2015-08-14T15:08:46-05:00 2014-09-30 411765929 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2013-10-01 410713914 WINONA HEALTH SERVICES INC WINO 5074543650 855 MANKATO AVENUE WINONA MN 55987 JAN BROSNAHAN CFO 5074543650 2015-08-12 1 KIM HUNWARDSEN CPA P00484560 6122536500 2015-08-11 2013 2016-04-25 22:37:26Z RACHELLE HEISING-SCHULTZ 855 MANKATO AVENUE WINONA MN 55987 118659832 0 X WWW.WINONAHEALTH.ORG X 1894 MN HOSPITAL SERVICES 17 8 1154 270 0 0 215052 360356 113078210 110452985 359965 668911 1394077 1453196 115047304 112935448 48371 117214 0 0 58993747 61834688 0 0 0 50269367 48710318 109311485 110662220 5735819 2273228 105644990 107397263 42297322 40865595 63347668 66531668 X DEVOTED TO IMPROVING THE HEALTH AND WELL-BEING OF OUR FAMILY, FRIENDS AND NEIGHBORS. 0 0 99019384 117214 111906181 WINONA HEALTH SERVICES (WHS), A 99-BED HOSPITAL, HAS A 120-YEAR HISTORY OF PROVIDING CARE TO ITS COMMUNITY AND SERVICES FROM BIRTH TO DEATH. IT IS THE SOLE COMMUNITY PROVIDER IN THE WINONA, MINNESOTA AREA. IN FISCAL YEAR 2014, WHS HAD 2,136 ADMISSIONS; 342 BIRTHS; 3,288 INPATIENT AND OUTPATIENT SURGERIES; AND 15,489 VISITS TO THE EMERGENCY ROOM.TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE CORPORATION PROVIDES CARE TO PATIENTS AND RESIDENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE AND COMMUNITY BENEFIT POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CORPORATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT AND RESIDENT SERVICE REVENUE.CHARITY CARE: WHS PROVIDES MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. TOTAL CHARITY CARE COST WAS APPROXIMATELY $925,000 FOR FY 2014. IN FURTHERANCE OF ITS CHARITABLE PURPOSE, THE CORPORATION PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY. THESE SERVICES AND DONATIONS ACCOUNT FOR A MEASURABLE PORTION OF THE CORPORATION'S COSTS AND SERVE TO PROMOTE HEALTHY LIFE STYLES, COMMUNITY DEVELOPMENT, HEALTH EDUCATION, AND AFFORDABLE ACCESS TO CARE.THE CORPORATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF COMMUNITY BENEFIT SERVICES IT PROVIDES. THOSE RECORDS INCLUDE MANAGEMENT'S ESTIMATE OF THE COST TO PROVIDE CHARITY CARE, THE COST OF SERVICES AND SUPPLIES FURNISHED FOR COMMUNITY BENEFIT PROGRAMS AND COSTS IN EXCESS OF PROGRAM PAYMENTS FOR TREATING MEDICAL ASSISTANCE PATIENTS.IN ADDITION TO COMMUNITY BENEFIT COSTS, THE CORPORATION PROVIDES ADDITIONAL COMMUNITY CONTRIBUTIONS SUCH AS SERVICES TO MEDICARE AND MEDICAID PATIENTS BELOW THE COSTS FOR TREATMENT, OTHER UNCOMPENSATED CARE, DISCOUNTED PRICING TO THE UNINSURED, AND PAYS TAXES AND FEES. 99019384 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 0 1 1 0 0 0 0 0 1 1 1 0 0 1 81 0 1 1154 1 0 0 0 0 0 0 0 0 0 0 X 17 8 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MN X JAN BROSNAHAN 5074543650 855 MANKATO AVENUE WINONA MN 55987 KEN MOGREN CHAIR 3.00 2.00 X X 0 0 0 SCOTT BIESANZ DIRECTOR 3.00 2.00 X 0 0 0 STEVE BLUE DIRECTOR 3.00 2.00 X 0 0 0 SCOTT BIRDSALL MD DIRECTOR 40.00 2.00 X 342140 0 56128 MATTHEW BROGHAMMER MD DIRECTOR 40.00 2.00 X 459857 0 78163 VICKI DECKER DIRECTOR 3.00 2.00 X 0 0 0 GARY EVANS DIRECTOR 3.00 2.00 X 0 0 0 RICHARD FERRIS MD DIRECTOR 40.00 2.00 X 221839 0 68267 JIM KILLIAN DIRECTOR 3.00 2.00 X 0 0 0 HERB HIGHUM DIRECTOR 3.00 2.00 X 0 0 0 RICK IGLESIAS DIRECTOR 3.00 2.00 X 0 0 0 HUGH MILLER DIRECTOR 3.00 2.00 X 0 0 0 KIM SCHWAB DIRECTOR 3.00 2.00 X 0 0 0 DANIEL PARKER MD DIRECTOR 40.00 2.00 X 234882 0 60939 MARK WAGNER DIRECTOR 3.00 2.00 X 0 0 0 ROD BAKER DIRECTOR 3.00 2.00 X 0 0 0 RACHELLE HEISING-SCHULTZ PRESIDENT/CEO/DIRECTOR 44.00 4.00 X X 467819 0 58572 JAN BROSNAHAN CFO/TREASURER 44.00 2.00 X 52090 0 19286 SARA GABRICK CNO 42.00 0.00 X 184332 0 40418 BRETT WHYTE MD EMERGENCY PHYSICIAN 40.00 0.00 X 369653 0 83729 EVERETT BEGUIN FAMILY PRACTICE PHYSICIAN 40.00 0.00 X 257455 0 49436 KATRINA HAMMEL HOSPITALIST 40.00 0.00 X 278827 0 52214 LEROY TROMBETTA MD GENERAL SURGEON 40.00 0.00 X 392636 0 97272 AMARJIT VIRDI MD ANESTHESIOLOGIST 40.00 0.00 X 375978 0 71490 WILLIAM KRUEGER RADIOLOGIST 40.00 0.00 X 522081 0 96690 CARLOS MORALES EMERGENCY PHYSICIAN 40.00 0.00 X 370453 0 59381 GIUSTINO ALBANESE RADIOLOGIST 40.00 0.00 X 497854 0 75658 MICHAEL ALLEN FORMER CFO/TREASURER 0.00 0.00 X 325389 0 32477 5353285 0 1000120 71 1 1 0 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 IT SERVICES/CONTRACTED EMPLOYEES 9280667 SODEXO INC & AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 CONTRACTED EVS, FACILITIES, FOOD 1445612 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CONTRACTED PHYSICIANS 812604 KISH ELECTRIC 1200 EAST 7TH STREET WINONA MN 55987 CONTRACTED ELECTRICAL 803124 MAYO COLLABORATIVE SERVICE INC PO BOX 9146 MINNEAPOLIS MN 55480 CONTRACTED LABORATORY 776569 21 308135 52221 1005 360356 PATIENT SERVICE REVENUE 622110 96354417 96354417 PURCHASED SERVICE REVENUE 900099 11143452 11143452 SUPPORTING REVENUE 900099 2955116 2955116 110452985 259187 259187 421898 0 12174 421898 -12174 409724 409724 7165406 5712210 1453196 1453196 112935448 111906181 0 668911 117214 117214 3371280 2003618 1367662 105388 105388 45426495 43288134 2138361 1418787 1393267 25520 8391418 7190756 1200662 3121320 2905942 215378 49720 49720 93466 93466 40496 40496 10665175 9847406 817769 332624 125594 207030 4610287 3801644 808643 2837363 2837363 11208152 11208152 617709 536362 81347 39571 39571 1411891 1411891 4320706 3973178 347528 883013 883013 MEDICAL SUPPLIES 6677713 6677713 BAD DEBT EXPENSE 3440343 3440343 MN CARE TAX 1319334 1319334 162755 162755 110662220 99019384 11642836 0 23671201 17774645 538852 1289001 12838864 12181089 2223813 2370401 698775 683267 94580936 55099259 40553305 39481677 18245366 25610959 559674 569335 2014538 2014538 4300602 5422351 105644990 107397263 9944507 9701082 30623237 30467876 327044 1402534 696637 42297322 40865595 X 63347668 66531668 63347668 66531668 105644990 107397263 2273228 910772 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4141674 4141674 52381840 27659084 24722756 35417000 26557117 8859883 2640422 883058 1757364 39481677 RECEIVABLE FROM AFFILIATED ORGANIZATIONS 5027635 DEFERRED BOND ISSUE COSTS, NET 394716 5422351 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 254567 DUE TO AFFILIATED ORGANIZATIONS 442070 696637 X PART X, LINE 2: THE CORPORATION AND ITS CONSOLIDATED ENTITIES ARE ORGANIZED AS MINNESOTA NONPROFIT ENTITIES AND ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, ALL ENTITIES ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE CORPORATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE CORPORATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE CORPORATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE CORPORATION'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE SEPTEMBER 30, 2011. 1 1 X 1 X 1 X 0 1 0 1 1 612 925000 925000 0.00860 19971315 13314233 6657082 0.06210 612 20896315 13314233 7582082 0.07070 7848 151245 6070 145175 0.00140 2255 409263 409263 0.00380 300 19380968 19066081 314887 0.00290 8447 75786 75786 0.00070 18850 20017262 19072151 945111 0.00880 19462 40913577 32386384 8527193 0.07950 164 1991 1991 0.00000 290 11995 11995 0.00010 52 192 192 0.00000 506 14178 14178 0.00010 0 3440343 798402 17724563 20117862 -2393299 X 1 1 1 WINONA AREA AMBULANCE SERVICES AMBULANCE SERVICES 0.50000 0.50000 1 1 WINONA HEALTH SERVICES 855 MANKATO AVENUE WINONA MN 55987 WWW.WINONAHEALTH.ORG 00701 X X X URGENT CARE & 2 PROVIDER BASED CLINICS WINONA HEALTH SERVICES 1 1 X X X X X X X X X 12 1 0 1 X SEE STATEMENT ON PAGE 7 OF SCHEDULE H X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X 1 0 X X X 1 X 0 0 WINONA HEALTH SERVICES PART V, SECTION B, LINE 3: TWO SURVEYS WERE CONDUCTED AND ARE IDENTIFIED AS SURVEY A AND SURVEY B:SURVEY A: SIX THOUSAND SURVEYS WERE MAILED TO THE GENERAL POPULATION RESIDING IN ZIP CODE 55987. RESPONDENTS RETURNED THEIR COMPLETED SURVEY IN A POSTAGE-PAID ENVELOPE TO AN INDEPENDENT TABULATION SITE LOCATED IN MINNEAPOLIS, MN. NEARLY 2000 SURVEYS WERE RETURNED AND THE RESPONSE RATE WAS 28%. SURVEY B: TWO HUNDRED SURVEYS WERE DISTRIBUTED TO THE IMMIGRANT POPULATION THROUGH A VARIETY OF METHODS INCLUDING DISTRIBUTION TO TARGETED HOUSEHOLDS, HOSTING FOCUS GROUPS AT CENTRAL LOCATIONS AND ONE-ON-ONE SURVEYING. THE SURVEYS WERE EITHER COMPLETED PRIVATELY OR BY ASSISTANCE FROM REPRESENTATIVES AND/OR TRANSLATORS OF PROJECT FINE. 30% OF THE IMMIGRANT POPULATION COMPLETED THE SURVEY. THE ASSESSMENT WAS DONE COLLABORATIVELY WITH WINONA HEALTH AND WINONA COUNTY PUBLIC HEALTH. THE MINNESOTA CENTER FOR HEALTH STATISTICS OF THE MINNESOTA DEPARTMENT OF HEALTH WAS CONTRACTED TO FACILITATE THE SURVEY PROCESS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT OF WINONA COUNTY. OTHER INPUT CAME FROM PROJECT FINE, WINONA COUNTY UNITED WAY, LIVE WELL WINONA, WINONA CHAMBER OF COMMERCE, WINONA COMMUNITY FOUNDATION, WINONA STATE UNIVERSITY, ST. MARY'S UNIVERSITY AND STILL OTHER ORGANIZATIONS AND INDIVIDUALS INPUT THROUGH FOCUS GROUPS. WINONA HEALTH SERVICES PART V, SECTION B, LINE 5D: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ON THE ORGANIZATION'S WEBSITE AT: HTTP://WWW.WINONAHEALTH.ORG/2014/01/15/WINONA-HEALTH-COMPLETES-COMMUNITY. WINONA HEALTH SERVICES PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE ORGANIZATION'S WEBSITE: HTTP://WWW.WINONAHEALTH.ORG/2014/01/15/WINONA-HEALTH-COMPLETES-COMMUNITY. WINONA HEALTH SERVICES PART V, SECTION B, LINE 7: BINGE DRINKING WAS IDENTIFIED AS A NEED IN THE AREA. THIS WILL NOT BE ADDRESSED AS IT WAS DETERMINED TO BE A LOW PRIORITY ISSUE AND THE ORGANIZATION DOES NOT HAVE THE RESOURCES/BUDGET TO LOOK AT THIS ISSUE AT THE PRESENT TIME. 6 LAKE WINONA MANOR 865 MANKATO AVENUE WINONA MN 55987 SKILLED NURSING WATKINS MANOR 175 E WABASHA STREET WINONA MN 55987 ASSISTED LIVING ADITH MILLER MANOR 885 MANKATO AVENUE WINONA MN 55987 MEMORY CARE ASSISTED LIVING ROGER METZ MANOR 875 MANKATO AVENUE WINONA MN 55987 MEMORY CARE ASSISTED LIVING RUSHFORD CLINIC 109 W JESSIE ST RUSHFORD MN 55971 PRIMARY CARE CLINIC WINONA HEALTH URGENT CARE CLINIC 420 EAST SARNIA WINONA MN 55987 URGENT CARE CLINIC PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS INCLUDED IN THE ANNUAL REPORT AND SENT TO 28,000 HOUSEHOLDS. COMMUNITY BENEFIT INFORMATION IS LISTED IN QUARTERLY NEWSLETTERS AND ON THE WEBSITE. INFORMATION IS ALSO INCLUDED IN THE WAITING ROOMS. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND DONATIONS, LINE 7K WERE ACTUAL EXPENSES COMPILED USING THE CBISA SOFTWARE. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $3,440,343. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ALLOW WINONA HEALTH SERVICES TO BETTER ASSIST THE COMMUNITY IT SERVES THROUGH BETTER PATIENT ACCESS, IMPROVING QUALITY OF CARE, AND ASSISTING THOSE VULNERABLE POPULATIONS IN A WAY THAT MAKES THEIR LIVELIHOOD A LITTLE EASIER AMONG OTHER THINGS. THESE ACTIVITIES ALSO ALLOW THE COMMUNITY AND STAFF TO BE BETTER PREPARED IF A DISASTER OR EMERGENCY WERE TO STRIKE. THESE ACTIVITIES ALLOW WINONA HEALTH SERVICES TO BE AS PREPARED AS POSSIBLE TO BEST ASSIST THE COMMUNITY WE SERVE.PROGRAMS LIKE HEALTHY KIDS CLUB INVOLVE SEVERAL COMMUNITY PARTNERS TO ADDRESS THIS HEALTH ISSUE IN OUR COMMUNITY, WITHOUT PUTTING THE FOCUS SPECIFICALLY ON WEIGHT LOSS. HEALTHY KIDS CLUB IS A FREE, FUN, COMMUNITY-WIDE PROGRAM DESIGNED TO ENCOURAGE CHILDREN AGES 5 TO 12 TO LIVE HEALTHY - FROM MAKING HEALTHFUL FOOD CHOICES TO MAINTAINING ACTIVE LIFESTYLES. AREA SCHOOLS AND NINE AREA NONPROFIT ORGANIZATIONS SUCH AS THE FAMILY YMCA, WINONA COUNTY PARKS AND RECREATION AND WINONA STATE UNIVERSITY ARE STRONG COMMUNITY PARTNERS. INVOLVEMENT WITH LOCAL SCHOOLS THROUGH CAREER EXPLORATION AND TOURS OF OUR ORGANIZATION PROMOTES THE IMPORTANCE OF HEALTHCARE AND SERVING OUR COMMUNITY. WE EXIST TO CARE FOR THOSE WHO NEED US AND SHARE THIS MESSAGE WITH STUDENTS THINKING OF ENTERING THE HEALTHCARE FIELD. OUR STAFF WORKED CLOSELY WITH WINONA WORKFORCE CENTER TO HELP TRAIN THEIR CLIENTS AND SUPERVISE THEM IN VARIOUS JOBS. COMMUNITY OUTREACH IS SOMETHING ENCOURAGED FOR ALL STAFF BECAUSE IT'S NOT ONLY THE RIGHT THING TO DO, BUT IT IS PART OF OUR MISSION AS WELL. PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.WHS DETERMINES BAD DEBT EXPENSE BY ESTIMATING WHAT MAY NOT BE COLLECTIBLE FROM PATIENT BALANCES AFTER TAKING INTO ACCOUNT APPROPRIATE DISCOUNTS AND PAYMENTS (UNINSURED DISCOUNT, ELIGIBLE CHARITY CARE DISCOUNTS/ADJUSTMENTS, AND PAYMENTS RECEIVED AND EXPECTED TO BE RECEIVED.) PAYMENTS ON ACCOUNTS THAT WERE WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.WHS IS ESTIMATING THAT 40% OF BAD DEBT ACCOUNTS WOULD LIKELY QUALIFY FOR THE ORGANIZATION'S CHARITY CARE GUIDELINES IF THE PATIENT WOULD HAVE BEEN IDENTIFIED AND FOLLOWED THROUGH ON THE APPLICATION PROCESS. THIS PERCENTAGE IS BASED ON HISTORICAL KNOWLEDGE ON THOSE BEING PROVIDED APPLICATIONS AND THOSE ACTUALLY COMPLETING THE APPLICATIONS TO QUALIFY.THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: WHS PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THEREFORE, THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. THE ORGANIZATION REPORTED ONLY THOSE ALLOWABLE COSTS AND MEDICARE REIMBURSEMENTS REPORTED IN THE MEDICARE COST REPORT FOR THE YEAR.TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: IN KEEPING WITH THE MISSION, VISION AND VALUES OF WINONA HEALTH SERVICES, OUR ORGANIZATION IS COMMITTED TO GIVING A PATIENT EVERY OPPORTUNITY TO PAY THEIR MEDICAL DEBT IN FULL OR TO MAKE ARRANGEMENTS BASED ON ORGANIZATIONAL POLICY. WHEN A PATIENT IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE, WHETHER CHARITY CARE OR AN INTEREST FREE PAYMENT PLAN, THERE WILL BE NO COLLECTION EFFORTS. COLLECTION EFFORTS INCLUDE PHONE CONTACTS, LETTERS, PATIENT INTERVIEWS AND FILING A JUDGEMENT AGAINST THE PATIENT AND POTENTIAL GARNISHMENT OF WAGES. AFTER A DETERMINATION OF FINANCIAL ASSISTANCE, ANY PERSONAL PORTION DUE FOLLOWS THE SAME COLLECTION PROCEDURES AS OTHER ACCOUNTS. PART VI, LINE 2: WINONA HEALTH SERVICES (WHS) USES A VARIETY OF METHODS TO LISTEN TO ITS CUSTOMERS, AND THE METHODOLOGIES VARY BY CUSTOMER GROUPS. THE DEVELOPMENT OF MOST MAJOR SERVICES INCLUDES THE MEETING OF A COMMUNITY ADVISORY GROUP TO ASSESS OPERATIONS AND PLANS AND PROVIDE RECOMMENDATIONS TO THE LEADERSHIP TEAM. WHS ALSO USES POINT OF CARE FEEDBACK COMMENT CARDS, FOCUS GROUPS, ADVISORY COMMITTEES COMPRISED OF COMMUNITY INDIVIDUALS, AND WEB AND CONSUMER NEWSLETTER SURVEYS TO CAPTURE FEEDBACK FROM PATIENTS/RESIDENTS AND COMMUNITY. IMMEDIATE FEEDBACK IS OBTAINED FROM PATIENTS/RESIDENTS AND COMMUNITY THROUGH PRE- AND POST-SERVICE CALLS, ROUNDING, AND INFORMAL SURVEYS. WHS ALSO WORKS WITH LOCAL NON-PROFIT ORGANIZATIONS GATHERING FEEDBACK FROM LOCAL AGENCIES AND THEIR BOARDS TO ENSURE COMMUNITY NEEDS ARE BEING MET. WHS AND WINONA COUNTY PUBLIC HEALTH BEGAN WORKING ON THE COMMUNITY HEALTH NEEDS ASSESSMENT IN LATE FY 2012 AND THE REPORT WAS PUBLISHED DURING FY 2013. THE ENTIRE REPORT IS AVAILABLE ON THE WINONA HEALTH WEBSITE. PART VI, LINE 3: WHS PLACES PAMPHLETS THAT CONTAIN INFORMATION ABOUT OUR CHARITY CARE PROGRAMS AND POLICIES THROUGHOUT THE ORGANIZATION, INCLUDING ALL PATIENT ACCESS AREAS. IN ADDITION, INFORMATION CAN BE FOUND ON OUR WEBSITE OR BY CALLING THE WHS BUSINESS OFFICE EITHER LOCALLY OR TOLL-FREE. WHS ALSO SENDS OUT A COVER LETTER WITH ALL FIRST TIME SELF-PAY STATEMENTS WHICH EXPLAINS OPTIONS FOR CHARITY CARE, GOVERNMENT PROGRAM ASSISTANCE, AND OUR UNINSURED DISCOUNT PROGRAM. IN ADDITION, THE WHS SOCIAL SERVICES DEPARTMENT AND/OR A CONTRACTED PATIENT ADVOCATE MAY MEET WITH IN-HOUSE OR RECENTLY DISCHARGED PATIENTS TO GO OVER ALL THE PAYMENT OPTIONS WHICH INCLUDE CHARITY CARE, GOVERNMENTAL PROGRAMS, OR OTHER ALTERNATIVE PAYMENT OPTIONS. WHS WORKS WITH THE COUNTY TO HELP INITIATE A SCREENING PROCESS FOR APPLYING FOR GOVERNMENTAL PROGRAMS BY OFFERING THE PATIENTS AN OPPORTUNITY TO LOCK IN AN EFFECTIVE DATE FOR THOSE PROGRAMS IF SUBSEQUENTLY FOUND ELIGIBLE. WHS ALSO IS CONTRACTED WITH MNSURE AND HAS CERTIFIED APPLICATION COUNSELORS ONSITE TO ASSIST PATIENTS IN APPLYING FOR INSURANCE COVERAGE THROUGH THE STATE RUN EXCHANGE. PART VI, LINE 4: WHS DEFINES ITS PRIMARY SERVICE AREA AS THE ZIP CODE OF WINONA AND THE IMMEDIATE SURROUNDING AREA WITH A POPULATION BASE OF APPROXIMATELY 35,000 RESIDENTS. ITS SECONDARY SERVICE AREA ENCOMPASSES A 20-MILE RADIUS FROM WINONA REPRESENTING ANOTHER 12,000 RESIDENTS. WHS IS LOCATED BETWEEN TWO LARGE, WELL-KNOWN TERTIARY HEALTH CARE CENTERS, MAYO AND GUNDERSEN LUTHERAN. WHS HAS FOCUSED ON FULFILLING ITS COMMUNITY NEED: A FULL PRIMARY CARE FACILITY. WHS DEFINES ITSELF AS A PRIMARY CARE HEALTH SYSTEM AND PROVIDES ITS PATIENTS AND RESIDENTS CONNECTIONS TO TERTIARY LEVEL SERVICES TO MEET THEIR NEEDS REGIONALLY OR NATIONALLY, AS THE PATIENT CHOOSES. IN 2010, WINONA HAD A MEDIAN HOUSEHOLD INCOME OF $36,296 AND 22.3% OF PERSONS WERE BELOW THE POVERTY LEVEL. THE MAJORITY OF OUR PATIENTS LIVE IN WINONA WHICH HAS A POPULATION OF OVER 27,000 PEOPLE. APPROXIMATELY 20% OF OUR PATIENTS ARE UNINSURED AND/OR MEDICAID RECIPIENTS. PART VI, LINE 5: WHS OFFERS EMERGENCY AND URGENT CARE, PRIMARY CARE FOR ALL AGES, SURGICAL AND SPECIALTY CARE, INPATIENT CARE, AND SENIOR SERVICES. OUR BOARD IS COMPRISED OF PHYSICIANS AND PRIMARILY COMMUNITY MEMBERS. THE BOARD AND MEDICAL STAFF ARE INVOLVED IN OUR STRATEGIC PLANNING WHICH FOCUSES ON THE HEALTH OF OUR COMMUNITY MEMBERS. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOSPITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED THROUGH LICENSURE IN THE STATE OF MINNESOTA. WE ARE INVOLVED IN SEVERAL ON-SITE AND OFF-SITE HEALTH FAIRS OFFERING FREE BLOOD PRESSURE CHECKS, GLUCOSE SCREENINGS AND STAFF EXPERTISE ON HEALTH QUESTIONS. WE ALSO PROVIDE FREE COMMUNITY HEALTH TALKS FOR COMMUNITY MEMBERS ON CERTAIN HEALTH TOPICS. EXCESS FUNDS ARE REINVESTED AND USED FOR PATIENT CARE AND FACILITY UPGRADES.ADDITIONAL PROGRAMS THAT BENEFIT THE COMMUNITY INCLUDE:HEALTH PROFESSIONAL TRAINING: WINONA HEALTH SERVICES WORKS CLOSELY WITH NURSE AND HEALTH PROFESSIONAL EDUCATION PROGRAMS AT WINONA STATE UNIVERSITY, ST. MARY'S UNIVERSITY AND SOUTHEAST TECHNICAL COLLEGE. ALONG WITH TRAINING LPNS AND RNS ON SITE, OTHER STUDENTS GOING INTO FIELDS OF ATHLETIC TRAINING, SOCIAL WORK, NUTRITION, LAB, RADIOLOGY, PHYSICAL THERAPY AND BIO MED ARE ALSO EDUCATED AND MENTORED ON SITE. APPROXIMATELY 1,890 STUDENTS WORK WITH STAFF IN THE FOLLOWING DEPARTMENTS: MEDICAL/SURGICAL/PEDIATRIC UNIT, FAMILY BIRTH CENTER, INTENSIVE CARE UNIT, EMERGENCY DEPARTMENT, LAB, RADIOLOGY, SOCIAL WORKERS, PHYSICAL AND OCCUPATIONAL THERAPY AND BIO MED.PREVENTIVE CARE: WHS ENCOURAGES PREVENTIVE CARE THROUGH A NUMBER OF RESOURCES. WINONA HEALTH ONLINE IS A FREE WEB-TOOL THAT ALLOWS PATIENTS TO HAVE ACCESS TO THEIR WINONA HEALTH SERVICES RECORDS ANYTIME, ANYWHERE WITH AN INTERNET CONNECTION. PATIENTS CAN DOCUMENT THEIR HEALTH HISTORY, ACCESS DIABETES AND ASTHMA MANAGEMENT PROGRAMS, RECEIVE LAB TEST RESULTS, AND TRACK WELLNESS ACTIVITIES. WINONA HEALTH SERVICES OFFERS A NUMBER OF EDUCATIONAL OPPORTUNITIES FOR THE COMMUNITY, FROM CPR CLASSES TO FREE OR LOW-COST SCREENINGS INCLUDING PROSTATE CANCER, CHOLESTEROL, DEPRESSION, AND MAMMOGRAMS. WHS IS THE MAIN SPONSOR FOR A COMMUNITY-WIDE DIABETES EXPO. COMMUNITY HEALTH TALKS PROVIDE INDIVIDUALS WITH EDUCATIONAL INFORMATION ON A VARIETY OF HEALTH TOPICS AND ARE FREE THROUGHOUT THE YEAR. THE WINONA HEALTH SERVICES OCCUPATIONAL HEALTH DEPARTMENT PRESENTS VARIOUS PREVENTIVE PROGRAMS GEARED TOWARD BUSINESS LEADERS AND HR PROFESSIONALS. THE DEPARTMENT TEAMS UP WITH PHYSICIANS AND LOCAL EXPERTS TO PROVIDE INFORMATION ON A WIDE VARIETY OF BUSINESS-RELATED TOPICS SUCH AS DRUG USE IN THE WORK PLACE, ERGONOMICS, WORKER'S COMPENSATION AND MORE. THESE ARE FREE AND WELL-ATTENDED. THE STAFF ALSO PARTICIPATES IN MANY COMMUNITY COLLABORATIVE HEALTHCARE EVENTS.EMPLOYEE HEALTH: THE HEALTHY U PROGRAM IS A HEALTH MANAGEMENT INCENTIVE INITIATIVE DESIGNED TO SUPPORT AND ENCOURAGE HEALTHY ACTIVITIES FOR OUR EMPLOYEES AND FAMILIES. THE PROGRAM REINFORCES THE EMPHASIS ON PREVENTION, AIMING TO IMPROVE THEIR HEALTH AND WELL-BEING. WELLNESS EVALUATIONS BY A CERTIFIED HEALTH ADVISOR ARE OFFERED FREE TO STAFF. EMPLOYEES CAN EARN CREDITS TIED TO COMPLETION OF PREDETERMINED ACTIVITIES SPECIFIC TO THEIR HEALTH GOALS WHICH COULD RESULT IN AN UP TO $600 SAVINGS IN HEALTH PLAN PREMIUMS. IN ITS SEVENTH YEAR, HEALTHY KIDS CLUB IS A COMMUNITY-WIDE PROGRAM FOR CHILDREN 5-12 AND FOCUSES ON TEACHING CHILDREN THE IMPORTANCE OF HEALTH AND WELLNESS AT AN EARLY AGE. COLLABORATING WITH OTHER ORGANIZATIONS IN THE COMMUNITY, THE PROGRAM IS FREE AND HAS SERVICED OVER 4,100 CHILDREN AND FAMILIES, PROVIDED OVER 4,500 HEALTHY SNACKS SINCE ITS OFFICIAL INCEPTION IN 2007. WHS HAS SPENT OVER $125,000 ON THIS ACTIVITY SINCE 1996. AREA SCHOOLS AND NINE AREA NONPROFIT ORGANIZATIONS SUCH AS THE FAMILY YMCA, WINONA COUNTY PARKS AND RECREATION AND WINONA STATE UNIVERSITY ARE STRONG COMMUNITY PARTNERS. EMERGENCY CARE: WHS PROVIDES 24-HOUR-A-DAY, 365-DAYS-PER-YEAR EMERGENCY CARE TO THE COMMUNITY. IT EMPLOYS SEVEN FULL-TIME PHYSICIANS AND SEVERAL MID-LEVEL PROVIDERS AS THE SERVICE CONTINUES TO GROW. WINONA HEALTH SERVICES HAS EXCELLENT RELATIONS WITH NEIGHBORING TERTIARY FACILITIES AND TRANSPORTS PATIENTS AS NEEDED TO LA CROSSE AND ROCHESTER.COMMUNITY RELATIONS: WHS WORKS WITH AREA NONPROFIT ORGANIZATIONS TO SUPPORT HEALTH AND YOUTH-RELATED ACTIVITIES. IN FY 2014, STAFF SPOKE TO 2,697 INDIVIDUALS THROUGH OUR OUTREACH SPEAKER'S BUREAU. IN ADDITION, WHS STAFF DELIVERED OVER 480 MEALS-ON-WHEELS TO COMMUNITY MEMBERS THROUGH A LOCAL MEAL DELIVERY PROGRAM. STAFF MEMBERS ARE ALSO INVOLVED IN SEVERAL NON-PROFIT COMMITTEES, DONATING THEIR TIME TO SUPPORT OUR COMMUNITY. COMMUNITY EDUCATION: WHS'S COMMUNITY EDUCATION PROGRAMMING INCLUDES FREE OR REDUCED-FEE CLASSES ON CHILDBIRTH AND PARENTING, SUPPORT GROUPS FOR BREASTFEEDING, CARDIO-PULMONARY RESUSCITATION, DIABETES PREVENTION, FIRST AID, AND SMOKING CESSATION. IN FY 2014, WHS SERVED 1,040 INDIVIDUALS THROUGH THESE CLASSES. STAFF AT LOCAL HEALTH FAIRS SERVED 844 INDIVIDUALS, OFTEN OFFERING FREE BLOOD SUGAR AND BLOOD PRESSURE SCREENINGS. VOLUNTEERS FROM THE WH AUXILIARY OFFER FREE HEALTHCARE DIRECTIVES EDUCATIONAL SESSIONS THROUGHOUT THE YEAR. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 WINONA HEALTH FOUNDATION 855 MANKATO AVENUE WINONA MN 55987 411879744 501(C)(3) 89541 DONATION TO LIVE WELL WINONA FUND 1 0 PART I, LINE 2: WINONA HEALTH SERVICES WILL REVIEW SOLICITATIONS FROM OTHER LEGALLY RECOGNIZED, TAX-EXEMPT NONPROFIT ORGANIZATIONS WHOSE WORK BENEFITS THE COMMUNITY BASED ON THE FOLLOWING: A. THE REQUEST ADDRESSES A COMMUNITY HEALTH OR WELLNESS ISSUE. B. THE REQUEST BENEFITS AREA YOUTH IN THE AREAS OF HEALTH AND WELLNESS. C. THE REQUEST SUPPORTS A PROJECT DIRECTLY BENEFITING THE COMMUNITY AND ALIGNED WITH WINONA HEALTH SERVICES' MISSIONS/VISION/VALUES. D. THE REQUEST SUPPORTS KEY WINONA HEALTH SERVICES BUSINESS AND MARKETING STRATEGIES. E. PRIORITY WILL BE GIVEN TO LOCAL NONPROFIT ORGANIZATIONS. F. TYPICALLY, ONLY ONE REQUEST WILL BE AWARDED TO A NONPROFIT IN A GIVEN YEAR. ALL DONATION REQUESTS WILL BE DIRECTED TO THE MARKETING COMMUNICATIONS DEPARTMENT FOR PROCESSING. A. STAFF WILL REVIEW THE REQUEST BASED ON THE ABOVE CRITERIA AND BUDGET PARAMETERS, WITH KEY DONATION DETERMINED YEARLY DURING THE BUDGETING PROCESS. B. THE FOLLOWING PROCESSES WILL BE USED TO REVIEW DONATION REQUESTS: 1. STAFF MAY PROCESS ALL DONATIONS APPROVED DURING THE BUDGETING PROCESS AND THOSE THAT MEET THE CRITERIA AND ARE LESS THAN $500 WITHOUT ADDITIONAL APPROVAL. 2. REQUESTS MEETING THE CRITERIA AND BETWEEN $500-$1,000 OR THOSE REQUESTS THAT REQUIRE FURTHER REVIEW SHOULD BE DISCUSSED WITH THE PRESIDENT/CEO BEFORE RECEIVING APPROVAL. 3. DONATION REQUESTS ABOVE $1,000 OR REQUESTS FOR MULTI-YEAR FUNDING SHOULD GO TO THE BOARD OF DIRECTOR'S PR/MARKETING COMMITTEE FOR REVIEW AND APPROVAL. X X X X X X 0 1 0 0 0 0 0 1 0 SCOTT BIRDSALL MD DIRECTOR 316385 0 9609 0 16146 0 29656 0 29937 0 401733 0 0 0 MATTHEW BROGHAMMER MD DIRECTOR 387760 0 47109 0 24988 0 51691 0 27570 0 539118 0 0 0 RICHARD FERRIS MD DIRECTOR 203917 0 10234 0 7688 0 42277 0 26928 0 291044 0 0 0 DANIEL PARKER MD DIRECTOR 211265 0 10234 0 13383 0 33096 0 28867 0 296845 0 0 0 RACHELLE HEISING-SCHULTZ PRESIDENT/CEO/DIRECTOR 366148 0 93800 0 7871 0 28503 0 33553 0 529875 0 0 0 SARA GABRICK CNO 151644 0 32000 0 688 0 11446 0 29726 0 225504 0 0 0 BRETT WHYTE MD EMERGENCY PHYSICIAN 321276 0 200 0 48177 0 57740 0 27088 0 454481 0 0 0 EVERETT BEGUIN FAMILY PRACTICE PHYSICIAN 239068 0 10234 0 8153 0 22964 0 27445 0 307864 0 0 0 KATRINA HAMMEL HOSPITALIST 262025 0 200 0 16602 0 24414 0 28618 0 331859 0 0 0 LEROY TROMBETTA MD GENERAL SURGEON 365226 0 25793 0 1617 0 65800 0 32570 0 491006 0 0 0 AMARJIT VIRDI MD ANESTHESIOLOGIST 374144 0 200 0 1634 0 45018 0 27570 0 448566 0 0 0 WILLIAM KRUEGER RADIOLOGIST 514144 0 200 0 7737 0 70218 0 27504 0 619803 0 0 0 CARLOS MORALES EMERGENCY PHYSICIAN 359594 0 200 0 10659 0 32909 0 27570 0 430932 0 0 0 GIUSTINO ALBANESE RADIOLOGIST 487576 0 200 0 10078 0 64818 0 11580 0 574252 0 0 0 MICHAEL ALLEN FORMER CFO/TREASURER 201723 0 0 0 123666 0 12406 0 20788 0 358583 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED EMPLOYER CONTRIBUTIONS TO A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: MATTHEW BROGHAMMER $12,025 THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IS AVAILABLE TO EXECUTIVES, PHYSICIANS, AND MID-LEVEL PROVIDERS AS DETERMINED BY THE BOARD OF DIRECTORS. IT IS FUNDED BY EMPLOYER CONTRIBUTIONS, AND EMPLOYEES ARE VESTED WITHIN FIVE YEARS. AN ALTERNATIVE PLAN IS AVAILABLE WHICH IS FUNDED BY EMPLOYEE CONTRIBUTIONS AND NOT SUBJECT TO FORFEITURE. PART I, LINE 7 LEROY TROMBETTA RECEIVED A PRODUCTION BONUS OF $25,793. SARA GABRICK RECEIVED A BONUS OF $32,000. RACHELLE HEISING-SCHULTZ RECEIVED A BONUS OF $93,800. A CITY OF WINONA 416005651 975232CE7 2012-05-04 19887849 REFUND REVENUE BONDS ISSUED 7/16/2004 0 0 0 B CITY OF WINONA 416005651 975232BQ1 2007-07-31 12779904 SEE BELOW FOR COMPLETE DESCRIPTION 0 0 0 A 19887849 1555683 356781 17975385 2012 1 0 1 1 B 2650000 12779904 927843 167030 5340000 6344845 2007 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF WINONA DATE THE REBATE COMPUTATION WAS PERFORMED: 08/14/2012 PART I, LINE B: SCHEDULE K INCLUDES THE ALLOCABLE SHARE OF THE SERIES 2007 TAX-EXEMPT BOND. THE REMAINING SHARE IS REPORTED ON RELATED ORGANIZATION SCHEDULE K, WINONA SENIOR SERVICES, EIN - 41-1936536. PART I, LINE B, COLUMN (F): REFUNDING OF PRIOR REVENUE BONDS ORIGINALLY ISSUED 8/1/2000 AND 7/1/2004 AND RENOVATION AND ACQUISITION OF PROPERTY ON SARNIA STREET AND PARKS AVENUE. PART II, LINE 11(A): THE AMOUNT REPORTED ON LINE 11 REPRESENTS THE AMOUNT OF PROCEEDS USED TO REFUND PRIOR BONDS ISSUED IN 2004. HIAWATHA BROADBAND COMMUNICATIONS INC ONE BOARD MEMBER IS OWNER & ONE BOARD MEMBER IS ON THE BOARD OF HBC, INC. 135293 PURCHASE OF TELEPHONE AND CABLE SERVICES 0 WINONA AGENCY OWNED BY BOARD MEMBER 124710 PURCHASE OF INSURANCE 0 MARIE OLSEN WAGNER SPOUSE OF BOARD MEMBER 65663 COMPENSATION AND BENEFITS AS AN EMPLOYEE 0 HEIDI FERRIS SPOUSE OF BOARD MEMBER 39726 COMPENSATION AND BENEFITS AS AN EMPLOYEE 0 SARNIA REALTY OWNED BY TWO BOARD MEMBERS 1119805 PROPERTY LEASE 0 SCHWAB BOARD MEMBER IS 50% OWNER 143210 CONTRACTORS 0 FORM 990, PART VI, SECTION A, LINE 1 1. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR TRANSACTING THE BUSINESS OF THE BOARD OF DIRECTORS IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. 2. THE COMMITTEE SHALL ACT ON MATTERS WHICH CANNOT REASONABLY AWAIT ACTION BY THE FULL BOARD OF DIRECTORS. 3. OTHER MATTERS MAY BE DELEGATED TO THE EXECUTIVE COMMITTEE BY THE BOARD OF DIRECTORS, FOR EXAMPLE: - RECRUITMENT, SELECTION, AND EVALUATION OF THE CEO; - REVIEW AND APPROVAL OF A SENIOR EXECUTIVE DEVELOPMENT PLAN AND A CEO SUCCESSION PLAN; - REVIEW AND APPROVAL OF THE INCENTIVE EXPECTATIONS FOR THE EXECUTIVE STAFF; - REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE'S RECOMMENDATIONS; 4. CONDUCT OTHER ACTIVITIES WITHIN THE SCOPE OF THE COMMITTEE'S PURPOSE AND AUTHORITY AS THE BOARD MAY FROM TIME TO TIME DETERMINE; 5. PERIODICALLY REVIEW THE COMMITTEE CHARTER AND MAKE RECOMMENDATIONS TO THE BOARD WITH REGARD TO ANY CHANGES TO THE CHARTER THAT THE COMMITTEE BELIEVES WOULD BE DESIRABLE. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS HAVE BUSINESS RELATIONSHIPS: SCOTT BIESANZ WITH KEN MOGREN GARY EVANS WITH HUGH MILLER SCOTT BIRDSALL WITH RACHELLE HEISING-SCHULTZ, AND STEVE BLUE RACHELLE HEISING-SCHULTZ WITH GARY EVANS, STEVE BLUE, AND SCOTT BIRDSALL MATT BROGHAMMER WITH DAN PARKER JIM KILLIAN WITH HUGH MILLER FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED INITIALLY BY THE CFO AND DIRECTOR OF FINANCIAL OPERATIONS. IT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS SENIOR LEADERS, DIRECTORS, OFFICERS AND BOARD COMMITTEE MEMBERS. THE POLICY IS SIGNED ANNUALLY AND REVIEWED BY THE CEO FOR CONFLICTS. ANY CONFLICTS ARE BROUGHT TO THE BOARD FOR DISCUSSION. IF A BOARD MEMBER HAS A POTENTIAL CONFLICT, THEY MUST ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE HAS A PROCESS IN PLACE FOR DETERMINING COMPENSATION FOR THE CEO AND CFO BASED ON RESULTS OF A COMPENSATION STUDY, APPROVAL AND DOCUMENTATION BY THE BOARD/COMMITTEE MEMBERS AND THE USE OF INDEPENDENT CONSULTING EVERY 3 YEARS. THE BOARD REVIEWS COMPENSATION FOR THESE INDIVIDUALS ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990. WINONA SENIOR SERVICES INC 855 MANKATO AVENUE WINONA MN 55987 411936536 LONG-TERM CARE MN 501(C)(3) LINE 3 WINONA HEALTH SERVICES 1 WINONA HEALTH FOUNDATION 855 MANKATO AVENUE WINONA MN 55987 411879744 FUNDRAISING MN 501(C)(3) LINE 7 WINONA HEALTH SERVICES 1 WINONA HEALTH PHYSICIAN CLINICS 420 E SARNIA WINONA MN 55987 411767741 HEALTH CARE SERVICES MN 501(C)(3) LINE 9 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 WINONA SENIOR SERVICES INC O 120724 DUE TO/FROM NET CHANGE IN BALANCE WINONA SENIOR SERVICES INC S 11553943 DUE TO/FROM NET CHANGE IN BALANCE WINONA SENIOR SERVICES INC R 11462125 DUE TO/FROM NET CHANGE IN BALANCE WINONA HEALTH FOUNDATION O 156646 DUE TO/FROM NET CHANGE IN BALANCE WINONA HEALTH FOUNDATION Q 51718 DUE TO/FROM NET CHANGE IN BALANCE WINONA HEALTH FOUNDATION S 934275 DUE TO/FROM NET CHANGE IN BALANCE WINONA HEALTH FOUNDATION C 308135 DUE TO/FROM NET CHANGE IN BALANCE