2014-05-08T07:51:03-05:00 2013-06-30 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2012-07-01 411806657 CENTRACARE CLINIC CENT 3202525131 1200 6TH AVENUE NORTH ST CLOUD MN 56303 DAVID TILSTRA 3202525131 2014-05-01 1 TODD A JACKSON P00092672 6123324300 2012 2015-11-30 17:44:51Z DAVID TILSTRA MD 1200 6TH AVENUE NORTH ST CLOUD MN 56303 158149353 0 X WWW.CENTRACARE.COM X 1995 MN WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. 10 4 989 4 0 0 14780171 500557 151571465 153646154 54771 60839 179963 3771631 166586370 157979181 9200 5500 0 0 118820961 123651381 0 0 0 45759744 44165109 164589905 167821990 1996465 -9842809 35897814 43096633 23943305 26429686 11954509 16666947 X CENTRACARE CLINIC WILL BE THE LEADER IN MINNESOTA FOR QUALITY, SAFETY, SERVICE AND VALUE. 0 0 98412864 5500 112982095 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 43974217 44435690 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 2699482 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. 145086563 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 100 0 1 989 1 0 0 0 0 0 0 0 0 0 0 X 10 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X THOMAS FELDHEGE 3202402152 1200 SIXTH AVENUE NORTH ST CLOUD MN 56303 THOMAS W LEITHER MD 40.00 2.00 X X 418284 1500 46751 GENE WINDFELDT 1.00 2.00 X 0 0 0 DENISE ROSIN 1.00 2.00 X 0 0 0 BYRON JOHN MD 1.00 X 0 0 0 DAVID AGERTER MD 1.00 2.00 X 0 0 0 DAVID ROBERTS MD 40.00 X 602253 0 42275 KEITH LEAVELL MD 40.00 2.00 X 432082 0 45922 ROBERT STOCKER MD 40.00 X 453124 0 22045 SHARON WIDSTROM 20.00 X 148842 0 11673 ALLEN E HORN MD 40.00 4.00 X 562764 0 37058 THOMAS M FELDHEGE 40.00 X 211954 0 37059 DAVID TILSTRA MD 40.00 3.00 X 371399 0 45686 MARK MURPHY 40.00 X 387318 0 42894 BERNARD R ERICKSON MD 40.00 X 908669 0 40794 RANDY C SALIARES MD 40.00 X 956382 0 42371 MARK JOHNSON MD 40.00 X 865160 0 41092 JACOB DUTCHER MD 40.00 X 882916 0 41145 WADE SCHMIDT MD 40.00 X 962844 0 42102 8163991 1500 538867 243 0 1 0 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 10 500557 500557 PATIENT & RESIDENT SERVICE REVENU 621110 128865164 128865164 OTHER PROGRAM REVENUE 900099 24780990 24780990 153646154 60839 60839 170172 170172 0 HEALTH INFO TECH INCENTIVE 900099 1976337 1976337 QUALITY INITIATIVES 900099 1795294 1795294 3771631 157979181 157417785 0 60839 5500 5500 3726991 3366699 360292 99266822 90201805 9065017 5024779 4907578 117201 10492206 7932687 2559519 5140583 4725561 415022 197382 11153 186229 32210 32210 3015 3015 8045590 7704470 341120 71049 15225 55824 877003 279546 597457 1417504 3574 1413930 6274739 1269764 5004975 193360 162172 31188 842271 679940 162331 1283143 1283143 DRUGS 14288588 14288588 OTHER SUPPLIES 2616792 2464335 152457 BAD DEBT EXPENSE 2269592 2269592 OTHER EXPENSES 871281 508079 363202 4881590 3004137 1877453 167821990 145086563 22735427 0 5724 5243 11576116 12686291 13115328 15178170 937861 1219653 1256910 1273346 458056 456811 18555185 14671119 3251679 3884066 5296140 8393053 35897814 43096633 19640845 21190271 4302460 5239415 23943305 26429686 X 11954509 16666947 11954509 16666947 35897814 43096633 X -9842809 14555247 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3015 3015 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CENTRACARE CLINIC PAID $3,015 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF, AS A MEMBER OF THE ASSOCIATIONS. 3102671 1372107 1730564 15433285 13299012 2134273 19229 19229 3884066 FUNDS HELD BY TRUSTEE 2210523 DUE FROM RELATED ORGANIZATIONS 6182530 8393053 DEFERRED COMPENSATION PLAN OBLIGATIONS 2110523 DUE TO RELATED ORGANIZATIONS 2898892 LT SETTLEMENT RESERVE 230000 5239415 1 CHAMBER OF COMMERCE PO BOX 487 ST CLOUD MN 56302 123456789 501C3 5500 PROGRAM SUPPORT 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. X X X X X 0 1 0 0 0 0 1 0 0 THOMAS W LEITHER MD 327986 1500 62257 0 28041 0 18750 0 28001 0 465035 1500 0 0 DAVID ROBERTS MD 533331 0 65062 0 3860 0 18750 0 23525 0 644528 0 0 0 KEITH LEAVELL MD 376844 0 53331 0 1907 0 18750 0 27172 0 478004 0 0 0 ROBERT STOCKER MD 399073 0 53416 0 635 0 18750 0 3295 0 475169 0 0 0 SHARON WIDSTROM 114140 0 33470 0 1232 0 10447 0 1226 0 160515 0 0 0 ALLEN E HORN MD 299783 0 145145 0 117836 0 18601 0 18457 0 599822 0 0 0 THOMAS M FELDHEGE 188240 0 22468 0 1246 0 15552 0 21507 0 249013 0 0 0 DAVID TILSTRA MD 275062 0 77615 0 18722 0 20346 0 25340 0 417085 0 15972 0 MARK MURPHY 220774 0 65519 0 101025 0 19241 0 23653 0 430212 0 98250 0 BERNARD R ERICKSON MD 835332 0 68203 0 5134 0 18750 0 22044 0 949463 0 0 0 RANDY C SALIARES MD 537332 0 58951 0 360099 0 18750 0 23621 0 998753 0 0 0 MARK JOHNSON MD 796857 0 66396 0 1907 0 18750 0 22342 0 906252 0 0 0 JACOB DUTCHER MD 812619 0 65917 0 4380 0 18750 0 22395 0 924061 0 0 0 WADE SCHMIDT MD 888634 0 69610 0 4600 0 18750 0 23352 0 1004946 0 0 0 PART I, LINE 4B THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED NON-QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO FORM 990, THE AMOUNTS LISTED IN PART VII AND SCHEDULE J, PART II, COLUMN C, REFLECT TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON FORM 990 - ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF AND WHEN IT IS PAID TO THE EXECUTIVE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED PLAN: 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS FROM AFFILIATES 14,555,247. 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 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH SERVICES-LONG PRAIRIE 20 SOUTHEAST 9TH STREET LONG PRAIRIE MN 56347 411924645 ACUTE & LONG-TERM CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH FOUNDATION 1406 6TH AVE N ST CLOUD MN 56303 411855173 FUNDRAISING MN 501(C)(3) LINE 7 CENTRACARE HEALTH SYSTEM 0 CENTRAL MINNESOTA EMERGENCY PHYSICIANS 1406 6TH AVE N ST CLOUD MN 56303 411708142 EMERGENCY PHYSICIAN PRACTICE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 ST CLOUD HOSPITAL 1406 6TH AVE N ST CLOUD MN 56303 410695596 ACUTE & LONG-TERM CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH-SAUK CENTRE 425 ELM STREET NORTH SAUK CENTRE MN 56378 452438973 ACUTE CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE PHARMACY SERVICES INC 1406 6TH AVE NORTH ST CLOUD MN 56303 411620618 RETAIL PHARMACIES MN CENTRACARE HEALTH SYSTEM C 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0