2018-05-15T08:44:57-05:00 2017-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2016-07-01 450226558 TRINITY HEALTH TRIN 7018575160 PO BOX 5020 MINOT ND 58702 DENNIS C EMPEY CHIEF FINANCIAL OFFICER 7018575160 2018-05-14 1 KACIE MCEWEN P01599614 6123764500 67.137.57.251 2018-05-14 09:02:37 CD P B3EA28BB1009F9E462E5A3B6A3DA5A80F0A4DDDC 4B5D7F6DD2BB6F9A88F16A339322AADA702C53A3 2016 2021-01-29 14:40:06Z JOHN M KUTCH PO BOX 5020 MINOT ND 58702 115633420 0 X WWW.TRINITYHEALTH.ORG X 1929 ND PROVIDE HEALTH EDUCATION & HEALTHCARE SERVICES TO RESIDENTS OF CENTRAL & NORTHWEST NORTH DAKOTA 10 7 3588 346 107854 0 0 0 119718401 115036453 590060 539468 -96511 -12620 120211950 115563301 0 0 0 0 114062290 117284218 0 0 0 23856977 23260829 137919267 140545047 -17707317 -24981746 64003594 62070423 94859488 84844091 -30855894 -22773668 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 114959879 0 97212524 TRINITY HEALTH PROVIDES EDUCATION AND HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 14461771 0 12451316 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. 10033895 0 10054561 TRINITY HEALTH RADIOLOGISTS ARE HIGHLY TRAINED AND SKILLED AT ASSESSING AND INTERPRETING X-RAYS, CT, NUCLEAR MEDICINE, ULTRASOUND, MRI SCANS, AND MAMMOGRAPHY IMAGES. 139455545 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 186 0 3588 0 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 DENNIS EMPEY 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 2.00 X X 0 0 0 KAREN KREBSBACH SECRETARY/TREASURER 2.00 2.50 X X 0 0 0 BORGI BEELER DIRECTOR 2.00 2.00 X 0 0 0 JOHN COUGHLIN DIRECTOR 2.00 2.00 X 0 0 0 SCOTT KNUTSON MD DIRECTOR 20.00 20.00 X 566909 0 14760 BRENT MATTSON DIRECTOR 2.00 2.00 X 0 0 0 CLARA SUE PRICE DIRECTOR 2.00 2.00 X 0 0 0 MARTIN ROTHBERG MD DIRECTOR 20.00 20.00 X 835681 0 14760 JOHN KUTCH PRESIDENT & CEO 12.00 28.00 X X 746253 0 14760 ALISON FRYE ASSISTANT SECRETARY 40.00 X 68236 0 1747 DENNIS EMPEY VICE PRESIDENT & CFO 12.00 28.00 X 356138 0 14760 RANDY SCHWAN VICE PRES. - MISSION INTEGRATION 4.00 36.00 X 207096 0 8960 PAUL SIMONSON VICE PRES. - HUMAN RESOURCES 4.00 36.00 X 263856 0 14282 THOMAS WARSOCKI VICE PRES. - PHYSICIAN OPERATIONS 40.00 X 203832 0 9008 DAVE KOHLMAN VICE PRES. - FACILITIES MANAGEMENT 8.00 32.00 X 198690 0 8747 KAREN ZIMMERMAN RN VICE PRES. & CNO 1.00 40.00 X 171353 0 7536 TRENT CHASTAIN VICE PRES. - REVENUE CYCLE 12.00 28.00 X 171184 0 7560 RHONDA WALTER VICE PRES - TRINITY HOMES ADMINISTRATOR 1.00 40.00 X 179285 0 7915 GLEN TAYLOR WILSON VICE PRES. - CLINICAL INTEGRATION 16.00 24.00 X 245872 0 500 RAVINDRA JOSHI MD PHYSICIAN 25.00 15.00 X 1774236 0 14760 SAMIR TURK MD PHYSICIAN 25.00 15.00 X 1502277 0 14760 EDMUNDO JUSTINO MD PHYSICIAN 25.00 15.00 X 1048041 0 14760 MICHAEL MCMAHON MD PHYSICIAN 25.00 15.00 X 1174539 0 14760 PATANIT WATANABOONYAKHET MD PHYSICIAN 25.00 15.00 X 1071121 0 14760 10784599 0 199095 18 0 1 0 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 ACCOUNTING/AUDITING SERVICES 484171 BASS BERRY SIMS PLC 150 3RD AVE SOUTH SUITE 2800 NASHVILLE TN 37201 LEGAL SERVICES 383090 PRINGLE & HERIGSTAD PC PO BOX 1000 MINOT ND 58702 LEGAL SERVICES 325476 REVSPRING INC 29241 BECK ROAD WIXOM MI 48393 PATIENT BILLING/COMMUNICATION SERVICES 321219 JABS 5023 LONG MEADOW DRIVE LEESBURG FL 34748 CONTRACT LABOR 144225 5 NET PATIENT REVENUE 621110 114573820 114573820 OTHER PATIENT REVENUE 621110 346902 346902 OPTICAL SALES 446199 115731 115731 115036453 175527 175527 363941 363941 105499 70119 35380 35380 -7877 43257 JOINT VENTURE REVENUE 900099 -48000 -48000 -48000 115563301 114920722 107854 534725 4709094 1399354 3309740 100011801 102994875 -2983074 3278774 3362433 -83659 4814144 4793912 20232 4470405 4453932 16473 2393745 1888710 505035 496270 496270 602665 599435 3230 434207 434207 4415349 4457644 -42295 39544 39544 88757 88740 17 382833 198493 184340 2981268 2931229 50039 560341 560341 BAD DEBT EXPENSE 4952093 4952093 MED. SUPPLIES & DRUGS 4731856 4731856 CONT. MEDICAL EDUCATION 727145 727145 DUES & FEES 408678 299254 109424 46078 46078 140545047 139455545 1089502 0 427313 593651 257165 257863 13483844 15065350 1804125 1884667 536468 519925 152675 192267 70857753 39174493 32951623 31683260 652711 13737670 11873440 64003594 62070423 18211998 17521603 67541070 58031728 9106420 9290760 94859488 84844091 X -30855894 -22773668 -30855894 -22773668 64003594 62070423 X -24981746 33063972 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 6824722 7095234 5779392 3482813 2296579 44323835 28866958 15456877 39341 39341 31683260 ASSETS HELD BY TRUSTEE UNDER BOND RESERVE FUND 6705108 ASSETS HELD BY TRUSTEE FOR DEBT SERVICE 5168332 11873440 ASSET RETIREMENT OBLIGATION 9290760 9290760 X 110189859 -4952093 -4952093 115141952 421349 421349 115563301 135663073 70119 70119 135592954 4952093 4952093 140545047 PART X, LINE 2: TRINITY HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 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: PROVISION FOR UNCOLLECTIBLE ACCOUNTS -4,952,093. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 539,468. LOSS ON JOINT VENTURE -48,000. RENTAL EXPENSES -70,119. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 70,119. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 4,952,093. X 1 1 X X X X X 0 0 0 1 1 0 0 0 0 SCOTT KNUTSON MD DIRECTOR 519689 0 0 0 47220 0 13800 0 960 0 581669 0 0 0 MARTIN ROTHBERG MD DIRECTOR 648578 0 0 0 187103 0 13800 0 960 0 850441 0 0 0 JOHN KUTCH PRESIDENT & CEO 738879 0 0 0 7374 0 13800 0 960 0 761013 0 0 0 DENNIS EMPEY VICE PRESIDENT & CFO 355814 0 0 0 324 0 13800 0 960 0 370898 0 0 0 RANDY SCHWAN VICE PRES. - MISSION INTEGRATION 206772 0 0 0 324 0 8380 0 580 0 216056 0 0 0 PAUL SIMONSON VICE PRES. - HUMAN RESOURCES 261732 0 0 0 2124 0 13800 0 482 0 278138 0 0 0 THOMAS WARSOCKI VICE PRES. - PHYSICIAN OPERATIONS 203508 0 0 0 324 0 8426 0 582 0 212840 0 0 0 DAVE KOHLMAN VICE PRES. - FACILITIES MANAGEMENT 198366 0 0 0 324 0 8181 0 566 0 207437 0 0 0 KAREN ZIMMERMAN RN VICE PRES. & CNO 171191 0 0 0 162 0 7031 0 505 0 178889 0 0 0 TRENT CHASTAIN VICE PRES. - REVENUE CYCLE 171184 0 0 0 0 0 7053 0 507 0 178744 0 0 0 RHONDA WALTER VICE PRES - TRINITY HOMES ADMINISTRATOR 175869 0 3254 0 162 0 7385 0 530 0 187200 0 0 0 GLEN TAYLOR WILSON VICE PRES. - CLINICAL INTEGRATION 245872 0 0 0 0 0 0 0 500 0 246372 0 0 0 RAVINDRA JOSHI MD PHYSICIAN 847237 0 823094 0 103905 0 13800 0 960 0 1788996 0 0 0 SAMIR TURK MD PHYSICIAN 1266993 0 233244 0 2040 0 13800 0 960 0 1517037 0 0 0 EDMUNDO JUSTINO MD PHYSICIAN 415711 0 630290 0 2040 0 13800 0 960 0 1062801 0 0 0 MICHAEL MCMAHON MD PHYSICIAN 499985 0 672532 0 2022 0 13800 0 960 0 1189299 0 0 0 PATANIT WATANABOONYAKHET MD PHYSICIAN 331084 0 739429 0 608 0 13800 0 960 0 1085881 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 FY 2017 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. A COUNTY OF WARD 456002248 934023EMO 2006-11-01 88455263 SEE PART VI 0 0 0 A 35480000 88455263 6702480 1077014 10000000 70839643 2006 1 1 0 1 A 0 1 1 0 0 0.01810 0.01810 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 SCHEDULE K, PART I, COLUMN F DESCRIPTION OF PURPOSE OF BONDS PROCEEDS OF THE SERIES 2006 BONDS WERE USED (I) TO CURRENTLY REFUND THE COUNTY OF WARD, NORTH DAKOTA, ADJUSTABLE RATE DEMAND HEALTH CARE REVENUE BONDS (TRINITY OBLIGATED GROUP) TAX-EXEMPT SERIES 2002A (THE "SERIES 2002 BONDS"), OUTSTANDING IN THE AMOUNT OF $58,615,000, (II) TO FUND A TERMINATION PAYMENT FOR THE INTEREST RATE SWAP ASSOCIATED WITH THE SERIES 2002 BONDS, (III) TO ADVANCE REFUND THE COUNTY OF WARD, NORTH DAKOTA HEALTH CARE FACILITIES REVENUE REFUNDING BONDS (TRINITY OBLIGATED GROUP) SERIES 1996A (THE "SERIES 1996A BONDS"), OUTSTANDING IN THE AMOUNT OF $9,400,000, (IV) TO FINANCE OR REIMBURSE THE CORPORATION FOR THE COSTS OF CERTAIN RENOVATION, REMODELING, AND EQUIPPING OF ITS HEALTH CARE FACILITIES (THE "PROJECT"), (V) TO FUND A DEPOSIT TO A DEBT SERVICE RESERVE FUND, AND (VI) TO PAY CERTAIN EXPENSES RELATING TO THE ISSUANCE OF THE SERIES 2006 BONDS AND THE REFUNDING OF THE SERIES 2002 BONDS AND THE SERIES 1996A BONDS. NICOLE KUTCH SPOUSE OF CEO 46127 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 CORPORATION 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 33,063,972. 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 1029983 3345780 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 4144617 3341832 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 30333 FMV MEDICAL ARTS OUTPATIENT SERVICES INC A 23533 FMV