2014-09-29T08:25:02-05:00 2013-12-31 450310328 BRADY MARTZ AND ASSOCIATES PC PO BOX 14296 GRAND FORKS ND 582084296 990 2013-01-01 450310462 ALTRU HEALTH SYSTEM ALTR 7017805200 1200 S COLUMBIA RD GRAND FORKS ND 582014036 DWIGHT THOMPSON CFO 7017805200 2014-09-23 1 MARK MILLER P00014209 7017754685 2013 2015-11-30 17:44:51Z ALTRU HOSPITAL DAVID MOLMEN 1200 S COLUMBIA RD GRAND FORKS ND 582014036 560707058 0 X ALTRU.ORG X 1970 ND HEALTHCARE DELIVERY 11 6 4645 377 3176434 407352 2240058 2714445 463961841 467457435 2230007 9018944 416829 385791 468848735 479576615 267360 244179 0 0 273143881 285707820 0 0 0 180398486 185746615 453809727 471698614 15039008 7878001 453496991 455613013 290811356 269648753 162685635 185964260 X IMPROVING HEALTH, ENRICHING LIFE.WHY WE SERVE: TO ACHIEVE OPTIMUM HEALTH FOR ALL RESIDENTS IN OUR REGION.HOW WE SERVE: BY PROVIDING HEALTH EDUCATION, PREVENTIVE SERVICES, EARLY INTERVENTION, AND APPROPRIATE CARE.WHOM WE SERVE: THE MORE THAN 200,000 RESIDENTS OF NORTHEAST NORTH DAKOTA AND NORTHWEST MINNESOTA.WHO WE ARE: A COMMUNITY OF OVER 3,000 HEALTH PROFESSIONALS AND SUPPORT STAFF COMMITTED TO SERVING THE REGION FOR MORE THAN 100 YEARS. 0 0 14464727 20328051 ORTHOPEDICS - ALTRU'S TEAM OF ORTHOPEDIC SURGEONS PROVIDE INPATIENT AND OUTPATIENT SURGICAL SERVICES TO PATIENTS WITH ISSUES RANGING FROM SIMPLE FRACTURES TO COMPLEX TRAUMATIC INJURIES. OUR ORTHOPEDIC SURGEONS ALSO PROVIDE OUTREACH CLINIC SERVICES TO COMMUNITIES THROUGHOUT OUR SERVICE AREA. IN 2013 THERE WERE 1,343 HOSPITAL DISCHARGES. 12807551 16291841 CARDIOLOGY - ALTRU OFFERS COMPREHENSIVE SERVICES INCLUDING INTERVENTIONAL AND MEDICAL CARDIOLOGY. ADDITIONAL SERVICES INCLUDE ECHOCARDIOGRAPHY, CARDIAC STRESS TESTS, AND CARDIAC REHAB. ALTRU HAS BEEN RECOGNIZED THREE TIMES AS A "100 TOP HOSPITALS" FOR CARDIOVASCULAR CARE. OUR CARDIOLOGY TEAM ALSO PROVIDES OUTREACH CLINIC SERVICES TO COMMUNITIES THROUGHOUT OUR SERVICE AREA. IN 2013 THERE WERE 1,234 HOSPITAL DISCHARGES. 10809208 14998322 GENERAL SURGERY - ALTRU'S TEAM OF GENERAL SURGEONS PERFORM INPATIENT AND OUTPATIENT SURGERY AND SEE PATIENTS AT ALTRU HOSPITAL, ALTRU MAIN CLINIC, AND SOME OF ALTRU'S REGIONAL CLINICS. IN 2013 THERE WERE 747 GENERAL SURGERY HOSPITAL DISCHARGES. 389356930 244179 415694194 OTHER PROGRAM SERVICES INCLUDE OTHER PATIENT CARE PROGRAMS. 389356930 244179 415694194 427438416 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 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 96 0 4645 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DWIGHT THOMPSON 7017805203 1200 SOUTH COLUMBIA ROAD GRAND FORKS ND 58201 JOHN SNUSTAD BOARD CHAIR 1.00 X X 0 0 0 KRIS COMPTON VICE CHAIR 1.00 X X 0 0 0 DARRELL LARSON ESQ BOARD MEMBER 1.00 X 0 0 0 CASEY RYAN MD BOARD MEMBER/PRESIDENT/PHY 40.00 X X 494266 0 86118 DAVID MOLMEN BOARD MEMBER/CEO 40.00 X X 486013 0 87418 BRADLEY WEHE BOARD MEMBER/COO 40.00 X X 351830 0 70487 BRADLEY BELLUK MD BOARD MEMBER/PHYSICIAN 40.00 X 475130 0 39918 PHILIP GISI SECRETARY 1.00 X X 0 0 0 LONNIE LAFFEN BOARD MEMBER 1.00 X 0 0 0 ALICE BREKKE BOARD MEMBER 1.00 X 0 0 0 MATTHEW ROLLER MD BOARD MEMBER/PHYSICIAN 40.00 X 402256 0 39918 CHRIS SEMRAU BOARD MEMBER 1.00 X 0 0 0 DWIGHT THOMPSON CFO/TREASURER 40.00 X 360255 0 105035 MARGARET REED RN CHIEF NURSE EXECUTIVE 40.00 X 246080 0 43502 RENEE M AXTMAN RN ADMIN DIR PRIMARY CARE 40.00 X 206444 0 50527 LELAND LINDQUIST ADMINISTRATIVE DIR HUMAN R 40.00 X 232847 0 18763 DENNIS REISNOUR ADM DIR CORP DEVELOPMENT 40.00 X 230931 0 39523 KENNETH VEIN ADM DIR PLANT SERVICES 40.00 X 206718 0 48856 MARK WAIND ADM DIR INFORMATION SERVIC 40.00 X 211162 0 47059 KERRY P CARLSON ADM DIR MEDICAL SPECIALTY 40.00 X 189770 0 46950 KELLY HAGEN RN ADM DIR CARDIOLOGY & MUSCU 40.00 X 178582 0 43069 ERIC LUNN CHIEF MEDICAL EXECUTIVE 40.00 X 275530 0 40924 MARK SIEGEL MEDICAL DIRECTOR OF CARE M 40.00 X 240795 0 42824 WILLIAM MCKINNON MD MEDICAL DIRECTOR 40.00 X 353173 0 42418 KELLEE FISK CHIEF PEOPLE RESOURCE EXECUTIVE 40.00 X 275500 0 32119 JILL WILSON ADMIN DIRECTOR 40.00 X 166284 0 41807 COLLEEN SWANK MD MEDICAL DIRECTOR PRIMARY CARE 40.00 X 273756 0 52418 SCOTT CHARETTE MD MEDICAL DIRECTOR SURGICAL CARE 40.00 X 522797 0 49918 SRINIVAS PULAGAM PHYSICIAN 40.00 X 957310 0 42418 IKECHUKWU ONYEKA PHYSICIAN 40.00 X 1095496 0 42418 ABDEL AHMED PHYSICIAN 40.00 X 1818947 0 42418 CHARLES OWENS PHYSICIAN 40.00 X 845358 0 42419 RANDALL SMITH PHYSICIAN 40.00 X 834412 0 39918 11931642 0 1279162 327 0 1 0 COMPHEALTH MEDICAL STAFFING PO BOX 713100 SALT LAKE CITY UT 841713100 SERVICES 3289057 DELPHI HEALTHCARE PARTNERS INC 170 SOUTHPORT DR MORRISVILLE NC 27560 LOCUM TENENS SERVICES 2082989 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 532880314 SERVICES 1794796 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 SERVICES 1746140 C&R CLEANERS & LAUNDRY 2100 S COLUMBIA RD GRAND FORKS ND 58201 SERVICES 1254100 54 1297384 1012343 404718 2714445 NET SERVICE TO PATIENTS 621110 448826232 446035589 2790643 PROGRAM SERVICE REVENUE 621110 18134326 16223532 1910794 RESEARCH GRANTS 621500 448028 448028 BIOMED SERVICES/SITE SERVICES FEE 900099 48849 48849 467457435 4413685 4413685 85735702 80244634 885809 5491068 -885809 4605259 4605259 RENTAL OFFICE SPACE/PARKING LOT 621300 185940 185940 FITNESS PROGRAM 621990 181875 181875 SNOW REMOVAL 812900 11927 11927 6049 6049 385791 479576615 467312408 3176434 6373328 234279 234279 9900 9900 7485240 2111195 5374045 228951570 211371200 17580370 14964402 13815339 1149063 20468173 18896495 1571678 13838435 12558205 1280230 2113036 2113036 2268116 1684411 583705 8595569 8595569 26257980 26257980 2628538 2628538 UNRELATED BUSINESS TAX 8003 8003 SUPPLIES 68892374 68427324 465050 PURCHASED SERVICES 32180942 22088940 10092002 BAD DEBTS 23893645 23893645 18908412 12744357 6164055 471698614 427438416 44260198 0 11824 10532 15501327 32709466 73924495 67167144 419577 455303 5957659 6157270 390297 342267 469675662 257591305 202798596 212084357 129132928 108227043 25360288 28459631 453496991 455613013 42668379 46898052 328650 170834 211102380 205507544 36711947 17072323 290811356 269648753 X 162685635 185964260 162685635 185964260 453496991 455613013 X 7878001 -3653268 19053892 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7624402 7624402 249563824 112777337 136786487 9577167 4910612 4666555 189489520 139903356 49586164 13420749 13420749 212084357 ASSETS HELD BY TRUSTEE 1259976 UNAMORTIZED BOND ISSUE COSTS 5511025 ASSETS HELD UNDER TRUST AGREEMENTS 14781310 ASSETS HELD UNDER BOND INDENTURE AGREEMENTS 6826694 DUE FROM AFFILIATES 80626 28459631 DUE TO AFFILIATES 43641 POST RETIREMENT HEALTH BENEFIT 6351327 OTHER 8237159 ESTIMATED THIRD PARTY LIABILITY 1314287 SPECIAL ASSESSMENTS PAYABLE 1125909 17072323 X PART X, LINE 2: ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES THE ORGANIZATION'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 ORGANIZATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURNS OF THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY INTERNAL REVENUE SERVICE GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. 1 1 X 1 X 1 X 1 1 1 0 1 1 3566208 0 3566208 0.00760 22016320 0 22016320 0.04670 1376658 0 1376658 0.00290 26959186 26959186 0.05720 865681 834664 0 834664 0.00180 1221 475189 0 475189 0.00100 366 227035 0 227035 0.00050 2270 8707 0 8707 0.00000 869538 1545595 1545595 0.00330 869538 28504781 28504781 0.06050 1 23893645 0 104577110 307658779 -203081669 X 1 1 2 1 ALTRU HOSPITAL 1200 S COLUMBIA RD GRAND FORKS ND 582066002 X X X 2 ALTRU REHABILITATION CENTER 1300 S COLUMBIA RD GRAND FORKS ND 582066002 X ALTRU HOSPITAL 1 1 X X X X X X X X 13 1 1 1 X WWW.ALTRU.ORG X X X X X X X X 0 0 1 1 150.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 X X X X 1 X X X X X X 1 X 0 1 ALTRU REHABILITATION CENTER 2 1 X X X X X X X X 13 1 1 1 X WWW.ALTRU.ORG X X X X X X X X 0 0 1 1 150.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 X X X X 1 X X X X X X 1 X 0 1 ALTRU HOSPITAL PART V, SECTION B, LINE 3: ALTRU HEALTH SYSTEM ENGAGED MORPACE MARKET RESEARCH & CONSULTING TO CONDUCT FOCUS GROUPS WITH COMMUNITY LEADERS TO GET THEIR INSIGHT ABOUT THE HEALTH OF THE COMMUNITY AND HOW IT CAN BE IMPROVED. THE SEVEN DIMENSIONS OF HEALTH DEVELOPED BY THE UNIVERSITY OF NORTH DAKOTA WAS USED AS A BASIS OF THE GROUP'S DISCUSSION. THE PARTICIPANTS WERE ALSO ASKED IF THEY COULD CHANGE ONE THING TO MAKE THE COMMUNITY HEALTHIER, WHAT WOULD THEY DO. ADDITIONALLY, THEY WERE ASKED TO GRADE THE COMMUNITY ON HOW IT IS SUPPORTING EACH OF THE 7 DIMENSIONS.A COMMUNITY-BASED ADVISORY COMMITTEE WAS FORMED TO WORK WITH ALTRU ON THE ASSESSMENT. THE CHIEF PLANNING EXECUTIVE (DENNIS REISNOUR) AND CHIEF EXECUTIVE OFFICER (DAVE MOLMEN) WERE THE EXECUTIVE TEAM REPRESENTATIVES ON THE ADVISORY COMMITTEE, ALONG WITH INDIVIDUALS REPRESENTING THE FOLLOWING AGENCIES/ORGANIZATIONS:GRAND FORKS PUBLIC HEALTHCOMMUNITY VIOLENCE INTERVENTION CENTERUNITED WAYGRAND FORKS PUBLIC SCHOOLSUNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINEUNIVERSITY OF NORTH DAKOTANORTHEAST HUMAN SERVICE CENTERGRAND FORKS POLICE DEPARTMENTGRAND FORKS FIRE DEPARTMENTALTRU FAMILY YMCAGRAND FORKS PARK DISTRICTGRAND FORKS AIR FORCE BSAE 319TH MEDICAL GROUPEAST GRAND FORKS PUBLIC SCHOOLSGRAND FORKS SENIOR CENTER ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 3: ALTRU HEALTH SYSTEM ENGAGED MORPACE MARKET RESEARCH & CONSULTING TO CONDUCT FOCUS GROUPS WITH COMMUNITY LEADERS TO GET THEIR INSIGHT ABOUT THE HEALTH OF THE COMMUNITY AND HOW IT CAN BE IMPROVED. THE SEVEN DIMENSIONS OF HEALTH DEVELOPED BY THE UNIVERSITY OF NORTH DAKOTA WAS USED AS A BASIS OF THE GROUP'S DISCUSSION. THE PARTICIPANTS WERE ALSO ASKED IF THEY COULD CHANGE ONE THING TO MAKE THE COMMUNITY HEALTHIER, WHAT WOULD THEY DO. ADDITIONALLY, THEY WERE ASKED TO GRADE THE COMMUNITY ON HOW IT IS SUPPORTING EACH OF THE 7 DIMENSIONS.A COMMUNITY-BASED ADVISORY COMMITTEE WAS FORMED TO WORK WITH ALTRU ON THE ASSESSMENT. THE CHIEF PLANNING EXECUTIVE (DENNIS REISNOUR) AND CHIEF EXECUTIVE OFFICER (DAVE MOLMEN) WERE THE EXECUTIVE TEAM REPRESENTATIVES ON THE ADVISORY COMMITTEE, ALONG WITH INDIVIDUALS REPRESENTING THE FOLLOWING AGENCIES/ORGANIZATIONS:GRAND FORKS PUBLIC HEALTHCOMMUNITY VIOLENCE INTERVENTION CENTERUNITED WAYGRAND FORKS PUBLIC SCHOOLSUNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINEUNIVERSITY OF NORTH DAKOTANORTHEAST HUMAN SERVICE CENTERGRAND FORKS POLICE DEPARTMENTGRAND FORKS FIRE DEPARTMENTALTRU FAMILY YMCAGRAND FORKS PARK DISTRICTGRAND FORKS AIR FORCE BSAE 319TH MEDICAL GROUPEAST GRAND FORKS PUBLIC SCHOOLSGRAND FORKS SENIOR CENTER ALTRU HOSPITAL PART V, SECTION B, LINE 4: ALTRU REHABILITATION CENTER ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 4: ALTRU HEALTH SYSTEM ALTRU HOSPITAL PART V, SECTION B, LINE 7: ALTRU HEALTH SYSTEM DEVELOPED A LIST OF APPROXIMATELY THIRTY SIGNIFICANT ISSUES/NEEDS WITH THE INPUT OF THE ADVISORY COMMITTEE. FROM THIS LIST, THE HEALTH ISSUES WERE RANKED BY PRIORITY, AND THE TOP 5 AREAS WERE IDENTIFIED FOR AREAS OF IMPROVEMENT. LIMITED FINANCIAL, COMMUNITY, AND PERSONNEL RESOURCES DID NOT ALLOW ALTRU HEALTH SYSTEM TO ADDRESS ALL OF THE IDENTIFIED NEEDS FOR THE 2013 CHNA. ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 7: ALTRU HEALTH SYSTEM DEVELOPED A LIST OF APPROXIMATELY THIRTY SIGNIFICANT ISSUES/NEEDS WITH THE INPUT OF THE ADVISORY COMMITTEE. FROM THIS LIST, THE HEALTH ISSUES WERE RANKED BY PRIORITY, AND THE TOP 5 AREAS WERE IDENTIFIED FOR AREAS OF IMPROVEMENT. LIMITED FINANCIAL, COMMUNITY, AND PERSONNEL RESOURCES DID NOT ALLOW ALTRU HEALTH SYSTEM TO ADDRESS ALL OF THE IDENTIFIED NEEDS FOR THE 2013 CHNA. ALTRU HOSPITAL PART V, SECTION B, LINE 20D: N/A - GROSS CHARGES ARE NOT ADJUSTED FOR UNINSURED PATIENTS IN ER UNLESS THEY APPLY FOR AND QUALIFY FOR CHARITY CARE. ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 20D: N/A - GROSS CHARGES ARE NOT ADJUSTED FOR UNINSURED PATIENTS IN ER UNLESS THEY APPLY FOR AND QUALIFY FOR CHARITY CARE. ALTRU HOSPITAL PART V, SECTION B, LINE 22: ALL PATIENTS ARE CHARGED THE GROSS CHARGE REGARDLESS OF INSURANCE STATUS. ADJUSTMENTS MAY BE APPLIED PROVIDING THE PATIENTS APPLY FOR AND QUALIFY FOR CHARITY CARE. ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 22: ALL PATIENTS ARE CHARGED THE GROSS CHARGE REGARDLESS OF INSURANCE STATUS. ADJUSTMENTS MAY BE APPLIED PROVIDING THE PATIENTS APPLY FOR AND QUALIFY FOR CHARITY CARE. 55 ALTRU MAIN CLINIC 1000 S COLUMBIA RD GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CANCER CENTER 960 S COLUMBIA RD GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC TRUYU AESTHETIC CENTER 3165 DEMERS AVE GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU FAMILY MEDICINE CENTER 1380 S COLUMBIA RD GRAND FORKS ND 582066003 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU FAMILY MEDICINE RESIDENCY 725 HAMLINE STREET GRAND FORKS ND 58203 OUTPATIENT CLINIC ALTRU FAMILY MEDICINE RESIDENCY PHARMACY 725 HAMLINE STREET GRAND FORKS ND 58203 OUTPATIENT PHARMACY ALTRU CLINIC - DRAYTON 1003 N MAIN DRAYTON ND 582254650 OUTPATIENT CLINIC/THERAPY ALTRU PSYCHIATRY CENTER 860 S COLUMBIA RD GRAND FORKS ND 582066002 OUTPATIENT DEPARTMENT - PSYCH SERVICES ALTRU HOSPITAL - CENTER COURT FITNESS 1600 32ND AVE S GRAND FORKS ND 58201 OUTPATIENT THERAPHY ALTRU OUTPATIENT CENTER 411 2ND ST NW EAST GRAND FORKS MN 56721 OUTPATIENT THERAPHY ALTRU CLINIC - CAVALIER 201 E 3RD AVE S CAVALIER ND 582200040 OUTPATIENT CLINIC ALTRU CLINIC - DEVILS LAKE 1001 7TH STREET NE DEVILS LAKE ND 583012719 OUTPATIENT CLINIC ALTRU CLINIC - CROOKSTON 400 SOUTH MINNESOTA CROOKSTON MN 567160606 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - RED LAKE FALLS 312 INTERNATIONAL DRIVE RED LAKE FALLS MN 567504662 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - ERSKINE 23076 347TH ST SE ERSKINE MN 565354201 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - FERTILE MILL STREET MAIN FERTILE MN 565404215 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC ALTRU CLINIC - ROSEAU 711 DELMORE DRIVE ROSEAU MN 567511534 OUTPATIENT CLINIC ALTRU CLINIC - WARROAD 412 MAIN AVE NE WARROAD MN 567632342 OUTPATIENT CLINIC ALTRU CLINIC - GREENBUSH 19120 200TH ST GREENBUSH MN 567269280 OUTPATIENT CLINIC UNITY MEDICAL CENTER 164 WEST 13TH STREET GRAFTON ND 58237 HOME HEALTH/HOSPICE FIRST CARE HEALTH CENTER PO BOX I PARK RIVER ND 58270 HOME HEALTH/HOSPICE/THERAPY NELSON COUNTY HEALTH SYSTEM BOX 367 MCVILLE ND 58254 HOME HEALTH/HOSPICE CO CAVALIER CLINIC 201 E 3RD AVE S CAVALIER ND 58220 HOME HEALTH/HOSPICE ALTRU HOME SVCS-NORTH VALLEY HOME HEALTH 109 S MINNESOTA ST WARREN MN 56762 HOME HEALTH/HOSPICE ANETA PARKVIEW HEALTH CENTER BOX 287 ANETA ND 58212 OUTREACH CLINIC CAVALIER COUNTY MEMORIAL 909 2ND ST LANGDON ND 58249 OUTREACH CLINIC CENTRAL BOILER 20502 160TH ST GREENBUSH MN 56726 OUTREACH CLINIC COOPERSTOWN MEDICAL CENTER 1200 ROBERTS ST COOPERSTOWN ND 58425 OUTREACH CLINIC DEVILS LAKE GOOD SAMARITAN 302 7TH AVE DEVILS LAKE ND 58301 OUTREACH CLINIC FIRST CARE HEALTH CENTER 115 VIVIAN ST PARK RIVER ND 58270 OUTREACH CLINIC FRIENDSHIP 554 W 12TH ST GRAFTON ND 58327 OUTREACH CLINIC 4TH CORP 120 11TH ST NEW ROCKFORD ND 58356 OUTREACH CLINIC GRIGGS COUNTY HOSPITAL 1200 ROBERTS AVE NE COOPERSTOWN ND 58425 OUTREACH CLINIC HATTON PRAIRIE VILLAGE 930 DAKOTA AVE HATTON ND 58240 OUTREACH CLINIC HEARTLAND CARE CENTER 620 14TH AVE NE DEVILS LAKE ND 58301 OUTREACH CLINIC KARLSTAD HEALTH CARE 304 WASHINGTON AVE W KARLSTAD MN 56732 OUTREACH CLINIC KITTSON MEMORIAL HEALTH CARE CENTER 1010 S BIRCH HALLOCK MN 56728 OUTREACH CLINIC KITTSON MEMORIAL CLINIC OF KARLSTAD 1ST AND ROOSEVELT KARLSTAD MN 56732 OUTREACH CLINIC LAKE REGION CORP 224 3TH ST NW DEVILS LAKE ND 583012908 OUTREACH CLINIC LAKOTA GOOD SAMARITAN 608 4TH AVE SW HWY 2 LAKOTA ND 583447500 OUTREACH CLINIC MAPLE MANOR CARE CENTER 1116 9TH AVE LANGDON ND 58249 OUTREACH CLINIC MCINTOSH MANOR NURSING HOME 600 RIVERSIDE AVE NE MCINTOSH MN 56556 OUTREACH CLINIC NELSON COUNTY CARE CENTER 108 E NYHUS AVE MCVILLE ND 58254 OUTREACH CLINIC NELSON COUNTY HEALTH SYSTEM 200 NORTH MAIN MCVILLE ND 58254 OUTREACH CLINIC NORTHWOOD DEACONESS 4 N PART ST NORTHWOOD ND 58267 OUTREACH CLINIC OAKLAND PARK COMMUNITIES INC 123 BAKEN STREET THIEF RIVER FALLS MN 56701 OUTREACH CLINIC PEMBILIER NURSING CENTER 500 DELANO AVE WALHALLA ND 58282 OUTREACH CLINIC PEMBINA COUNTY MEMORIAL HOSPITAL 301 MOUNTAIN STREET E CAVALIER ND 58220 OUTREACH CLINIC PIONEER MEMORIAL CARE CENTER 23028 347TH ST SE ERSKINE MN 565359466 OUTREACH CLINIC REM-GRAFTON 817 HILL AVE GRAFTON ND 58327 OUTREACH CLINIC VALLEY 4000 4004 24TH AVE SOUTH GRAND FORKS ND 58201 OUTREACH CLINIC VALLEY MEMORIAL HOMES 2900 14TH AVE SOUTH GRAND FORKS ND 58201 OUTREACH CLINIC WEDGEWOOD MANOR 804 MAIN STREET WEST CAVALIER ND 58220 OUTREACH CLINIC CENTER FOR PREVENTION & GENETICS 4401 S 11TH ST GRAND FORKS ND 58201 OUTREACH CLINIC ALTRU CLINIC - EAST GRAND FORKS 607 DEMERS AVE EAST GRAND FORKS MN 56721 OUTPATIENT DEPT OF ALTRU HOSP - CLINIC PART I, LINE 6A: PREPARATION OF ANNUAL COMMUNITY BENEFIT REPORT: ALTRU HEALTH SYSTEM PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT BASED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION. ONCE ALL REPORTING FORMS HAVE BEEN COMPILED FOR THE YEAR, THE CATHOLIC HEALTH ORGANIZATION'S REFERENCE GUIDE FROM "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT" IS USED TO DETERMINE WHAT ITEMS SHOULD BE REPORTED INTO WHAT CATEGORY. THE COMMUNITY BENEFIT REPORT IS PUBLISHED AS A PART OF THE CORPORATION'S ANNUAL REPORT, WHICH IS PLACED ON OUR WEB SITE FOR PUBLIC ACCESS. PART I, LINE 7: COLUMN (F) - PERCENT OF TOTAL EXPENSES: IN DETERMINING THE DENOMINATOR FOR THE PERCENT OF TOTAL EXPENSE CALCULATION, THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WAS REDUCED BY BAD DEBTS EXPENSE OF $23,893,645.CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE METHODOLOGY USED TO DETERMINE THE REPORTED AMOUNTS FOR THE CHARITY CARE IS A COST-TO-CHARGE RATIO BASED ON GROSS CHARGES WRITTEN OFF PURSUANT TO OUR CHARITY CARE AND MEANS-TESTED PROGRAMS ELIGIBILITY CRITERIA. OTHER COMMUNITY BENEFIT IS DETERMINED FROM INFORMATION THAT WAS COMPILED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION AND USING THEIR REFERENCE GUIDE, "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT," TO DETERMINE WHICH CATEGORY THE AMOUNTS ARE PROPERLY REPORTED UNDER. PART II, COMMUNITY BUILDING ACTIVITIES: NONE DOCUMENTED ON FORM 990. PART III, LINE 4: FOOTNOTE DISCLOSURE REGARDING BAD DEBTS EXPENSE: NOTES 1 AND 13 TO THE AUDITED FINANCIAL STATEMENTS REPORT ON BAD DEBT EXPENSE. NOTE 1 - ACCOUNTS RECEIVABLE: "PATIENT RECEIVABLES ARE UNCOLLATERALIZED PATIENT AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS ON PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED IN THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM.PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ALTRU HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, ALTRU RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.ALTRU'S PROCESS FOR CALCULATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS HAS NOT SIGNIFICANTLY CHANGED FROM DECEMBER 31, 2012 TO DECEMBER 31, 2013. ALTRU DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYORS. ALTRU HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2012 OR 2013.NOTE 13 - "...NEITHER THE CHARITY CARE NOR THE UNCOMPENSATED CARE AMOUNTS INCLUDE BAD DEBTS AS SHOWN IN THE STATEMENT OF OPERATIONS." PART III, LINE 8: NONE OF THE SHORTFALL SHOWN ON PART III, LINE 7 OF $203,081,669 HAS BEEN TREATED AS COMMUNITY BENEFIT AS REPORTED ON SCHEDULE H. THE SOURCE OF THE AMOUNT SHOWN ON PART III, LINE 6 COMES FROM THE MEDICARE ALLOWABLE COSTS REPORTED IN ALTRU'S MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR ENDING DECEMBER 31, 2013, UTILIZING THE FOLLOWING WORKSHEETS: WORKSHEETS B PART I, H-7 PARTS 1&2, I-4, AND K-6. PART III, LINE 9B: PROVISION FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE FOUND IN ALTRU'S POLICIES 2611 "DEDUCTIONS FROM REVENUES" AND 2614 "CHARITY CARE." ALTRU'S COMMUNITY CARE PROGRAM IS DESIGNED TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO HAVE NO INSURANCE AND/OR LIMITED MEANS TO PAY FOR THEIR MEDICAL SERVICES AND DO NOT QUALIFY FOR OTHER PROGRAMS. IN ADDITION TO QUALITY HEALTHCARE, PATIENTS OF ALTRU HEALTH SYSTEM ARE PROVIDED FINANCIAL COUNSELING REGARDING THEIR MEDICAL BILLS, BY SOMEONE WHO CAN UNDERSTAND AND OFFER POSSIBLE SOLUTIONS FOR THOSE WHO CANNOT PAY IN FULL. PROGRAMS ARE ALSO AVAILABLE FOR UNINSURED PATIENTS, AND FOR THOSE FOUND TO BE IN MEDICAL HARDSHIP. PART VI, LINE 2: NEEDS ASSESSMENT: ALTRU HEALTH SYSTEM'S MISSION - IMPROVING HEALTH, ENRICHING LIFE - CONFIRMS THAT OUR RESPONSIBILITY TO THE REGION GOES BEYOND PROVIDING QUALITY HEALTHCARE SERVICES. ALL OF OUR RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. AT ALTRU, GOOD HEALTH MEANS THAT EVERY INDIVIDUAL SHOULD ENJOY THE BEST ACHIEVABLE AND SO SHOULD OUR COMMUNITIES. ALTRU'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS APPROVED BY THE BOARD OF DIRECTORS ON JULY 22, 2013. AS A RESULT OF THE ASSESSMENT, ALTRU PRIORITIZED AND IS FOCUSING ON THE FOLLOWING FIVE ISSUES: 1) RATE OF OBESITY; 2) ACCESS TO MENTAL HEALTH SERVICES; 3) BINGE DRINKING/EXCESSIVE DRINKING; 4) IMPACT OF POVERTY ON HEALTH; AND 5) FINANCIAL BARRIERS TO HEALTH CARE ACCESS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:ALTRU HAS SEVERAL AVENUES IN WHICH INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS COMMUNICATED TO PATIENTS. UNINSURED AND SELF-PAY PATIENTS IN THE HOSPITAL RECEIVE A VISIT FROM PATIENT REPRESENTATIVES AFTER INTAKE. DURING THIS MEETING, THEY ARE INFORMED OF VARIOUS FEDERAL, STATE AND COMMUNITY-BASED PROGRAMS THAT MAY PROVIDE ASSISTANCE. UNINSURED OR SELF-PAY PATIENTS FROM OUTPATIENTS RECEIVE CONTACT FROM PATIENT REPRESENTATIVES BY PHONE OR EMAIL INFORMING THEM OF POTENTIAL SOURCES OF FINANCIAL ASSISTANCE. BOTH SETS OF PATIENTS ARE ALSO PROVIDED INFORMATION ON HOW TO MOVE FORWARD IN APPLYING FOR THE PROGRAMS. IF PATIENTS ARE FOUND TO BE STRUGGLING WITH MEDICAL EXPENSES, OUR CREDIT AND COLLECTIONS REPRESENTATIVES UTILIZE LETTERS AND PHONE CALLS TO INFORM THEM OF VARIOUS RESOURCES THAT MAY PROVIDE ASSISTANCE.FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE TO THE PUBLIC AS A WHOLE. ALTRU'S WEBSITE, ALTRU.ORG, INCLUDES FINANCIAL ASSISTANCE CONTACT INFORMATION AND ELIGIBILITY GUIDELINES. PATIENTS MAY REVIEW THIS ON THEIR OWN AND CONTACT AGENCIES THAT MAY PROVIDE ASSISTANCE BASED ON THEIR CIRCUMSTANCES. ALSO, ALTRU DISTRIBUTES BROCHURES FEATURING OUR COMMUNITY CARE PROGRAM AND OTHER FEDERAL AND STATE PROGRAMS. THESE BROCHURES ARE AVAILABLE TO BOTH PATIENTS AND VISITORS IN WAITING ROOMS OF OUR INPATIENT AND OUTPATIENT FACILITIES AS WELL AS IN ALL BUSINESS OFFICE LOCATIONS. PART VI, LINE 4: COMMUNITY INFORMATION:ALTRU HEALTH SYSTEM SERVES A 17-COUNTY AREA THAT IS DIVIDED INTO THREE DISTINCT SERVICE AREAS (PRIMARY, SECONDARY, AND REFERRAL) AND HAS A POPULATION OF 221,676 PERSONS (2014 ESTIMATE) WHO RESIDE IN A DIVERSE AREA OF AGRICULTURE AND INDUSTRY. THE SERVICE AREA STRETCHES 265 MILES EAST AND WEST AND 120 MILES NORTH AND SOUTH. GRAND FORKS SITS IN THE MIDDLE OF THE RED RIVER VALLEY, ONE OF THE WORLD'S RICHEST AGRICULTURAL AREAS. PRINCIPAL CROPS INCLUDE SUGAR BEETS, POTATOES, EDIBLE BEANS, AND SMALL GRAINS SUCH AS WHEAT AND BARLEY. MUCH OF THE INDUSTRY IN THE AREA IS RELATED TO AGRICULTURE AND FOOD PROCESSING.THE PRIMARY SERVICE AREA, COMPRISED OF GRAND FORKS COUNTY (NORTH DAKOTA) AND EAST GRAND FORKS (MINNESOTA), IS HOME TO 78,132 PEOPLE (2014 ESTIMATE). LOCATED IN THIS MARKET IS ALTRU HOSPITAL, ALTRU REHABILITATION CENTER, ALTRU CANCER CENTER, AND 13 OTHER LOCATIONS THAT ARE HOME TO OUR PROVIDERS' CLINIC PRACTICES AND OTHER SERVICES OFFERED BY ALTRU. ALTRU HOSPITAL SERVES AS THE MAJOR REFERRAL CENTER FOR THE PEOPLE OF THE REGION. AS SUCH, IT PROVIDES A BROAD SPECTRUM OF PROGRAMS AND SERVICES. A FULL RANGE OF SERVICES ARE AVAILABLE FOR PATIENTS SUFFERING FROM CANCER, HEART DISEASE, END-STAGE RENAL DISEASE, NEUROLOGICAL DISORDERS, ALCOHOL OR CHEMICAL DEPENDENCY, HIGH RISK OBSTETRICAL COMPLICATIONS, AND PSYCHIATRIC DISORDERS. ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN 2013 FOR OUR PRIMARY MARKET WAS 81 PERCENT BASED ON CLAIMS DATA FROM BLUE CROSS BLUE SHIELD OF NORTH DAKOTA. ABOUT 83 PERCENT OF THE PHYSICIANS IN THE PRIMARY AREA ARE EMPLOYED BY ALTRU HEALTH SYSTEM. ALSO LOCATED IN GRAND FORKS COUNTY IS NORTHWOOD COMMUNITY HEALTH CENTER (IN NORTHWOOD, ND). A COUPLE NOTABLE POPULATIONS ALTRU SERVES THAT ARE LOCATED IN OUR PRIMARY SERVICE AREA INCLUDE THE UNIVERSITY OF NORTH DAKOTA AND GRAND FORKS AIR FORCE BASE. THE UNIVERSITY OF NORTH DAKOTA IS THE STATE'S OLDEST INSTITUTION OF HIGHER LEARNING WITH AN ENROLLMENT OF ABOUT 15,250 STUDENTS (FALL 2013). THE NUMBER OF RESIDENTS AT GRAND FORKS AIR FORCE BASE WAS COUNTED AT 2,367 IN THE 2010 CENSUS.WITH A POPULATION OF 57,512 (2014 ESTIMATE), THE SECONDARY SERVICE AREA IS COMPRISED OF SIX COUNTIES TO THE WEST, NORTH, AND EAST OF GRAND FORKS COUNTY: NELSON, WALSH, AND PEMBINA COUNTIES IN NORTH DAKOTA, AND POLK, MARSHALL, AND KITTSON COUNTIES IN MINNESOTA; THIS AREA IS LARGELY RURAL AND AGRICULTURAL. WITHIN THIS AREA, ALTRU HAS FIVE REGIONAL CLINIC LOCATIONS; IT IS ALSO HOME TO SEVERAL SMALL HOSPITALS AS LISTED BELOW.SECONDARY SERVICE AREA HOSPITALS: LOCATIONUNITY MEDICAL CENTER: GRAFTON, NDFIRST CARE HEALTH CENTER: PARK RIVER, NDPEMBINA COUNTY MEMORIAL HOSPITAL: CAVALIER, NDNELSON COUNTY HEALTH SYSTEM: MCVILLE, NDKITTSON MEMORIAL HOSPITAL: HALLOCK, MNNORTH VALLEY HEALTH CENTER: WARREN, MNRIVERVIEW HOSPITAL: CROOKSTON, MNESSENTIA HEALTH: FOSSTON, MNIN 2013, ALTRU'S HOSPITAL INPATIENT MARKET SHARE IN THIS SERVICE AREA WAS AROUND 54 PERCENT ACCORDING TO CLAIMS PAID BY BLUE CROSS BLUE SHIELD OF NORTH DAKOTA. THE SYSTEM EMPLOYS MANY OF THE PHYSICIANS IN THE SECONDARY SERVICE AREA. ALL OF THESE PHYSICIANS ARE ON MEDICAL STAFFS OF COMMUNITY HOSPITALS THROUGHOUT THE REGION, AND REFER PATIENTS TO GRAND FORKS AND ELSEWHERE FOR SPECIALTY CARE.THE SYSTEM'S REFERRAL AREA IS COMPRISED OF TEN COUNTIES ENCIRCLING THE PRIMARY AND SECONDARY SERVICE AREAS (ROLETTE, TOWNER, BENSON, RAMSEY, CAVALIER, AND TRAILL COUNTIES IN NORTH DAKOTA AND ROSEAU, LAKE OF THE WOODS, PENNINGTON, AND RED LAKE COUNTIES IN MINNESOTA.) THIS REGION IS ALSO MOSTLY RURAL AND AGRICULTURAL AND INCLUDES SEVERAL SMALLER HOSPITALS AS LISTED SERVING THE PRIMARY CARE NEEDS OF THEIR COMMUNITIES. ALTRU HAS FIVE REGIONAL CLINICS IN THIS SERVICE AREA AND ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN THIS REGION IS ABOUT 24 PERCENT ACCORDING TO 2013 CLAIMS PAID BY BLUE CROSS BLUE SHIELD OF NORTH DAKOTA. ALTRU, ONCE AGAIN, EMPLOYS MANY OF THE PHYSICIANS IN THIS AREA, AND THESE PHYSICIANS HAVE PRACTICE PATTERNS SIMILAR TO THOSE OF THE PHYSICIANS IN OUR SECONDARY SERVICE AREA.REFERRAL SERVICE AREA HOSPITALS: LOCATIONCAVALIER COUNTY MEMORIAL HOSPITAL: LANGDON, NDHILLSBORO MEDICAL CENTER: HILLSBORO, NDLAKEWOOD HEALTH CENTER: BAUDETTE, MNMERCY HOSPITAL: DEVILS LAKE, NDSANFORD-THIEF RIVER FALLS MEDICAL CENTER: THIEF RIVER FALLS, MNPRESENTATION MEDICAL CENTER: ROLLA, NDTOWNER COUNTY MEDICAL CENTER: CANDO, NDSANFORD MAYVILLE MEDICAL CENTER: MAYVILLE, NDLIFECARE MEDICAL CENTER: ROSEAU, MNQUENTIN N. BURDICK MEMORIAL HOSPITAL: BELCOURT, NDAS PREVIOUSLY MENTIONED, ALTRU'S 17-COUNTY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 221,675 (2014 ESTIMATE). USING DATA FROM TRUVEN HEALTH (A VENDOR SPECIALIZING IN HEALTH CARE PLANNING INFORMATION), THE INSURANCE COVERAGE FOR COMMUNITIES IN OUR SERVICE AREA IS ESTIMATED TO BE AS FOLLOWS: 2014 PROJECTIONS AS A PERCENTMEDICAID 35,528 16%MEDICARE 32,298 15%DUAL ELIGIBLE 3,889 2%PRIVATE EMPLOYER SPONSORED 113,529 51%PRIVATE DIRECT 15,628 7%PRIVATE EXCHANGE 4,244 2%UNINSURED 16,559 7%A PERCENTAGE BREAKDOWN OF INPATIENT UTILIZATION FOR ALTRU HOSPITAL BASED ON DISCHARGES BY TYPE OF PAYER PER 2014 PROJECTION SHOWS APPROXIMATELY 16 PERCENT OF DISCHARGES WERE FOR MEDICAID AND 7 PERCENT WERE SELF PAY (UNINSURED). ALSO FROM TRUVEN HEALTH, OUR TOTAL SERVICE AREA'S INCOME BY HOUSEHOLD IS AS FOLLOWS:INCOME RANGE 2014 HOUSEHOLDS$ < $ 9,999 7,247 $ 10,000 - $ 14,999 5,417$ 15,000 - $ 19,999 5,234$ 20,000 - $ 24,999 5,099$ 25,000 - $ 29,999 4,919$ 30,000 - $ 39,999 5,200$ 35,000 - $ 39,999 5,006$ 40,000 - $ 44,999 4,573$ 45,000 - $ 49,999 4,485$ 50,000 - $ 59,999 7,312$ 60,000 - $ 74,999 10,374$ 75,000 - $ 99,999 12,119$100,000 - $124,999 6,799$125,000 - $149,999 3,509$150,000 - $199,999 2,434$ > $200,000 2,469ACCORDING TO THE WEBSITE FOR HEALTH RESOURCES AND SERVICES ADMINISTRATION, THE FOLLOWING AREAS IN OUR SERVICE AREA ARE MUA'S:NORTH DAKOTA:BENSON COUNTY: BENSON SERVICE AREACAVALIER COUNTY: CAVALIER SERVICE AREAGRAND FORKS COUNTY: NORTHWOOD SERVICE AREA, GRAND FORKS SERVICE AREANELSON COUNTY: NELSON SERVICE AREAPEMBINA COUNTY: WALHALLA SERVICE AREAROLETTE COUNTY: ROLETTE SERVICE AREATOWNER COUNTY: CANDO CITY SERVICE AREATRAILL COUNTY: TRAILL SERVICE AREAWALSH COUNTY: PARK RIVER CITY SERVICE AREAMINNESOTA:KITTSON COUNTY: KITTSON SERVICE AREAMARSHALL COUNTY: MARSHALL SERVICE AREAPOLK COUNTY: POLK SERVICE AREARED LAKE COUNTY: RED LAKE SERVICE AREAROSEAU COUNTY: ROSEAU SERVICE AREA PART VI, LINE 5: ALL OF ALTRU'S RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. TO DO SO, WE KNOW THAT NOT ALL MEDICAL SERVICES WILL COME FROM STAFF EMPLOYED BY ALTRU HEALTH SYSTEM. ALTRU EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR NEARLY ALL DEPARTMENTS. ALSO, OUR BOARD OF DIRECTORS IS MADE UP OF INDIVIDUALS FROM OUTSIDE ALTRU HEALTH SYSTEM. THESE PEOPLE ARE VOLUNTEERS WHO HAVE THE SAME DEDICATION AND FOCUS ON ALTRU'S MISSION AS OUR OWN STAFF. PART VI, LINE 6: ALTRU HEALTH SYSTEM IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. IN SEPTEMBER 2011, ALTRU HEALTH SYSTEM BECAME THE FIRST MEMBER OF THE MAYO CLINIC CARE NETWORK. THIS IS A NON-OWNERSHIP RELATIONSHIP THAT BENFITS THE ORGANIZATION'S PHYSICIANS AND PATIENTS FROM ENHANCED ACCESS TO MAYO PHYSICIANS AND CLINICAL RESOURCES. MORE SPECIFICALLY, PHYSICIANS HAVE ACCESS TO MAYO CLINIC'S EVIDENCE-BASED DISEASE MANAGEMENT PROTOCOLS, CLINIC CARE GUIDELINES, AND TREATMENT RECOMMENDATIONS AND REFERENCE MATERIALS FOR COMPLEX MEDICAL CONDITIONS.PART VI, LINE 7: ALTRU HEALTH SYSTEM IS NOT REQUIRED TO FILE OUR COMMUNITY BENEFIT REPORT WITH ANY OUTSIDE ORGANIZATIONS BUT HAS MADE OUR REPORT AVAILABLE TO ANYONE ON OUR WEB SITE. 1 COMMUNITY VIOLENCE INTERVENTION CENTER 211 S 4TH ST STE 207 GRAND FORKS ND 58201 450359167 501(C)(3) 25000 PLEDGE FOR DREAM MAKER SOCIETY NORTHLAND COMMUNITY & TECHNICAL COLLEGE FOUNDATION 1101 HWY 1 EAST THIEF RIVER FALLS MN 56701 411287038 501(C)(3) 25000 RADIOLOGIC EQUIPMENT UNIVERSITY OF MINNESOTA FOUNDATION 200 OAK ST SE STE 500 MINNEAPOLIS MN 55455 416042488 501(C)(3) 10000 STUDENT SCHOLARSHIP FUND RE ARENA INC ONE RALPH ENGLESTAD DR GRAND FORKS ND 58203 113666663 501(C)(3) 80000 GAME DAY SPONSORSHIPS UNITED WAY GRAND FORKSEAST GRAND FORKS 1407 24TH AVE S STE 400 GRAND FORKS ND 58201 450255772 501(C)(3) 6000 CORPORATE GIFT UND FOUNDATION 3100 UNIVERSITY AVE STOP 8157 GRAND FORKS ND 58202 450348296 501(C)(3) 6050 STUDENT SCHOLARSHIP FUND GREATER GRAND FORKS YOUNG PROFESSIONALS 202 NORTH 3RD ST GRAND FORKS ND 58203 320134204 501(C)(6) 11000 2013 CORPORATE SPONSORSHIP GRAND FORKS MARATHON INC PO BOX 14867 GRAND FORKS ND 58203 273739718 501(C)(3) 10000 PRESENTING SPONSOR UND GRANTS AND CONTRACTS ADMIN 264 CENTENNIAL DRIVE TWAMLEY HALL ROOM 100 MAIL STOP 7306 GRAND FORKS ND 58202 456002491 501(C)(3) 10000 SIM - ND HEALTH SYSTEMS FIX SPONSORSHIP 8 1 SCHOLARSHIPS 12 9900 PART I, LINE 2: NORTHLAND COMMUNITY & TECHNICAL COLLEGE FOUNDATION - FUNDS WERE GRANTED FOR THE PURPOSE OF PURCHASING RADIOLOGICAL EQUIPMENT. UNIVERSITY OF MINNESOTA FOUNDATION - SCHOLARSHIPS ARE DIRECTED BY THE UNIVERSITY OF MINNESOTA FOUNDATION AS PART OF THE SCHOLARSHIP PROGRAM AND ALTRU DOES NOT DIRECTLY DESIGNATE SCHOLARSHIP RECIPIENTS. COMMUNITY VIOLENCE INTERVENTION CENTER - FUNDS WERE GRANTED WITH THE DIRECTION THAT CVIC WAS ABLE TO USE FUNDS AS NEEDED. CVIC DETERMINES THE RECIPIENTS OF THE ASSISTANCE PROVIDED THROUGH THOSE FUNDS. RE ARENA, INC. - ALTRU REVIEWS THE SPONSORSHIPS WITH RE ARENA/UNIVERSITY OF NORTH DAKOTA OFFICIALS PRIOR TO THE EVENTS AND HAS REPRESENTATIVES ATTEND THE EVENTS TO ACKNOWLEDGE THE PROPRIETY OF THE ANNOUNCEMENTS MADE REGARDING THE SPONSORSHIP OF THE DAY'S EVENT. UNITED WAY GRAND FORKS/EAST GRAND FORKS - FUNDS WERE GRANTED TO THE ANNUAL CAMPAIGN AND UNITED WAY USES THE FUNDS AS NEEDED. UND FOUNDATION - SCHOLARSHIPS ARE DIRECTED BY UND AS PART OF THE SCHOLARSHIP PROGRAM AND ALTRU DOES NOT DIRECTLY DESIGNATE SCHOLARSHIP RECIPIENTS. GREATER GRAND FORKS YOUNG PROFESSIONALS - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. GRAND FORKS MARATHON - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. A REPRESENTATIVE ATTENDED THE EVENT TO ACKNOWLEDGE THE PROPRIETY OF THE ANNOUNCEMENTS MADE REGARDING THE SPONSORSHIP OF THE DAY'S EVENT. UND GRANTS & CONTRACTS - FUNDS GRANTED WITH THE DIRECTION THAT THEY WERE ABLE TO USE THE FUNDS AS NEEDED. X X X X X X 0 0 0 0 0 0 0 0 0 CASEY RYAN MD BOARD MEMBER/PRESIDENT/PHY 450251 0 0 0 44015 0 69288 0 16830 0 580384 0 0 0 DAVID MOLMEN BOARD MEMBER/CEO 445057 0 0 0 40956 0 69288 0 18130 0 573431 0 0 0 BRADLEY WEHE BOARD MEMBER/COO 328148 0 0 0 23682 0 52357 0 18130 0 422317 0 0 0 BRADLEY BELLUK MD BOARD MEMBER/PHYSICIAN 455620 0 0 0 19510 0 24288 0 15630 0 515048 0 0 0 MATTHEW ROLLER MD BOARD MEMBER/PHYSICIAN 366872 0 0 0 35384 0 24288 0 15630 0 442174 0 0 0 DWIGHT THOMPSON CFO/TREASURER 318364 0 0 0 41891 0 54285 0 50750 0 465290 0 0 0 MARGARET REED RN CHIEF NURSE EXECUTIVE 229126 0 0 0 16954 0 42369 0 1133 0 289582 0 0 0 RENEE M AXTMAN RN ADMIN DIR PRIMARY CARE 196954 0 0 0 9490 0 32397 0 18130 0 256971 0 0 0 LELAND LINDQUIST ADMINISTRATIVE DIR HUMAN R 209574 0 0 0 23273 0 15773 0 2990 0 251610 0 0 0 DENNIS REISNOUR ADM DIR CORP DEVELOPMENT 214869 0 0 0 16062 0 35890 0 3633 0 270454 0 0 0 KENNETH VEIN ADM DIR PLANT SERVICES 185495 0 0 0 21223 0 30756 0 18100 0 255574 0 0 0 MARK WAIND ADM DIR INFORMATION SERVIC 203054 0 0 0 8108 0 35101 0 11958 0 258221 0 0 0 KERRY P CARLSON ADM DIR MEDICAL SPECIALTY 178228 0 0 0 11542 0 28820 0 18130 0 236720 0 0 0 KELLY HAGEN RN ADM DIR CARDIOLOGY & MUSCU 178004 0 0 0 578 0 24938 0 18131 0 221651 0 0 0 ERIC LUNN CHIEF MEDICAL EXECUTIVE 251477 0 0 0 24053 0 34288 0 6636 0 316454 0 0 0 MARK SIEGEL MEDICAL DIRECTOR OF CARE M 215128 0 0 0 25667 0 34288 0 8536 0 283619 0 0 0 WILLIAM MCKINNON MD MEDICAL DIRECTOR 326973 0 0 0 26200 0 24288 0 18130 0 395591 0 0 0 KELLEE FISK CHIEF PEOPLE RESOURCE EXECUTIVE 275234 0 0 0 266 0 22313 0 9806 0 307619 0 0 0 JILL WILSON ADMIN DIRECTOR 156894 0 0 0 9390 0 26177 0 15630 0 208091 0 0 0 COLLEEN SWANK MD MEDICAL DIRECTOR PRIMARY CARE 255986 0 0 0 17770 0 34288 0 18130 0 326174 0 0 0 SCOTT CHARETTE MD MEDICAL DIRECTOR SURGICAL CARE 504487 0 0 0 18310 0 34288 0 15630 0 572715 0 0 0 SRINIVAS PULAGAM PHYSICIAN 921824 0 0 0 35486 0 24288 0 18130 0 999728 0 0 0 IKECHUKWU ONYEKA PHYSICIAN 1059686 0 0 0 35810 0 24288 0 18130 0 1137914 0 0 0 ABDEL AHMED PHYSICIAN 1776125 0 0 0 42822 0 24288 0 18130 0 1861365 0 0 0 CHARLES OWENS PHYSICIAN 802536 0 0 0 42822 0 24288 0 18131 0 887777 0 0 0 RANDALL SMITH PHYSICIAN 792670 0 0 0 41742 0 24288 0 15630 0 874330 0 0 0 A CITY OF GRAND FORKS 456002085 38546WAW0 2005-12-01 40000000 CAPITAL EXPENDITURES, FUND DEBT SERVICE FUND 0 0 0 B CITY OF GRAND FORKS 456002085 38546WAZ3 2007-08-15 30755173 REFUND BONDS ISSUED JUNE 17, 1997 AND MARCH 23, 2000 0 0 0 C CITY OF GRAND FORKS 456002085 2011-08-02 23620000 REFUND BONDS ISSUED MAY 19, 1994 AND JUNE 17, 1997 0 0 0 D CITY OF GRAND FORKS 456002085 38546WCC2 2012-05-01 112375000 REFUND BONDS ISSUED 1992, 1997, AND 2010A/2010B; INFRASTRUCTURE, EQUIPMENT 0 0 0 A 6550000 40000000 3530586 425000 1506870 34537534 2007 0 0 1 1 B 3575173 30755173 3075517 27283893 395763 2007 1 0 1 1 C 4930000 23620000 23487901 103099 2011 1 0 1 1 D 170000 112375000 49370134 2487053 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 DARRELL LARSON ESQ BOARD MEMBER 141721 PROFESSIONAL SERVICES PROVIDED TO THE ORGANIZATION THROUGH A BUSINESS RELATIONSHIP - LEGAL FILE #1183 0 DARRELL LARSON ESQ BOARD MEMBER 26215 PROFESSIONAL SERVICES PROVIDED TO THE ORGANIZATION THROUGH A BUSINESS RELATIONSHIP - LEGAL FILE #1187 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY IS REVIEWED AND SIGNED OFF ANNUALLY BY ALL MEMBERS OF THE BOARD OF DIRECTORS. THESE FORMS ARE COLLECTED AND REVIEWED BY THE SECRETARY. FORM 990, PART VI, SECTION B, LINE 15 DETERMINATION OF THE COMPENSATION FOR THE PRESIDENT AND CEO ARE DETERMINED BY THE BOARD. SUBSTANTIATION OF THESE DISCUSSIONS APPEAR IN THE BOARD MINUTES. COMPENSATION OF KEY EMPLOYEES ARE DETERMINED BY A COMPENSATION COMMITTEE FORMED OF PHYSICIANS THAT REPORT TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATIONS 990 AND 990-T PUBLIC INSPECTION COPIES ARE AVAILABLE UPON REQUEST. FORM 1023 IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH PUBLISHED ANNUAL REPORTS AND VIA ITS WEB SITE. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: APPLICATION OF FASB ASC TOPIC 715 19,053,892. HEADING ITEM C ALTRU CLINIC-MAIN, ALTRU REHAB CENTER, ALTRU CANCER CENTER, ALTRU FAMILY MEDICINE CENTER, ALTRU FAMILY MEDICINE RESIDENCY, TRUYU AESTHETIC CENTER, ALTRU CLINIC-LAKE REGION, ALTRU CLINIC-CAVALIER, ALTRU CLINIC-DRAYTON, ALTRU CLINIC-CROOKSTON, ALTRU CLINIC-RED LAKE FALLS, ALTRU CLINIC-FERTILE, ALTRU CLINIC-ERSKINE, ALTRU CLINIC-ROSEAU, ALTRU CLINIC-WARROAD, ALTRU CLINIC-GREENBUSH, ALTRU CLINIC-KARLSTAD FORM 990, PART VIII, LINE 2B & 2D EXCLUSION AMOUNT BIOMED SERVICES $42,500 SITE SERVICE FEES $6,349 SUBTOTAL $48,849 CAFETERIA RECEIPTS $1,219,745 PHARMACY SALES TO EMPLOYEES $14,088 HOUSING/SPACE RENTALS $565,077 VENDING MACHINE INCOME $75,486 SALE OF SCRAP/OTHER $5,498 GAIN ON DISPOSAL $30,900 SUBTOTAL $1,910,794 TOTAL EXCLUSION AMOUNT $1,959,643 RELATED OR EXEMPT FUNCTION INCOME CEPT REVENUE $135,360 HEARING CENTER $773,559 OCCUPATIONAL HEALTH $484,655 VHA SUPPLY CO - DISTRIBUTION $728,559 PURCHASE DISCOUNTS $39,971 REBATES $44,464 CONTRACT SERVICES, OUTREACH, EDUCATION $3,103,076 CPE FUND $6,350 MEDICAL RECORDS TRANSCRIPT FEES $160,744 AFFILIATED OTHER REVENUE $389,950 MISCELLANEOUS REVENUE $10,336,578 TOTAL RELATED/EXEMPT INCOME $16,203,266 FORM 990, PART VIII, LINE 2B & 2D 1. CAFETERIA RECEIPTS: REVENUE INCURRED THROUGH THE PROVISION OF MEALS FOR EMPLOYEES WHO HAVE TO BE IN THE BUILDING DURING THEIR REGULAR WORKDAY. PURPOSE: PROVIDE THESE EMPLOYEES WITH A PLACE TO ACQUIRE AND CONSUME THEIR MEALS; NO ALTERNATIVES ARE AVAILABLE. 2. BIOMED SERVICES: REVENUE EARNED THROUGH THE PROVISION OF SERVICES TO AREA HEALTH CARE FACILITIES NEEDING TO KEEP THEIR EQUIPMENT IN OPERATION IN ORDER TO PROVIDE THEIR PATIENTS WITH THEIR SERVICE. THE BIOMED PROGRAM PROVIDES SMALL REGIONAL HOSPITALS WITH A SERVICE OTHERWISE UNOBTAINABLE FROM ANYONE IN THE LOCAL AREA; IT IS OFTEN ON A PRIORITY BASIS. 3. PHARMACY SALES TO EMPLOYEES: REVENUE INCURRED IN SALES STRICTLY FOR THE CONVENIENCE OF EMPLOYEES. 4. HOUSING/SPACE RENTALS: INCOME INCURRED THROUGH THE RENTAL OF SPACE TO THE AREA HEALTH EDUCATION CENTER WHICH IS REQUIRED TO BE ON-SITE TO WORK WITH OUR PHYSICIANS PROVIDING HEALTH CARE TO PATIENTS. 5. CEPT REVENUE: REVENUE EARNED FROM THE EVALUATION AND TREATMENT OF ADOLESCENTS THROUGH A MULTI-DISCIPLINARY APPROACH INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, AND PSYCHOLOGY. 6. HEARING CENTER: REVENUE FROM THE PROVISION OF AUDIOLOGICAL SERVICES AND HEARING AIDS TO PATIENTS. 7. OCCUPATIONAL HEALTH: FEES FOR PROVIDING DRUG SCREENINGS FOR REGIONAL EMPLOYERS. 8. VHA SUPPLY DISTRIBUTION: REBATE RECEIVED BASED ON VOLUME OF SUPPLY PURCHASES. 9. PURCHASE DISCOUNTS: THIS FIGURE REPRESENTS COST SAVINGS ON PURCHASES FROM SUPPLIERS FOR GOODS USED IN THE PROVISION OF HEALTH CARE SERVICES. 10. REBATES: REBATES RECEIVED BASED ON VOLUME OF PHARMACY PURCHASES. 11. SITE SERVICE FEES: FEES CHARGED FOR PROVIDING GROUNDS AND MAINTENANCE FOR THE AREA SURROUNDING THE UNITED HOSPITAL, INCLUDING FEES FOR SUCH SERVICES AS MAINTENANCE OF HOSPITAL PARKING LOT, SNOW SHOVELING, AND SNOW REMOVAL. 12. VENDING MACHINE INCOME: INCOME EARNED THROUGH THE OPERATION OF VENDING MACHINES IN THE BUILDINGS. 13. CONTRACT SERVICES, OUTREACH, EDUCATION: REVENUES EARNED IN THE PROVISION OF COMMUNITY EDUCATION/WELLNESS PROGRAMS, PASTORAL COUNSELING SERVICES, AND CONTRACTED SERVICES WITH REGIONAL HEALTHCARE SYSTEMS TO BRING OUTREACH SERVICES INTO THEIR COMMUNITIES. 14. CPE FUND: CLINICAL PASTORAL EDUCATION INCOME FROM PASTORAL RESIDENTS. PROGRAM SPONSORED BY THE ASSOCIATION OF CLINICAL PASTORAL EDUCATION. 15. MEDICAL RECORD TRANSCRIPTION FEES: INCOME EARNED THROUGH THE CHARGING OF VARIOUS THIRD PARTY PAYERS FOR THE PHOTOCOPYING OF PATIENT RECORDS. INSURANCE COMPANIES AND PAYERS ARE CHARGED TO OFFSET THE COST OF COPYING. 16. SALE OF SCRAP: INCOME EARNED THROUGH THE SALE OF ITEMS THAT ARE NOT FIXED ASSETS AND ARE OF DIMINISHED USE TO THE ORGANIZATION. 17.OTHER REVENUE CHARGED TO AFFILIATED CORPORATIONS: REVENUE FROM THE PROVISION OF PATIENT SERVICES, SUCH AS PSYCH OR LABORATORY, TO THE PATIENTS OF OTHER CORPORATIONS, WHICH ARE AFFILIATED TO ALTRU HEALTH SYSTEM. 18. MISCELLANEOUS INCOME: INCLUDES PRINCIPALLY MONIES FROM MEDICARE & MEDICAID FOR UPGRADING EPIC AND MANDATED ELECTRONIC HEALTH RECORDS SOFTWARE SYSTEMS. INCLUDES A RETURN OF EXPENSES FROM AN INSURANCE POOL. ALSO INCLUDES INCOME EARNED THROUGH THE PROVISION OF SERVICES THAT ARE OPERATING IN THE HOSPITAL IN NATURE, BUT HAVE NO SPECIFIC COST CENTER IDENTIFICATIONS. AN EXAMPLE OF THIS WOULD BE IF THE DIRECTOR OF THE COMMUNICATIONS DEPARTMENT RECEIVED A SMALL TOKEN AMOUNT FOR FILLING OUT A SURVEY FROM SOME HEALTH CARE ORGANIZATION. ALTRU HEALTH FOUNDATION 2501 DEMERS AVE GRAND FORKS ND 58201 450368330 FUNDRAISING ND 501(C)(3) LINE 11A, I N/A 0 ALTRU HEALTH RESOURCES 1200 S COLUMBIA RD GRAND FORKS ND 58201 450368332 CONGREGATE HOUSING, ASSISTED LIVING ND 501(C)(3) LINE 11A, I N/A 0 DAK-MINN BLOOD BANK 1200 S COLUMBIA RD GRAND FORKS ND 58201 363453164 BLOOD BANK ND 501(C)(3) LINE 11D, III-O N/A 0 ALTRU ALLIANCE 1200 S COLUMBIA RD GRAND FORKS ND 58201 237389089 SUPPORT HOSPITAL AND AFFILIATES ND 501(C)(3) LINE 11B, II N/A 0 ALTRU SPECIALTY SERVICES INC 1200 S COLUMBIA RD GRAND FORKS ND 58201 450395652 DME SALES, RETAIL PHARMACY ND N/A C 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 ALTRU HEALTH FOUNDATION C 1297384 CASH DONATED ALTRU SPECIALTY SERVICES A 185940 RENT PAYMENT RECEIVED DAK-MINN BLOOD BANK O 431231 COMPENSATION TO RELATED ORG ALTRU ALLIANCE Q 81194 AMOUNT REIMBURSED ALTRU HEALTH RESOURCES P 159039 AMOUNT REIMBURSED ALTRU HEALTH RESOURCES O 685718 COMPENSATION TO RELATED ORG ALTRU HEALTH FOUNDATION M 74850 AMOUNT REIMBURSED