2015-05-08T07:43:23-05:00 2014-06-30 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2013-07-01 411806657 CENTRACARE CLINIC CENT 3202525131 1200 6TH AVENUE NORTH ST CLOUD MN 56303 DAVID TILSTRA PRESIDENT 3202525131 2015-04-21 1 TODD A JACKSON P00092672 6123324300 2013 2016-02-25 16:41:14Z DAVID TILSTRA MD 1200 6TH AVENUE NORTH ST CLOUD MN 56303 154234747 0 X WWW.CENTRACARE.COM X 1995 MN WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. 10 4 1040 11 0 0 500557 176103 153646154 153831756 60839 77829 3771631 0 157979181 154085688 5500 10984 0 0 123651381 125615876 0 0 0 44165109 43541815 167821990 169168675 -9842809 -15082987 43096633 41337405 26429686 27673322 16666947 13664083 X CENTRACARE CLINIC WILL BE THE LEADER IN MINNESOTA FOR QUALITY, SAFETY, SERVICE AND VALUE. 0 0 90857426 10984 108093242 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 46599306 45738515 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 5950773 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. 143407505 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 89 0 1 1040 1 0 0 0 0 0 0 0 0 0 0 X 10 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X THOMAS FELDHEGE 3202402152 1200 SIXTH AVENUE NORTH ST CLOUD MN 56303 DAVID TILSTRA MD CPE DIRECTOR & PRESIDENT 36.00 4.00 X X 463047 0 92387 DAVID ROBERTS MD DIRECTOR, CHAIR & GASTROENTEROLOGIST 38.00 2.00 X X 604530 0 39614 ROBERT STOCKER MD DIRECTOR & OBGYN 38.00 2.00 X 536750 0 19125 SHARON WIDSTROM DIRECTOR & INTERNIST 20.00 X 151001 0 10584 DONALD JURGENS MD DIRECTOR & ONCOLOGIST 40.00 X 499968 0 39614 KEITH LEAVELL MD DIRECTOR & PULMONOLOGIST 40.00 X 481044 0 42864 DENISE ROSIN DIRECTOR 1.00 2.00 X 0 2000 0 DAVID AGERTER MD DIRECTOR 1.00 2.00 X 0 1000 0 BYRON JOHN DIRECTOR 1.00 X 0 0 0 PATRICK LYNCH DIRECTOR 1.00 X 0 0 0 THOMAS M FELDHEGE TREASURER & CFO 40.00 X 222113 0 36937 GEORGE MORRIS MEDICAL DIRECTOR 40.00 X 332735 0 53800 MARK MURPHY VICE PRESIDENT OF OPERATIONS 40.00 X 308321 0 64858 WADE SCHMIDT MD INTERVENTIONAL CARDIOLOGIST 40.00 X 990354 0 41614 BERNARD R ERICKSON MD INTERVENTIONAL CARDIOLOGIST 40.00 X 979707 0 39614 HOWARD ZIMRING MD INTERVENTIONAL CARDIOLOGIST 40.00 X 962706 0 42864 JACOB DUTCHER MD INTERVENTIONAL CARDIOLOGIST 40.00 X 928637 0 40364 RICHARD APLIN MD INTERVENTIONAL CARDIOLOGIST 40.00 X 902828 0 42749 8363741 3000 606988 253 0 1 0 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PHYSICIAN SERVICES 479089 DERMATOPATHOLOGY ASSOCIATES 7205 UNIVERSITY AVE NE MINNEAPOLIS MN 55440 LABORATORY SERVICES 471182 UNIVERSITY OF MINNESOTA SES 12-1562 BOX 86 MINNEAPOLIS MN 55486 LOCUM FEES 227300 REGIONAL DIAGNOSTIC RADIOLOGY 1990 CONNECTICUT AVE S SUITE 100 SARTELL MN 56377 RADIOLOGY FEES 200462 DAVID PENCE MD 1010 MULBERRY STREET MANKATO MN 56001 LOCUM FEES 192949 14 176103 176103 PATIENT & RESIDENT SERVICE REVENU 621110 134114717 134114717 OTHER PROGRAM REVENUE 900099 16217920 16217920 QUALITY INITIATIVES 900099 1856984 1856984 HEALTH INFO TECH INCENTIVE 900099 1642135 1642135 153831756 77829 77829 149059 149059 0 154085688 153831756 0 77829 10984 10984 4156316 3677712 478604 100812954 89593022 11219932 5547655 5452074 95581 9597545 7262640 2334905 5501406 4843660 657746 230934 23286 207648 16809 16809 7219292 5869583 1349709 75266 75266 917640 114619 803021 1329801 2165 1327636 6936956 1353971 5582985 228220 188806 39414 878887 672679 206208 1511454 1462370 49084 DRUGS 14284336 14284336 OTHER SUPPLIES 2607934 2607934 BAD DEBT EXPENSE 2555904 2555904 MN CARE/MEDICAID SURCHA 1669786 1669786 3078596 1686708 1391888 169168675 143407505 25761170 0 5243 5888 12686291 11619180 15178170 16321778 1219653 1179034 1273346 1213602 456811 546265 18567928 15008924 3884066 3559004 8393053 6892654 43096633 41337405 21190271 25206639 5239415 2466683 26429686 27673322 X 16666947 13664083 16666947 13664083 43096633 41337405 X -15082987 12080123 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 978 978 0 PART II-B, LINE 1: 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. 3211833 1570699 1641134 15356095 13438225 1917870 3559004 FUNDS HELD BY TRUSTEE 2416683 DUE FROM RELATED ORGANIZATIONS 4475971 6892654 DEFERRED COMPENSATION PLAN OBLIGATIONS 1854226 LT SETTLEMENT RESERVE 200000 EXECUTIVE BENEFIT ACCRUAL 412457 2466683 1 CHAMBER OF COMMERCE PO BOX 487 ST CLOUD MN 56302 123456789 501C3 5500 SCHOLARSHIP 2014/PROGRAM SUPPORT 1 PART I, LINE 2: 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. X X X X X 0 1 0 0 0 1 1 0 0 DAVID TILSTRA MD CPE DIRECTOR & PRESIDENT 321776 0 101769 0 39502 0 71513 0 25691 0 560251 0 18818 0 DAVID ROBERTS MD DIRECTOR, CHAIR & GASTROENTEROLOGIST 514594 0 68376 0 21560 0 19125 0 25271 0 648926 0 0 0 ROBERT STOCKER MD DIRECTOR & OBGYN 445755 0 90360 0 635 0 19125 0 3295 0 559170 0 0 0 SHARON WIDSTROM DIRECTOR & INTERNIST 115032 0 34608 0 1361 0 10584 0 1225 0 162810 0 0 0 DONALD JURGENS MD DIRECTOR & ONCOLOGIST 415855 0 59185 0 24928 0 19125 0 22747 0 541840 0 0 0 KEITH LEAVELL MD DIRECTOR & PULMONOLOGIST 407996 0 54193 0 18855 0 19125 0 26679 0 526848 0 0 0 THOMAS M FELDHEGE TREASURER & CFO 179883 0 23590 0 18640 0 16313 0 22170 0 260596 0 0 0 GEORGE MORRIS MEDICAL DIRECTOR 248348 0 74417 0 9970 0 33310 0 23417 0 389462 0 0 0 MARK MURPHY VICE PRESIDENT OF OPERATIONS 217598 0 51410 0 39313 0 42428 0 26081 0 376830 0 18870 0 WADE SCHMIDT MD INTERVENTIONAL CARDIOLOGIST 739848 0 246228 0 4278 0 19125 0 30348 0 1039827 0 0 0 BERNARD R ERICKSON MD INTERVENTIONAL CARDIOLOGIST 730705 0 244928 0 4074 0 19125 0 22590 0 1021422 0 0 0 HOWARD ZIMRING MD INTERVENTIONAL CARDIOLOGIST 695739 0 245607 0 21360 0 19125 0 26980 0 1008811 0 0 0 JACOB DUTCHER MD INTERVENTIONAL CARDIOLOGIST 686577 0 238470 0 3590 0 19125 0 23391 0 971153 0 0 0 RICHARD APLIN MD INTERVENTIONAL CARDIOLOGIST 653428 0 227600 0 21800 0 19125 0 26028 0 947981 0 0 0 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. 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. 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 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH SYSTEM-LONG PRAIRIE 20 SOUTHEAST 9TH STREET LONG PRAIRIE MN 56347 411924645 ACUTE & LONG-TERM CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 FUNDRAISING MN 501(C)(3) LINE 7 CENTRACARE HEALTH SYSTEM 0 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1406 6TH AVE N ST CLOUD MN 56303 411708142 EMERGENCY PHYSICIANS MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 ST CLOUD HOSPITAL 1406 6TH AVE N ST CLOUD MN 56303 410695596 ACUTE & LONG-TERM CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH SYSTEM-SAUK CENTRE 425 ELM STREET NORTH SAUK CENTRE MN 56378 452438973 ACUTE CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE PHARMACY SERVICES INC 1406 6TH AVE NORTH ST CLOUD MN 56303 411620618 RETAIL PHARMACY MN CENTRACARE HEALTH SYSTEM C 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1