2014-05-13T16:20:45-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-07-01 450226558 TRINITY HEALTH TRIN 7018575160 PO BOX 5020 MINOT ND 58702 DENNIS C EMPEY 7018575160 2014-05-13 1 KOREY BOELTER P00775161 6123764500 2012 2015-11-30 17:44:51Z JOHN M KUTCH PO BOX 5020 MINOT ND 58702 97002889 0 X WWW.TRINITYHEALTH.ORG X 1929 ND PROVIDE HEALTH EDUCATION & HEALTHCARE SERVICES TO RESIDENTS OF CENTRAL & NORTHWEST NORTH DAKOTA 11 5 3760 342 265083 57669 0 0 83879278 94432927 1265774 1382177 -224607 -293919 84920445 95521185 25000 0 0 0 75318064 82816590 0 0 0 29359991 26831657 104703055 109648247 -19782610 -14127062 313704511 373375142 484477208 557136062 -170772697 -183760920 X TRINITY HEALTH IS COMMITTED TO PRESERVING AND IMPROVING THE QUALITY OF HEALTH OF THE PEOPLE WE SERVE. OUR MISSION IS TO EXCEL AT MEETING THE NEEDS OF THE WHOLE PERSON THROUGH THE PROVISION OF QUALITY HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 78600146 0 76385199 TRINITY HEALTH PROVIDES EDUCATION AND HEALTHCARE SERVICES FOR RESIDENTS OF CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. 9236441 8001369 TRINITY HEALTH RADIOLOGISTS ARE HIGHLY TRAINED AND SKILLED AT ASSESSING AND INTERPRETING X-RAYS, CT, NUCLEAR MEDICINE, ULTRASOUND, MRI SCANS, AND MAMMOGRAPHY IMAGES. 5942926 0 7861399 TRINITY HEALTH PROVIDES OPTOMETRY SERVICES FOR GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS; OPHTHALMOLOGY WHO PROVIDE COMPREHENSIVE EYE AND VISION CARE, INCLUDING SURGERY TO REPAIR AND ENHANCE VISION; OPTOMETRY WHO PROVIDES GENERAL EYECARE AND EYE TESTING FOR OPTICAL AIDS AND OPTICAL SALE OF CONTACT LENS AND EYEGLASSES. 5910219 0 2184960 TRINITY HEALTH HOSPITALISTS PROVIDE AND COORDINATE ALL ASPECTS OF INPATIENT AND OBSERVATION CARE FOR TRINITY HOSPITALS. 5910219 2184960 99689732 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 225 0 3760 1 1 1 0 0 0 0 0 0 0 0 0 0 X 11 5 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X DENNIS EMPEY 7018575160 PO BOX 5020 MINOT ND 58702 PATRICK HOLIEN 2.00 2.00 X X 0 0 0 STEVE LYNSE 2.00 2.00 X X 0 0 0 KAREN KREBSBACH 2.00 2.00 X X 0 0 0 DAVID FULLER 2.00 2.00 X 0 0 0 CLARA SUE PRICE 2.00 2.00 X 0 0 0 MARTIN ROTHBERG MD 20.00 20.00 X 113199 0 12332 KEVIN COLLINS MD 20.00 20.00 X 801483 0 22362 BORGI BEELER 2.00 2.00 X 0 0 0 JOHN COUGHLIN 2.00 2.00 X 0 0 0 DARYL SOMERVILLE 2.00 2.00 X 0 0 0 BLAINE DESLAURIERS 2.00 0.00 X 0 0 0 JOHN KUTCH 12.00 28.00 X X 471119 0 17862 ALISON FRYE 40.00 0.00 X 44921 0 505 MAX OWENS 12.00 28.00 X 0 0 0 RANDY SCHWAN 4.00 36.00 X 176059 0 10830 PAUL SIMONSON 4.00 36.00 X 238621 0 17329 THOMAS WARSOCKI 40.00 0.00 X 158819 0 14816 DAVE KOHLMAN 8.00 32.00 X 180794 0 15271 BARBRA BROWN 1.00 39.00 X 205737 0 10291 JUAN ULLOA MD 25.00 15.00 X 1100691 0 22362 MICHAEL MCMAHON MD 25.00 15.00 X 1132339 0 22362 DAVID BILLINGS MD 25.00 15.00 X 965555 0 22362 RAVINDRA JOSHI MD 25.00 15.00 X 1304481 0 22362 SAMIR TURK MD 25.00 15.00 X 1517454 0 22362 JEFFREY VERHEY MD 25.00 15.00 X 525060 0 22362 8936332 0 255770 238 1 1 0 B E SMITH INTERIM SERVICES 9777 RIDGE DR SUITE 300 LENEXA KS 66219 INTERIM SERVICES 3415573 AUREUS NURSING LLC PO BOX 3037 OMAHA NE 68103 LOCUM NURSING SERVICES 2924826 COMMUNITY AMBULANCE SERVICE OF MINOT PO BOX 2195 MINOT ND 58702 AMBULANCE SERVICES 2854593 DELTA LOCUM TENENS LP PO BOX 678082 DALLAS TX 75267 LOCUM PHYSICIAN SERVICES 2039007 ON ASSIGNMENT HEALTHCARE STAFFING PO BOX 633307 CINCINNATI OH 45263 LOCUM PHYSICIAN SERVICES 1864131 42 NET PATIENT REVENUE 621110 93674333 93674333 OTHER PATIENT REVENUE 621110 535765 535765 OPTICAL SALES 446199 222829 222829 94432927 457560 457560 579067 579067 761127 953954 -192827 -192827 42254 -235081 20942 852358 0 527750 20942 324608 345550 345550 JOINT VENTURE REVENUE 900099 -101092 -101092 -101092 95521185 94210098 265083 1046004 2512350 949376 1562974 74944586 73985125 959461 631496 631496 1873640 1651303 222337 2854518 2680801 173717 8049651 7504922 544729 960676 46645 914031 514223 247424 266799 184952 3422 181530 4497309 1287356 3209953 51341 47007 4334 52031 32204 19827 427604 427604 2036034 922709 1113325 686863 685863 1000 UNRELATED BUSINESS INCO 23247 23247 BAD DEBT EXEPENSE 5927245 5927245 MEDICAL SUPPLIES / DRUG 2350266 2340322 9944 CME 629899 629899 440316 93366 346950 109648247 99689732 9958515 0 1284055 1042276 850449 797160 2138844 8137926 16729 13286 2681901 2652875 541869 683452 56058 13807 59025777 25780085 32091449 33245692 10573565 12029277 250000 171848 889222 830095 262330370 313757448 313704511 373375142 13030895 13699467 83067160 79484970 388379153 463951625 484477208 557136062 X -170772697 -183760920 -170772697 -183760920 313704511 373375142 -14127062 1138839 0 X 0 1 X 1 1 1 X X X 0 0 0 TRINITY HOSPITALS 412002771 3 1 1 1 0 TRINITY KENMARE HOSPITAL 412002769 3 1 1 1 0 TRINITY HOMES 450404412 9 1 1 1 0 3 0 0 0 0 305323 305323 313288 -5031 2934 305323 0.00000 0.00000 0.00000 6770229 6770229 12119956 4417138 7702818 4839973 2112406 2727567 35183975 19250541 15933434 111644 111644 33245692 ASSETS HELD BY TRUSTEE UNDER BOND RESERVE FUND 7815504 ASSETS HELD BY TRUSTEE FOR DEBT SERVICE 5659991 INVESTMENTS PLEDGED BY FOUNDATION 5500000 DUE FROM AFFILIATES 294781953 313757448 ASSET RETIREMENT OBLIGATION 8553400 DUE TO AFFILIATES 455398225 463951625 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: TRINITY HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. ALL UNRELATED BUSINESS INCOME GENERATED BY TRINITY IS SUBJECT TO FEDERAL INCOME TAX UNDER 511 OF THE IRC. TRINITY'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS, AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. TRINITY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 KEVIN COLLINS MD 588810 0 203000 0 9673 0 8350 0 14012 0 823845 0 0 0 JOHN KUTCH 470543 0 0 0 576 0 8350 0 9512 0 488981 0 0 0 RANDY SCHWAN 176059 0 0 0 0 0 6204 0 4626 0 186889 0 0 0 PAUL SIMONSON 236191 0 0 0 2430 0 8195 0 9134 0 255950 0 0 0 THOMAS WARSOCKI 158819 0 0 0 0 0 5803 0 9013 0 173635 0 0 0 DAVE KOHLMAN 180128 0 0 0 666 0 6517 0 8754 0 196065 0 0 0 BARBRA BROWN 205071 0 0 0 666 0 5946 0 4345 0 216028 0 0 0 JUAN ULLOA MD 496314 0 599880 0 4497 0 8350 0 14012 0 1123053 0 0 0 MICHAEL MCMAHON MD 497826 0 630016 0 4497 0 8350 0 14012 0 1154701 0 0 0 DAVID BILLINGS MD 440845 0 520047 0 4663 0 8350 0 14012 0 987917 0 0 0 RAVINDRA JOSHI MD 842746 0 369773 0 91962 0 8350 0 14012 0 1326843 0 0 0 SAMIR TURK MD 1092827 0 420130 0 4497 0 8350 0 14012 0 1539816 0 0 0 JEFFREY VERHEY MD 292813 0 130000 0 102247 0 8350 0 14012 0 547422 0 0 0 PART I, LINE 1A TRINITY HEALTH OWNS THEIR OWN AIRPLANE AND DURING FY 2013 OFFICERS USED THIS PLANE FOR BUSINESS USE TRAVEL. BECAUSE THE USE WAS RESTRICTED FOR BUSINESS THIS DID NOT EFFECT THE OFFICER'S COMPENSATION. A COUNTY OF WARD ND HEALTH CARE FACILITIES REVENUE BONDS SERIES 2006 456002248 934023EMO 2006-11-01 78145000 SEE PART VI 0 0 0 A 8180000 78145000 6699749 71402536 712412 203858 2006 1 0 0 1 A 0 1 1 0 0 0.01810 0.01810 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 SCHEDULE K, PART I, COLUMN F DESCRIPTION OF PURPOSE OF BONDS PROCEEDS OF THE SERIES 2006 BONDS WERE USED (I) TO CURRENTLY REFUND THE COUNTY OF WARD, NORTH DAKOTA, ADJUSTABLE RATE DEMAND HEALTH CARE REVENUE BONDS (TRINITY OBLIGATED GROUP) TAX-EXEMPT SERIES 2002A (THE "SERIES 2002 BONDS"), OUTSTANDING IN THE AMOUNT OF $58,615,000, (II) TO FUND A TERMINATION PAYMENT FOR THE INTEREST RATE SWAP ASSOCIATED WITH THE SERIES 2002 BONDS, (III) TO ADVANCE REFUND THE COUNTY OF WARD, NORTH DAKOTA HEALTH CARE FACILITIES REVENUE REFUNDING BONDS (TRINITY OBLIGATED GROUP) SERIES 1996A (THE "SERIES 1996A BONDS"), OUTSTANDING IN THE AMOUNT OF $9,400,000, (IV) TO FINANCE OR REIMBURSE THE CORPORATION FOR THE COSTS OF CERTAIN RENOVATION, REMODELING, AND EQUIPPING OF ITS HEALTH CARE FACILITIES (THE "PROJECT"), (V) TO FUND A DEPOSIT TO A DEBT SERVICE RESERVE FUND, AND (VI) TO PAY CERTAIN EXPENSES RELATING TO THE ISSUANCE OF THE SERIES 2006 BONDS AND THE REFUNDING OF THE SERIES 2002 BONDS AND THE SERIES 1996A BONDS. KEVIN COLLINS RECRUITMENT & RETENTION X 150000 13286 0 1 1 13286 DARYL SOMERVILLE OWNER OF MINOT TOWN AND COUNTRY INVESTORS, LLC 242570 TRINITY HEALTH PAID RENT TO MINOT TOWN AND COUNTRY INVESTORS, LLC 0 NICOLE KUTCH SPOUSE OF CEO 17133 THERAPIST 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD OF DIRECTORS' CHAIR, VICE CHAIR, PRESIDENT, SECRETARY, TREASURER AND ONE ADDITIONAL MEMBER OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD OF DIRECTORS AT ITS FIRST MEETING AFTER ITS ELECTION. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 TRINITY HEALTH CONTRACTED WITH A MANAGEMENT COMPANY TO PROVIDE FINANCIAL MANAGEMENT SERVICES, INCLUDING A CONTRACTED CFO, DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE FORM 990 IS GIVEN TO THE GOVERNING BODY OF TRINITY HEALTH FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL SALARIED EMPLOYEES (AT MANAGER LEVEL AND ABOVE AS DETERMINED BY TRINITY) AND SUCH OTHER EMPLOYEES AS FROM TIME TO TIME MAY BE DIRECTED TO DO SO, ARE REQUIRED TO COMPLETE TRINITY HEALTH'S CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. ANY EMPLOYEE WHO HAS ASSUMED, OR IS ABOUT TO ASSUME, A FINANCIAL OR OTHER INTEREST OR RELATIONSHIP THAT MIGHT INVOLVE A CONFLICT OF INTEREST MUST IMMEDIATELY INFORM HIS/HER SUPERVISOR, A MEMBER OF THE COMPLIANCE COMMITTEE, OR THE COMPLIANCE OFFICER. ISSUES INVOLVING CONFLICT OF INTEREST SHALL BE REVIEWED AND A DETERMINATION OF EACH SHALL BE MADE BY THE TRINITY COMPLIANCE COMMITTEE. IF A CONFLICT EXISTS, THE CONFLICTED PERSON MUST ABSTAIN FROM DISCUSSION OF AND VOTING ON THE CONFLICTED TOPIC. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE REVIEWED COMPENSATION INFORMATION FOR THE CEO PREPARED BY DELOITTE & TOUCHE. DELOITTE & TOUCHE ANALYZED FOUR COMPENSATION SURVEYS OF HEALTH CARE EMPLOYERS AND REVIEWED FORM 990 FILINGS FOR A PEER GROUP ANALYSIS. THIS PROCESS WAS LAST PERFORMED IN 2013. FORM 990, PART VI, SECTION C, LINE 19 ON OUR WEBSITE, WWW.TRINITYHEALTH.ORG, WE LIST OUR BOARD OF DIRECTORS, MISSION, VISION, VALUES, AND OUR ANNUAL REPORT WHICH INCLUDES FINANCIAL INFORMATION. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. COMMUNITY AMBULANCE SERVICE OF MINOT INC PO BOX 2195 MINOT ND 58702 450363593 AMBULANCE SERVICES ND 501(C)(3) LINE 11A, I TRINITY HEALTH 0 TRINITY HOSPITALS PO BOX 5020 MINOT ND 58702 412002771 MEDICAL SERVICES ND 501(C)(3) LINE 3 TRINITY HEALTH 0 TRINITY KENMARE HOSPITAL PO BOX 5020 MINOT ND 58702 412002769 MEDICAL SERVICES ND 501(C)(3) LINE 3 TRINITY HEALTH 0 TRINITY HOMES PO BOX 5020 MINOT ND 58702 450404412 SKILLED NURSING FACILITY ND 501(C)(3) LINE 9 TRINITY HEALTH 0 TRINITY HEALTH FOUNDATION PO BOX 5020 MINOT ND 58702 450215346 FUNDRAISING ND 501(C)(3) LINE 11B, II TRINITY HEALTH 0 B&B DRUG INC 20 BURDICK EXPRESSWAY WEST MINOT ND 58701 450260565 RETAIL DRUG STORE ND TRINITY HEALTH C 5427642 1598618 1.00000 1 MEDICAL ARTS OUTPATIENT SERVICES INC 400 BURDICK EXPRESSWAY EAST MINOT ND 58701 450278212 RETAIL PHARMACY & DURABLE MEDICAL EQUIPMENT ND N/A C 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 0 0 B&B DRUG A 28000 FMV