CENTRACARE CLINIC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CENTRACARE CLINIC (EIN 41-1806657)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-08
- IRS object ID
- 201501289349300800
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-08T07:43:23-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411806657 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRACARE CLINIC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 3202525131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 6TH AVENUE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID TILSTRA | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 3202525131 | PhoneNum |
| Signature | 2015-04-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD A JACKSON | PreparerPersonNm |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID TILSTRA MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 6TH AVENUE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $154,234,747 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CENTRACARE.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 1040 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $500,557 | PYContributionsGrantsAmt |
| CY Contributions Grants | $176,103 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $153,646,154 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $153,831,756 | CYProgramServiceRevenueAmt |
| PY Investment Income | $60,839 | PYInvestmentIncomeAmt |
| CY Investment Income | $77,829 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,771,631 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $157,979,181 | PYTotalRevenueAmt |
| CY Total Revenue | $154,085,688 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,984 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $123,651,381 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $125,615,876 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $44,165,109 | PYOtherExpensesAmt |
| CY Other Expenses | $43,541,815 | CYOtherExpensesAmt |
| PY Total Expenses | $167,821,990 | PYTotalExpensesAmt |
| CY Total Expenses | $169,168,675 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$9,842,809 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$15,082,987 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $43,096,633 | TotalAssetsBOYAmt |
| Total Assets EOY | $41,337,405 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $26,429,686 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,673,322 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,666,947 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,664,083 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CENTRACARE CLINIC WILL BE THE LEADER IN MINNESOTA FOR QUALITY, SAFETY, SERVICE AND VALUE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $90,857,426 | ExpenseAmt |
| Grant | $10,984 | GrantAmt |
| Revenue | $108,093,242 | RevenueAmt |
| Desc | MEDICAL PROFESSIONAL SERVICES CENTRACARE CLINIC (CCC) PROVIDES A WIDE RANGE OF PRIMARY CARE AND SPECIALTY MEDICAL SERVICES THROUGH A MULTI-SPECIALTY CLINIC STRUCTURE AS THE PHYSICIAN COMPONENT OF CENTRACARE HEALTH, AN INTEGRATED HEALTH CARE DELIVERY SYSTEM. CCC'S FORMALLY ADOPTED CORE VALUES ARE: PATIENT CENTERED: SERVING PATIENTS ABOVE ALL.INTEGRITY: ADHERING TO HONEST AND ETHICAL PRACTICES.COLLABORATION: WORKING JOINTLY WITH OTHERS TO IMPROVE HEALTH AND HEALTH CARE.COMPASSION: SERVING ALL WHO SEEK OUR CARE WITH KINDNESS, DIGNITY AND RESPECT.STEWARDSHIP: ENSURING RESPONSIBLE USE OF ALL RESOURCES TO BEST SERVE OUR COMMUNITIES. CCC ACHIEVES THESE VALUES THROUGH SERVICES PROVIDED BY A TEAM OF PHYSICIANS, ADVANCED PRACTICE PROVIDERS, NURSES, DIETICIANS, EDUCATORS AND OTHER HEALTH CARE PROFESSIONALS. MANY SERVICES ARE PROVIDED TO THE GROWING DIVERSE POPULATION IN CENTRAL MINNESOTA. CCC ALSO PROVIDES THE PROFESSIONAL STAFFING FOR DESIGNATED RURAL HEALTH CLINICS AND HEALTH MANPOWER SHORTAGE AREAS SERVED BY CENTRACARE HEALTH IN RURAL MINNESOTA. A SUMMARY OF THE MAJOR ACTIVITIES ACCOMPLISHED FOR THE YEAR ENDED JUNE 30, 2014:CLINIC VISITS - 278,709HOSPITAL VISISTS - 146,669NURSING HOME VISITS - 5,304SURGICAL SERVICES - 134,376LABORATORY TESTS - 538,523IMMUNIZATION/INJECTION - 956,248RADIOLOGY TESTS - 22,588PROFESSIONAL INTERPRETATIONS - 54,248SURGICAL, MINOR - 29,416RADIATION ONCOLOGY - 2,966SPECIAL PROCEDURE - 39,751 | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $46,599,306 | ExpenseAmt |
| Revenue | $45,738,515 | RevenueAmt |
| Desc | CCC PARTICIPATES IN A WIDE VARIETY OF GOVERNMENTAL HEALTHCARE PROGRAMS INCLUDING: MEDICARE, MEDICAID, MINNESOTA CARE, MINNESOTA GENERAL ASSISTANCE AND PROGRAMS FOR MILITARY, VETERANS AND THEIR FAMILIES. FOR THE YEAR ENDED JUNE 30, 2014, CCC INCURRED COSTS OF $46,599,306 IN EXCESS OF PAYMENTS RECEIVED FOR SERVICES TO PATIENTS COVERED UNDER THESE PROGRAMS AND TAXES AND FEES RELATING TO THESE PROGRAMS. GOVERNMENTAL HEALTHCARE PROGRAMS PROVIDER REIMBURSEMENT AMOUNTS ARE BELOW THE COSTS THE PROVIDER INCURS TO PROVIDE THESE SERVICES. MEDICARE COSTS IN EXCESS OF PAYMENTS $32,072,179 MEDICAID COSTS IN EXCESS OF PAYMENTS $11,637,206 SURCHARGES, FEES AND MINNESOTACARE TAX $1,669,786 MILITARY COSTS IN EXCESS OF PAYMENTS $1,220,135 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,950,773 | ExpenseAmt |
| Desc | CCC SUPPORTS A WIDE VARIETY OF PATIENTS WHO EXPRESS A WILLINGNESS TO PAY BUT ARE UNABLE TO DO SO DUE TO SOCIOECONOMIC FACTORS. ADDITIONALLY CCC RECORDS BAD DEBT AT TIMES WHEN IT IS UNABLE TO RECEIVE PAYMENT FOR SERVICES PROVIDED. FOR THE ENDED JUNE 30, 2014, $3,394,868 OF UNCOMPENSATED CARE WAS PROVIDED. $838,963 OF CHARITY CARE WAS PROVIDED UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE PROGRAM. THE FINANCIAL ASSISTANCE PROGRAM PROVIDES PATIENTS WILLING, BUT UNABLE TO PAY, TO HAVE PATIENT BALANCES OTHERWISE DUE, REDUCED OR WAIVED. THE FINANCIAL ASSISTANCE PROGRAM ENSURES THE PATIENT S OF THE COMMUNITIES SERVED BY CCC HAVE ACCESS TO QUALITY MEDICAL CARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. CCC PROVIDES SERVICES TO ALL IN NEED AND AT TIMES PATIENT ACCOUNT BALANCES GO UNPAID, KNOWN AS BAD DEBT, THESE BAD DEBT AMOUNT FOR THE YEAR ENDED JUNE 30, 2014 TOTALED $2,555,905. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $143,407,505 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 89 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1040 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THOMAS FELDHEGE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3202402152 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 SIXTH AVENUE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DAVID TILSTRA MD CPE | |||||||||
| DIRECTOR & PRESIDENT | 36.00 | 4.00 | Yes (X) | Yes (X) | $463,047 | $0 | $92,387 | ||
| DAVID ROBERTS MD | |||||||||
| DIRECTOR, CHAIR & GASTROENTEROLOGIST | 38.00 | 2.00 | Yes (X) | Yes (X) | $604,530 | $0 | $39,614 | ||
| ROBERT STOCKER MD | |||||||||
| DIRECTOR & OBGYN | 38.00 | 2.00 | Yes (X) | $536,750 | $0 | $19,125 | |||
| SHARON WIDSTROM | |||||||||
| DIRECTOR & INTERNIST | 20.00 | Yes (X) | $151,001 | $0 | $10,584 | ||||
| DONALD JURGENS MD | |||||||||
| DIRECTOR & ONCOLOGIST | 40.00 | Yes (X) | $499,968 | $0 | $39,614 | ||||
| KEITH LEAVELL MD | |||||||||
| DIRECTOR & PULMONOLOGIST | 40.00 | Yes (X) | $481,044 | $0 | $42,864 | ||||
| DENISE ROSIN | |||||||||
| DIRECTOR | 1.00 | 2.00 | Yes (X) | $0 | $2,000 | $0 | |||
| DAVID AGERTER MD | |||||||||
| DIRECTOR | 1.00 | 2.00 | Yes (X) | $0 | $1,000 | $0 | |||
| BYRON JOHN | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| PATRICK LYNCH | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| THOMAS M FELDHEGE | |||||||||
| TREASURER & CFO | 40.00 | Yes (X) | $222,113 | $0 | $36,937 | ||||
| GEORGE MORRIS | |||||||||
| MEDICAL DIRECTOR | 40.00 | Yes (X) | $332,735 | $0 | $53,800 | ||||
| MARK MURPHY | |||||||||
| VICE PRESIDENT OF OPERATIONS | 40.00 | $308,321 | $0 | $64,858 | Yes (X) | ||||
| WADE SCHMIDT MD | |||||||||
| INTERVENTIONAL CARDIOLOGIST | 40.00 | $990,354 | $0 | $41,614 | Yes (X) | ||||
| BERNARD R ERICKSON MD | |||||||||
| INTERVENTIONAL CARDIOLOGIST | 40.00 | $979,707 | $0 | $39,614 | Yes (X) | ||||
| HOWARD ZIMRING MD | |||||||||
| INTERVENTIONAL CARDIOLOGIST | 40.00 | $962,706 | $0 | $42,864 | Yes (X) | ||||
| JACOB DUTCHER MD | |||||||||
| INTERVENTIONAL CARDIOLOGIST | 40.00 | $928,637 | $0 | $40,364 | Yes (X) | ||||
| RICHARD APLIN MD | |||||||||
| INTERVENTIONAL CARDIOLOGIST | 40.00 | $902,828 | $0 | $42,749 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $8,363,741 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,000 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $606,988 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 253 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | PHYSICIAN SERVICES | $479,089 |
| DERMATOPATHOLOGY ASSOCIATES | |||||
| 7205 UNIVERSITY AVE NE | MINNEAPOLIS | MN | 55440 | LABORATORY SERVICES | $471,182 |
| UNIVERSITY OF MINNESOTA | |||||
| SES 12-1562 BOX 86 | MINNEAPOLIS | MN | 55486 | LOCUM FEES | $227,300 |
| REGIONAL DIAGNOSTIC RADIOLOGY | |||||
| 1990 CONNECTICUT AVE S SUITE 100 | SARTELL | MN | 56377 | RADIOLOGY FEES | $200,462 |
| DAVID PENCE MD | |||||
| 1010 MULBERRY STREET | MANKATO | MN | 56001 | LOCUM FEES | $192,949 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $176,103 | AllOtherContributionsAmt |
| Total Contributions | $176,103 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT & RESIDENT SERVICE REVENU | 621110 | $134,114,717 | $134,114,717 |
| OTHER PROGRAM REVENUE | 900099 | $16,217,920 | $16,217,920 |
| QUALITY INITIATIVES | 900099 | $1,856,984 | $1,856,984 |
| HEALTH INFO TECH INCENTIVE | 900099 | $1,642,135 | $1,642,135 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $153,831,756 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,829 | TotalRevenueColumnAmt |
| Exclusion | $77,829 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $149,059 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $149,059 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $154,085,688 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $153,831,756 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $77,829 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,984 | TotalAmt |
| Program Services | $10,984 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,156,316 | TotalAmt |
| Program Services | $3,677,712 | ProgramServicesAmt |
| Management And General | $478,604 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,812,954 | TotalAmt |
| Program Services | $89,593,022 | ProgramServicesAmt |
| Management And General | $11,219,932 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,547,655 | TotalAmt |
| Program Services | $5,452,074 | ProgramServicesAmt |
| Management And General | $95,581 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,597,545 | TotalAmt |
| Program Services | $7,262,640 | ProgramServicesAmt |
| Management And General | $2,334,905 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,501,406 | TotalAmt |
| Program Services | $4,843,660 | ProgramServicesAmt |
| Management And General | $657,746 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,934 | TotalAmt |
| Program Services | $23,286 | ProgramServicesAmt |
| Management And General | $207,648 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,809 | TotalAmt |
| Management And General | $16,809 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,219,292 | TotalAmt |
| Program Services | $5,869,583 | ProgramServicesAmt |
| Management And General | $1,349,709 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,266 | TotalAmt |
| Program Services | $75,266 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $917,640 | TotalAmt |
| Program Services | $114,619 | ProgramServicesAmt |
| Management And General | $803,021 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,329,801 | TotalAmt |
| Program Services | $2,165 | ProgramServicesAmt |
| Management And General | $1,327,636 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,936,956 | TotalAmt |
| Program Services | $1,353,971 | ProgramServicesAmt |
| Management And General | $5,582,985 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $228,220 | TotalAmt |
| Program Services | $188,806 | ProgramServicesAmt |
| Management And General | $39,414 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $878,887 | TotalAmt |
| Program Services | $672,679 | ProgramServicesAmt |
| Management And General | $206,208 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,511,454 | TotalAmt |
| Program Services | $1,462,370 | ProgramServicesAmt |
| Management And General | $49,084 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| DRUGS | $14,284,336 | $14,284,336 |
| OTHER SUPPLIES | $2,607,934 | $2,607,934 |
| BAD DEBT EXPENSE | $2,555,904 | $2,555,904 |
| MN CARE/MEDICAID SURCHA | $1,669,786 | $1,669,786 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,078,596 | TotalAmt |
| Program Services | $1,686,708 | ProgramServicesAmt |
| Management And General | $1,391,888 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,168,675 | TotalAmt |
| Program Services | $143,407,505 | ProgramServicesAmt |
| Management And General | $25,761,170 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,243 | BOYAmt |
| EOY | $5,888 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,686,291 | BOYAmt |
| EOY | $11,619,180 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,178,170 | BOYAmt |
| EOY | $16,321,778 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,219,653 | BOYAmt |
| EOY | $1,179,034 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,273,346 | BOYAmt |
| EOY | $1,213,602 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,811 | BOYAmt |
| EOY | $546,265 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,567,928 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,008,924 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,884,066 | BOYAmt |
| EOY | $3,559,004 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,393,053 | BOYAmt |
| EOY | $6,892,654 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,096,633 | BOYAmt |
| EOY | $41,337,405 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,190,271 | BOYAmt |
| EOY | $25,206,639 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,239,415 | BOYAmt |
| EOY | $2,466,683 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,429,686 | BOYAmt |
| EOY | $27,673,322 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,666,947 | BOYAmt |
| EOY | $13,664,083 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,666,947 | BOYAmt |
| EOY | $13,664,083 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,096,633 | BOYAmt |
| EOY | $41,337,405 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$15,082,987 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $12,080,123 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $978 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $978 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | CENTRACARE CLINIC PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION (MHA), A PORTION OF WHICH RELATES TO LOBBYING ACTIVITIES. FOR CALENDAR YEAR 2013, $978 OF THE CLINIC'S MEMBERSHIP DUES WERE USED TO CONDUCT LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,211,833 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,570,699 | DepreciationAmt |
| Book Value | $1,641,134 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,356,095 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,438,225 | DepreciationAmt |
| Book Value | $1,917,870 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,559,004 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| FUNDS HELD BY TRUSTEE | $2,416,683 |
| DUE FROM RELATED ORGANIZATIONS | $4,475,971 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,892,654 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION PLAN OBLIGATIONS | $1,854,226 |
| LT SETTLEMENT RESERVE | $200,000 |
| EXECUTIVE BENEFIT ACCRUAL | $412,457 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,466,683 | TotalLiabilityAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAMBER OF COMMERCE | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 487 | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56302 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 123456789 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $5,500 | CashGrantAmt |
| Purpose Of Grant | SCHOLARSHIP 2014/PROGRAM SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | CENTRACARE HEALTH SYSTEM, INCLUDING CENTRACARE CLINIC, HAS THE FOLLOWING POLICY REGARDING CHARITABLE CONTRIBUTIONS: CONTRIBUTIONS MUST BE IN KEEPING WITH THE MISSION OF CENTRACARE HEALTH, WHICH IS TO WORK TO IMPROVE THE HEALTH OF EVERY PATIENT, EVERY DAY. CONTRIBUTIONS WILL BE MADE TO ORGANIZATIONS RATHER THAN TO INDIVIDUALS WITHIN THE CENTRAL MINNESOTA REGION. CENTRACARE'S CHARITABLE FUNDS MAY NOT BE USED TO SUPPORT ANY ORGANIZATION OR EVENT THAT WOULD RESULT IN BENEFITS OF ANY KIND TO AN EMPLOYEE OF THE HEALTH SYSTEM OR A MEMBER OF THE VARIOUS BOARDS OF DIRECTORS, EITHER DIRECTLY OR INDIRECTLY. ONE EXCEPTION EXISTS TO THE GUIDELINE REGARDING BENEFIT TO EMPLOYEES: WE WILL SUPPORT, VIA SCHOLARSHIPS AND THE PURCHASE OF SUPPLIES, THE MEDICAL MISSION WORK OF OUR STAFF AND PHYSICIANS. THE CENTRACARE HEALTH CONTRIBUTIONS COMMITTEE IS MADE UP OF : ONE REPRESENTATIVE FROM CENTRACARE HEALTH FOUNDATION; ONE REPRESENTATIVE FROM ST. CLOUD HOSPITAL HUMAN RESOURCES/DIVERSITY COMMITTEE; THE DIRECTOR OF CENTRACARE HEALTH'S COMMUNICATION DEPARTMENT AND THE COMMUNICATIONS/MARKETING FOR ST. BENEDICT'S SENIOR COMMUNITY; THE DIRECTOR OF CENTRACARE HEALTH'S MARKETING DEPARTMENT; THE DIRECTOR OF ST. CLOUD HOSPITAL VOLUNTEER SERVICES; AND ST. CLOUD HOSPITAL'S DIRECTOR OF MISSION & SPIRITUAL CARE. THE COMMITTEE MEETS MONTHLY TO ENSURE A STREAMLINED, COORDINATED PROCESS OF REVIEWING REQUESTS AND DETERMINING FUNDING. THE COMMITTEE MAINTAINS A DATABASE TO TRACK ALL CONTRIBUTIONS. OTHER CENTRACARE ENTITIES, INCLUDING CENTRACARE HEALTH - LONG PRAIRIE, MELROSE, MONTICELLO, PAYNESVILLE AND SAUK CENTRE, MAY DEVELOP A BUDGET FOR APPROVAL AND IMPLEMENT THEIR OWN CONTRIBUTIONS DECISIONS WITHIN THE GUIDELINES OF THIS DOCUMENT. CONTRIBUTIONS MAY NOT EXCEED THE STATED BUDGET AND NO MULTI-YEAR COMMITMENTS TO ORGANIZATIONS MAY BE MADE WITHOUT APPROVAL FORM THE CENTRACARE HEALTH EXECUTIVE COUNCIL. INDIVIDUALS AND DEPARTMENTS FORM THROUGHOUT ST. CLOUD HOSPITAL AND CENTRACARE CLINIC SHOULD FORWARD ALL OUTSIDE FUNDING REQUESTS TO A MEMBER OF THE COMMITTEE FOR THE FULL GROUP'S CONSIDERATION. THOSE REQUESTING FUNDS SHOULD BE ASKED TO SUBMIT REQUESTS IN WRITING. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID TILSTRA MD CPE | ||||||||||||||
| DIRECTOR & PRESIDENT | $321,776 | $0 | $101,769 | $0 | $39,502 | $0 | $71,513 | $0 | $25,691 | $0 | $560,251 | $0 | $18,818 | $0 |
| DAVID ROBERTS MD | ||||||||||||||
| DIRECTOR, CHAIR & GASTROENTEROLOGIST | $514,594 | $0 | $68,376 | $0 | $21,560 | $0 | $19,125 | $0 | $25,271 | $0 | $648,926 | $0 | $0 | $0 |
| ROBERT STOCKER MD | ||||||||||||||
| DIRECTOR & OBGYN | $445,755 | $0 | $90,360 | $0 | $635 | $0 | $19,125 | $0 | $3,295 | $0 | $559,170 | $0 | $0 | $0 |
| SHARON WIDSTROM | ||||||||||||||
| DIRECTOR & INTERNIST | $115,032 | $0 | $34,608 | $0 | $1,361 | $0 | $10,584 | $0 | $1,225 | $0 | $162,810 | $0 | $0 | $0 |
| DONALD JURGENS MD | ||||||||||||||
| DIRECTOR & ONCOLOGIST | $415,855 | $0 | $59,185 | $0 | $24,928 | $0 | $19,125 | $0 | $22,747 | $0 | $541,840 | $0 | $0 | $0 |
| KEITH LEAVELL MD | ||||||||||||||
| DIRECTOR & PULMONOLOGIST | $407,996 | $0 | $54,193 | $0 | $18,855 | $0 | $19,125 | $0 | $26,679 | $0 | $526,848 | $0 | $0 | $0 |
| THOMAS M FELDHEGE | ||||||||||||||
| TREASURER & CFO | $179,883 | $0 | $23,590 | $0 | $18,640 | $0 | $16,313 | $0 | $22,170 | $0 | $260,596 | $0 | $0 | $0 |
| GEORGE MORRIS | ||||||||||||||
| MEDICAL DIRECTOR | $248,348 | $0 | $74,417 | $0 | $9,970 | $0 | $33,310 | $0 | $23,417 | $0 | $389,462 | $0 | $0 | $0 |
| MARK MURPHY | ||||||||||||||
| VICE PRESIDENT OF OPERATIONS | $217,598 | $0 | $51,410 | $0 | $39,313 | $0 | $42,428 | $0 | $26,081 | $0 | $376,830 | $0 | $18,870 | $0 |
| WADE SCHMIDT MD | ||||||||||||||
| INTERVENTIONAL CARDIOLOGIST | $739,848 | $0 | $246,228 | $0 | $4,278 | $0 | $19,125 | $0 | $30,348 | $0 | $1,039,827 | $0 | $0 | $0 |
| BERNARD R ERICKSON MD | ||||||||||||||
| INTERVENTIONAL CARDIOLOGIST | $730,705 | $0 | $244,928 | $0 | $4,074 | $0 | $19,125 | $0 | $22,590 | $0 | $1,021,422 | $0 | $0 | $0 |
| HOWARD ZIMRING MD | ||||||||||||||
| INTERVENTIONAL CARDIOLOGIST | $695,739 | $0 | $245,607 | $0 | $21,360 | $0 | $19,125 | $0 | $26,980 | $0 | $1,008,811 | $0 | $0 | $0 |
| JACOB DUTCHER MD | ||||||||||||||
| INTERVENTIONAL CARDIOLOGIST | $686,577 | $0 | $238,470 | $0 | $3,590 | $0 | $19,125 | $0 | $23,391 | $0 | $971,153 | $0 | $0 | $0 |
| RICHARD APLIN MD | ||||||||||||||
| INTERVENTIONAL CARDIOLOGIST | $653,428 | $0 | $227,600 | $0 | $21,800 | $0 | $19,125 | $0 | $26,028 | $0 | $947,981 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED NON-QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO FORM 990, THE AMOUNTS LISTED IN PART VII AND SCHEDULE J, PART II, COLUMN C, REFLECT TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON FORM 990 - ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF AND WHEN IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: DAVID TILSTRA, MD - PAID $18,818; ACCRUED $51,203 MARK MURPHY - PAID $18,870; ACCRUED $24,199 GEORGE MORRIS, MD - PAID $0; ACCRUED $14,237 |
| PART I, LINE 6 | THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR CENTRACARE CLINIC OR CENTRACARE HEALTH SYSTEM; ACHIEVEMENT OF IMPROVEMENT IN PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; ACHIEVEMENT OF IMPROVEMENT IN OVERALL EMPLOYMENT ENGAGEMENT SCORES; AND ACHIEVEMENT OF UP TO THREE INDIVIDUAL GOALS WHICH ARE TIED TO THE CENTRACARE SYSTEM'S STRATEGIC PLAN. THE INCENTIVE COMPENSATION PAID OUT IS NOT A PORTION OR PERCENTAGE OF ACTUAL NET EARNINGS OF ANY CENTRACARE HEALTH SYSTEM AFFILIATE, HOWEVER NET EARNINGS GOALS ARE REQUIRED TO BE MET BEFORE INCENTIVE COMPENSATION IS PAID. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS CENTRACARE HEALTH SYSTEM, A MINNESOTA NON-PROFIT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | PHYSICIAN AND CORPORATE DIRECTORS SHALL BE ELECTED OR APPOINTED AS FOLLOWS: (A) PRIMARY CARE PHYSICIAN DIRECTORS SHALL BE ELECTED BY THE PRIMARY CARE PHYSICIANS EMPLOYED BY CENTRACARE CLINIC. (B) SPECIALIST PHYSICIAN DIRECTORS SHALL BE ELECTED BY THE SPECIALIST PHYSICIANS EMPLOYED BY CENTRACARE CLINIC. (C) THE AT LARGE DIRECTORS SHALL BE ELECTED BY THE PHYSICIANS EMPLOYED BY CENTRACARE CLINIC. (D) THE CORPORATE DIRECTORS ARE APPOINTED BY THE SOLE MEMBER, CENTRACARE HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING MATTERS ARE RESERVED TO THE SOLE MEMBER, CENTRACARE HEALTH SYSTEM, WHICH SHALL BE TAKEN BY A VOTE APPROVED BY AT LEAST 75% OF THE BOARD OF DIRECTORS OF CENTRACARE HEALTH SYSTEM: 1. ADOPTION OF AMENDMENTS TO THE ARTICLES OF CENTRACARE CLINIC. 2. APPROVE AMENDMENTS TO THE BYLAWS OF CENTRACARE CLINIC WHICH MAY AFFECT ANY POWERS OF FUNCTIONS RESERVED TO THE SOLE MEMBER. THE FOLLOWING MATTERS ARE RESERVED TO CENTRACARE HEALTH SYSTEM, WHICH SHALL BE TAKEN BY A VOTE APPROVED BY AT LEAST 51% OF THE BOARD OF DIRECTORS OF CENTRACARE HEALTH SYSTEM: 1. REVIEW AND APPROVE THE FOLLOWING: (I) THE ANNUAL OPERATING AND CAPITAL BUDGETS, (II) ANY CAPITAL EXPENDITURES IN EXCESS OF $1.0 MILLION WHETHER BUDGETED OR NOT BUDGETED, (III) ANY DEBTS TO BE INCURRED. 2. APPROVE ANY ENCUMBRANCE OF THE ASSETS OF CENTRACARE CLINIC. 3. REVIEW AND APPROVE ALL STRATEGIC PLANS OF CENTRACARE CLINIC. 4. REVIEW AND APPROVE ALL MEDICAL STAFF DEVELOPMENT PLANS FOR AN INTEGRATED DELIVERY STEM OF CENTRACARE CLINIC. 5. REVIEW AND APPROVE ALL THIRD PARTY CONTRACTS WHICH ARE FIRST APPROVED BY THE BOARD OF DIRECTORS OF CENTRACARE CLINIC. 6. APPROVE ANY APPOINTMENT OF THE PRESIDENT OF CENTRACARE CLINIC. 7. APPROVE CENTRACARE CLINIC'S ANNUAL BUDGET FOR ALL PROFESSIONAL COMPENSATION AND APPROVE ALL COMPENSATION POLICIES AND PLANS FOR PHYSICIANS EMPLOYED BY CENTRACARE CLINIC. 8. OVERSEE AND MONITOR ALL COMPLIANCE AND RISK MANAGEMENT PRACTICES OF CENTRACARE CLINIC. 9. REVIEW AND APPROVE ANY TRANSACTION OF CENTRACARE CLINIC WHICH MAY AFFECT (I) THE CORPORATION'S STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXATION OR (II) THE TAX EXEMPT STATUS OF ANY FINANCING OF CENTRACARE CLINIC. 10. APPROVE ANY USE OF ANY TRADE NAMES OR ANY INTELLECTUAL PROPERTY OF CENTRACARE CLINIC. 11. THE DETERMINATION OF THE DISSOLUTION OF OR THE DISCONTINUATION OF BUSINESS OF CENTRACARE CLINIC. 12. THE MERGERS WITH, THE ACQUISITION OF, OR THE AFFILIATION WITH ANY HOSPITAL, CLINIC, OR PHYSICIAN PROVIDER GROUP. 13. OVERSEE AUDITING AND ACCOUNTING PRACTICES OF CENTRACARE CLINIC. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN IS REVIEWED IN DETAIL BY MANAGEMENT AND LEGAL COUNSEL. IN ADDITION, THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW FORM 990 WITH STAFF, ASK QUESTIONS, SEEK CLARIFICATIONS, AND APPROVE THE FINAL RETURN PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE TWICE A YEAR. ALL STAFF SIGN CONFLICTS OF INTEREST FORMS ON AN ANNUAL BASIS. THE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AS WELL AS THE CORPORATE COMPLIANCE GROUP (A COMPLIANCE COMMITTEE WHICH INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRES ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD. THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTERESTS RELATED TO BOARD AND STAFF AND TO ALERT AFFECTED PARTIES WHEN A CONFLICT ARISES. WHEN AN ACTUAL CONFLICT ARISES, THE AFFECTED PARTY IS ASKED TO RECUSE HIM/HER SELF FROM THE DECISION MAKING PROCESS. THE CORPORATE COMPLIANCE OFFICER ATTENDS BOARD MEETINGS AND SPECIFIED BOARD COMMITTEE MEETINGS WHERE CONFLICT ISSUES MAY ARISE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION AND BENEFITS OF THE PRESIDENT AND VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES CONDUCTED BIENNIALLY BY A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT. HOWEVER, THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMPENSATION COMMITTEE AND BOARD OF DIRECTORS REVIEW AND APPROVAL. THE MOST RECENT FULL REVIEW WAS DONE MAY 2013. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. COULD HOSPITAL TO PERFORM SERVICES. THE ORGANIZATION'S EMPLOYED PRACTICING PHYSICIANS ARE SUBJECT TO ANNUAL FULL COMPENSATION AND BENEFITS REVIEW THROUGH COMPARABILITY STUDIES BY AN OUTSIDE, INDEPENDENT CONSULTANT USING NATIONAL AND REGIONAL DATA FROM MULTIPLE SOURCES. THIS STUDY IS REVIEWED BY THE COMPENSATION COMMITTEE AND APPROVED BY THE COMMITTEE AND THE BOARD. THE LAST FULL REVIEW WAS COMPLETED IN APRIL 2013. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT OPEN TO PUBLIC DISCLOSURE. |
| FORM 990, PART XI, LINE 9: | NET EQUITY TRANSFERS FROM AFFILIATES 12,080,123. |
| FORM 990, PART I, LINE 6 - TOTAL NUMBER OF VOLUNTEERS: | CENTRACARE CLINIC HAD 11 VOLUNTEERS DURING FY14 WHO DONATED A TOTAL OF APPROXIMATLEY 747.95 HOURS TO VARIOUS DEPARTMENTS. |
| FORM 990, PAGE 1, LINE 11 "OTHER REVENUE" | THE AMOUNT REPORTED ON LINE 11 OF PAGE 1, "OTHER REVENUE" IS $0 FOR THE CURRENT YEAR AND $3,771,631 FOR THE PRIOR YEAR. THE REASON FOR THE DIFFERENCE IS DUE TO A CHANGE IN REPORTING PRESENTATION. THE HEALTH INFO TECH INCENTIVE INCOME REPORTED ON LINE 2D AND THE QUALITY INITIATIVES INCOME REPORTED ON LINE 2C OF THE STATEMENT OF REVENUE WERE REPORTED ON LINE 11 AS MISCELLANEOUS INCOME ON THE 2012 (FY13) FORM 990. THE INCOME OF THESE ACTIVITIES RELATES TO THE MISSION OF CENTRACARE CLINIC AND IS THE REASON FOR THE CHANGE IN PRESENTATION. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTRACARE HEALTH SYSTEM | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 411813221 | HEALTHCARE HOLDING COMPANY | MN | 501(C)(3) | 11- TYPE 3 FI | N/A | 0 | |
| CENTRACARE HEALTH SYSTEM-MELROSE | |||||||||||
| 11 NORTH 5TH AVE WEST | MELROSE | MN | 56352 | 411865315 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRACARE HEALTH SYSTEM-LONG PRAIRIE | |||||||||||
| 20 SOUTHEAST 9TH STREET | LONG PRAIRIE | MN | 56347 | 411924645 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRACARE HEALTH FOUNDATION | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 411855173 | FUNDRAISING | MN | 501(C)(3) | LINE 7 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRAL MINNESOTA EMERGENCY PHYSICIANS | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 411708142 | EMERGENCY PHYSICIANS | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| ST CLOUD HOSPITAL | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 410695596 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRACARE HEALTH SYSTEM-SAUK CENTRE | |||||||||||
| 425 ELM STREET NORTH | SAUK CENTRE | MN | 56378 | 452438973 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRACARE PHARMACY SERVICES INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1406 6TH AVE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411620618 | EIN |
| Primary Activities | RETAIL PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRACARE HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |