2019-05-15T09:43:42-05:00 2018-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-07-01 450226558 TRINITY HEALTH TRIN 7018575160 PO BOX 5020 MINOT ND 58702 JOHN M KUTCH PRESIDENT/CEO 7018575160 2019-05-14 1 KURT BENNION P01469618 6123764500 2019-05-14 67.137.57.251 2019-05-14 10:18:05 PD P 92465E57DADAD6C24A7EB17F4905229B30516652 3C05182BCE949607266F40F8D21D5C2A178D6925 2017 2019-02-21 02:37:17Z JOHN M KUTCH PO BOX 5020 MINOT ND 58702 125035629 0 X WWW.TRINITYHEALTH.ORG X 1929 ND MEETING THE NEEDS OF THE WHOLE PERSON THROUGH QUALITY HEALTH CARE AND HEALTH-RELATED SERVICES. 10 7 3571 327 120899 0 0 0 115036453 124668304 539468 294692 -12620 -88643 115563301 124874353 0 0 0 0 117284218 123442195 0 0 0 23260829 27234660 140545047 150676855 -24981746 -25802502 62070423 50225056 84844091 25779896 -22773668 24445160 TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 124046745 0 100636468 TRINITY HEALTH PROVIDES EDUCATION AND HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 14814714 0 12880958 TRINITY HEALTH PROVIDES OPTOMETRY SERVICES FOR GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS; OPHTHALMOLOGISTS WHO PROVIDE COMPREHENSIVE EYE AND VISION CARE, INCLUDING SURGERY TO REPAIR AND ENHANCE VISION; OPTOMETRISTS WHO PROVIDES GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS AND OPTICAL SALE OF CONTACT LENS AND EYEGLASSES. 10673250 0 11150878 TRINITY HEALTH RADIOLOGISTS ARE HIGHLY TRAINED AND SKILLED AT ASSESSING AND INTERPRETING X-RAYS, CT, NUCLEAR MEDICINE, ULTRASOUND, MRI SCANS, AND MAMMOGRAPHY IMAGES. 149534709 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 168 0 3571 1 1 1 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X TAYLOR WILSON 7018575160 PO BOX 5020 MINOT ND 58702 PATRICK HOLIEN CHAIRMAN 2.00 2.50 X X 0 0 0 STEVE LYSNE VICE CHAIRMAN 2.00 2.50 X X 0 0 0 KAREN KREBSBACH SECRETARY/TREASURER 2.00 2.50 X X 0 0 0 BORGI BEELER DIRECTOR 2.00 2.50 X 0 0 0 JOHN COUGHLIN DIRECTOR 2.00 2.50 X 0 0 0 SCOTT KNUTSON MD DIRECTOR 20.00 20.00 X 581454 0 22483 BRENT MATTSON DIRECTOR 2.00 2.50 X 0 0 0 CLARA SUE PRICE DIRECTOR 2.00 2.50 X 0 0 0 MARTIN ROTHBERG MD DIRECTOR 20.00 20.00 X 767651 0 13003 JOHN KUTCH PRESIDENT & CEO 12.00 28.00 X X 813059 0 22483 ALISON FRYE ASSISTANT SECRETARY 40.00 0.00 X 69167 0 19601 DENNIS EMPEY VICE PRESIDENT & CFO 12.00 28.00 X 355522 0 23983 RANDY SCHWAN VICE PRES. - MISSION INTEGRATION 4.00 36.00 X 210818 0 11369 PAUL SIMONSON VICE PRES. - HUMAN RESOURCES 4.00 36.00 X 267862 0 23983 THOMAS WARSOCKI VICE PRES. - PHYSICIAN OPERATIONS 40.00 0.00 X 207195 0 21651 DAVE KOHLMAN VICE PRES. - FACILITIES MANAGEMENT 8.00 32.00 X 194476 0 21703 KAREN ZIMMERMAN RN VICE PRES. & CNO 0.00 40.00 X 172760 0 5410 TRENT CHASTAIN VICE PRES - REVENUE CYCLE (THROUGH MARCH 2018) 12.00 28.00 X 170987 0 18637 RHONDA WALTER VICE PRES. - NCF ADMINISTRATOR 0.00 40.00 X 175914 0 22699 PHILIP PATTERSON VICE PRES. & CAO (THROUGH FEB 2018) 4.00 36.00 X 251845 0 11203 GLEN TAYLOR WILSON VICE PRES. - CLINICAL INTEGRATION 40.00 0.00 X 265655 0 12418 RAVINDRA JOSHI MD PHYSICIAN 25.00 15.00 X 1801818 0 20595 SAMIR TURK MD PHYSICIAN 25.00 15.00 X 1460136 0 23983 CHARLES WOOD MD PHYSICIAN 25.00 15.00 X 1217491 0 13738 MICHAEL MCMAHON MD PHYSICIAN 25.00 15.00 X 1206766 0 23983 PATANIT WATANABOONYAKHET MD PHYSICIAN 25.00 15.00 X 1350912 0 13003 11541488 0 345928 315 0 1 0 EXECUTIVE AIR TAXI CORPORATION PO BOX 1093 BISMARCK ND 58502 AIRCRAFT CHARTER SERVICES 3537667 PRINGLE & HERIGSTAD PC PO BOX 1000 MINOT ND 58702 LEGAL SERVICES 368418 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 ACCOUNTING/AUDITING SERVICES 367363 SCRIBEAMERICA LLC PO BOX 417756 BOSTON MA 02241 SCRIBE SERVICES 321180 DORSEY WHITNEY LLP PO BOX 1680 MINNEAPOLIS MN 55480 LEGAL SERVICES 222491 5 NET PATIENT REVENUE 621110 122475399 122475399 OTHER PATIENT REVENUE 621110 2058385 2058385 OPTICAL SALES 446199 134520 134520 124668304 211089 211089 83603 83603 121633 161276 -39643 -39643 -13621 -26022 JOINT VENTURE REVENUE 900099 -49000 -49000 -49000 124874353 124533784 120899 219670 4739834 1444120 3295714 105807412 108683739 -2876327 3324741 3362907 -38166 4907868 5021133 -113265 4662340 4646917 15423 3228825 2628357 600468 534411 531411 3000 533616 533079 537 424955 424955 4427996 4486133 -58137 40643 40561 82 126649 126078 571 354918 170578 184340 2901847 2888864 12983 613150 613150 MED. SUPPLIES & DRUGS 6891392 6891392 BAD DEBT EXPENSE 5849553 5849553 CONT. MEDICAL EDUCATION 767739 767739 DUES & FEES 456528 341605 114923 82438 82438 150676855 149534709 1142146 0 593651 500148 257863 258982 15065350 17960291 1884667 1611328 519925 396443 192267 209183 71096155 41807474 31683260 29288681 11873440 0 62070423 50225056 17521603 16304796 58031728 9290760 9475100 84844091 25779896 X -22773668 24445160 -22773668 24445160 62070423 50225056 X -25802502 73021330 X 0 1 X 1 0 X X 4 TRINITY HOSPITALS 412002771 3 1 0 0 TRINITY KENMARE HOSPITAL 412002769 3 0 0 0 TRINITY HOMES 450404412 10 1 0 0 COMMUNITY AMBULANCE SERVICE OF MINOT 450363593 10 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1 1 PART IV, SECTION A, LINE 1: TRINITY KENMARE HOSPITAL AND COMMUNITY AMBULANCE SERVICE OF MINOT ARE NOT SPECIFICALLY LISTED IN TRINITY HEALTH'S GOVERNING DOCUMENTS AS SUPPORTED ORGANIZATIONS OF TRINITY HEALTH. HOWEVER, TRINITY HEALTH'S PURPOSE IS TO SUPPORT ALL OF THE TAX-EXEMPT SUBSIDIARIES OF TRINITY HEALTH, WHICH INCLUDES TRINITY KENMARE HOSPITAL AND COMMUNITY ABMULANCE SERVICE OF MINOT. TRINITY KENMARE HOSPITAL IS A TAX-EXEMPT 501(C)(3) HOSPITAL THAT IS CONTROLLED BY TRINITY HEALTH. COMMUNITY AMBULANCE SERVICE OF MINOT IS A 509(A)(2) PUBLIC CHARITY THAT IS CONTROLLED BY TRINITY HEALTH. PART IV, SECTION D, LINE 2: SEE PART IV, SECTION E, LINES 3A AND 3B FOR INFORMATION ABOUT HOW TRINITY HEALTH MAINTAINS A CLOSE AND CONTINUOUS WORKING RELATIONSHIP WITH EACH SUPPORTED ORGANIZATION. PART IV, SECTION E, LINE 3A: TRINITY HEALTH HAS THE POWER TO APPOINT ALL BOARD MEMBERS OF EACH OF THE SUPPORTED ORGANIZATIONS. PART IV, SECTION E, LINE 3B: TRINITY HEALTH EMPLOYS THE OFFICERS, KEY EMPLOYEES AND OTHER INDIVIDUALS WHO MANAGE AND OPERATE EACH SUPPORTED ORGANIZATION. BECAUSE OF THIS MANAGEMENT RELATIONSHIP, AS WELL AS TRINITY HEALTH'S POWER TO APPOINT ALL BOARD MEMBERS OF EACH SUPPORTED ORGANIZATION, TRINITY HEALTH EXERCISES A SUBSTANTIAL DEGREE OF DIRECTION OVER THE POLICIES, PROGRAMS, AND ACTIVITIES OF EACH SUPPORTED ORGANIZATION. 6795229 6795229 13919956 7114334 6805622 5779392 3891692 1887700 44546437 30801448 13744989 55141 55141 29288681 ASSET RETIREMENT OBLIGATION 9475100 9475100 X 118940384 210276 210276 118730108 6144245 6144245 124874353 144988578 161276 161276 144827302 5849553 5849553 150676855 PART X, LINE 2: TRINITY HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NONPROFIT CORPORATION AS DESCRIBED IN SEC. 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. ALL UNRELATED BUSINESS INCOME GENERATED BY TRINITY IS SUBJECT TO FEDERAL INCOME TAX UNDER 511 OF THE IRC. TRINITY'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 COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. TRINITY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON JOINT VENTURE 49,000. RENTAL EXPENSES 161,276. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 5,849,553. INVESTMENT INCOME 294,692. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 161,276. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 5,849,553. X 1 1 X X X X X 0 0 0 1 1 0 0 0 0 SCOTT KNUTSON MD DIRECTOR 541454 0 40000 0 0 0 4050 0 18433 0 603937 0 0 0 MARTIN ROTHBERG MD DIRECTOR 717651 0 50000 0 0 0 5550 0 7453 0 780654 0 0 0 JOHN KUTCH PRESIDENT & CEO 797156 0 14967 0 936 0 4050 0 18433 0 835542 0 0 0 DENNIS EMPEY VICE PRESIDENT & CFO 354586 0 0 0 936 0 5550 0 18433 0 379505 0 0 0 RANDY SCHWAN VICE PRES. - MISSION INTEGRATION 206020 0 3862 0 936 0 3200 0 8169 0 222187 0 0 0 PAUL SIMONSON VICE PRES. - HUMAN RESOURCES 260178 0 6748 0 936 0 5550 0 18433 0 291845 0 0 0 THOMAS WARSOCKI VICE PRES. - PHYSICIAN OPERATIONS 202375 0 3884 0 936 0 3218 0 18433 0 228846 0 0 0 DAVE KOHLMAN VICE PRES. - FACILITIES MANAGEMENT 189770 0 3770 0 936 0 4511 0 17192 0 216179 0 0 0 KAREN ZIMMERMAN RN VICE PRES. & CNO 171824 0 0 0 936 0 4169 0 1241 0 178170 0 0 0 TRENT CHASTAIN VICE PRES - REVENUE CYCLE (THROUGH MARCH 2018) 170051 0 0 0 936 0 204 0 18433 0 189624 0 0 0 RHONDA WALTER VICE PRES. - NCF ADMINISTRATOR 174978 0 0 0 936 0 4266 0 18433 0 198613 0 0 0 PHILIP PATTERSON VICE PRES. & CAO (THROUGH FEB 2018) 251845 0 0 0 0 0 3750 0 7453 0 263048 0 0 0 GLEN TAYLOR WILSON VICE PRES. - CLINICAL INTEGRATION 264719 0 0 0 936 0 5489 0 6929 0 278073 0 0 0 RAVINDRA JOSHI MD PHYSICIAN 850000 0 672776 0 279042 0 5550 0 15045 0 1822413 0 0 0 SAMIR TURK MD PHYSICIAN 1265002 0 191102 0 4032 0 5550 0 18433 0 1484119 0 0 0 CHARLES WOOD MD PHYSICIAN 1198228 0 19263 0 0 0 693 0 13045 0 1231229 0 0 0 MICHAEL MCMAHON MD PHYSICIAN 500001 0 704740 0 2025 0 5550 0 18433 0 1230749 0 0 0 PATANIT WATANABOONYAKHET MD PHYSICIAN 330000 0 1019202 0 1710 0 5550 0 7453 0 1363915 0 0 0 PART I, LINE 1A TRINITY HEALTH HAS LEASED AN AIRPLANE AND PILOTS TO BE ABLE TO FLY PHYSICIANS TO VARIOUS CLINICS AROUND THE STATE. THE AIRPLANE IS PRIMARILY USED FOR THIS SERVICE, BUT IT IS ALSO USED BY ADMINISTRATIVE STAFF FOR TRAVELING TO MEETINGS THAT ARE OUTSIDE OF MINOT TO SAVE DRIVING TIME. USE OF THIS AIRPLANE BY OFFICERS IN FISCAL YEAR 2018 WAS RESTRICTED FOR BUSINESS AND NO AMOUNTS WERE INCLUDED IN THEIR COMPENSATION. PART I, LINE 5 PHYSICIANS RECEIVE INCENTIVE COMPENSATION BASED ON MULTIPLE FACTORS INCLUDING THE NUMBER OF PATIENTS SERVED, WHICH IS CLOSELY CONNECTED TO REVENUES. NICOLE KUTCH SPOUSE OF CEO 18618 THERAPIST 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD OF DIRECTORS' CHAIR, VICE CHAIR, PRESIDENT, SECRETARY, TREASURER AND ONE ADDITIONAL MEMBER OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD OF DIRECTORS AT ITS FIRST MEETING AFTER ITS ELECTION. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE FORM 990 WAS GIVEN TO THE GOVERNING BODY OF TRINITY HEALTH FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL SALARIED EMPLOYEES (AT MANAGER LEVEL AND ABOVE AS DETERMINED BY TRINITY) AND SUCH OTHER EMPLOYEES AS FROM TIME TO TIME MAY BE DIRECTED TO DO SO, ARE REQUIRED TO COMPLETE TRINITY HEALTH'S CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. ANY EMPLOYEE WHO HAS ASSUMED, OR IS ABOUT TO ASSUME, A FINANCIAL OR OTHER INTEREST OR RELATIONSHIP THAT MIGHT INVOLVE A CONFLICT OF INTEREST MUST IMMEDIATELY INFORM HIS/HER SUPERVISOR, A MEMBER OF THE COMPLIANCE COMMITTEE, OR THE COMPLIANCE OFFICER. ISSUES INVOLVING CONFLICT OF INTEREST SHALL BE REVIEWED AND A DETERMINATION OF EACH SHALL BE MADE BY THE TRINITY COMPLIANCE COMMITTEE. IF A CONFLICT EXISTS, THE CONFLICTED PERSON MUST ABSTAIN FROM DISCUSSION OF AND VOTING ON THE CONFLICTED TOPIC. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE REVIEWED COMPENSATION INFORMATION FOR THE CEO PREPARED BY DELOITTE & TOUCHE. DELOITTE & TOUCHE ANALYZED FOUR COMPENSATION SURVEYS OF HEALTH CARE EMPLOYERS AND REVIEWED FORM 990 FILINGS FOR A PEER GROUP ANALYSIS. THIS PROCESS WAS LAST PERFORMED IN 2015. FORM 990, PART VI, SECTION C, LINE 19 ON OUR WEBSITE, WWW.TRINITYHEALTH.ORG, WE LIST OUR BOARD OF DIRECTORS, MISSION, VISION, VALUES, AND OUR ANNUAL REPORT WHICH INCLUDES FINANCIAL INFORMATION. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS 73,021,330. COMMUNITY AMBULANCE SERVICE OF MINOT INC PO BOX 2195 MINOT ND 58702 450363593 AMBULANCE SERVICES ND 501(C)(3) LINE 10 TRINITY HEALTH 1 TRINITY HOSPITALS PO BOX 5020 MINOT ND 58702 412002771 MEDICAL SERVICES ND 501(C)(3) LINE 3 TRINITY HEALTH 1 TRINITY KENMARE HOSPITAL PO BOX 5020 MINOT ND 58702 412002769 MEDICAL SERVICES ND 501(C)(3) LINE 3 TRINITY HEALTH 1 TRINITY HOMES PO BOX 5020 MINOT ND 58702 450404412 SKILLED NURSING FACILITY ND 501(C)(3) LINE 10 TRINITY HEALTH 1 TRINITY HEALTH FOUNDATION PO BOX 5020 MINOT ND 58702 450215346 FUNDRAISING ND 501(C)(3) LINE 12B, II TRINITY HEALTH 1 TRINITY 1922 FOUNDATION PO BOX 2195 MINOT ND 58702 474591148 FUNDRAISING ND 501(C)(3) LINE 7 TRINITY HEALTH 1 B&B DRUG INC 20 BURDICK EXPRESSWAY WEST MINOT ND 58701 450260565 RETAIL DRUG STORE ND TRINITY HEALTH C 1165122 4527501 1.00000 1 MEDICAL ARTS OUTPATIENT SERVICES INC 400 BURDICK EXPRESSWAY EAST MINOT ND 58701 450278212 RETAIL PHARMACY & DURABLE MEDICAL EQUIPMENT ND TRINITY HEALTH C 4776435 6722333 1.00000 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 0 1 B&B DRUG INC A 25667 FMV MEDICAL ARTS OUTPATIENT SERVICES INC A 23533 FMV