2015-10-13T10:58:04-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-01-01 411949230 GLENCOE REGIONAL HEALTH SERVICES GLEN 3208643121 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 JON BRABAND PRESIDENT & CEO 3208643121 2015-09-30 1 ROBERT E SCHILE P00369682 6123764500 2014 2016-03-07 17:11:31Z JON BRABAND 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 61327907 0 X WWW.GRHSONLINE.ORG X 1999 MN TO PROVIDE HIGH QUALITY, CONVENIENT AND PERSONAL HEALTH CARE TO THOSE WE SERVE. 7 4 628 135 0 0 220815 789302 47909950 51943927 1255086 4135327 -173354 278729 49212497 57147285 19084 10374 0 0 31587547 29953723 0 0 0 18378280 19662232 49984911 49626329 -772414 7520956 81104350 87081889 28180192 28682471 52924158 58399418 X GLENCOE REGIONAL HEALTH SERVICES EXISTS TO PROVIDE HIGH QUALITY, CONVENIENT AND PERSONAL HEALTH CARE TO THOSE WE SERVE. WE DO SO BY PROVIDING COMPREHENSIVE, EVIDENCE-BASED, COST-EFFECTIVE HEALTH CARE SERVICES AND EDUCATION. WE COLLABORATE WITH OTHERS TO COORDINATE AND IMPROVE THE HEALTH OF OUR COMMUNITIES, AND COMMIT OUR SKILLS AND RESOURCES TO BENEFIT THE WHOLE PERSON THROUGH ALL STAGES OF LIFE. 0 0 36465417 10374 43950821 HOSPITAL - THE FACILITY IS LICENSED FOR 49 BEDS. MEDICAL/SURGICAL SERVICES ARE PROVIDED FOR ACUTE AND SWING BED PATIENTS. MAJOR SERVICES PROVIDED INCLUDE ER, URGENT CARE, MEDICAL IMAGING, SURGERY, LABORATORY, REHABILITATION THERAPY, OBSTETRICS AND TRANSITIONAL CARE. WE PROUDLY REPORT THAT GRHS HAS RECEIVED FIVE PATIENT SAFETY AWARDS FROM THE MINNESOTA HOSPITAL ASSOCIATION (MHA): SAFE FROM FALLS, SAFE SKIN, SAFE COUNT, SAFE SITE AND SAFE ACCOUNT. WE HAVE ALSO BEEN RECOGNIZED BY MHA AND THE MARCH OF DIMES FOR OUR WORK TO REDUCE EARLY ELECTIVE LABOR INDUCTIONS. 6611736 0 7513726 NURSING HOME - LONG TERM CARE IS A 110-BED SKILLED NURSING FACILITY, WITH ALL BEDS MEDICARE AND MEDICAID CERTIFIED. WE'RE PLEASED TO ANNOUNCE THAT LONG TERM CARE AT GRHS HAS RECEIVED AN OVERALL RATING OF FOUR-OUT-OF-FIVE STARS FROM MEDICARE'S NURSING HOME COMPARE PROGRAM. WE ARE ALSO CURRENTLY PARTICIPATING IN THE MINNESOTA DEPARTMENT OF HEALTH'S QUALITY IMPROVEMENT INCENTIVE PAYMENT PROGRAM. THROUGH OUR PARTICIPATION, WE HAVE REDUCED THE PREVALENCE OF ANTI-PSYCHOTIC MEDICATION IN RESIDENTS WITHOUT A DIAGNOSIS OF PSYCHOSIS FROM 9.477% TO 1.939%. LONG TERM CARE IS ALSO ACTIVELY PARTICIPATING IN THE GRHS PATIENT AND FAMILY ADVISORY COUNCIL. THIS COUNCIL WORKS TO IMPROVE THE QUALITY OF CARE AND PATIENT/RESIDENT EXPERIENCE. IT IS MADE UP OF OUR LONG TERM CARE RESIDENTS, PATIENTS AND STAFF. 421833 0 479380 INDEPENDENT SENIOR LIVING - ORCHARD ESTATES IS A 40-UNIT SENIOR-HOUSING COMPLEX COMPRISED OF ONE AND TWO BEDROOM APARTMENTS. WE OFFER A MONTHLY SCHEDULE OF ORGANIZED ACTIVITIES, SO THERE IS ALWAYS SOMETHING TO DO AT ORCHARD ESTATES. EVERY TENANT RECEIVES A CALENDAR OF EACH MONTH'S PLANNED ACTIVITIES. HERE ARE JUST A FEW EXAMPLES: BIRTHDAY PARTIES AND HOLIDAY CELEBRATIONS, CHURCH SERVICES FOR VARIOUS DENOMINATIONS ARE HELD EACH WEEK IN THE LONG TERM CARE CHAPEL AT GLENCOE REGIONAL HEALTH SERVICES, EXERCISE CLASSES, BINGO, TRIVIA CONTESTS AND MORE. WE ALSO TAKE OCCASIONAL FIELD TRIPS, FOR THOSE WHO ARE INTERESTED.MANY ORCHARD ESTATES TENANTS ALSO ENJOY THE OPPORTUNITY TO VOLUNTEER THEIR TIME AND TALENTS AT GLENCOE REGIONAL HEALTH SERVICES. THERE ARE DOZENS OF AREAS IN WHICH VOLUNTEERS CAN SERVE HOSPITAL AND CLINIC PATIENTS, VISITORS, AND LONG TERM CARE RESIDENTS. 43498986 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 25 0 628 1 0 0 0 0 0 0 0 0 0 0 X 7 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X ANGELA ERICKSON 3208647797 1805 HENNEPIN AVENUE NORTH GLENCOE MN 553361416 JEANNE CONKEL CHAIR 0.50 X X 1200 0 0 JAN BRATSCH VICE CHAIR 0.50 X X 1300 0 0 CAROL HAUKOS SECRETARY 0.50 X X 1300 0 0 STEVE OLMSTEAD DIRECTOR 0.50 X 1300 0 0 DR KRISTINE KNUDTEN DIRECTOR & PHYSICIAN 40.50 X 262188 0 37879 DR JOHN BERGSENG DIRECTOR & PHYSICIAN 40.50 X 418786 0 36608 DR JOHN TIEBEN DIRECTOR & PHYSICIAN 40.50 X 342712 0 37879 JOHN BRABAND PRESIDENT & CEO 40.00 X 0 0 0 JOHN DOIDGE VICE PRESIDENT OF FINANCE 40.00 X 150657 0 33756 DR BRYAN PETERSON PHYSICIAN & FORMER DIRECTOR 40.00 X 345424 0 30988 DR JOHN MARK JOHNSON PHYSICIAN 40.00 X 388155 0 37879 DR CHAD ROBBINS PHYSICIAN 40.00 X 369742 0 44108 DR JAMES JESSEN PHYSICIAN 40.00 X 323794 0 31623 DR CHRISTA WAYMIRE PHYSICIAN 40.00 X 321790 0 39108 2928348 0 329828 33 0 1 0 PREMIER STAFFING INC 243 WINKLER TRAIL COLOGNE MN 55322 PHYSICIAN SERVICES 829625 SCHATZ CONSTRUCTION INC 1011 ARMSTRONG AVE GLENCOE MN 55336 CONSTRUCTION 467298 REHABCARE GROUP EAST INC PO BOX 503534 ST LOUIS MO 63150 REHAB SERVICES 412165 SHARED MEDICAL SERVICES PO BOX 330 COTTAGE GROVE WI 53527 MRI SERVICES 274800 PARK NICOLLETMETHODIST HOSPITAL PO BOX 16300 ST LOUIS PARK MN 55416 MANAGEMENT FEES 261123 16 303071 486231 789302 HOSPITAL 623000 41440124 41440124 NURSING HOME 623000 7513726 7513726 PHARMACY 623000 1601979 1601979 EHR INCENTIVE PROGRAM 623000 1063644 1063644 SENIOR LIVING 623990 479380 479380 -154926 -154926 51943927 574884 574884 27528 0 27528 27528 27528 7560866 161105 4093397 68131 3467469 92974 3560443 3560443 27712 19094 8618 8618 CAFETERIA REVENUE 722210 181144 181144 MISCELLANEOUS 900099 61439 61439 242583 57147285 51943927 0 4414056 10374 10374 1568415 1124691 443724 23428870 22128115 1300755 769156 730148 39008 2599522 2463914 135608 1587760 1493124 94636 44948 44948 60070 6523 53547 4153856 2623145 1530711 216394 2605 213789 1587688 1291189 296499 208842 208842 1317315 1310202 7113 165779 136070 29709 15307 5537 9770 732282 732282 3415566 3415566 670925 206942 463983 MEDICAL EXPENSES 2651776 2651299 477 DRUGS 2140643 2137794 2849 LICENSES & TAXES 1147393 1147393 BAD DEBT EXPENSE 693968 693968 439480 335498 103982 49626329 43498986 6127343 0 9585864 13658058 30454258 22213162 7141057 9235377 321509 407119 466506 547794 64003001 43120114 22802498 20882887 8324417 18663780 667286 0 370185 348725 970770 1124987 81104350 87081889 4134185 4246049 23046409 22051762 28828 32938 970770 2351722 28180192 28682471 X 52924158 58399418 52924158 58399418 81104350 87081889 7520956 -2045696 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2802 2802 0 PART II-B, LINE 1: LOBBYING PORTION OF ASSOCIATION DUES PAID TO AHA AND MHA. 0 1 X 1232257 1232257 32103455 18678052 13425403 1484494 1190559 293935 28970047 23251503 5718544 212748 212748 20882887 DEFERRED COMPENSATION 1124987 THIRD PARTY PAYOR CONTIGENCY 1226735 2351722 X 51753980 -693968 -693968 52447948 4699337 4699337 57147285 48951455 19094 19094 48932361 693968 693968 49626329 PART IV, LINE 2B: INDEPENDENT SENIOR LIVING TENANTS MAKE SECURITY DEPOSITS WHEN THEY MOVE IN TO THE FACILITY. DEPOSITS, WITH INTEREST, LESS ANY COSTS OF REPAIRS, ARE RETURNED TO TENANTS OR THEIR ESTATES WHEN THE TENANT LEAVES THE FACILITY. THE ORGANIZATION HOLDS SMALL AMOUNTS DEPOSITED BY RESIDENTS OF THE NURSING HOME ON THEIR BEHALF. RESIDENTS MAY MAKE DEPOSITS OR WITHDRAWALS AT ANY TIME. PART X, LINE 2: THE FACILITY QUALIFIES AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE FACILITY IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE FACILITY HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FACILITY FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE FACILITY'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -693,968. PART XI, LINE 4B - OTHER ADJUSTMENTS: UNRESTRICTED CONTRIBUTIONS AND GRANTS 714,525. INVESTMENT INCOME 4,042,353. EQUITY IN INCOME OF AFFILIATED ORGANIZATION -158,949. RENTAL PROPERTY 27,528. GAIN ON DISPOSAL OF ASSETS 92,974. GIFT SHOP MERCHANDISE -19,094. PART XII, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP MERCHANDISE 19,094. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 693,968. 1 1 X 1 X 1 X 0 1 0 1 1 1038013 130338 907675 0.01830 8789254 8781142 8112 0.00020 9827267 8911480 915787 0.01850 156866 9235 147631 0.00300 79524 74777 4747 0.00010 27992 24459 3533 0.00010 53938 53938 0.00110 318320 108471 209849 0.00430 10145587 9019951 1125636 0.02280 34831 34831 0.00070 199 199 0.00000 35030 35030 0.00070 0 693968 11528059 11448703 79356 X 1 1 1 1 GLENCOE REGIONAL HEALTH SERVICES 1805 HENNEPIN AVENUE NORTH GLENCOE MN 55336 WWW.GRHSONLINE.ORG 360844 X X X X NURSING HOME/SNF GLENCOE REGIONAL HEALTH SERVICES 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X HTTP://GRHSONLINE.ORG/CHNA/ X 1 13 1 HTTP://GRHSONLINE.ORG/CHNA/ 0 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X X X X X X X X 1 X 0 X X 1 X 0 0 GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 5: INVITATIONS TO PARTICIPATE IN TWO HALF-DAY WORKSHOPS WERE SENT OUT TO OVER 100 PEOPLE AND AGENCIES IN OUR COMMUNITY, REPRESENTING PUBLIC HEALTH, EDUCATION, BUSINESS, LOCAL GOVERNMENT AND OTHER COMMUNITY SERVICE AGENCIES. APPROXIMATELY 60 INDIVIDUALS PARTICIPATED IN THE TWO FOCUS GROUP SESSIONS. IT WAS FELT THAT THE NEEDS AND INTEREST OF THE MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS WERE ABLE TO BE REPRESENTED THROUGH INPUT FROM REPRESENTATIVES FROM THE MCLEOD COUNTY FOOD SHELF, COUNTY PUBLIC HEALTH AND HUMAN SERVICES, CITY AND COUNTY GOVERNMENT OFFICIALS, AND OTHER COMMUNITY SERVICE AGENCIES. THE NEEDS OF THE MOST SIGNIFICANT MINORITY POPULATION IN THE AREA WERE ALSO FELT TO BE REPRESENTED THROUGH PARTICIPATION BY A SPANISH INTERPRETER EMPLOYED BY GLENCOE REGIONAL HEALTH SERVICES. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 6A: HUTCHINSON HEALTH, MEEKER MEMORIAL HOSPITAL, SIBLEY HEALTH CENTER GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 11: GRHS HAS BEEN OBTAINING TELEMEDICINE SERVICES THAT ARE ABLE TO HELP PROVIDE MENTAL HELP ACCESS SUCH AS PSYCHIATRISTS AND PSYCHOLOGISTS AS NEEDED. THIS IS AN EXPANSION OF THESE SERVICES FOR THIS AREA. THIS INTERVENTION WILL BE MONITORED OVER TIME TO DETERMINE ITS EFFECTIVENESS AND WHETHER THE COMMUNITY NEEDS ARE BEING ADDRESSED IN THIS AREA. WE WILL ASSESS UTILIZATION AS A PROXY MEASURE OF ACCEPTANCE OF THE SERVICE. THE ASSUMPTION WILL BE THAT USE OF THE SERVICE WILL HAVE A POSITIVE IMPACT ON THE OVERALL MENTAL HEALTH STATUS OF THE PATIENTS OF THE COMMUNITY. REGARDING THE OTHER TOP TWO IDENTIFIED NEEDS, IT WAS DETERMINED THAT OBESITY PREVENTION AND PREVENTION/WELLNESS CAN BE ADDRESSED ON A PER-PATIENT BASIS DURING ONE-ON-ONE ENCOUNTERS WITH GRHS MEDICAL PROVIDERS. IT WAS ALSO DETERMINED THAT GRHS WILL EVALUATE AVENUES TO COLLABORATE WITH OTHER COMMUNITY AGENCIES TO ADDRESS THESE ISSUES AS THESE OPPORTUNITIES PRESENT THEMSELVES. GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 16I: FIANCIAL ASSISTANCE POLICY WAS GIVEN TO EACH SELF PAY ER PATIENT WHEN LEAVING OUR FACILITY. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 16A WEBSITE: WWW.GRHSONLINE.ORG/INSURANCE-BILLING GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 16B WEBSITE: WWW.GRHSONLINE.ORG/INSURANCE-BILLING GLENCOE REGIONAL HEALTH SERVICES PART V, SECTION B, LINE 16C WEBSITE: SEE WEBSITE ABOVE 4 GLENCOE REGIONAL HEALTH SERVICES 1024 CENTRAL AVENUE LESTER PRAIRIE MN 55354 CLINIC GLENCOE REGIONAL HEALTH SERVICES 300 BOWMAN STREET STEWART MN 55385 CLINIC GRHS LONG-TERM CARE 705 EAST 18TH STREET GLENCOE MN 55336 NURSING HOME ORCHARD ESTATES 1900 FORD AVENUE NORTH GLENCOE MN 55336 SENIOR APARTMENTS PART I, LINE 7: THE AMOUNTS IN PART I, LINE 7 WERE CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990, SCHEDULE H. PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN ITS SUBSIDIZED HEALTH SERVICES IN SCHEDULE H, PART I, LINE 7G. PART I, LN 7 COL(F): BAD DEBT EXPENSE REPORTED IN FORM 990, PART IX, LINE 24D WERE $693,968. THIS AMOUNT WAS SUBTRACTED IN CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: OUR COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH DISASTER PREPAREDNESS EFFORTS, COMMUNITY DISEASE SURVEILLANCE ACTIVITIES, FINANCIAL AND IN-KIND SUPPORT AND EDUCATION. FIRST, THROUGH DISASTER PREPAREDNESS TRAINING, WE SUPPORT AND PROTECT THE HEALTH OF OUR COMMUNITIES BY WORKING TO INSURE THAT THOSE NEEDING MEDICAL ATTENTION CAN ACCESS QUALITY CARE IN A SAFE AND TIMELY MANNER. DISASTER PREPAREDNESS EFFORTS ARE A YEAR-ROUND ACTIVITY, AS DISASTERS CAN INCLUDE PANDEMICS, NATURAL DISASTERS AND MASS CASUALTY SITUATIONS. OUR COMMUNITY DISEASE SURVEILLANCE ACTIVITIES ARE CLOSELY ALIGNED WITH OUR DISASTER PREPAREDNESS EFFORTS. WE TRACK AND MONITOR CLOSTRIDIUM DIFFICILE (CDIF), RESPIRATORY SYNCYTIAL VIRUS (RSV) AND INFLUENZA CASES AND REPORT OUR NUMBERS TO THE STATE OF MINNESOTA. THIS MONITORING DETERMINES THE NEED FOR VISITOR RESTRICTIONS TO PROTECT BOTH PATIENTS AND VISITORS. IT ALSO HELPS DETERMINE IF A PANDEMIC/EMERGENCY RESPONSE SHOULD BE INITIATED TO FURTHER PROTECT PATIENTS, VISITORS AND THE COMMUNITY. IN ADDITION TO DISASTER PREPAREDNESS AND COMMUNITY DISEASE SURVEILLANCE EFFORTS, WE PROVIDE CASE MANAGEMENT OF UNDERINSURED AND UNINSURED INPATIENTS BY WORKING TO HELP PATIENTS RETURN HOME AND REGAIN THEIR INDEPENDENCE AFTER AN ILLNESS, INJURY OR SURGERY. IN CASES WHERE IT IS NOT POSSIBLE FOR SOMEONE TO RETURN HOME, WE WORK TO MAKE SURE THEY HAVE ACCESS TO THE CARE AND RESOURCES THEY NEED TO CONTINUE THEIR RECOVERY OR LIVE WITH DIGNITY. THROUGH HELPING OUR PATIENTS OBTAIN FINANCIAL SUPPORT, AS WELL AS OBTAIN ACCESS TO COMMUNITY SUPPORT SYSTEMS, WE WORK TO ENSURE THAT THEY GET ADDITIONAL SERVICES THAT MAY BE NEEDED TO ASSIST IN THEIR RECOVERY. THIS PROMOTES THE HEALTH OF THE COMMUNITY BY INSURING THAT PATIENTS HAVE THE SUPPORT AND RESOURCES THEY NEED TO LIVE AS PRODUCTIVE CITIZENS, AS WELL AS HELPING TO CREATE A COMMUNITY IN WHICH PEOPLE ARE VALUED AND TREATED WITH RESPECT. BY PROVIDING FINANCIAL AND IN-KIND SUPPORT TO THE GLENCOE AREA CHAMBER OF COMMERCE, WE SUPPORT THE ECONOMIC HEALTH OF OUR REGION. A STRONG LOCAL ECONOMY CONTRIBUTES TO THE OVERALL HEALTH AND WELL-BEING OF ALL ITS RESIDENTS. BY PROVIDING SUPPORT FOR COMMUNITY ACTIVITIES, SUCH AS THE MCLEOD COUNTY FOOD DRIVE CHALLENGE, WE ENHANCE THE QUALITY OF LIFE IN OUR REGION. FINALLY, BY PROVIDING EDUCATIONAL PRESENTATIONS AND TOURS TO OUR AREA SCHOOLS, WE ARE INVESTING IN A FUTURE GENERATION OF HEALTH CARE WORKERS WHO MAY SOMEDAY PROVIDE DIRECT CARE TO OUR PATIENTS AND OTHERS IN THE COMMUNITIES WE SERVE. WE ARE ALSO EDUCATING INDIVIDUALS ABOUT THE WORK WE DO, WHY WE DO IT, AND HOW OUR EFFORTS AFFECT THEIR LIVES AND THE LIVES OF OTHERS. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE, NET" PARAGRAPH IN NOTE 1 (PAGES 8-9) TO THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION USES A COST-TO-CHARGE RATIO TO CALCULATE THE MEDICARE ALLOWABLE COSTS REPORTED IN ITS MEDICARE COST REPORT. THE ORGANIZATION USES THE MEDICARE REIMBURSEMENT PROVIDER MANUAL 15-2 TO DETERMINE ACCEPTABLE METHODOLOGIES. PART III, LINE 9B: OUR GENERAL DEBT COLLECTION POLICY FOR ALL PATIENTS IS AS FOLLOWS: TWO BILLING STATEMENTS ARE SENT OUT TO THE PATIENT. ACCOUNTS WITH NO SELF-PAY ACTIVITY WITHIN TWO MONTHS RECEIVE A FIRST REMINDER LETTER. IF NO PAYMENT IS RECEIVED WITHIN ONE MONTH OF THE FIRST LETTER A SECOND REMINDER IS SENT. IF NO PAYMENT IS MADE WITHIN THREE WEEKS OF THE SECOND LETTER BEING SENT, A PHONE CALL IS PLACED TO THE PATIENT IN ORDER TO SET UP PAYMENT ARRANGEMENTS. IF AN AGREEMENT IS NOT MET, THE ACCOUNT IS SENT TO COLLECTIONS. IN ALL, PATIENTS RECEIVE FOUR NOTICES BEFORE AN ACCOUNT IS SENT TO COLLECTIONS. PAYMENT PLANS ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE OR FINANCIAL SITUATION. WE DO NOT CHARGE INTEREST OR FEES ON PAYMENT PLANS. FOR 2014, THERE WAS A MINIMUM $50.00 PAYMENT REQUIRED ON PAYMENT PLANS. IF PATIENTS CONTACT US ABOUT THEIR BILL, WE WILL REFER THEM TO FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE OR DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE PROGRAMS OR UNINSURED DISCOUNT PROGRAMS. INFORMATION ABOUT THE DISCOUNTS AND PROGRAMS THAT ARE AVAILABLE TO PATIENTS CAN ALSO BE FOUND ON THE BACK OF EACH MONTHLY STATEMENT AND ON EACH PAYMENT REMINDER LETTER THAT IS SENT AS WELL AS POSTED ON OUR WEBSITE. WHEN INSURANCE COMPANIES NEED MORE INFORMATION FROM THE PATIENT TO PROCESS THE CLAIM, WE WILL CALL THE PATIENT AND SEND THE PATIENT A REMINDER LETTER ASKING THE PATIENT TO CONTACT THEIR INSURANCE COMPANY. PART VI, LINE 2: GRHS ASSESSES OUR COMMUNITIES' HEALTH NEEDS THROUGH VARIOUS METHODS. WE HAVE CONDUCTED COMMUNITY-BASED RESEARCH ON SEVERAL OCCASIONS, INCLUDING USE OF FOCUS GROUPS AND STATISTICALLY VALID TELEPHONIC SURVEYS. DURING OUR ANNUAL STRATEGIC PLANNING PROCESS, WE REVIEW UTILIZATION TRENDS, ALONG WITH THE RESULTS OF ANY COMMUNITY-BASED RESEARCH CONDUCTED THAT YEAR. WE SOLICIT FEEDBACK FROM OUR MEDICAL STAFF REGARDING ISSUES AND TRENDS THEY SEE. WE VERIFY THOSE TRENDS, AS WELL AS IDENTIFY OTHER ISSUES AND NEEDS BY CONDUCTING INTERNAL RESEARCH AND REVIEWS OF PATIENT DATA AND STATISTICS. WE ALSO MONITOR FEEDBACK RECEIVED THROUGH PATIENT SATISFACTION SURVEYS. IN ADDITION, WE SURVEY OUR PATIENTS AT ALL OF OUR COMMUNITY HEALTH EVENTS TO FIND OUT WHAT TOPICS THEY WOULD LIKE TO KNOW MORE ABOUT. WE ALSO COLLABORATE WITH LOCAL PUBLIC HEALTH AND OTHER AGENCIES AS APPROPRIATE TO LEARN ABOUT OUR COMMUNITIES' NEEDS. PART VI, LINE 3: GRHS EDUCATES AND INFORMS PATIENTS ABOUT FINANCIAL ASSISTANCE, CHARITY CARE AND UNINSURED DISCOUNT PROGRAMS IN ALL BILLING INVOICES SENT. THE INFORMATION IS LISTED ON THE BACK OF THE BILLING STATEMENT. WE ALSO POST THE INFORMATION IN OUR FACILITY AND INCLUDE IT ON OUR WEB SITE, WWW.GRHSONLINE.ORG. IN ADDITION, WE PROVIDE A REPORT BACK TO THE COMMUNITY ANNUALLY ABOUT OUR FINANCES AND CHARITY CARE AMOUNTS. THIS REPORT IS SENT TO ALL OF OUR PATIENTS, AS WELL AS THE RESIDENTS IN THE COMMUNITIES WE SERVE. PART VI, LINE 4: PATIENTS CARED FOR BY GRHS RESIDE, PRIMARILY, IN AN AREA WITHIN A RADIUS OF TWENTY MILES OF THE CITY OF GLENCOE, WHICH IS APPROXIMATELY 55 MILES WEST OF MINNEAPOLIS. THE POPULATION OF GRHS'S PRIMARY SERVICE AREA WAS PROJECTED TO BE 29,148 IN 2000, AN INCREASE OF 4.8% SINCE 1990. THE REPORTED POPULATION OF THE CITY OF GLENCOE FOR THE YEAR 2000 AND 2010 WERE 5,453 AND 5,631 RESPECTIVELY, AN INCREASE OF 3.3%. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 EMPLOYEE SCHOLARSHIPS 10 10374 PART I, LINE 2: THE ORGANIZATION PROVIDES TUITION REIMBURSEMENT ASSISTANCE TO EMPLOYEES. EMPLOYEES ARE REQUIRED TO COMPLETE THE REIMBURSEMENT REQUEST FORM, WHICH IS TO BE SIGNED BY THEIR SUPERVISOR, PRIOR TO BEGINNING THEIR COURSE(S) TO RESERVE FUNDS. THEY ARE TO INCLUDE A DESCRIPTION OF THE COURSE(S) THEY PLAN TO TAKE, AND RECEIPTS FOR TUITION AND BOOKS, (FEES ARE NOT ELIGIBLE FOR REIMBURSEMENT), WITH THEIR REQUEST. EMPLOYEES ARE REQUIRED TO COMPLETE THEIR COURSE WITH A GRADE OF C OR BETTER TO BE ELIGIBLE FOR REIMBURSEMENT. EMPLOYEES ARE RESPONSIBLE FOR ALL UP-FRONT COSTS. X X X X 0 0 0 0 0 0 0 0 0 DR KRISTINE KNUDTEN DIRECTOR & PHYSICIAN 249657 0 12531 0 0 0 0 0 37879 0 300067 0 0 0 DR JOHN BERGSENG DIRECTOR & PHYSICIAN 400809 0 17977 0 0 0 0 0 36608 0 455394 0 0 0 DR JOHN TIEBEN DIRECTOR & PHYSICIAN 327967 0 14745 0 0 0 0 0 37879 0 380591 0 0 0 JOHN DOIDGE VICE PRESIDENT OF FINANCE 123164 0 7092 0 20401 0 7270 0 26486 0 184413 0 0 0 DR BRYAN PETERSON PHYSICIAN & FORMER DIRECTOR 331876 0 13548 0 0 0 0 0 30988 0 376412 0 0 0 DR JOHN MARK JOHNSON PHYSICIAN 370509 0 17646 0 0 0 0 0 37879 0 426034 0 0 0 DR CHAD ROBBINS PHYSICIAN 352456 0 17286 0 0 0 0 0 44108 0 413850 0 0 0 DR JAMES JESSEN PHYSICIAN 309827 0 13967 0 0 0 0 0 31623 0 355417 0 0 0 DR CHRISTA WAYMIRE PHYSICIAN 301138 0 12202 0 8450 0 0 0 39108 0 360898 0 0 0 A CITY OF GLENCOE MINNESOTA 416005185 378160BW4 2013-02-27 23087781 DEFEASE SERIES 2005 BONDS 0 0 0 A 945000 23087781 1738331 388068 20961913 2013 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WHICH SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS, THE VICE CHAIRPERSON OF THE BOARD OF DIRECTORS, THE PRESIDENT AND THE SECRETARY OF THE BOARD OF DIRECTORS. THE CHAIRPERSON OF THE BOARD OF DIRECTORS SHALL BE THE CHAIRPERSON OF THE EXECUTIVE COMMITTEE AND THE SECRETARY SHALL ACT AS THE SECRETARY THEREOF. THE EXECUTIVE COMMITTEE SHALL ADVISE WITH AND AID THE OFFICERS OF THE CORPORATION IN ALL MATTERS CONCERNING THE MANAGEMENT OF ITS BUSINESS; AND BETWEEN MEETINGS OF DIRECTORS THE EXECUTIVE COMMITTEE SHALL POSSESS AND MAY EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS EXCEPT WITH REFERENCE TO MAKING OR AMENDING THE BYLAWS FOR THE BOARD OF DIRECTORS, REMOVING ANY MEMBER OF THE BOARD OF DIRECTORS OR FILLING VACANCIES IN THEIR OWN MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A CONTRACTUAL ARRANGEMENT WITH PARK NICOLLET HEALTH SERVICES, UNDER WHICH PARK NICOLLET HEALTH SERVICES PROVIDES A CHIEF EXECUTIVE OFFICER, MANAGEMENT CONSULTATION, AND OTHER SERVICES TO THE FACILITY. THE ARRANGEMENT DOES NOT ALTER THE AUTHORITY OR RESPONSIBILITY OF THE BOARD OF DIRECTORS OF GLENCOE REGIONAL HEALTH SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE 990 REPORT WAS REVIEWED WITH THE BOARD MEMBERS AT A REGULARY SCHEDULED BOARD MEETING. THE BOARD WAS ASKED TO APPROVE THE DOCUMENT PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C GLENCOE REGIONAL HEALTH SERVICES HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF A COMMITTEE OF THE BOARD OF DIRECTORS, AND SENIOR MANAGEMENT. ANNUALLY, THE BOARD MEMBERS AND SENIOR MANAGMENT ARE ASKED TO COMPLETE THE CONFLICT OF INTEREST DECLARATION. ANY INDIVIDUAL HAVING A CONFLICT OF INTEREST IS REQUIRED TO INFORM THE BOARD OR COMMITTEE. THE INDIVIDUAL ABSTAINS FROM VOTING ON THE MATTER, BUT IS PERMITTED TO BRIEFLY STATE THEIR POSITION AND ANSWER PERTINENT QUESTIONS. THE MINUTES OF THE MEETING REFLECT THAT THE DISCLOSURE WAS MADE AND THAT THE PERSON ABSTAINED FROM VOTING. THE PRESIDENT AND CEO IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CEO REVIEW PROCESS IS PERFORMED UNDER THE DIRECTION OF PARK NICOLLET AND INDEPENDENT COMPARISON DATA IS USED TO ESTABLISH COMPENSATION. THE BOARD OF DIRECTORS FINALIZES THE REVIEW AND COMPENSATION. THE VICE PRESIDENT OF FINANCE REVIEW IS CONDUCTED BY THE CEO AND COMPENSATION IS DETERMINED USING INDEPENDENT COMPARISON DATA. BOTH POSITIONS WERE REVIEWED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL STATEMENTS ARE PUBLISHED ONCE PER YEAR IN THE FACILITY PUBLICATION TOUCHING LIVES. THE TOUCHING LIVES PUBLICATION IS MAILED TO ALL RESIDENTS IN THE FACILITY'S SERVICE AREA.