CENTRACARE CLINIC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CENTRACARE CLINIC (EIN 41-1806657)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-08
- IRS object ID
- 201401289349300805
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-08T07:51:03-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411806657 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRACARE CLINIC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CENT | NameControl |
| Phone | 3202525131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 6TH AVENUE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID TILSTRA | Name |
| Title | PRESIDENT | Title |
| Phone | 3202525131 | Phone |
| Date Signed | 2014-05-01 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TODD A JACKSON | Name |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID TILSTRA MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 6TH AVENUE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 158149353 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CENTRACARE.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 989 | TotalNbrEmployees |
| Total Nbr Volunteers | 4 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 14780171 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 500557 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 151571465 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 153646154 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 54771 | InvestmentIncomePriorYear |
| Investment Income Current Year | 60839 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 179963 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3771631 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 166586370 | TotalRevenuePriorYear |
| Total Revenue Current Year | 157979181 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 9200 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5500 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 118820961 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 123651381 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 45759744 | OtherExpensePriorYear |
| Other Expenses Current Year | 44165109 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 164589905 | TotalExpensesPriorYear |
| Total Expenses Current Year | 167821990 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1996465 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -9842809 | RevenuesLessExpensesCY |
| Total Assets BOY | 35897814 | TotalAssetsBOY |
| Total Assets EOY | 43096633 | TotalAssetsEOY |
| Total Liabilities BOY | 23943305 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 26429686 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11954509 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 16666947 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CENTRACARE CLINIC WILL BE THE LEADER IN MINNESOTA FOR QUALITY, SAFETY, SERVICE AND VALUE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 98412864 | Expense |
| Grants | 5500 | Grants |
| Revenue | 112982095 | Revenue |
| Description | 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, 2013 IS:CLINIC VISITS - 268,078 HOSPITAL VISITS - 134,883 NURSING HOME VISITS - 4,852 SURGICAL SERVICES - 134,850 LABORATORY TESTS - 537,960 IMMUNIZATION/INJECTION - 809,817 RADIOLOGY TESTS - 24,277 PROFESSIONAL INTERPRETATIONS - 51,824 SURGICAL-MINOR - 28,512 RADIATION ONCOLOGY - 2,961 SPECIAL PROCEDURE- 44,448 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 43974217 | Expense |
| Revenue | 44435690 | Revenue |
| Description | COST OF PARTICIPATING IN GOVERNMENTAL HEALTHCARE PROGRAMS - 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, 2013, CCC INCURRED COSTS OF $43,974,217 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 - $29,249,637MEDICAID COSTS IN EXCESS OF PAYMENTS - $12,167,403SURCHARGES, FEES AND MINNESOTACARE TAX - $1,639,569MILITARY COSTS IN EXCESS OF PAYMENTS - $917,608 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2699482 | Expense |
| Description | UNCOMPENSATED CHARITY CARE - 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, 2013, $2,699,482 OF UNCOMPENSATED CARE WAS PROVIDED. $429,891 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, 2013 TOTALED $2,269,591. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 145086563 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 100 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 989 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THOMAS FELDHEGE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3202402152 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 SIXTH AVENUE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| THOMAS W LEITHER MD | |||||||||
| DIRECTOR, CHAIR | 40.00 | 2.00 | X | X | 418284 | 1500 | 46751 | ||
| GENE WINDFELDT | |||||||||
| DIRECTOR | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| DENISE ROSIN | |||||||||
| DIRECTOR | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| BYRON JOHN MD | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| DAVID AGERTER MD | |||||||||
| DIRECTOR | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| DAVID ROBERTS MD | |||||||||
| DIRECTOR & GASTROENTEROLOGIST | 40.00 | X | 602253 | 0 | 42275 | ||||
| KEITH LEAVELL MD | |||||||||
| DIRECTOR & PULMONOLOGIST | 40.00 | 2.00 | X | 432082 | 0 | 45922 | |||
| ROBERT STOCKER MD | |||||||||
| DIRECTOR & OBGYN | 40.00 | X | 453124 | 0 | 22045 | ||||
| SHARON WIDSTROM | |||||||||
| DIRECTOR & INTERNIST | 20.00 | X | 148842 | 0 | 11673 | ||||
| ALLEN E HORN MD | |||||||||
| PRESIDENT & CEO | 40.00 | 4.00 | X | 562764 | 0 | 37058 | |||
| THOMAS M FELDHEGE | |||||||||
| TREASURER & CFO | 40.00 | X | 211954 | 0 | 37059 | ||||
| DAVID TILSTRA MD | |||||||||
| PRESIDENT/MEDICAL DIRECTOR & GENETICIST | 40.00 | 3.00 | X | 371399 | 0 | 45686 | |||
| MARK MURPHY | |||||||||
| VICE PRESIDENT OF OPERATIONS | 40.00 | 387318 | 0 | 42894 | X | ||||
| BERNARD R ERICKSON MD | |||||||||
| INTERVENTIONAL CARDIOLOGIST | 40.00 | 908669 | 0 | 40794 | X | ||||
| RANDY C SALIARES MD | |||||||||
| GASTROENTEROLOGIST | 40.00 | 956382 | 0 | 42371 | X | ||||
| MARK JOHNSON MD | |||||||||
| CARDIOLOGIST | 40.00 | 865160 | 0 | 41092 | X | ||||
| JACOB DUTCHER MD | |||||||||
| CARDIOLOGIST | 40.00 | 882916 | 0 | 41145 | X | ||||
| WADE SCHMIDT MD | |||||||||
| CARDIOLOGIST | 40.00 | 962844 | 0 | 42102 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 8163991 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1500 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 538867 | TotalOtherCompensation |
| Number Individuals GT100 K | 243 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DERMATOPATHOLOGY ASSOCIATES | |||||
| 7205 UNIVERSITY AVE NE | MINNEAPOLIS | MN | 55440 | LABORATORY SERVICES | 532693 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | PHYSICIAN SERVICES | 372096 |
| REGIONAL DIAGNOSTIC RADIOLOGY | |||||
| 1990 CONNECTICUT AVE S SUITE 100 | SARTELL | MN | 56377 | RADIOLOGY SERVICES | 218030 |
| UNIVERSITY OF MINNESOTA | |||||
| SES 12-1562 BOX 86 | MINNEAPOLIS | MN | 55486 | PHYSICIAN SERVICES | 187517 |
| THE BLACKHAWK CONSULTING GROUP | |||||
| 25650 NETWORK PLACE | CHICAGO | IL | 60673 | BILLING STMTS SERVICES | 159718 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Related Organizations | 500557 | RelatedOrganizations |
| Total Contributions | 500557 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT & RESIDENT SERVICE REVENU | 621110 | 128865164 | 128865164 |
| OTHER PROGRAM REVENUE | 900099 | 24780990 | 24780990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 153646154 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 60839 | TotalRevenueColumn |
| Exclusion | $60,839 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 170172 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 170172 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HEALTH INFO TECH INCENTIVE | 900099 | 1976337 | 1976337 |
| QUALITY INITIATIVES | 900099 | 1795294 | 1795294 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3771631 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 157979181 | TotalRevenueColumn |
| Related Or Exempt Function Income | 157417785 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $60,839 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5500 | Total |
| Program Services | 5500 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3726991 | Total |
| Program Services | 3366699 | ProgramServices |
| Management And General | 360292 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99266822 | Total |
| Program Services | 90201805 | ProgramServices |
| Management And General | 9065017 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5024779 | Total |
| Program Services | 4907578 | ProgramServices |
| Management And General | 117201 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10492206 | Total |
| Program Services | 7932687 | ProgramServices |
| Management And General | 2559519 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5140583 | Total |
| Program Services | 4725561 | ProgramServices |
| Management And General | 415022 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197382 | Total |
| Program Services | 11153 | ProgramServices |
| Management And General | 186229 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32210 | Total |
| Management And General | 32210 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3015 | Total |
| Program Services | 3015 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8045590 | Total |
| Program Services | 7704470 | ProgramServices |
| Management And General | 341120 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71049 | Total |
| Program Services | 15225 | ProgramServices |
| Management And General | 55824 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 877003 | Total |
| Program Services | 279546 | ProgramServices |
| Management And General | 597457 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1417504 | Total |
| Program Services | 3574 | ProgramServices |
| Management And General | 1413930 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6274739 | Total |
| Program Services | 1269764 | ProgramServices |
| Management And General | 5004975 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193360 | Total |
| Program Services | 162172 | ProgramServices |
| Management And General | 31188 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 842271 | Total |
| Program Services | 679940 | ProgramServices |
| Management And General | 162331 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1283143 | Total |
| Program Services | 1283143 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| DRUGS | 14288588 | 14288588 | |
| OTHER SUPPLIES | 2616792 | 2464335 | 152457 |
| BAD DEBT EXPENSE | 2269592 | 2269592 | |
| OTHER EXPENSES | 871281 | 508079 | 363202 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4881590 | Total |
| Program Services | 3004137 | ProgramServices |
| Management And General | 1877453 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 167821990 | Total |
| Program Services | 145086563 | ProgramServices |
| Management And General | 22735427 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5724 | BOY |
| EOY | 5243 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11576116 | BOY |
| EOY | 12686291 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13115328 | BOY |
| EOY | 15178170 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 937861 | BOY |
| EOY | 1219653 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1256910 | BOY |
| EOY | 1273346 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 458056 | BOY |
| EOY | 456811 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18555185 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14671119 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3251679 | BOY |
| EOY | 3884066 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5296140 | BOY |
| EOY | 8393053 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35897814 | BOY |
| EOY | 43096633 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19640845 | BOY |
| EOY | 21190271 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4302460 | BOY |
| EOY | 5239415 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23943305 | BOY |
| EOY | 26429686 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11954509 | BOY |
| EOY | 16666947 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11954509 | BOY |
| EOY | 16666947 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35897814 | BOY |
| EOY | 43096633 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -9842809 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 14555247 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,015 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3015 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | CENTRACARE CLINIC PAID $3,015 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. | Explanation |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3102671 | OtherCostOrOtherBasis |
| Depreciation | 1372107 | Depreciation |
| Book Value | 1730564 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15433285 | OtherCostOrOtherBasis |
| Depreciation | 13299012 | Depreciation |
| Book Value | 2134273 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19229 | OtherCostOrOtherBasis |
| Book Value | 19229 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3884066 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| FUNDS HELD BY TRUSTEE | 2210523 |
| DUE FROM RELATED ORGANIZATIONS | 6182530 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 8393053 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION PLAN OBLIGATIONS | $2,110,523 |
| DUE TO RELATED ORGANIZATIONS | $2,898,892 |
| LT SETTLEMENT RESERVE | $230,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5239415 | TotalOfAmounts |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAMBER OF COMMERCE | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 487 | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56302 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 123456789 | EINOfRecipient |
| IRC Section | 501C3 | IRCSection |
| Amount Of Cash Grant | 5500 | AmountOfCashGrant |
| Purpose Of Grant | PROGRAM SUPPORT | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: CENTRACARE HEALTH SYSTEM, INCLUDING CENTRACARE CLINIC, HAS THE FOLLOWING POLICY REGARDING CHARITABLE CONTRIBIONS: 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 HEALTHS COMMUNICATIONS DEPARTMENT AND THE COMMUNICATIONS/ MARKETING SPECIALIST RESPONSIBLE FOR CENTRACARE CLINIC; THE DIRECTOR OF COMMUNICATIONS/MARKETING FOR ST. BENEDICTS SENIOR COMMUNITY; THE DIRECTOR OF CENTRACARE HEALTHS MARKETING DEPARTMENT; THE DIRECTOR OF ST. CLOUD HOSPITAL VOLUNTEER SERVICES; AND ST. CLOUD HOSPITALS 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 FROM THE CENTRACARE HEALTH EXECUTIVE COUNCIL. INDIVIDUALS AND DEPARTMENTS FROM THROUGHOUT ST. CLOUD HOSPITAL AND CENTRACARE CLINIC SHOULD FORWARD ALL OUTSIDE FUNDING REQUESTS TO A MEMBER OF THE COMMITTEE FOR THE FULL GROUPS CONSIDERATION. THOSE REQUESTING FUNDS SHOULD BE ASKED TO SUBMIT REQUESTS IN WRITING. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS W LEITHER MD | ||||||||||||||
| DIRECTOR, CHAIR | 327986 | 1500 | 62257 | 0 | 28041 | 0 | 18750 | 0 | 28001 | 0 | 465035 | 1500 | 0 | 0 |
| DAVID ROBERTS MD | ||||||||||||||
| DIRECTOR & GASTROENTEROLOGIST | 533331 | 0 | 65062 | 0 | 3860 | 0 | 18750 | 0 | 23525 | 0 | 644528 | 0 | 0 | 0 |
| KEITH LEAVELL MD | ||||||||||||||
| DIRECTOR & PULMONOLOGIST | 376844 | 0 | 53331 | 0 | 1907 | 0 | 18750 | 0 | 27172 | 0 | 478004 | 0 | 0 | 0 |
| ROBERT STOCKER MD | ||||||||||||||
| DIRECTOR & OBGYN | 399073 | 0 | 53416 | 0 | 635 | 0 | 18750 | 0 | 3295 | 0 | 475169 | 0 | 0 | 0 |
| SHARON WIDSTROM | ||||||||||||||
| DIRECTOR & INTERNIST | 114140 | 0 | 33470 | 0 | 1232 | 0 | 10447 | 0 | 1226 | 0 | 160515 | 0 | 0 | 0 |
| ALLEN E HORN MD | ||||||||||||||
| PRESIDENT & CEO | 299783 | 0 | 145145 | 0 | 117836 | 0 | 18601 | 0 | 18457 | 0 | 599822 | 0 | 0 | 0 |
| THOMAS M FELDHEGE | ||||||||||||||
| TREASURER & CFO | 188240 | 0 | 22468 | 0 | 1246 | 0 | 15552 | 0 | 21507 | 0 | 249013 | 0 | 0 | 0 |
| DAVID TILSTRA MD | ||||||||||||||
| PRESIDENT/MEDICAL DIRECTOR & GENETIC | 275062 | 0 | 77615 | 0 | 18722 | 0 | 20346 | 0 | 25340 | 0 | 417085 | 0 | 15972 | 0 |
| MARK MURPHY | ||||||||||||||
| VICE PRESIDENT OF OPERATIONS | 220774 | 0 | 65519 | 0 | 101025 | 0 | 19241 | 0 | 23653 | 0 | 430212 | 0 | 98250 | 0 |
| BERNARD R ERICKSON MD | ||||||||||||||
| INTERVENTIONAL CARDIOLOGIST | 835332 | 0 | 68203 | 0 | 5134 | 0 | 18750 | 0 | 22044 | 0 | 949463 | 0 | 0 | 0 |
| RANDY C SALIARES MD | ||||||||||||||
| GASTROENTEROLOGIST | 537332 | 0 | 58951 | 0 | 360099 | 0 | 18750 | 0 | 23621 | 0 | 998753 | 0 | 0 | 0 |
| MARK JOHNSON MD | ||||||||||||||
| CARDIOLOGIST | 796857 | 0 | 66396 | 0 | 1907 | 0 | 18750 | 0 | 22342 | 0 | 906252 | 0 | 0 | 0 |
| JACOB DUTCHER MD | ||||||||||||||
| CARDIOLOGIST | 812619 | 0 | 65917 | 0 | 4380 | 0 | 18750 | 0 | 22395 | 0 | 924061 | 0 | 0 | 0 |
| WADE SCHMIDT MD | ||||||||||||||
| CARDIOLOGIST | 888634 | 0 | 69610 | 0 | 4600 | 0 | 18750 | 0 | 23352 | 0 | 1004946 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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: ALLEN E HORN, MD - PAID $0; ACCRUED $0 DAVID TILSTRA, MD - PAID $15,972; ACCRUED $12,515 MARK MURPHY - PAID $98,250; ACCRUED $15,329 |
| PART I, LINE 6 | THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO DESIGNATED INDIVIDUALS BASED ON FOUR DISCRETE AREAS: A COMPARISON BETWEEN BUDGETED AND ACTUAL NET OPERATING INCOME FOR CENTRACARE CLINIC OR CENTRACARE HEALTH SYSTEM; ACHIEVEMENT OF IMPROVEMENT IN PATIENT SATISFACTION GOALS AS COMPARED TO NATIONAL AND BASELINE RANKINGS; ACHIEVEMENT OF IMPROVEMENT IN OVERALL EMPLOYMENT ENGAGEMENT SCORES; AND ACHIEVEMENT OF UP TO THREE INDIVIDUAL GOALS WHICH ARE TIED TO THE CENTRACARE SYSTEM'S STRATEGIC PLAN. THE INCENTIVE COMPENSATION PAID OUT IS NOT A PORTION OR PERCENTAGE OF ACTUAL NET EARNINGS OF ANY CENTRACARE HEALTH SYSTEM AFFILIATE, HOWEVER NET EARNINGS GOALS ARE REQUIRED TO BE MET BEFORE INCENTIVE COMPENSATION IS PAID. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 PHYSICIAN DIRECTOR 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) ADOPT AMENDMENTS TO THE ARTICLES OF CENTRACARE CLINIC. (2) APPROVE AMENDMENTS TO THE BYLAWS OF CENTRACARE CLINIC WHICH MAY AFFECT ANY POWERS OR 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 HTE 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 SYSTEM 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 THE 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 CENTRACLINIC. (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 HOSPTIAL, CLINIC, OR PHYSICIAN PROVIDER GROUP. (13) OVERSEE AUDITNG AND ACCOUNTING PRACTICES OF CENTRACARE CLINIC. | |
| FORM 990, PART VI, SECTION B, LINE 11 | ANNUALLY AT THE BOARD OF DIRECTOR'S APRIL MEETING THE FULL BOARD HAS AN OPPORTUNITY TO REVIEW FORM 990 WITH THE STAFF, TO ASK QUESTIONS, AND SEEK CLARIFICATIONS. THE BOARD OF DIRECTORS APPROVES THE FINAL DOCUMENT PRIOR TO FILING FORM 990 WITH THE IRS. | |
| 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 APPROVEL 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 QUESTIONNAIRE ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTE 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 IN MAY 2012. THE THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT IS RETAINED BY ST. CLOUD HOSPITAL TO PERFORM THESE SERVICES. THE ORGANIZATION'S EMPLOYED PRACTICING PHYSICIANS ARE SUBJECT TO ANNUAL FULL COMPENSATION AND BENEFITS REVIEWS 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 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT OPEN TO THE PUBLIC. | |
| FORM 990, PART XI, LINE 9: | NET EQUITY TRANSFERS FROM AFFILIATES 14,555,247. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTRACARE HEALTH SYSTEM | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 411813221 | HEALTH CARE | MN | 501(C)(3) | 11- TYPE 3 FI | N/A | 0 | |
| CENTRACARE HEALTH SERVICES-MELROSE | |||||||||||
| 11 NORTH 5TH AVE WEST | MELROSE | MN | 56352 | 411865315 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRACARE HEALTH SERVICES-LONG PRAIRIE | |||||||||||
| 20 SOUTHEAST 9TH STREET | LONG PRAIRIE | MN | 56347 | 411924645 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRACARE HEALTH FOUNDATION | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 411855173 | FUNDRAISING | MN | 501(C)(3) | LINE 7 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRAL MINNESOTA EMERGENCY PHYSICIANS | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 411708142 | EMERGENCY PHYSICIAN PRACTICE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| ST CLOUD HOSPITAL | |||||||||||
| 1406 6TH AVE N | ST CLOUD | MN | 56303 | 410695596 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
| CENTRACARE HEALTH-SAUK CENTRE | |||||||||||
| 425 ELM STREET NORTH | SAUK CENTRE | MN | 56378 | 452438973 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | 0 | CENTRACARE HEALTH SYSTEM | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRACARE PHARMACY SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1406 6TH AVE NORTH | AddressLine1 |
| City | ST CLOUD | City |
| State | MN | State |
| ZIP Code | 56303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411620618 | EIN |
| Primary Activity | RETAIL PHARMACIES | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRACARE HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |