY SUCH AS "LINED IN PINK" FOR BREAST CANCER AWARENESS. WE PARTICIPATE IN LOCAL COMMUNITY EVENTS SUCH AS SUPER SATURDAY KIDS EVENTS, YOUTH SAFETY CAMP, SCHOOL SUPPLIES AND WINTER CLOTHING DRIVES FOR THE SCHOOL, AND THE FOOD SHELF DRIVE. WE ALSO PARTICIPATE WITH THE COMMUNITY'S SENIOR EXPO EACH YEAR THAT HIGHLIGHTS SERVICES TO SENIORS. RIDGEVIEW LE SUEUR MEDICAL CENTER HAD A BOOTH AT THE ANNUAL RETAIL AND BUSINESS EXPO THAT WAS HELD AT THE LOCAL MALL TO EDUCATE THE COMMUNITY ON SERVICES AVAILABLE AT THE HEALTH CENTER. THE OUTPATIENT CLINIC WING PROVIDES SPACE FOR VISITING SPECIALISTS (CARDIOLOGY, PODIATRY, ORTHOPEDICS, UROLOGY, GENERAL SURGERY) FROM OTHER HEALTH CARE SYSTEMS TO SEE PATIENTS LOCALLY AND TO PERFORM OUTPATIENT PROCEDURES LOCALLY. MOST OF OUR POPULATION IS ELDERLY AND ARE UNABLE TO DRIVE GREAT DISTANCES SO THEY ARE ABLE TO RECEIVE CARE FROM SPECIALISTS LOCALLY. WE STRIVE TO PROVIDE HIGH-QUALITY, PATIENT-CENTERED CARE CLOSE TO HOME FOR THE COMMUNITIES WE SERVE. WE CONTINUE TO UPGRADE FACILITIES AND TECHNOLOGY TO ENSURE PATIENTS IN RURAL COMMUNITIES HAVE NEARBY ACCESS TO THESE SERVICES. PART VI, LINE 6: RIDGEVIEW MEDICAL CENTER IS A 109-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE: RIDGEVIEW CLINICS PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA. SIBLEY MEDICAL CENTER (DBA: RIDGEVIEW SIBLEY MEDICAL CENTER) IS A CRITICAL ACCESS HOSPITAL PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY MEDICAL CENTER ALSO HAS CLINICAL LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON AND WINTHROP.MINNESOTA VALLEY HEALTH CENTER (DBA: RIDGEVIEW LE SUEUR MEDICAL CENTER) OPERATES A 15-BED ACCUTE CARE HOSPITAL, A 55-BED NURSING HOME, AND A 37-UNIT HUD APARTMENT BUILDING FOR THE ELDERLY.CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST.MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST. WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS. RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS. RIDGEVIEW COMMUNITY NETWORK OPERATES AN ACCOUNTABLE CARE ORGANIZATION. RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW FOUNDATION OPERATES FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 1 0 0 0 0 0 0 0 GORDON GABLENZ CFO 0 305950 0 45814 0 0 0 24113 0 59955 0 435832 0 0 PAMELA WILLIAMS VICE PRESIDENT 0 124695 0 0 0 0 0 5234 0 34949 0 164878 0 0 MICHAEL PHELPS CEO 0 488825 0 75194 0 0 0 11000 0 65156 0 640175 0 0 PART I, LINE 3 THE CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICIAL CENTER TO DETERMINE THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYEMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) PART I, LINE 4B MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2018, $0 WAS CONTRIBUTED TO THE PLAN, $26,930 WAS ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2018, $0 WAS CONTRIBUTED TO THE PLAN, $16,003 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY RIDGEVIEW MEDICAL CENTER FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE FILING ORGANIZATION'S BOARD SHALL CONSIST TWO PERSONS APPOINTED BY THE SOLE MEMBER. OTHER MEMBERS OF THE FILING ORGANIZATION'S BOARD ARE SELECTED BY A NOMINATING COMMITTEE AND MUST BE APPROVED BY THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS PROVIDE THE SOLE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES & BYLAWS AND GENERAL OPERATION DECISIONS. FORM 990, PART VI, SECTION A, LINE 8B FILING ORGANIZATION HAS NO EXECUTIVE COMMITTEE OR SIMILAR COMMITTEE WITH BOARD DELEGATED AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE CEO & CFO ARE PAID BY RIDGEVIEW MEDICAL CENTER, THE SOLE CORPORATE MEMBER, WHICH PERFORMS THE REVIEW AND APPROVAL OF THE COMPENSATION FOR THE CEO AND CFO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFILICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION -72,562. FORM 990, PART XII, LINE 2C THE PROCESS REGARDING OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. MINNESOTA VALLEY MEMORIAL HOSPITAL FOUNDATION 621 SOUTH FOURTH STREET LE SUEUR MN 56058 411754182 RAISING FUNDS FOR MINNESOTA VALLEY HEALTH CENTER, INC. MN 501(C)(3) LINE 12A, I N/A 0 RIDGEVIEW MEDICAL CENTER 500 S MAPLE ST WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 RIDGEVIEW FOUNDATION 500 S MAPLE ST WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW CLINICS 500 S MAPLE ST WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW INSURANCE CO 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 SIBLEY MEDICAL CENTER 601 W CHANDLER ST ARLINGTON MN 55307 411801967 CRITICAL ACCESS HOSPITAL MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC 500 S MAPLE ST WACONIA MN 55387 205785920 CARDIOLOGY MN N/A CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A EXECUTIVE HEALTH MANAGEMENT SERVICES 500 SOUTH MAPLE ST WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0