2019-11-15T08:21:50-06:00 2018-12-31 450310328 BRADY MARTZ AND ASSOCIATES PC PO BOX 14296 GRAND FORKS ND 582084296 990 2018-01-01 450310462 ALTRU HEALTH SYSTEM ALTR 7017805200 1200 S COLUMBIA RD GRAND FORKS ND 582014036 SARA LUSIGNAN CFO 7017805200 2019-11-14 1 NICOLE HELDSTAB P01220683 7017754685 2019-11-14 24.111.23.187 2019-11-14 14:10:01 CS P B9303B9D082645F0E9C5F4109FC0868A6B9608B2 6C39C89A0B916563EEFC9C4D81EC75D1023FE21F 2018 2020-03-31 21:24:44Z ALTRU HOSPITAL SARA LUSIGNAN 1200 S COLUMBIA RD GRAND FORKS ND 582014036 599973053 0 X ALTRU.ORG X 1970 ND HEALTHCARE DELIVERY 11 6 4638 310 4044693 1491440 2878464 6701741 555999359 570773013 4914964 7968361 155431 153570 563948218 585596685 1062049 1159546 0 0 338818207 338123032 0 0 0 225285087 246874130 565165343 586156708 -1217125 -560023 548207089 543017154 282364561 290423688 265842528 252593466 X IMPROVING HEALTH, ENRICHING LIFE.WHY WE SERVE: TO ACHIEVE OPTIMUM HEALTH FOR ALL RESIDENTS IN OUR REGION.HOW WE SERVE: BY PROVIDING HEALTH EDUCATION, PREVENTIVE SERVICES, EARLY INTERVENTION, AND APPROPRIATE CARE.WHOM WE SERVE: THE MORE THAN 200,000 RESIDENTS OF NORTHEAST NORTH DAKOTA AND NORTHWEST MINNESOTA.WHO WE ARE: A COMMUNITY OF OVER 4,000 HEALTH PROFESSIONALS AND SUPPORT STAFF COMMITTED TO SERVING THE REGION FOR MORE THAN 100 YEARS. 0 0 25338039 29295315 ONCOLOGY - ALTRU'S TEAM OF ONCOLOGISTS PROVIDE INPATIENT AND OUTPATIENT CANCER TREATMENT SERVICES TO PATIENTS WITHIN OUR SERVICE REGION AND ALSO PROVIDE OUTREACH CLINIC SERVICES TO COMMUNITIES THROUGHOUT OUR SERVICE AREA. IN 2018, THERE WERE 661 HOSPITAL DISCHARGES. 9424358 28980335 CARDIOLOGY - ALTRU OFFERS COMPREHENSIVE SERVICES INCLUDING INTERVENTIONAL AND MEDICAL CARDIOLOGY. ADDITIONAL SERVICES INCLUDE ECHOCARDIOGRAPHY, CARDIAC STRESS TESTS, AND CARDIAC REHAB. ALTRU HAS BEEN RECOGNIZED THREE TIMES AS A "100 TOP HOSPITALS" FOR CARDIOVASCULAR CARE. OUR CARDIOLOGY TEAM ALSO PROVIDES OUTREACH CLINIC SERVICES TO COMMUNITIES THROUGHOUT OUR SERVICE AREA. IN 2018, THERE WERE 1,055 HOSPITAL DISCHARGES. 27945610 58099432 GENERAL SURGERY - ALTRU'S TEAM OF GENERAL SURGEONS PERFORM INPATIENT AND OUTPATIENT SURGERY AND SEE PATIENTS AT ALTRU HOSPITAL, ALTRU MAIN CLINIC, AND SOME OF ALTRU'S REGIONAL CLINICS. IN 2018, THERE WERE 704 GENERAL SURGERY HOSPITAL DISCHARGES. 450540426 1159546 449792171 OTHER PROGRAM SERVICES INCLUDE OTHER PATIENT CARE PROGRAMS. 450540426 1159546 449792171 513248433 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 107 0 4638 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 7017805203 1200 SOUTH COLUMBIA ROAD GRAND FORKS ND 58201 KRIS COMPTON BOARD CHAIR 1.00 X X 0 0 0 LONNIE LAFFEN VICE CHAIR 1.00 X X 0 0 0 PHILIP GISI SECRETARY 1.00 X X 0 0 0 ALICE BREKKE BOARD MEMBER 1.00 X 0 0 0 KRISTI HALL-JIRAN BOARD MEMBER 1.00 X 0 0 0 KEITH OKESON BOARD MEMBER 1.00 X 0 0 0 MATTHEW ROLLER MD BOARD MEMBER/PHYSICIAN 40.00 X 576056 0 45008 BRADLEY BELLUK MD BOARD MEMBER/PHYSICIAN 40.00 X 603925 0 44358 ERIC LUNN MD BOARD MEMBER/PRESIDENT/PHY 40.00 X X 580193 0 28054 DAVID MOLMEN BOARD MEMBER/CEO 40.00 X X 732811 0 51657 BRADLEY WEHE BOARD MEMBER/COO 40.00 X X 516271 0 45565 DWIGHT THOMPSON CFO/TREASURER 40.00 X 820051 0 33990 JOSHUA DEERE MEDICAL DIRECTOR 40.00 X 451297 0 42559 KELLEE FISK CHIEF PEOPLE OFFICER 40.00 X 404915 0 41059 YVONNE GOMEZ MEDICAL DIRECTOR 40.00 X 449194 0 58126 WILLIAM MCKINNON MD MEDICAL DIRECTOR 40.00 X 366581 0 74636 DENNIS REISNOUR CHIEF STRATEGY OFFICER 40.00 X 296662 0 33899 HEATHER STRANDELL ADMINISTRATIVE DIRECTOR 40.00 X 269546 0 17698 COLLEEN SWANK MD CHIEF MEDICAL OFFICER 40.00 X 571880 0 5433 MARK WAIND CHIEF INFORMATION OFFICER 40.00 X 375329 0 37809 JILL WILSON ADMIN DIRECTOR 40.00 X 247443 0 43792 RABEEA ABOUFAKHER MEDICAL DIRECTOR 40.00 X 1156693 0 42620 JEREMY GARDNER MEDICAL DIRECTOR 40.00 X 770635 0 79328 STEVEN WEISER MEDICAL DIRECTOR 40.00 X 534849 0 72983 JANICE HAMSCHER CHIEF NURSE OFFICER 40.00 X 363443 0 33288 MEGHAN COMPTON CHIEF LEGAL COUNSEL 40.00 X 295337 0 54016 JENNIFER NUELLE-DIMOULAS ADMIN DIRECTOR 40.00 X 186651 0 21719 JONATHAN HAUG MEDICAL DIRECTOR 40.00 X 587135 0 48772 BARRY BJORGAARD PHYSICIAN 40.00 X 1121832 0 43358 IKECHUKWU ONYEKA PHYSICIAN 40.00 X 1328471 0 45241 ADAM NICHOLSON PHYSICIAN 40.00 X 1001695 0 46197 GRANT SEEGER PHYSICIAN 40.00 X 983195 0 51447 SUNIL KARTHAM PHYSICIAN 40.00 X 957220 0 49447 KENNETH VEIN FORMER KEY EMPLOYEE 40.00 X 358000 0 2700 16907310 0 1194759 440 1 1 0 MEDEFIS CONSOLIDATED 2121 N 117TH AVE STE 200 OMAHA NE 68164 SERVICES 11043118 COMPHEALTH MEDICAL STAFFING PO BOX 713100 SALT LAKE CITY UT 841713100 SERVICES 6984179 WEATHERBY LOCUMS INC PO BOX 75397 DALLAS TX 753972633 SERVICES 3053276 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 SERVICES 2802281 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 532880314 SERVICES 2494568 86 1614599 1758743 3328399 3269467 6701741 NET SERVICE TO PATIENTS 621110 534879267 530988144 3891123 PROGRAM SERVICE REVENUE 621110 35872638 35179109 693529 BIOMED SERVICES/SITE SERVICES FEE 900099 21108 21108 570773013 7143347 7143347 15201382 14311092 65276 890290 -65276 825014 825014 RENTAL OFFICE SPACE/PARKING LOT 531120 146279 146279 TELECOMMUNICATIONS 517000 5642 5642 SNOW REMOVAL 812900 1649 1649 153570 585596685 566167253 4044693 8682998 1142948 1142948 16598 16598 12113267 5103583 7009684 262744973 238578573 24166400 17120617 15567291 1553326 29429163 26759103 2670060 16715012 14845300 1869712 578347 578347 3187437 3187437 5701751 1766475 3935276 7665782 7665782 26517196 26517196 2333026 2333026 SUPPLIES 102242191 99008504 3233687 UNRELATED BUSINESS TAX 447703 447703 PURCHASED SERVICES 42537055 25623527 16913528 FEES 31034965 27690277 3344688 24628677 16416763 8211914 586156708 513248433 72908275 0 13120 1182824 32548213 33347813 74258859 71372757 438170 469416 7485482 8385316 356779 583558 573416984 351871959 198545852 221545025 160151970 152003774 20765106 24243096 53643538 29883575 548207089 543017154 44914358 55351066 591481 1349246 215620975 209011862 21237747 24711514 282364561 290423688 X 265842528 252593466 265842528 252593466 548207089 543017154 X -560023 -11786637 -350997 -551405 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9118416 9118416 268489195 144642471 123846724 11967049 7599219 4367830 243711930 199630269 44081661 40130394 40130394 221545025 ASSETS HELD BY TRUSTEE 945822 UNAMORTIZED BOND ISSUE AND OTHER COSTS 7375171 ASSETS HELD UNDER TRUST AGREEMENTS 15973839 DUE FROM AFFILIATES 279028 OTHER ASSETS 5309715 29883575 DUE TO AFFILIATES 77541 POST RETIREMENT HEALTH BENEFIT 7020952 OTHER 15006305 ESTIMATED THIRD PARTY LIABILITY 2000000 SPECIAL ASSESSMENTS PAYABLE 606716 24711514 X PART X, LINE 2: ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES THE ORGANIZATION'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE ORGANIZATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURNS OF THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY INTERNAL REVENUE SERVICE GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. ALL FILINGS ARE CURRENT. 1 1 X 1 X 1 X 1 1 1 0 1 1 4540575 4540575 0.00770 20956838 20956838 0.03580 614477 614477 0.00100 26111890 26111890 0.04450 1064272 1064272 0.00180 638284 638284 0.00110 36626 36626 0.00010 203150 203150 0.00030 1942332 1942332 0.00330 28054222 28054222 0.04780 1 7754284 0 135714491 400151042 -264436551 X 1 1 3 1 ALTRU HOSPITAL 1200 S COLUMBIA RD GRAND FORKS ND 582066002 X X X A 2 ALTRU REHABILITATION CENTER 1300 S COLUMBIA RD GRAND FORKS ND 582066002 X A 3 ALTRU SPECIALTY CENTER 4500 S WASHINGTON ST GRAND FORKS ND 58201 X X A ALTRU HOSPITAL 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.ALTRU.ORG 1 17 1 WWW.ALTRU.ORG 0 1 X 150.000000000000 250.000000000000 X X X X X X 1 1 X X X 1 X WWW.ALTRU.ORG X WWW.ALTRU.ORG X WWW.ALTRU.ORG X X X X 1 X X 1 X X X X X 1 X 0 1 55 1 - ALTRU CANCER CENTER 960 S COLUMBIA RD GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 2 - TRUYU AESTHETIC CENTER 3165 DEMERS AVE GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 3 - ALTRU FAMILY MEDICINE CENTER 1380 S COLUMBIA RD GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 4 - ALTRU FAMILY MEDICINE RESIDENCY 725 HAMLINE STREET GRAND FORKS ND 58203 OUTPATIENT CLINIC 5 - ALTRU FAMILY MEDICINE RESIDENCY PHARMACY 725 HAMLINE STREET GRAND FORKS ND 58203 OUTPATIENT PHARMACY 6 - ALTRU CLINIC - DRAYTON 1003 N MAIN DRAYTON ND 582254650 OUTPATIENT CLINIC/THERAPY 7 - ALTRU PSYCHIATRY CENTER 860 S COLUMBIA RD GRAND FORKS ND 582066002 OUTPATIENT DEPARTMENT - PSYCH SERVICES 8 - ALTRU OUTPATIENT CENTER 411 2ND ST NW EAST GRAND FORKS MN 56721 OUTPATIENT THERAPY 9 - ALTRU CLINIC - CAVALIER 201 E 3RD AVE S CAVALIER ND 582200040 OUTPATIENT CLINIC 10 - ALTRU CLINIC - DEVILS LAKE 1001 7TH STREET NE DEVILS LAKE ND 583012719 OUTPATIENT CLINIC 11 - ALTRU CLINIC - CROOKSTON 400 SOUTH MINNESOTA CROOKSTON MN 567160606 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 12 - ALTRU CLINIC - RED LAKE FALLS 312 INTERNATIONAL DRIVE RED LAKE FALLS MN 567504662 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 13 - ALTRU CLINIC - ERSKINE 23076 347TH ST SE ERSKINE MN 565354201 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 14 - ALTRU CLINIC - FERTILE MILL STREET MAIN FERTILE MN 565404215 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 15 - ALTRU CLINIC - ROSEAU 711 DELMORE DRIVE ROSEAU MN 567511534 OUTPATIENT CLINIC 16 - ALTRU CLINIC - WARROAD 412 MAIN AVE NE WARROAD MN 567632342 OUTPATIENT CLINIC 17 - ALTRU CLINIC - GREENBUSH 19120 200TH ST GREENBUSH MN 567269280 OUTPATIENT CLINIC 18 - UNITY MEDICAL CENTER 164 WEST 13TH STREET GRAFTON ND 58237 HOME HEALTH/HOSPICE 19 - FIRST CARE HEALTH CENTER PO BOX I PARK RIVER ND 58270 HOME HEALTH/HOSPICE/THERAPY 20 - NELSON COUNTY HEALTH SYSTEM BOX 367 MCVILLE ND 58254 HOME HEALTH/HOSPICE 21 - CO CAVALIER CLINIC 201 E 3RD AVE S CAVALIER ND 58220 HOME HEALTH/HOSPICE 22 - ALTRU HOME SVCS-NORTH VALLEY HOME HEALTH 109 S MINNESOTA ST WARREN MN 56762 HOME HEALTH/HOSPICE 23 - ANETA PARKVIEW HEALTH CENTER BOX 287 ANETA ND 58212 OUTREACH CLINIC 24 - CAVALIER COUNTY MEMORIAL 909 2ND ST LANGDON ND 58249 OUTREACH CLINIC 25 - CENTRAL BOILER 20502 160TH ST GREENBUSH MN 56726 OUTREACH CLINIC 26 - COOPERSTOWN MEDICAL CENTER 1200 ROBERTS ST COOPERSTOWN ND 58425 OUTREACH CLINIC 27 - DEVILS LAKE GOOD SAMARITAN 302 7TH AVE DEVILS LAKE ND 58301 OUTREACH CLINIC 28 - FIRST CARE HEALTH CENTER 115 VIVIAN ST PARK RIVER ND 58270 OUTREACH CLINIC 29 - FRIENDSHIP 554 W 12TH ST GRAFTON ND 58327 OUTREACH CLINIC 30 - 4TH CORP 120 11TH ST NEW ROCKFORD ND 58356 OUTREACH CLINIC 31 - GRIGGS COUNTY HOSPITAL 1200 ROBERTS AVE NE COOPERSTOWN ND 58425 OUTREACH CLINIC 32 - HATTON PRAIRIE VILLAGE 930 DAKOTA AVE HATTON ND 58240 OUTREACH CLINIC 33 - HEARTLAND CARE CENTER 620 14TH AVE NE DEVILS LAKE ND 58301 OUTREACH CLINIC 34 - KARLSTAD HEALTH CARE 304 WASHINGTON AVE W KARLSTAD MN 56732 OUTREACH CLINIC 35 - KITTSON MEMORIAL HEALTH CARE CENTER 1010 S BIRCH HALLOCK MN 56728 OUTREACH CLINIC 36 - KITTSON MEMORIAL CLINIC OF KARLSTAD 1ST AND ROOSEVELT KARLSTAD MN 56732 OUTREACH CLINIC 37 - LAKE REGION CORP 224 3TH ST NW DEVILS LAKE ND 583012908 OUTREACH CLINIC 38 - LAKOTA GOOD SAMARITAN 608 4TH AVE SW HWY 2 LAKOTA ND 583447500 OUTREACH CLINIC 39 - MAPLE MANOR CARE CENTER 1116 9TH AVE LANGDON ND 58249 OUTREACH CLINIC 40 - MCINTOSH MANOR NURSING HOME 600 RIVERSIDE AVE NE MCINTOSH MN 56556 OUTREACH CLINIC 41 - NELSON COUNTY CARE CENTER 108 E NYHUS AVE MCVILLE ND 58254 OUTREACH CLINIC 42 - NELSON COUNTY HEALTH SYSTEM 200 NORTH MAIN MCVILLE ND 58254 OUTREACH CLINIC 43 - NORTHWOOD DEACONESS 4 N PART ST NORTHWOOD ND 58267 OUTREACH CLINIC 44 - OAKLAND PARK COMMUNITIES INC 123 BAKEN STREET THIEF RIVER FALLS MN 56701 OUTREACH CLINIC 45 - PEMBILIER NURSING CENTER 500 DELANO AVE WALHALLA ND 58282 OUTREACH CLINIC 46 - PEMBINA COUNTY MEMORIAL HOSPITAL 301 MOUNTAIN STREET E CAVALIER ND 58220 OUTREACH CLINIC 47 - PIONEER MEMORIAL CARE CENTER 23028 347TH ST SE ERSKINE MN 565359466 OUTREACH CLINIC 48 - REM-GRAFTON 817 HILL AVE GRAFTON ND 58327 OUTREACH CLINIC 49 - VALLEY 4000 4004 24TH AVE SOUTH GRAND FORKS ND 58201 OUTREACH CLINIC 50 - VALLEY MEMORIAL HOMES 2900 14TH AVE SOUTH GRAND FORKS ND 58201 OUTREACH CLINIC 51 - WEDGEWOOD MANOR 804 MAIN STREET WEST CAVALIER ND 58220 OUTREACH CLINIC 52 - CENTER FOR PREVENTION & GENETICS 4401 S 11TH ST GRAND FORKS ND 58201 OUTREACH CLINIC 53 - ALTRU CLINIC - EAST GRAND FORKS 607 DEMERS AVE EAST GRAND FORKS MN 56721 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC 54 - ALTRU PROFESSIONAL CENTER 4440 S WASHINGTON ST GRAND FORKS ND 58201 OUTPATIENT CLINIC 55 - ALTRU CLINIC - THIEF RIVER FALLS 1845 HWY 59 S STE 800 THIEF RIVER FALLS MN 56701 OUTPATIENT CLINIC PART I, LINE 6A: PREPARATION OF ANNUAL COMMUNITY BENEFIT REPORT: ALTRU HEALTH SYSTEM PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT BASED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION. ONCE ALL REPORTING FORMS HAVE BEEN COMPILED FOR THE YEAR, THE CATHOLIC HEALTH ORGANIZATION'S REFERENCE GUIDE FROM "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT" IS USED TO DETERMINE WHAT ITEMS SHOULD BE REPORTED INTO WHAT CATEGORY. THE COMMUNITY BENEFIT REPORT IS PUBLISHED AS A PART OF THE CORPORATION'S ANNUAL REPORT, WHICH IS PLACED ON OUR WEB SITE FOR PUBLIC ACCESS. PART I, LINE 7: COLUMN (F) - PERCENT OF TOTAL EXPENSES: IN DETERMINING THE DENOMINATOR FOR THE PERCENT OF TOTAL EXPENSE CALCULATION, THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WAS REDUCED BY BAD DEBTS EXPENSE OF $7,754,284CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE METHODOLOGY USED TO DETERMINE THE REPORTED AMOUNTS FOR THE CHARITY CARE IS A COST-TO-CHARGE RATIO BASED ON GROSS CHARGES WRITTEN OFF PURSUANT TO OUR CHARITY CARE AND MEANS-TESTED PROGRAMS ELIGIBILITY CRITERIA. OTHER COMMUNITY BENEFIT IS DETERMINED FROM INFORMATION THAT WAS COMPILED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION AND USING THEIR REFERENCE GUIDE, "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT," TO DETERMINE WHICH CATEGORY THE AMOUNTS ARE PROPERLY REPORTED UNDER. PART II, COMMUNITY BUILDING ACTIVITIES: NONE DOCUMENTED ON FORM 990. PART III, LINE 4: FOOTNOTE DISCLOSURE REGARDING BAD DEBTS EXPENSE: NOTE 1 ON PAGE 9, 14 ON PAGE 32 AND 16 ON PAGE 33 TO THE AUDITED FINANCIAL STATEMENTS REPORT ON BAD DEBT EXPENSE. PART III, LINE 8: NONE OF THE SHORTFALL SHOWN ON PART III, LINE 7 OF $264,436,551 HAS BEEN TREATED AS COMMUNITY BENEFIT AS REPORTED ON SCHEDULE H. THE SOURCE OF THE AMOUNT SHOWN ON PART III, LINE 6 COMES FROM THE MEDICARE ALLOWABLE COSTS REPORTED IN ALTRU'S MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR ENDING DECEMBER 31, 2018, UTILIZING THE FOLLOWING WORKSHEETS: WORKSHEETS B PART I, H-7 PARTS 1&2, I-4, AND K-6. PART III, LINE 9B: PROVISION FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE FOUND IN ALTRU'S POLICIES 2611 "DEDUCTIONS FROM REVENUES AND 2614 "CHARITY CARE." ALTRU'S COMMUNITY CARE PROGRAM IS DESIGNED TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO HAVE NO INSURANCE AND/OR LIMITED MEANS TO PAY FOR THEIR MEDICAL SERVICES AND DO NOT QUALIFY FOR OTHER PROGRAMS. IN ADDITION TO QUALITY HEALTHCARE, PATIENTS OF ALTRU HEALTH SYSTEM ARE PROVIDED FINANCIAL COUNSELING REGARDING THEIR MEDICAL BILLS, BY SOMEONE WHO CAN UNDERSTAND AND OFFER POSSIBLE SOLUTIONS FOR THOSE WHO CANNOT PAY IN FULL. PROGRAMS ARE ALSO AVAILABLE FOR UNINSURED PATIENTS, AND FOR THOSE FOUND TO BE IN MEDICAL HARDSHIP. PART VI, LINE 2: NEEDS ASSESSMENT: ALTRU HEALTH SYSTEM'S MISSION - IMPROVING HEALTH, ENRICHING LIFE - CONFIRMS THAT OUR RESPONSIBILITY TO THE REGION GOES BEYOND PROVIDING QUALITY HEALTHCARE SERVICES. ALL OF OUR RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. AT ALTRU, GOOD HEALTH MEANS THAT EVERY INDIVIDUAL SHOULD ENJOY THE BEST ACHIEVABLE AND SO SHOULD OUR COMMUNITIES. ALTRU'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS APPROVED BY THE BOARD OF DIRECTORS ON SEPTEMBER 26, 2016. AS A RESULT OF THE ASSESSMENT, ALTRU PRIORITIZED AND IS FOCUSING ON THE FOLLOWING FIVE ISSUES: 1) ACCESS TO BEHAVIORAL HEALTH SERVICES, INCLUDING ADDICTION TREATMENT AND COUNSELING; 2) PRESCRIPTION AND ILLEGAL DRUG ABUSE; 3) RATE OF OBESITY; 4) BINGE DRINKING/EXCESSIVE DRINKING; AND 5) CARE COORDINATION AND ACCESS TO HEALTH CARE. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:ALTRU HAS SEVERAL AVENUES IN WHICH INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS COMMUNICATED TO PATIENTS. UNINSURED AND SELF-PAY PATIENTS IN THE HOSPITAL RECEIVE A VISIT FROM PATIENT REPRESENTATIVES AFTER INTAKE. DURING THIS MEETING, THEY ARE INFORMED OF VARIOUS FEDERAL, STATE AND COMMUNITY-BASED PROGRAMS THAT MAY PROVIDE ASSISTANCE. UNINSURED OR SELF-PAY PATIENTS FROM OUTPATIENTS RECEIVE CONTACT FROM PATIENT REPRESENTATIVES BY PHONE OR EMAIL INFORMING THEM OF POTENTIAL SOURCES OF FINANCIAL ASSISTANCE. BOTH SETS OF PATIENTS ARE ALSO PROVIDED INFORMATION ON HOW TO MOVE FORWARD IN APPLYING FOR THE PROGRAMS. IF PATIENTS ARE FOUND TO BE STRUGGLING WITH MEDICAL EXPENSES, OUR CREDIT AND COLLECTIONS REPRESENTATIVES UTILIZE LETTERS AND PHONE CALLS TO INFORM THEM OF VARIOUS RESOURCES THAT MAY PROVIDE ASSISTANCE.FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE TO THE PUBLIC AS A WHOLE. ALTRU'S WEBSITE, ALTRU.ORG, INCLUDES FINANCIAL ASSISTANCE CONTACT INFORMATION AND ELIGIBILITY GUIDELINES. PATIENTS MAY REVIEW THIS ON THEIR OWN AND CONTACT AGENCIES THAT MAY PROVIDE ASSISTANCE BASED ON THEIR CIRCUMSTANCES. ALSO, ALTRU DISTRIBUTES BROCHURES FEATURING OUR COMMUNITY CARE PROGRAM AND OTHER FEDERAL AND STATE PROGRAMS. THESE BROCHURES ARE AVAILABLE TO BOTH PATIENTS AND VISITORS IN WAITING ROOMS OF OUR INPATIENT AND OUTPATIENT FACILITIES AS WELL AS IN ALL BUSINESS OFFICE LOCATIONS. PART VI, LINE 4: COMMUNITY INFORMATION:ALTRU HEALTH SYSTEM SERVES A 17-COUNTY AREA THAT IS DIVIDED INTO THREE DISTINCT SERVICE AREAS (PRIMARY, SECONDARY, AND REFERRAL) AND HAS A POPULATION OF APPROXIMATELY 224,000 PERSONS (2018 ESTIMATE) WHO RESIDE IN A DIVERSE AREA OF AGRICULTURE AND INDUSTRY. THE SERVICE AREA STRETCHES 265 MILES EAST AND WEST AND 120 MILES NORTH AND SOUTH. GRAND FORKS SITS IN THE MIDDLE OF THE RED RIVER VALLEY, ONE OF THE WORLD'S RICHEST AGRICULTURAL AREAS. PRINCIPAL CROPS INCLUDE SUGAR BEETS, POTATOES, EDIBLE BEANS, AND SMALL GRAINS SUCH AS WHEAT AND BARLEY. MUCH OF THE INDUSTRY IN THE AREA IS RELATED TO AGRICULTURE AND FOOD PROCESSING.THE PRIMARY SERVICE AREA, COMPRISED OF GRAND FORKS COUNTY (NORTH DAKOTA) AND POLK COUNTY (MINNESOTA), IS HOME TO 110,223 PEOPLE (2018 ESTIMATE). LOCATED IN THIS MARKET ARE ALTRU HOSPITAL, ALTRU REHABILITATION CENTER, ALTRU CANCER CENTER, AND 13 OTHER LOCATIONS THAT ARE HOME TO OUR PROVIDERS' CLINIC PRACTICES AND OTHER SERVICES OFFERED BY ALTRU. ALTRU HOSPITAL SERVES AS THE MAJOR REFERRAL CENTER FOR THE PEOPLE OF THE REGION. AS SUCH, IT PROVIDES A BROAD SPECTRUM OF PROGRAMS AND SERVICES. A FULL RANGE OF SERVICES ARE AVAILABLE FOR PATIENTS SUFFERING FROM CANCER, HEART DISEASE, END-STAGE RENAL DISEASE, NEUROLOGICAL DISORDERS, ALCOHOL OR CHEMICAL DEPENDENCY, HIGH RISK OBSTETRICAL COMPLICATIONS, AND PSYCHIATRIC DISORDERS. ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN 2018 FOR OUR PRIMARY MARKET WAS 63 PERCENT BASED ON CLAIMS DATA FROM THE MINNESOTA HOSPITAL ASSOCIATION (MHA). ABOUT 80 PERCENT OF THE PHYSICIANS IN THE PRIMARY AREA ARE EMPLOYED BY ALTRU HEALTH SYSTEM. ALSO LOCATED IN GRAND FORKS COUNTY IS NORTHWOOD COMMUNITY HEALTH CENTER (IN NORTHWOOD, ND). A COUPLE NOTABLE POPULATIONS ALTRU SERVES THAT ARE LOCATED IN OUR PRIMARY SERVICE AREA INCLUDE THE UNIVERSITY OF NORTH DAKOTA AND GRAND FORKS AIR FORCE BASE. THE UNIVERSITY OF NORTH DAKOTA IS THE STATE'S OLDEST INSTITUTION OF HIGHER LEARNING WITH AN ENROLLMENT OF ABOUT 14,406 STUDENTS (FALL 2018). THE NUMBER OF RESIDENTS AT GRAND FORKS AIR FORCE BASE WAS COUNTED AT 2,367 IN THE 2010 CENSUS.WITH A POPULATION OF 35,930 (2018 ESTIMATE), THE SECONDARY SERVICE AREA IS COMPRISED OF FIVE COUNTIES TO THE WEST, NORTH, AND EAST OF GRAND FORKS COUNTY: NELSON, WALSH, AND PEMBINA COUNTIES IN NORTH DAKOTA, AND MARSHALL AND KITTSON COUNTIES IN MINNESOTA; THIS AREA IS LARGELY RURAL AND AGRICULTURAL. WITHIN THIS AREA, ALTRU HAS FIVE REGIONAL CLINIC LOCATIONS; IT IS ALSO HOME TO SEVERAL SMALL HOSPITALS AS LISTED BELOW.SECONDARY SERVICE AREA HOSPITALS: LOCATIONUNITY MEDICAL CENTER: GRAFTON, NDFIRST CARE HEALTH CENTER: PARK RIVER, NDPEMBINA COUNTY MEMORIAL HOSPITAL: CAVALIER, NDNELSON COUNTY HEALTH SYSTEM: MCVILLE, NDKITTSON MEMORIAL HOSPITAL: HALLOCK, MNNORTH VALLEY HEALTH CENTER: WARREN, MNIN 2018, ALTRU'S HOSPITAL INPATIENT MARKET SHARE IN THIS SERVICE AREA WAS AROUND 43 PERCENT ACCORDING TO CLAIMS PROVIDED BY MHA. THE SYSTEM EMPLOYS MANY OF THE PHYSICIANS IN THE SECONDARY SERVICE AREA. ALL OF THESE PHYSICIANS ARE ON MEDICAL STAFFS OF COMMUNITY HOSPITALS THROUGHOUT THE REGION, AND REFER PATIENTS TO GRAND FORKS AND ELSEWHERE FOR SPECIALTY CARE.THE SYSTEM'S REFERRAL AREA IS COMPRISED OF TEN COUNTIES ENCIRCLING THE PRIMARY AND SECONDARY SERVICE AREAS (ROLETTE, TOWNER, BENSON, RAMSEY, CAVALIER, AND TRAILL COUNTIES IN NORTH DAKOTA AND ROSEAU, LAKE OF THE WOODS, PENNINGTON, AND RED LAKE COUNTIES IN MINNESOTA.) THIS REGION IS ALSO MOSTLY RURAL AND AGRICULTURAL AND INCLUDES SEVERAL SMALLER HOSPITALS AS LISTED SERVING THE PRIMARY CARE NEEDS OF THEIR COMMUNITIES. ALTRU HAS SIX REGIONAL CLINICS IN THIS SERVICE AREA AND ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN THIS REGION IS ABOUT 32 PERCENT ACCORDING TO 2018 CLAIMS DATA PROVIDED BY MHA. ALTRU, ONCE AGAIN, EMPLOYS MANY OF THE PHYSICIANS IN THIS AREA, AND THESE PHYSICIANS HAVE PRACTICE PATTERNS SIMILAR TO THOSE OF THE PHYSICIANS IN OUR SECONDARY SERVICE AREA.REFERRAL SERVICE AREA HOSPITALS: LOCATIONCAVALIER COUNTY MEMORIAL HOSPITAL: LANGDON, NDHILLSBORO MEDICAL CENTER: HILLSBORO, NDLAKEWOOD HEALTH CENTER: BAUDETTE, MNMERCY HOSPITAL: DEVILS LAKE, NDSANFORD-THIEF RIVER FALLS MEDICAL CENTER: THIEF RIVER FALLS, MNPRESENTATION MEDICAL CENTER: ROLLA, NDTOWNER COUNTY MEDICAL CENTER: CANDO, NDSANFORD MAYVILLE MEDICAL CENTER: MAYVILLE, NDLIFECARE MEDICAL CENTER: ROSEAU, MNQUENTIN N. BURDICK MEMORIAL HOSPITAL: BELCOURT, NDAS PREVIOUSLY MENTIONED, ALTRU'S 17-COUNTY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 224,000 (2018 ESTIMATE). USING DATA FROM OPTUM(A VENDOR SPECIALIZING IN HEALTH CARE PLANNING INFORMATION), THE INSURANCE COVERAGE FOR COMMUNITIES IN OUR SERVICE AREA IS ESTIMATED TO BE AS FOLLOWS: 2018 PROJECTIONS COVERED LIVES AS A PERCENTMEDICARE 33,700 26.3%COMMERCIAL 94,300 73.7%TOTAL LIVES 128,000 100%ALSO FROM OPTUM, OUR TOTAL SERVICE AREA'S INCOME BY HOUSEHOLD IS AS FOLLOWS:INCOME RANGE 2018 PERCENTAGES$ < $ 9,999 3.7% $ 10,000 - $ 14,999 5.0%$ 15,000 - $ 19,999 5.0%$ 20,000 - $ 24,999 5.2%$ 25,000 - $ 29,999 4.6%$ 30,000 - $ 39,999 4.5%$ 35,000 - $ 39,999 4.5%$ 40,000 - $ 44,999 5.5%$ 45,000 - $ 49,999 5.2%$ 50,000 - $ 59,999 9.5%$ 60,000 - $ 74,999 11.0%$ 75,000 - $ 99,999 14.0%$100,000 - $124,999 9.2%$125,000 - $149,999 4.8%$150,000 - $199,999 4.3%$ > $200,000 4.0%ACCORDING TO THE WEBSITE FOR HEALTH RESOURCES AND SERVICES ADMINISTRATION, THE FOLLOWING AREAS IN OUR SERVICE AREA ARE MUA'S:NORTH DAKOTA:BENSON COUNTY: BENSON SERVICE AREACAVALIER COUNTY: CAVALIER SERVICE AREAGRAND FORKS COUNTY: NORTHWOOD SERVICE AREA, GRAND FORKS SERVICE AREANELSON COUNTY: NELSON SERVICE AREAPEMBINA COUNTY: WALHALLA SERVICE AREAROLETTE COUNTY: ROLETTE SERVICE AREATOWNER COUNTY: CANDO CITY SERVICE AREATRAILL COUNTY: TRAILL SERVICE AREAWALSH COUNTY: PARK RIVER CITY SERVICE AREAMINNESOTA:KITTSON COUNTY: KITTSON SERVICE AREAMARSHALL COUNTY: MARSHALL SERVICE AREAPOLK COUNTY: POLK SERVICE AREARED LAKE COUNTY: RED LAKE SERVICE AREAROSEAU COUNTY: ROSEAU SERVICE AREA PART VI, LINE 5: ALL OF ALTRU'S RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. TO DO SO, WE KNOW THAT NOT ALL MEDICAL SERVICES WILL COME FROM STAFF EMPLOYED BY ALTRU HEALTH SYSTEM. ALTRU EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR NEARLY ALL DEPARTMENTS. ALSO, OUR BOARD OF DIRECTORS IS MADE UP OF INDIVIDUALS FROM OUTSIDE ALTRU HEALTH SYSTEM. THESE PEOPLE ARE VOLUNTEERS WHO HAVE THE SAME DEDICATION AND FOCUS ON ALTRU'S MISSION AS OUR OWN STAFF. PART VI, LINE 6: ALTRU HEALTH SYSTEM IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. IN SEPTEMBER 2011, ALTRU HEALTH SYSTEM BECAME THE FIRST MEMBER OF THE MAYO CLINIC CARE NETWORK. THIS IS A NON-OWNERSHIP RELATIONSHIP THAT BENFITS THE ORGANIZATION'S PHYSICIANS AND PATIENTS FROM ENHANCED ACCESS TO MAYO PHYSICIANS AND CLINICAL RESOURCES. MORE SPECIFICALLY, PHYSICIANS HAVE ACCESS TO MAYO CLINIC'S EVIDENCE-BASED DISEASE MANAGEMENT PROTOCOLS, CLINIC CARE GUIDELINES, AND TREATMENT RECOMMENDATIONS AND REFERENCE MATERIALS FOR COMPLEX MEDICAL CONDITIONS.PART VI, LINE 7: ALTRU HEALTH SYSTEM IS NOT REQUIRED TO FILE OUR COMMUNITY BENEFIT REPORT WITH ANY OUTSIDE ORGANIZATIONS BUT HAS MADE OUR REPORT AVAILABLE TO ANYONE ON OUR WEB SITE. 1 COMMUNITY VIOLENCE INTERVENTION CENTER 211 S 4TH ST STE 207 GRAND FORKS ND 58201 450359167 501(C)(3) 40000 2018 SUPPORT UNIVERSITY OF MINNESOTA FOUNDATION 200 OAK ST SE STE 500 MINNEAPOLIS MN 55455 416042488 501(C)(3) 20000 STUDENT SCHOLARSHIP FUND RE ARENA INC ONE RALPH ENGLESTAD DR GRAND FORKS ND 58203 113666663 501(C)(3) 108750 GAME DAY SPONSORSHIPS UND FOUNDATION 3100 UNIVERSITY AVE STOP 8157 GRAND FORKS ND 58202 450348296 501(C)(3) 458480 UND ATHLETICS HIGH PERFORMANCE CENTER; ALTRU TURF FUND GREATER GRAND FORKS YOUNG PROFESSIONALS 202 NORTH 3RD ST GRAND FORKS ND 58203 320134204 501(C)(6) 12000 GGFYP VISIONARY SPONSORSHIP GRAND FORKS PARK DISTRICT FOUNDATION 1060 47TH AVE S GRAND FORKS ND 58201 260625504 501(C)(3) 175500 WELLNESS CENTER PROJECT; LEGENDS & HEROES PLEDGE ALTRU FAMILY YMCA 215 N 7TH ST GRAND FORKS ND 58203 450226434 501(C)(3) 52000 YMCA PROJECT; FIRECRACKER ROAD RACE; CATALOG SPONSOR CITY OF EAST GRAND FORKS 600 DEMERS AVE NW EAST GRAND FORKS MN 56721 416005112 EAST GRAND FORKS, MN 45000 WELLNESS PROGRAM CITY OF GRAND FORKS 255 N 4TH ST GRAND FORKS ND 58203 456002085 GRAND FORKS, ND 50600 SOCIAL DETOX FACILITY GRAND FORKS DOWNTOWN DEVELOPMENT ASSOCIATION 23 N 3RD ST STE 2 GRAND FORKS ND 58203 464711617 501(C)(6) 32500 GREENWAY TAKEOVER FESTIVAL, VISIONARY PARTNERSHIP GRAND FORKS MARATHON INC PO BOX 14867 GRAND FORKS ND 58203 273739718 501(C)(3) 20000 PRESENTING SPONSOR UND GRANTS AND CONTRACT ADMIN TWAMLEY HALL 100 264 CENTENNIAL DR STOP 7306 GRAND FORKS ND 58202 456002491 501(C)(3) 25000 SIM-ND PROJECT NORTHLAND COMMUNITY AND TECHNICAL COLLEGE-EGF 1312 HARMON PLACE MINNEAPOLIS MN 55403 411687554 501(C)(3) 10000 STUDENT SCHOLARSHIP FUND MAYVILLE STATE UNIVERSITY FOUNDATION 330 3RD ST NE MAYVILLE ND 58257 456013477 501(C)(3) 8333 ARTIFICIAL TURF CHAMBER OF GRAND FORKS EAST GRAND FORKS 202 N 3RD ST GRAND FORKS ND 58203 202924979 501(C)(6) 10000 2018 SUPPORT 12 3 SCHOLARSHIPS 20 14700 SPONSORSHIPS 4 1898 PART I, LINE 2: UNIVERSITY OF MINNESOTA FOUNDATION - SCHOLARSHIPS ARE DIRECTED BY THE UNIVERSITY OF MINNESOTA FOUNDATION AS PART OF THE SCHOLARSHIP PROGRAM AND ALTRU DOES NOT DIRECTLY DESIGNATE SCHOLARSHIP RECIPIENTS. COMMUNITY VIOLENCE INTERVENTION CENTER - FUNDS WERE GRANTED WITH THE DIRECTION THAT CVIC WAS ABLE TO USE FUNDS AS NEEDED. CVIC DETERMINES THE RECIPIENTS OF THE ASSISTANCE PROVIDED THROUGH THOSE FUNDS. RE ARENA, INC. - ALTRU REVIEWS THE SPONSORSHIPS WITH RE ARENA/UNIVERSITY OF NORTH DAKOTA OFFICIALS PRIOR TO THE EVENTS AND HAS REPRESENTATIVES ATTEND THE EVENTS TO ACKNOWLEDGE THE PROPRIETY OF THE ANNOUNCEMENTS MADE REGARDING THE SPONSORSHIP OF THE DAY'S EVENT. UND FOUNDATION - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED TOWARDS THE UND ATHLECTICS HIGH PERFORMANCE CENTER AND THE ALTRU TURF FUND. GREATER GRAND FORKS YOUNG PROFESSIONALS - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. GRAND FORKS PARK DISTRICT FOUNDATION - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED TOWARDS THE WELLNESS CENTER FACILITY PROJECT. ALTRU FAMILY YMCA - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED TOWARDS THE YMCA PROJECT. CITY OF EAST GRAND FORKS - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. CITY OF GRAND FORKS - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED TOWARDS A SOCIAL DETOX FACILITY. GRAND FORKS DOWNTOWN DEVELOPMENT ASSOCIATION - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. GRAND FORKS REGIONAL ECONOMIC DEVELOPMENT CORPORATION - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. CHAMBER OF GRAND FORKS EAST GRAND FORKS - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. MAYVILLE STATE UNIVERSITY FOUNDATION - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED TOWARDS ARTIFICIAL TURF. NORTHLAND COMMUNITY AND TECHNICAL COLLEGE-EGF - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. UND GRANTS AND CONTRACT ADMIN - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. GRAND FORKS MARATHON - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED FOR A PRESENTING SPONSOR. X X X X X X 1 0 0 0 0 0 0 0 0 MATTHEW ROLLER MD BOARD MEMBER/PHYSICIAN 538516 0 0 0 37540 0 20500 0 26068 0 622624 0 0 0 BRADLEY BELLUK MD BOARD MEMBER/PHYSICIAN 559888 0 0 0 44037 0 20500 0 25338 0 649763 0 0 0 ERIC LUNN MD BOARD MEMBER/PRESIDENT/PHY 534129 0 0 0 46064 0 21137 0 10554 0 611884 0 0 0 DAVID MOLMEN BOARD MEMBER/CEO 597420 0 0 0 135391 0 21210 0 34084 0 788105 0 0 0 BRADLEY WEHE BOARD MEMBER/COO 421686 0 0 0 94585 0 20824 0 28350 0 565445 0 0 0 DWIGHT THOMPSON CFO/TREASURER 290382 0 113594 0 416075 0 20500 0 16192 0 856743 0 113594 0 JOSHUA DEERE MEDICAL DIRECTOR 405139 0 17151 0 29007 0 20551 0 23489 0 495337 0 17151 0 KELLEE FISK CHIEF PEOPLE OFFICER 327571 0 25000 0 52344 0 16789 0 27771 0 449475 0 0 0 YVONNE GOMEZ MEDICAL DIRECTOR 415121 0 7898 0 26175 0 51209 0 8342 0 508745 0 7898 0 WILLIAM MCKINNON MD MEDICAL DIRECTOR 300662 0 19864 0 46055 0 57086 0 18757 0 442424 0 19864 0 DENNIS REISNOUR CHIEF STRATEGY OFFICER 235229 0 16849 0 44584 0 16500 0 20551 0 333713 0 16849 0 HEATHER STRANDELL ADMINISTRATIVE DIRECTOR 235268 0 23698 0 10580 0 15048 0 5507 0 290101 0 132 0 COLLEEN SWANK MD CHIEF MEDICAL OFFICER 5667 0 0 0 566213 0 4421 0 1012 0 577313 0 0 0 MARK WAIND CHIEF INFORMATION OFFICER 293629 0 0 0 81700 0 20909 0 20353 0 416591 0 0 0 JILL WILSON ADMIN DIRECTOR 208891 0 22098 0 16454 0 27529 0 18925 0 293897 0 65 0 RABEEA ABOUFAKHER MEDICAL DIRECTOR 1137653 0 0 0 19040 0 20529 0 23651 0 1200873 0 0 0 JEREMY GARDNER MEDICAL DIRECTOR 749129 0 2466 0 19040 0 55237 0 25651 0 851523 0 2466 0 STEVEN WEISER MEDICAL DIRECTOR 504509 0 4598 0 25742 0 44936 0 29607 0 609392 0 4463 0 JANICE HAMSCHER CHIEF NURSE OFFICER 319612 0 0 0 43831 0 16888 0 19860 0 400191 0 0 0 MEGHAN COMPTON CHIEF LEGAL COUNSEL 255659 0 15021 0 24657 0 19702 0 37477 0 352516 0 15021 0 JENNIFER NUELLE-DIMOULAS ADMIN DIRECTOR 186270 0 0 0 381 0 8088 0 15817 0 210556 0 0 0 JONATHAN HAUG MEDICAL DIRECTOR 568095 0 0 0 19040 0 22825 0 27507 0 637467 0 0 0 BARRY BJORGAARD PHYSICIAN 1067226 0 11389 0 43217 0 20500 0 24418 0 1166750 0 0 0 IKECHUKWU ONYEKA PHYSICIAN 1284931 0 0 0 43540 0 20500 0 26301 0 1375272 0 0 0 ADAM NICHOLSON PHYSICIAN 939155 0 25000 0 37540 0 20500 0 27257 0 1049452 0 0 0 GRANT SEEGER PHYSICIAN 964155 0 0 0 19040 0 20500 0 32507 0 1036202 0 0 0 SUNIL KARTHAM PHYSICIAN 919680 0 0 0 37540 0 20500 0 30507 0 1008227 0 0 0 KENNETH VEIN FORMER KEY EMPLOYEE 0 0 0 0 358000 0 2700 0 0 0 360700 0 0 0 PART I, LINE 4A COLLEEN SWANK, $565,213 KENNETH VEIN, $358,000 DWIGHT THOMPSON, $312,000 A CITY OF GRAND FORKS 456002085 000000000 2011-08-02 23620000 REFUND BONDS ISSUED IN MAY 19, 1994 AND JUNE 17, 1997 0 0 0 B CITY OF GRAND FORKS 456002085 38546WCC2 2012-05-01 117025978 REFUND BONDS ISSUED IN 1997, AND 2010A/2010B; INFRASTRUCTURE, EQUIPMENT 0 0 0 C CITY OF GRAND FORKS 456002085 38546WCR9 2017-07-12 65233846 REFUND BONDS ISSUED IN 2005; FINANCE FACILITIES, INFRASTRUCTURE, EQUIPMENT 0 0 0 D CITY OF GRAND FORKS 456002085 000000000 2017-09-06 21720835 REFUND BONDS ISSUED IN 2007 0 0 0 A 16700000 23620001 132001 1 0 1 1 B 1495000 117026065 447684 83269 1295167 66185853 49461776 2012 1 0 1 1 C 1695000 65335308 381082 19519 24569957 708177 16073000 23964656 0 1 0 0 D 3507914 21720835 21638388 82447 1 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 0 1 1 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF GRAND FORKS DATE THE REBATE COMPUTATION WAS PERFORMED: 01/23/2017 SCHEDULE K, PART II, PROCEEDS, LINE 3: (A) TOTAL PROCEEDS OF ISSUE CONSIST OF SALES PROCEEDS OF $23,620,000 PLUS $1 OF INVESTMENT EARNINGS. (B) TOTAL PROCEEDS OF ISSUE CONSIST OF SALES PROCEEDS OF $117,025,978 PLUS $87 OF INVESTMENT EARNINGS. (C) TOTAL PROCEEDS OF ISSUE CONSIST OF SALES PROCEEDS OF $65,233,846 PLUS $101,462 OF INVESTMENT EARNINGS. X 1 3269467 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED ELECTRONICALLY FOR REVIEW BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY IS REVIEWED AND SIGNED OFF ANNUALLY BY ALL MEMBERS OF THE BOARD OF DIRECTORS. THESE FORMS ARE COLLECTED AND REVIEWED BY THE SECRETARY. FORM 990, PART VI, SECTION B, LINE 15 DETERMINATION OF THE COMPENSATION FOR THE PRESIDENT AND CEO ARE DETERMINED BY THE BOARD. SUBSTANTIATION OF THESE DISCUSSIONS APPEAR IN THE BOARD MINUTES. COMPENSATION OF KEY EMPLOYEES ARE DETERMINED BY A COMPENSATION COMMITTEE FORMED OF PHYSICIANS THAT REPORT TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATIONS 990 AND 990-T PUBLIC INSPECTION COPIES ARE AVAILABLE UPON REQUEST. FORM 1023 IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH PUBLISHED ANNUAL REPORTS AND VIA ITS WEB SITE. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: APPLICATION OF FASB ASC TOPIC 715 -551,405. 990, PAGE 1, HEADING ITEM C ALTRU REHAB CENTER, ALTRU CANCER CENTER, ALTRU FAMILY MEDICINE CENTER, ALTRU FAMILY MEDICINE RESIDENCY, TRUYU AESTHETIC CENTER, ALTRU CLINIC-LAKE REGION, ALTRU CLINIC-CAVALIER, ALTRU CLINIC-DRAYTON, ALTRU CLINIC-CROOKSTON, ALTRU CLINIC-RED LAKE FALLS, ALTRU CLINIC-FERTILE, ALTRU CLINIC-ERSKINE, ALTRU CLINIC-ROSEAU, ALTRU CLINIC-WARROAD, ALTRU CLINIC-GREENBUSH, ALTRU CLINIC-KARLSTAD FORM 990, PART VIII, LINE 2B & 2D EXCLUSION AMOUNT BIOMED SERVICES $13,848 SITE SERVICE FEES $7,260 SUBTOTAL $21,108 PHARMACY SALES TO EMPLOYEES $3,409 HOUSING/SPACE RENTALS $594,103 VENDING MACHINE INCOME $93,823 SALE OF SCRAP/OTHER $2,194 SUBTOTAL $693,529 TOTAL EXCLUSION AMOUNT $714,637 RELATED OR EXEMPT FUNCTION INCOME CEPT REVENUE $67,055 HEARING CENTER $1,120,953 OCCUPATIONAL HEALTH $541,816 VHA SUPPLY CO - DISTRIBUTION $1,306,113 PURCHASE DISCOUNTS $94,912 REBATES $283,323 CONTRACT SERVICES, OUTREACH, EDUCATION $5,910,598 MEDICAL RECORDS TRANSCRIPT FEES $179,185 AFFILIATED OTHER REVENUE $393,353 340B PHARMACY REVENUE $18,234,769 DL HOSPITALIST CONTRACT REVENUE $705,000 SPORTS ADVANTAGE $212,241 EPIC RELATED FEES- CRITICAL ACCESS $1,135,728 MISCELLANEOUS REVENUE $4,994,060 TOTAL RELATED/EXEMPT INCOME $35,179,109 FORM 990, PART VIII, LINE 2B & 2D 1. BIOMED SERVICES: REVENUE EARNED THROUGH THE PROVISION OF SERVICES TO AREA HEALTH CARE FACILITIES NEEDING TO KEEP THEIR EQUIPMENT IN OPERATION IN ORDER TO PROVIDE THEIR PATIENTS WITH THEIR SERVICE. THE BIOMED PROGRAM PROVIDES SMALL REGIONAL HOSPITALS WITH A SERVICE OTHERWISE UNOBTAINABLE FROM ANYONE IN THE LOCAL AREA; IT IS OFTEN ON A PRIORITY BASIS. 2. SITE SERVICE FEES: FEES CHARGED FOR PROVIDING GROUNDS AND MAINTENANCE FOR THE AREA SURROUNDING THE HOSPITAL, INCLUDING FEES FOR SUCH SERVICES AS MAINTENANCE OF HOSPITAL PARKING LOT, SNOW SHOVELING, AND SNOW REMOVAL. 3. PHARMACY SALES TO EMPLOYEES: REVENUE INCURRED IN SALES STRICTLY FOR THE CONVENIENCE OF EMPLOYEES. 4. HOUSING/SPACE RENTALS: INCOME INCURRED THROUGH THE RENTAL OF SPACE TO THE AREA HEALTH EDUCATION CENTER WHICH IS REQUIRED TO BE ON-SITE TO WORK WITH OUR PHYSICIANS PROVIDING HEALTH CARE TO PATIENTS. 5. VENDING MACHINE INCOME: INCOME EARNED THROUGH THE OPERATION OF VENDING MACHINES IN THE BUILDINGS. 6. SALE OF SCRAP: INCOME EARNED THROUGH THE SALE OF ITEMS THAT ARE NOT FIXED ASSETS AND ARE OF DIMINISHED USE TO THE ORGANIZATION. 7. CEPT REVENUE: REVENUE EARNED FROM THE EVALUATION AND TREATMENT OF ADOLESCENTS THROUGH A MULTI-DISCIPLINARY APPROACH INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, AND PSYCHOLOGY. 8. HEARING CENTER: REVENUE FROM THE PROVISION OF AUDIOLOGICAL SERVICES AND HEARING AIDS TO PATIENTS. 9. OCCUPATIONAL HEALTH: FEES FOR PROVIDING DRUG SCREENINGS FOR REGIONAL EMPLOYERS. 10. VHA SUPPLY DISTRIBUTION: REBATE RECEIVED BASED ON VOLUME OF SUPPLY PURCHASES. 11. PURCHASE DISCOUNTS: THIS FIGURE REPRESENTS COST SAVINGS ON PURCHASES FROM SUPPLIERS FOR GOODS USED IN THE PROVISION OF HEALTH CARE SERVICES. 12. REBATES: REBATES RECEIVED BASED ON VOLUME OF PHARMACY PURCHASES. 13. CONTRACT SERVICES, OUTREACH, EDUCATION: REVENUES EARNED IN THE PROVISION OF COMMUNITY EDUCATION/WELLNESS PROGRAMS, PASTORAL COUNSELING SERVICES, AND CONTRACTED SERVICES WITH REGIONAL HEALTHCARE SYSTEMS TO BRING OUTREACH SERVICES INTO THEIR COMMUNITIES. 14. MEDICAL RECORD TRANSCRIPTION FEES: INCOME EARNED THROUGH THE CHARGING OF VARIOUS THIRD PARTY PAYERS FOR THE PHOTOCOPYING OF PATIENT RECORDS. INSURANCE COMPANIES AND PAYERS ARE CHARGED TO OFFSET THE COST OF COPYING. 15. OTHER REVENUE CHARGED TO AFFILIATED CORPORATIONS: REVENUE FROM THE PROVISION OF PATIENT SERVICES, SUCH AS PSYCH OR LABORATORY, TO THE PATIENTS OF OTHER CORPORATIONS, WHICH ARE AFFILIATED TO ALTRU HEALTH SYSTEM. 16. 340B PHARMACY REVENUE: INCOME EARNED FROM AREA PHARMACIES USING THE 340(B) BUYING CONTRACT TO PURCHASE PHARMACEUTICALS AT DISCOUNTED RATES. 17. DL HOSPITALIST CONTRACT REVENUE: INCOME FROM ALTRU PHYSICIANS PROVIDING HOSPITALIST SERVICES AT MERCY HOSPITAL, DEVILS LAKE. 18. SPORTS ADVANTAGE: EXOS PROGRAM FEES; PERFORMANCE TRAINING PROVIDED TO AREA ATHLETES AND COACHES 19. EPIC RELATED FEES FROM CRITICAL ACCESS HOSPITALS:ANNUAL FEES, INCLUDING ONE-TIME IMPLEMENTATION, OF AREA CRITICAL ACCESS HOSPITALS USING OUR EPIC VENDOR SOFTWARE FOR PATIENT BILLING 20. MISCELLANEOUS INCOME: INCLUDES A RETURN OF EXPENSES FROM AN INSURANCE POOL. ALSO INCLUDES INCOME EARNED THROUGH THE PROVISION OF SERVICES THAT ARE OPERATING IN THE HOSPITAL IN NATURE, BUT HAVE NO SPECIFIC COST CENTER IDENTIFICATIONS. AN EXAMPLE OF THIS WOULD BE IF THE DIRECTOR OF THE COMMUNICATIONS DEPARTMENT RECEIVED A SMALL TOKEN AMOUNT FOR FILLING OUT A SURVEY FROM SOME HEALTH CARE ORGANIZATION. ALTRU HEALTH FOUNDATION 2501 DEMERS AVE GRAND FORKS ND 58201 450368330 FUNDRAISING ND 501(C)(3) LINE 12B, II N/A 0 DAK-MINN BLOOD BANK 1200 S COLUMBIA RD GRAND FORKS ND 58201 363453164 BLOOD BANK ND 501(C)(3) LINE 12D, III-O N/A 0 ALTRU ALLIANCE 1200 S COLUMBIA RD GRAND FORKS ND 58201 237389089 SUPPORT HOSPITAL AND AFFILIATES ND 501(C)(3) LINE 12C, III-FI N/A 0 ALTRU SPECIALTY SERVICES INC 1200 S COLUMBIA RD GRAND FORKS ND 58201 450395652 DME SALES, RETAIL PHARMACY ND N/A C 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 ALTRU HEALTH FOUNDATION C 1614599 CASH DONATED ALTRU HEALTH FOUNDATION O 2467231 COMPENSATION TO RELATED ORG ALTRU SPECIALTY SERVICES A 146279 RENT PAYMENT RECEIVED DAK-MINN BLOOD BANK O 424034 COMPENSATION TO RELATED ORG ALTRU ALLIANCE Q 87583 AMOUNT REIMBURSED