2015-11-10T14:13:54-06:00 2014-12-31 420714325 MCGLADREY LLP 310 BROADWAY AVENUE S SUITE 300 ROCHESTER MN 55904 990 2014-01-01 410855367 OLMSTED MEDICAL CENTER OLMS 5072883443 210 NINTH STREET SE ROCHESTER MN 55904 TIM WEIR CHIEF EXECUTIVE OFFICER 5072883443 2015-09-21 1 DANIEL W EDWARDS P00043974 5072886476 2014 2016-03-07 17:11:31Z KATHRYN LOMBARDO 210 NINTH STREET SE ROCHESTER MN 55904 197733984 0 X HTTP://WWW.OLMMED.ORG X 1949 MN THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY AND SERVICE. 16 10 1337 95 100709 -33103 2546060 2739501 181842362 182483969 1571512 1157747 3315664 1568327 189275598 187949544 465778 527999 0 0 109446281 108702045 0 0 407402 64957815 66508964 174869874 175739008 14405724 12210536 218598004 226978369 83532410 79202650 135065594 147775719 X THE DELIVERY OF EXCEPTIONAL PATIENT CARE FOCUSING ON CARING, QUALITY, SAFETY AND SERVICE. 0 0 154269628 527999 182421545 PATIENT CARE: PERSONAL APPROACH TO CARE THROUGH MORE THAN 25 SPECIALTIES. ALL OF OUR SPECIALTY SERVICES COMPLIMENT PRIMARY CARE AND OFFER PATIENTS GREATER CONVENIENCE AND PEACE OF MIND. WE CONTINUE TO WORK TO POSITION OMC AS A PREFERRED HEALTHCARE PROVIDER FOR PRIMARY AND SECONDARY CARE AMONG SOUTHEASTERN MINNESOTA RESIDENTS. OMC'S 160 CLINICIANS AND 1,000+ HEALTHCARE PROFESSIONALS SERVE AT 18 LOCATIONS, INCLUDING TWO MULTI-SPECIALTY CLINICS, PHYSICAL/OCCUPATIONAL THERAPY, SPORTS MEDICINE FACILITIES, A LEVEL IV TRAUMA HOSPITAL WITH 24-HOUR EMERGENCY ROOM AND BIRTHCENTER, TWO WALK-IN FASTCARE RETAIL CLINICS, A WALK-IN SKYWAY CLINIC IN DOWNTOWN ROCHESTER, AND 10 COMMUNITY BRANCH CLINICS.RECENT EXPANSION INCLUDES CURRENT CONSTRUCTION OF A 80,000 SQUARE-FOOT WOMEN'S HEALTH PAVILION ADDITION TO OMC'S HOSPITAL IN SOUTHEAST ROCHESTER OPENED IN 2014, TWO NEW BRANCH CLINIC FACILITIES, A 15,000 SQUARE-FOOT SPORTS MEDICINE AND ATHLETIC PERFORMANCE FACILITY IN NORTHWEST ROCHESTER, AND RETAIL PHARMACIES.OMC IS ADDING/EXPANDING PROGRAMS IN TELEHEALTH, WOUND CARE, ORTHOPEDICS, BARIATRIC SURGERY, WOMEN'S HEALTH, NON-SURGICAL CARDIOLOGY, NUCLEAR RADIOLOGY, PAIN MANAGEMENT, AND SPORTS MEDICINE/ATHLETIC PERFORMANCE. 144594 COMMUNITY OUTREACH AND SUPPORT ACTIVIITES: OMC WELCOMES ITS MANY OPPORTUNITIES TO BE AN ACTIVE, CONTRIBUTING PARTNER TO SOUTHEASTERN MINNESOTA'S HEALTH AND WELLNESS EFFORTS.AS A 501(C)3 NON-PROFIT ORGANIZATION, OMC ACTIVELY SUPPORTS SOUTHEASTERN MINNESOTA'S HEALTH AND WELLNESS EFFORTS THROUGH THE CONTRIBUTION OF STAFF TIME/TALENT, IN-KIND RESOURCES, AND FINANCIAL ASSISTANCE. IN 2014, OUR COMMUNITY CONTRIBUTIONS MADE UP 29.38% OF OUR ANNUAL OPERATING EXPENSES-MORE THAN $49 MILLION IN SUPPORT OF OUR COMMITMENT TO BE AN ACTIVE, CONTRIBUTING PARTNER IN THE COMMUNITIES WE SERVE. ANOTHER WAY OMC ACTIVELY SUPPORTS COMMUNITY HEALTH IS THROUGH ITS PARTNERSHIP WITH MAYO CLINIC, OLMSTED COUNTY PUBLIC HEALTH, AND SEVERAL OTHER COMMUNITY-SERVICE ORGANIZATIONS AS TOGETHER WE IMPLEMENTED THE YEAR-ONE ACTION PLAN BASED ON OUR COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IN 2014, OMC CONTINUED ITS TRADITION OF WELCOMING HUNDREDS OF SCHOOL-AGED CHILDREN AND COLLEGE STUDENTS FOR ON-SITE SCIENCE, TECHNOLOGY, ENGINEERING, AND MATH (STEM) EDUCATION EXPERIENCES DESIGNED TO CULTIVATE THE NEXT GENERATION OF CAREGIVERS. OUR CAREGIVERS ALSO EXTENDED THEIR COMMUNITY OUTREACH DURING THE YEAR, REPRESENTING OMC AT MORE THAN 50 COMMUNITY HEALTH FAIRS AND EVENTS IN SOUTHEASTERN MINNESOTA. OVER THE PAST YEAR, WE CONTINUED TO MAKE IT EASIER FOR COMMUNITY MEMBERS TO DONATE THEIR TIME AND TALENT TO OMC. IN ADDITION TO ADDING AN ONLINE VOLUNTEER APPLICATION FORM TO OUR WEBSITE, WE EXPANDED OUR VOLUNTEERS IN PATIENT CARE OPPORTUNITIES LIKE CANINE COMPANIONS AND ESCORT/GREETER ROLES TO HELP PATIENTS NAVIGATE OUR EXPANDING HOSPITAL CAMPUS. 865659 1090375 OMC'S RESEARCH DEPARTMENT, LED BY DR. BARBARA YAWN, MD, HELPS RESEARCHERS FROM AROUND THE WORLD STUDY DISEASES AND CONDITIONS, INCLUDING THE EFFECT OF DISEASES OF PEOPLE'S LIVES AND THE VALUE OF TREATMENT IN PREVENTING, CURING AND IMPROVING TREATMENT OUTCOMES. OMC RESEARCH IS A KEY PARTNER IN STUDIES OF THE HEALTH OF POPULATIONS IN OLMSTED COUNTY AND THROUGHOUT THE UNITED STATES. THE DEPARTMENT HAS INITIATED SEVERAL NATIONAL STUDIES TO IMPROVE THE HEALTH AND MEDICAL CARE OF ALL AMERICANS.BEACON COMMUNITY PROJECT - OMC ASSUMED A LEADERSHIP ROLE IN THE FEDERALLY FUNDED $12.2 MILLION SOUTHEAST MINNESOTA REGION BEACON COMMUNITY PROJECT AND ITS GOAL OF CREATING A NATIONAL MODEL FOR THE SECURE EXCHANGE OF PATIENTS' HEALTH INFORMATION AT ANY POINT OF CLINICAL SERVICE. 155279881 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 189 0 1 1337 1 1 1 0 0 0 0 0 0 0 0 0 X 16 10 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X KEVIN HIGGINS 5072883443 717 THIRD AVENUE SE ROCHESTER MN 55904 X KATHRYN LOMBARDO MD CURRENT PRESIDENT 40.00 1.00 X X 506947 0 28878 MATTHEW KIRSCH MD PHYSICIAN 40.00 X 898347 0 31792 TIM WEIR CEO 40.00 1.00 X 585395 0 47757 KEVIN HIGGINS CFO 40.00 X 364405 0 46235 ROXANNE FLATEN PUBLIC TRUSTEE 1.00 X 0 0 0 JAY HESLEY PUBLIC TRUSTEE 1.00 X 0 0 0 JUSTIN MCNEILUS PUBLIC TRUSTEE 1.00 X 0 0 0 ELAINE GARRY PUBLIC TRUSTEE 1.00 X 0 0 0 JULIE ANDERSON PUBLIC TRUSTEE 1.00 X 0 0 0 MARY BENIKE KISILEWSKI PUBLIC TRUSTEE 1.00 X 0 0 0 KIMBERLY MCKEON MD PHYSICIAN TRUSTEE 40.00 X 310151 0 45790 MELISSA BRINKMAN PUBLIC TRUSTEE 1.00 X 0 0 0 SUSAN KNUTSON PUBLIC TRUSTEE 1.00 X 0 0 0 SRDAN BABOVIC MD TREASURER/SECRETARY 40.00 X X 695632 0 30961 STEVE YAGGY PUBLIC TRUSTEE 1.00 X 0 0 0 KEN BROWN PUBLIC TRUSTEE 1.00 X 0 0 0 RANDY HEMANN MD MEDICAL VICE PRESIDENT MEDICAL SERVICES 40.00 X 357538 0 47049 DAVID WESTGARD MD CHIEF MEDICAL OFFICER(RETIRED) 40.00 1.00 X 286588 0 34154 DAVID LOWE MD PHYSICIAN 40.00 X 605339 0 48837 MARCO SANTAMARIA MD PHYSICIAN 40.00 X 637235 0 49273 GRAHAM RITTS MD PHYSICIAN 40.00 X 655091 0 43936 SUSANNE PFEFFER-KLEEMAN MD PHYSICIAN 40.00 X 579969 0 48929 MARK WILBUR MD PHYSICIAN TRUSTEE 40.00 X 296888 0 24636 JOSEPH TRICARICO MD TREASURER/SECRETARY 40.00 X X 587749 0 49875 CHARLES BRANCH MD FORMER PHYSICIAN TRUSTEE 40.00 X 549560 0 47746 JAMES HOFFMANN MD MEDICAL VICE PRESIDENT/SURG SVCS 40.00 X 400124 0 47541 LINDA WILLIAMS MD FORMER PHYSICIAN TRUSTEE 40.00 X 234261 0 32990 THOMAS ERBACH MD FORMER PHYSICIAN TRUSTEE 40.00 X 287982 0 41116 JAY MYERS MD FORMER PHYSICIAN TRUSTEE 40.00 X 535840 0 48607 VIDHAN CHANDRA MD PHYSICIAN TRUSTEE 40.00 X 861630 0 33933 10236671 0 830035 170 1 1 0 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64141 COMPUTER SUPPORT 1410504 MAYO COLLABORATIVE SERVICES 200 1ST STREET SW ROCHESTER MN 55905 MEDICAL SERVICES 1088449 UNIVERSAL HOSPITAL SERVICE INC SDS 12-0940 PO BOX 86 MINNEAPOLIS MN 554860940 EQUIPMENT MAINTENANCE 950697 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 753972651 LOCUM PHYSICIAN SERVICE 891775 ALL SYSTEMS INSTALLATION 8300 10TH AVE NORTH STE A GOLDEN VALLEY MN 55427 ELECTRICAL SERVICES 871631 65 1617883 944977 176641 2739501 NET PATIENT SERVICES 621110 181875426 181875426 PHARMACY 446110 608543 507834 100709 182483969 1354994 1354994 76485 0 76485 76485 76485 9587193 9508505 275935 78688 -275935 -197247 -275935 78688 ELECTRONIC HEALTH RECORDS INCENTI 900099 1551976 1551976 CAFETERIA REVENUE 722210 192619 192619 -252753 -252753 1491842 187949544 183406548 100709 1702786 527999 527999 5418618 4057161 1361457 2312200 2312200 77844154 70132267 7444186 267701 5966231 5484218 454087 27926 11671971 8792114 2787749 92108 5488871 4704725 764479 19667 190791 186723 4068 231849 7030 224819 281360 281360 84330 84330 7086993 5826266 1260727 366009 4570 361439 2716375 2028006 688369 748619 219968 528651 5851162 5024500 826662 66557 54536 12021 855554 640290 215264 1815878 1757100 58778 7685206 7685206 878700 878700 MEDICAL SUPPLIES 17164793 17162877 1916 PROVISION FOR BAD DEBTS 8586219 8586219 EQUIPMENT & SOFTWARE MA 5164389 3602425 1561964 MINNESOTACARE TAX 3629170 3629170 3105010 1975611 1129399 175739008 155279881 20051725 407402 85343961 73077385 29558546 29212158 1612877 1851151 5167197 5827061 146951488 53359430 75928606 93592058 20005981 22512535 980836 906021 218598004 226978369 3873160 3241245 677797 185555 35605000 34900000 18987656 13822441 24388797 27053409 83532410 79202650 X 135065594 147775719 135065594 147775719 218598004 226978369 12210536 499589 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5285183 5285183 89880737 22694080 67186657 51610787 30513320 21097467 174781 152030 22751 93592058 PAYROLL LIABILITY 14549973 OTHER ACCRUED LIABILITY 9352181 ACCRUED INTEREST 913197 ACCRUED REAL ESTATE TAXES 1041782 THIRD PARTY PAYOR SETTLEMENTS 1196276 27053409 X PART X, LINE 2: OLMSTED MEDICAL CENTER AND THE OMC REGIONAL FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES AS TAX-EXEMPT ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT FOR INCOME ON CERTAIN UNRELATED BUSINESS INCOME. THERE IS NO MATERIAL UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013. THE MEDICAL CENTER AND FOUNDATION ARE ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE MINNESOTA STATUTES. THE MEDICAL CENTER AND FOUNDATION FILE FEDERAL AND STATE INCOME TAX RETURNS. GENERALLY, THE MEDICAL CENTER AND THE FOUNDATION ARE NO LONGER SUBJECT TO STATE AND FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEAR ENDED DECEMBER 31, 2010, AND PRIOR. OMC RETAIL SERVICES, LLC IS A DISREGARDED LLC UNDER IRS REGULATIONS, AND IT ACHIEVES TAX-EXEMPT TREATMENT BASED ON THE EXEMPT STATUS OF ITS PARENT, OLMSTED MEDICAL CENTER. AT DECEMBER 31, 2014, THERE WERE NO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 240.000000000000 1 X 1 1 1 0 1 1 1303227 15304 1287923 0.00730 34473400 18618348 15855052 0.09020 3347200 728918 2618282 0.01490 39123827 19362570 19761257 0.11240 144594 0 144594 0.00080 0 0 1107913 0 1107913 0.00630 1265521 1121618 143903 0.00080 613534 0 613534 0.00350 3131562 1121618 2009944 0.01140 42255389 20484188 21771201 0.12380 1 8586219 14894738 18061931 -3167193 X 1 1 1 1 OLMSTED MEDICAL CENTER-HOSPITAL 1650 4TH STREET SE ROCHESTER MN 55904 X X X OLMSTED MEDICAL CENTER 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X HTTP://WWW.OLMMED.ORG 1 14 1 HTTP://WWW.OLMMED.ORG 0 0 1 X 240.000000000000 300.000000000000 0 1 X X X 1 X X X 1 X 0 X X X 1 X 0 0 OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 5: OLMSTED MEDICAL CENTER LAUNCHED A COLLABORATIVE EFFORT WITH OLMSTED COUNTY, MAYO CLINIC, MANY OF THE COMMUNITY BENEFIT NON-PROFIT ORGANIZATIONS AND THE PUBLIC TO IDENTIFY THE COMMUNITY NEEDS. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 6A: OLMSTED MEDICAL CENTER COLLABORATED WITH MAYO CLINIC. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 11: OLMSTED MEDICAL CENTER REVIEWED INFANT MORTALITY, MORBIDITY, HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL AND ECONOMIC FACTORS, PHYSICAL ENVIRONMENT, ADOLESCENT CHEMICAL HEALTH, DENTAL ISSUES, DIABETES, MATERNAL MORTALITY, MENTAL ILLNESS-ADULTS, MENTAL ILLNESS-CHILDREN AND OBESITY. KNOWING WE HAD LIMITED RESOURCES (TIME, MONEY, KNOWLEDGE) THE COMMITTEE OPTED TO ADDRESS WHAT IT CONSIDERED THE FIVE MOST IMPORTANT ISSUES. OLMSTED MEDICAL CENTER PART V, SECTION B, LINE 22D: FOR UNINSURED PATIENTS OMC HAS AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL'S OFFICE FOR WHICH OMC PROVIDES A DISCOUNT TO UNINSURED PATIENTS EQUAL TO THEIR LOWEST NON-GOVERNMENTAL PAYER. FOR INSURED PATIENTS COVERED BY FAP, THEY CHARGE A SET RATE LESS THE NEGOTIATED DISCOUNT FOR THE SPECIFIC INSURANCE COMPANY. PART V, SECTION B, LINE 14: OMC VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING THE CHARITY CARE PROGRAM. ADDITIONALY, OMC HAS SIGNED AN AGREEMENT WITH THE MINNESOTA STATE ATTORNEY GENERAL TO FOLLOW THE ATTORNEY GENERAL'S BILLING AND COLLECTION PRACTICES PER THE ATTORNEY GENERAL'S LETTER. 18 OLMSTED MEDICAL CENTER - MAIN CLINIC 210 NINTH STREET SE ROCHESTER MN 55904 MAIN CLINIC - OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - BYRON CLINIC 846 HIGH POINT DR NE BYRON MN 55920 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - CHATFIELD CLINIC 207 TWIFORD STREET SW CHATFIELD MN 55923 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - CANNON FALLS CLINIC 1705 HIGHWAY 20 CANNON FALLS MN 55009 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PINE ISLAND CLINIC 111 COUNTY ROAD 11 NW PINE ISLAND MN 55963 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PLAINVIEW CLINIC 20 2ND AVENUE NE PLAINVIEW MN 55964 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PRESTON CLINIC 405 KANSAS STREET NW PRESTON MN 55965 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - ST CHARLES CLINIC 403 W FOURTH STREET ST CHARLES MN 55972 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - SPRING VALLEY CLINIC 302 WEST TRACY ROAD SPRING VALLEY MN 55975 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - STEWARTVILLE CLINIC 208 CENTERTOWN PLAZA STEWARTVILLE MN 55976 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - WANAMINGO CLINIC 217 MAIN STREET STE B WANAMINGO MN 55983 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - FASTCARE NORTH CLINIC 3708 HIGHWAY 63N ROCHESTER MN 55906 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - FASTCARE SOUTH CLINIC 2820 S BROADWAY ROCHESTER MN 55904 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - NW CLINIC 5067 55TH STREET NW ROCHESTER MN 55901 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - SKYWAY CLINIC 318 1ST AVENUE SW SUITE 203 ROCHESTER MN 55902 OUTPATIENT PHYSICIAN CLINIC OLMSTED MEDICAL - PHYSICAL THERAPY 102 ELTON HILLS DRIVE ROCHESTER MN 55901 PHYSICAL THERAPY CENTER OLMSTED MEDICAL - RESEARCH DEPT 829 3RD AVE SE KINGS ROW ROCHESTER MN 55904 RESEARCH FACILITY OLMSTED MEDICAL CENTER - SPORTS MED 5155 55TH STREET NW ROCHESTER MN 55901 PHYSICAL THERAPY/ATHLETIC PERFORMANCE PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED FOR DETERMINING FINANCIAL ASSISTANCE. PART I, LINE 7: LINE 7A-7C: AMOUNTS SHOWN ARE BASED UPON A COST-TO-CHARGE RATIO FROM IRS WORKSHEET 2.LINE 7E-7I: AMOUNTS SHOWN ARE BASED UPON THE ORGANIZATIONS COST ACCOUNTING SYSTEM. PART I, LINE 6A: THE OLMSTED MEDICAL CENTER ANNUAL REPORT IS MADE WIDELY AVAILABLE AND IS AVAILABLE ON THE WEBSITE. PART III, LINE 4: THE FOOTNOTE FROM THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF PATIENT ACCOUNTS RECEIVABLE PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA.THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE: ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.AS REPORTED ON THE AUDITED FINANCIAL STATEMENTS, THE COMMUNITY BENEFIT OF COSTS IN EXCESS OF MEDICARE PAYMENTS WAS $17,853,222. PART III, LINE 9B: PATIENT FINANCIAL HARDSHIP POLICY: TO SUPPORT THE ORGANIZATION'S MISSION AND PHILOSOPHY IN THAT THE PATIENT COMES FIRST AND PROVIDE A GUIDELINE IN IDENTIFYING PATIENT'S WHO HAVE AN EXCEPTIONAL PERSONAL FINANCIAL HARDSHIP AND REQUIRED NEEDED AND NECESSARY MEDICAL CARE AND THERE IS REMOTE OR NEGLIBLE CHANCE THAT THE INDIVIDUAL WILL BE ABLE TO REPAY. PROCEDURE: FACTORS THAT MAY CONTRIBUTE TO EXCEPTIONAL FINANCIAL HARDSHIP INCLUDE:1) UNEMPLOYMENT OR UNDEREMPLOYMENT THROUGH NO FAULT OF THE PATIENT AND/OR FAMILY; 2) THREATENED LOSS OF SHELTER THROUGH FORECLOSURE, ETC; 3) LOSS OF INCOME FROM FEDERAL, STATE OR OTHER GOVERNMENT BENEFITS INCLUDING, BUT NOT LIMITED TO SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, PUBLIC ASSISTANCE, ETC; 4) LOSS OF INCOME DUE TO DEATH OR DISABILITY; 5) EXCEPTIONAL EXPENSES INCURRED BECAUSE OF UNINSURED PROPERTY DAMAGE OR COSTLY REPAIRS TO PRINCIPAL RESIDENCE; 6) EXCEPTIONAL EXPENSES DUE TO TEMPORARY OR CHRONIC ILLNESS; 7) EXCEPTIONAL EXPENSES DUE TO INCREASE IN LIVING EXPENSES BECAUSE OF A DIVORCE, ABANDONMENT OR SEPARATION FROM SPOUSE OR INCOME EARNER; 8) LOSS OF INCOME DUE TO DECLARATION OF INCOMPETENCE OR IN PROCESS OF BEING DECLARED INCOMPETENT; 9) PATIENT OR FAMILY MEMBER IS CONFINED TO A CONVALESCENT HOME OR OTHER RESIDENCE OTHER THAN THEIR PRINCIPAL RESIDENCE; 10) NATURAL DISASTERS SUCH AS FLOODS, FIRES, HURRICANES AND EARTHQUAKES; 11) EVICTION, HOMELESSNESS, LOSS OF OWNED RESIDENCE, ARSON, THEFT, ETC; 12) DISCONTINUANCE OF UTILITIES OR HEAT, OR UNSAFE OR UNHEALTHY LIVING CONDITIONS; 13) ANY OTHER CONDITION CONSIDERED LIFE THREATENING DUE TO EXCEPTIONAL FINANCIAL HARDSHIP.APPLICATION PROCESS: THE FINANCIAL HARDSHIP APPLICATION, UTILIZING OMC'S FINANCIAL ASSISTANCE APPLICATION, CONTAINS THE NECESSARY INFORMATION TO DETERMINE ELIGIBILITY FOR THE OMC FINANCIAL HARDSHIP PROGRAM. NO SEPARATE APPLICATION IS NECESSARY. SUPPORTING DOCUMENTATION REQUIRED TO MAKE AN ELIGIBILITY DETERMINATION ARE: 1) MOST RECENT TAX RETURNS, 2) CURRENT FAMILY PAYROLL STUB SHOWING YEAR-TO-DATE INCOME; 3) CURRENT TRANSUNION CREDIT REPORT AND OTHER FINANCIAL HARDSHIP DOCUMENTATION TO SUPPORT HARDSHIP; 4) EXPLANATION OF HARDSHIP SITUATION/NECESSITY AND RARE COMPLICATIONS.ELIGIBILITY DETERMINATION: BASED UPON PATIENT'S/FAMILY'S INCOME AND ASSETS AND COMPLETED FINANCIAL ASSISTANCE APPLICATION. BASED UPON TAKING INTO CONSIDERATION ALL PERSONAL FACTORS IN DETERMINING EXCEPTIONAL FINANCIAL HARDSHIP. THE BUSINESS SERVICES DEPARTMENT EVALUATES THE APPLICATIONS MEETING THE CRITERIA AND PRESENTS TO ADMINISTRATION FOR APPROVAL. OMC RESERVES THE RIGHT TO MAKE ADJUSTMENT DETERMINATIONS ON A CASE-BY-CASE BASIS. PART III, SECTION A, LINE 1: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF PATIENT ACCOUNTS RECEIVABLE PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. PART VI, LINE 2: OMC ACTIVELY WORKS WITH LOCAL GOVERNMENT IN ASSESSING AND ADDRESSING COMMUNITY NEEDS THROUGH MEETINGS, WORKSHOPS, AND COMMUNITY INPUT. IN ADDITION, OMC IS ACTIVELY INVOLVED WITH LOCAL GOVERNMENTS IN EMERGENCY PREPAREDNESS AND DISEASE MANAGEMENT. PART VI, LINE 3: OMC INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AND ASSISTS PATIENTS WHO INDICATE AN INABILITY TO PAY. OMC INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAMS BY PROVIDING THE FINANCIAL ASSISTANCE POLICY ON BROCHURES IN THE NEW PATIENT PACKET AND AT THE FRONT DESK FOR ALL PATIENTS. THE POLICY IS ALSO PROVIDED ON THE BACK OF THE HOSPITAL BILL STATEMENTS, ON THE HOSPITAL WEBSITE AND ON THE HOSPITAL'S ONLINE BILL-PAY SYSTEM. OMC PATIENT FINANCIAL COUNSELORS PROVIDE INFORMATION TO PATIENTS REGARDING AVAILABLE HEALTHCARE FINANCIAL COVERAGE OPTIONS, SUCH AS: 1) MEDICAL ASSISTANCE, 2) MINNESOTA CARE, 3) OTHER FINANCIAL SERVICES AVAILABLE FOR LOW INCOME FAMILIES IN THE COMMUNITY, 4) OMC'S FINANCIAL ASSISTANCE PROGRAM.THE PATIENT FINANCIAL COUNSELORS ASSIST OMC PATIENTS IN THE APPLICATION PROCESS. ALL APPLICATIONS ARE PROCESSED IN A TIMELY MANNER. PATIENT APPLICATIONS ARE CONSIDERED FOR CURRENT PATIENT RESPONSIBLE BALANCES, AS WELL AS NEAR FUTURE SCHEDULED MEDICAL SERVICES. PATIENTS MAY QUALIFY FOR FULL OR PARTIAL FINANCIAL ASSISTANCE. PATIENT FINANCIAL COUNSELORS NOTE PATIENT'S ACCOUNT VIA ON-LINE NOTES REGARDING APPLICATIONS SENT, APPLICATIONS IN PROCESS, AND WHETHER APPLICATIONS HAVE BEEN APPROVED, DENIED, OR ADDITIONAL INFORMATION IS REQUIRED. THE PATIENT FINANCIAL COUNSELORS INFORM THE PATIENT VIA A LETTER REGARDING THE DETERMINATION (APPROVED, DENIED, OR PARTIAL COVERAGE APPROVED) OF THE RECEIVED AND COMPLETED APPLICATION. PRIOR TO TURNING ACCOUNTS OVER THE THIRD PARTY COLLECTION, THE ACCOUNT WILL BE REVIEWED FOR POSSIBLE FINANCIAL ASSISTANCE PROGRAM QUALIFICATION THROUGH THE E-BUREAU PROCESS. PART VI, LINE 4: OMC IS A REGIONAL HEALTH CARE FACILITY SERVING PATIENTS WITHIN A SIXTY MILE RADIUS OF ROCHESTER, MN. PART VI, LINE 5: THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE AREA.THE ORGANIZATION UTILIZES ITS SURPLUS FUNDS TO INCREASE THE SERVICES OFFERED TO ITS PATIENTS. THE ORGANIZATION HAS EXPANDED THE OPERATIONS AT FASTCARE FACILITIES AND ADDED CARDIOLOGY AND ENDOCRINOLOGY SERVICES FOR ITS PATIENTS. PART VI, LINE 6: N/A PART VI, LINE 7: THE ORGANIZATION DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF MINNESOTA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE MINNESOTA HOSPITAL ASSOCIATION WHICH IS THEN USED IN A STATEWIDE SUMMARY REPORT OF COMMUNITY BENEFITS PROVIDED BY MINNESOTA HOSPITALS. 1 OLMSTED MEDICAL CENTER REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 501(C)(3) 527999 PROVIDE FUNDING TO OMC REGIONAL FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES. PROVIDE FUNDING TO UNDERWRITE CHILDREN'S PROGRAM PART I, LINE 2: MOST OF GRANT EXPENDITURES ARE PROVIDED TO OLMSTED MEDICAL CENTER REGIONAL FOUNDATION, A RELATED ORGANIZATION. OMC PROVIDES FUNDS TO THE FOUNDATION FOR HEALTHCARE EDUCATION AND COMMUNITY PURPOSES AS NEEDED. THERE ARE NUMEROUS WAYS TO MONITOR THE USE OF THE GRANT FUNDS. MANY OF THE EVENTS ARE OPEN TO THE PUBLIC AND EASILY VERIFIABLE. STAFF OFTEN ASSIST AS VOLUNTEERS. THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE ITS MISSION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS COMMUNITY NEEDS IN THE HEALTH CARE AREA. NO ADDITIONAL MONITORING IS PERFORMED. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 KATHRYN LOMBARDO MD CURRENT PRESIDENT 466292 0 37944 0 2711 0 25500 0 3378 0 535825 0 0 0 MATTHEW KIRSCH MD PHYSICIAN 896808 0 0 0 1539 0 25500 0 6292 0 930139 0 0 0 TIM WEIR CEO 456400 0 127250 0 1745 0 25500 0 22257 0 633152 0 0 0 KEVIN HIGGINS CFO 287733 0 65685 0 10987 0 25500 0 20735 0 410640 0 0 0 KIMBERLY MCKEON MD PHYSICIAN TRUSTEE 308275 0 0 0 1876 0 25500 0 20290 0 355941 0 0 0 SRDAN BABOVIC MD TREASURER/SECRETARY 690501 0 0 0 5131 0 25500 0 5461 0 726593 0 0 0 RANDY HEMANN MD MEDICAL VICE PRESIDENT MEDICAL SERVI 315028 0 38850 0 3660 0 25500 0 21549 0 404587 0 0 0 DAVID WESTGARD MD CHIEF MEDICAL OFFICER(RETIRED) 174786 0 108400 0 3402 0 25500 0 8654 0 320742 0 0 0 DAVID LOWE MD PHYSICIAN 602896 0 0 0 2443 0 25500 0 23337 0 654176 0 0 0 MARCO SANTAMARIA MD PHYSICIAN 631590 0 0 0 5645 0 25500 0 23773 0 686508 0 0 0 GRAHAM RITTS MD PHYSICIAN 650377 0 0 0 4714 0 25500 0 18436 0 699027 0 0 0 SUSANNE PFEFFER-KLEEMAN MD PHYSICIAN 575774 0 0 0 4195 0 25500 0 23429 0 628898 0 0 0 MARK WILBUR MD PHYSICIAN TRUSTEE 286593 0 10012 0 283 0 22390 0 2246 0 321524 0 0 0 JOSEPH TRICARICO MD TREASURER/SECRETARY 583249 0 2056 0 2444 0 25500 0 24375 0 637624 0 0 0 CHARLES BRANCH MD FORMER PHYSICIAN TRUSTEE 537025 0 0 0 12535 0 25500 0 22246 0 597306 0 0 0 JAMES HOFFMANN MD MEDICAL VICE PRESIDENT/SURG SVCS 388710 0 8054 0 3360 0 25500 0 22041 0 447665 0 0 0 LINDA WILLIAMS MD FORMER PHYSICIAN TRUSTEE 231272 0 0 0 2989 0 20050 0 12940 0 267251 0 0 0 THOMAS ERBACH MD FORMER PHYSICIAN TRUSTEE 286231 0 0 0 1751 0 25500 0 15616 0 329098 0 0 0 JAY MYERS MD FORMER PHYSICIAN TRUSTEE 533627 0 0 0 2213 0 25500 0 23107 0 584447 0 0 0 VIDHAN CHANDRA MD PHYSICIAN TRUSTEE 857098 0 2350 0 2182 0 25500 0 8433 0 895563 0 0 0 SCHEDULE J PART II COMPENSATION PAID TO PHYSICIAN TRUSTEES IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS EMPLOYED PHYSICIANS OF THE ORGANIZATION. SCHEDULE J PART I OLMSTED MEDICAL CENTER HAS A POLICY TO GROSS UP (COVER THE TAX PORTION) FOR EMPLOYEE RECOGNITION YEARS OF SERVICE GIFT CARDS AND RETIREMENT GIFT CARDS. A CITY OF ROCHESTER MINNESOTA 416005494 771902FY4 2010-07-07 20360000 NW CLINIC CONSTRUCTION 0 0 0 B CITY OF ROCHESTER MINNESOTA 416005494 771902GU1 2013-04-01 17260000 WOMEN'S HEALTH PAVILLION CONSTRUCTION 0 0 0 A 20202546 1736608 1341608 407200 17968405 275180 2011 0 0 1 1 B 19290018 490226 286285 18513507 2014 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 1 B 1 JULIE WINKELS FAMILY MEMBER OF THOMAS WINKELS, FORMER TRUSTEE 26150 EMPLOYEE OF ORGANIZATION 0 DR LOUIS WAGNER FAMILY MEMBER OF DR. LINDA WILLIAMS, FORMER TRUSTEE 322367 EMPLOYEE OF ORGANIZATION 0 DR BARBARA YAWN FAMILY MEMBER OF DR. ROY YAWN, PAST PRESIDENT 185581 EMPLOYEE OF ORGANIZATION 0 MERCHANTS BANK JOHN DOYLE, FORMER BOARD CHAIR, SERVES AS PRESIDENT OF MERCHANTS BANK 957578 OPERATING LEASE PAYMENTS ON RIS/PACS SYSTEM AND THE EHR LEASE 0 EXPRESS SERVICES INCTAZ INC NORM DOTY, FORMER TRUSTEE 17409 TEMP STAFFING SERVICES 0 JUSTIN MCNEILUS BOARD MEMBER, SON OF MAJORITY OWNER STERLING STATE BANK 104007 BANKING RELATIONSHIP, OMC LOAN/INTEREST PAYMENTS 0 TOM WINKELS FORMER BOARD MEMBER AND MINORITY OWNER STERLING STATE BANK 104007 BANKING RELATIONSHIP, OMC LOAN/INTEREST PAYMENTS 0 FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF GOVERNORS IS ELECTED BY PHYSICIAN VOTE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE FINANCIAL SERVICES MANAGER, CONTROLLER AND CFO. ANY NECESSARY CORRECTIONS AND ADJUSTMENTS ARE MADE. THE FORM 990 IS REVIEWED BY THE CEO AND CFO AND PRESENTED TO THE COMPENSATION COMMITTEE. THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PER OMC POLICY THE BOARD OF TRUSTEES AND PRINCIPAL OFFICERS ANNUALLY SIGN CONFLICT OF INTEREST STATEMENTS. SIGNED CONFLICT OF INTEREST STATEMENTS ARE OBTAINED AND REVIEWED BY SENIOR MANAGEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 IN ORDER TO ENSURE THAT ALL OLMSTED MEDICAL CENTER (OMC) EXECUTIVE COMPENSATION DECISIONS ARE COMPETITIVE, EQUITABLE, UNIFORMLY ADMINISTERED, AND CONSISTENT WITH MARKET PRACTICES, OMC FOLLOWS RECOMMENDED BEST PRACTICES. THE GOALS OF EXECUTIVE COMPENSATION ARE TO ATTRACT AND RETAIN HIGHLY QUALIFIED PERSONNEL, TO MAINTAIN COMPENSATION LEVELS COMMENSURATE WITH THE SCOPE OF RESPONSIBILITIES FOR EACH POSITION, AND TO REWARD OUTSTANDING PERFORMANCE. OMC WILL SEEK MANAGEMENT TALENT BY CONDUCTING NATIONAL SEARCHES FOR QUALIFIED APPLICANTS FOR ANY VACANCIES AT THE MEDICAL VICE PRESIDENT HOSPITAL/SURGICAL SERVICES, VICE PRESIDENT MEDICAL SERVICES AND CEO POSITIONS IN ADDITION TO VICE PRESIDENT POSITIONS AS NECESSARY. THE SAME PHILOSOPHY IS APPLICABLE TO THE POSITION OF OMC PRESIDENT. OMC ENGAGES AN EXTERNAL CONSULTANT WHO ANNUALLY COMPILES A PEER GROUP COMPENSATION ANALYSIS AND ON A TWO YEAR BASIS COMPILES A PEER GROUP COMPENSATION AND BENEFITS ANALYSIS. PEER GROUPS FOR EXECUTIVE COMPENSATION, WHICH INCLUDES BASE SALARIES, INCENTIVE AND BENEFITS, WILL BE PROVIDED FOR HEALTH DELIVERY SYSTEMS WITH A MINIMUM OF A HOSPITAL AND AN EMPLOYED PHYSICIAN NETWORK AND NET REVENUES ROUGHLY SIMILAR TO THE REVENUES OF OLMSTED MEDICAL CENTER. MOST RECENTLY A COMPENSATION PEER REVIEW STUDY WAS COMPLETED FOR THE CEO, PRESIDENT, MEDICAL VICE PRESIDENTS, CHIEF MEDICAL INFORMATION OFFICER AND VICE PRESIDENTS AND PRESENTED TO THE BOARD EXECUTIVE COMPENSATION COMMITTEE. THE BOARD OF GOVERNORS RECEIVES AN EXECUTIVE SUMMARY. THE EXECUTIVE COMPENSATION COMMITTEE RECEIVES A SUMMARY OF EVERYONE'S COMPENSATION TO ENSURE IT IS IN ALIGNMENT WITH THE SAME COMPENSATION METHODOLOGY AND AGREED UPON METHODOLOGY OF THE EXECUTIVE COMPENSATION SYSTEM OF OMC. THESE POSITIONS INCLUDE THE MEDICAL VICE PRESIDENTS, CHIEF MEDICAL INFORMATION OFFICER AND VICE PRESIDENTS OF OMC. THE EXECUTIVE COMPENSATION COMMITTEE WILL SET THE COMPENSATION OF THE PRESIDENT, CEO, MEDICAL VICE PRESIDENT HOSPITAL/SURGICAL SERVICES AND VICE PRESIDENT MEDICAL SERVICES AND MINUTES ARE KEPT OF THESE DISCUSSIONS. THE BOARD OF TRUSTEES, ACTING THROUGH THE BOARD OF TRUSTEES COMPENSATION COMMITTEE, MUST APPROVE THE EXECUTIVE COMPENSATION POLICY AND PROCESS OF DETERMINING EXECUTIVE COMPENSATION AND BENEFITS. IN ADDITION, THE PHYSICIAN SALARIES ARE CALCULATED ANNUALLY, USING REGIONAL PHYSICIAN SALARY COMPARISON GUIDES FACTORING IN PRODUCTIVITY AND QUALITY MEASURES, AND REVIEWED ON AN ANNUAL BASIS FOR MARKET REASONABLENESS BY MCGLADREY. THE PHYSICIANS RECEIVE NO COMPENSATION AS ATTENDING BOARD MEMBERS. THESE DISCUSSIONS ARE NOTED IN THE MINUTES OF THE BOARD OF TRUSTEES COMPENSATION COMMITTEE ANNUAL MEETING. THE BOARD OF TRUSTEES COMPENSATION COMMITTEE REPORTS TO THE FULL BOARD OF TRUSTEES ON AN ANNUAL BASIS THE COMPLETION OF SUCH DUTIES AND ARE ALSO NOTED IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ANNUAL FORM 990 & ATTACHED AUDITED FINANCIAL STATEMENT REPORT IS AVAILABLE IN ACCORDANCE WITH THE PUBLIC INSPECTION OF THE RETURN REQUIREMENTS. FORM 990, PART VII, SECTION A BOARD MEMBERS ARE NOT COMPENSATED FOR THEIR SERVICES TO THE ORGANIZATION. COMPENSATION SHOWN FOR PHYSICIAN TRUSTEES IS RELATED TO THEIR POSITION AS AN EMPLOYED PHYSICIAN OF THE ORGANIZATION. FORM 990, PART IX, LINE 6 FORMER BOARD TRUSTEES CONTINUE TO BE PAID FOR THEIR SERVICES RENDERED AS PHYSICIANS OF OLMSTED MEDICAL CENTER AND ARE NOT PAID FOR PAST SERVICES AS BOARD TRUSTEES. OMC RETAIL SERVICES LLC 210 NINTH STREET SE ROCHESTER MN 55904 460960716 PHARMACY MN 608546 1392447 OLMSTED MEDICAL CENTER OLMSTED MEDICAL CENTER REGIONAL FOUNDATION 210 9TH STREET SE ROCHESTER MN 55904 260022777 HEALTHCARE EDUCATION AND COMMUNITY PURPOSES MN 501(C)(3) LINE 11A, I OLMSTED MEDICAL CENTER 1 OLMSTED MEDICAL CENTER AUXILIARY 1650 4TH STREET SE ROCHESTER MN 55904 363382873 SUPPORT OLMSTED MEDICAL CENTER MN 501(C)(3) LINE 11C, III-FI OLMSTED MEDICAL CENTER 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 OLMSTED MEDICAL CENTER REGIONAL FOUNDATION B 527999 GAAP OLMSTED MEDICAL CENTER REGIONAL FOUNDATION C 1613220 GAAP OLMSTED MEDICAL CENTER AUXILIARY C 4663 GAAP OLMSTED MEDICAL CENTER REGIONAL FOUNDATION O 347789 GAAP