CENTRACARE CLINIC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CENTRACARE CLINIC (EIN 41-1806657)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-01
- IRS object ID
- 201301219349300715
- Schema version
- 2011v1.5
- 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 | 2013-05-01T10:33:01-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | 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 | 2011-07-01 | 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 J TILSTRA MD | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 3202525131 | Phone |
| Date Signed | 2013-04-22 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KOREY BOELTER | Name |
| PTIN | P00775161 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID J 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 | 166586370 | 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 | 965 | TotalNbrEmployees |
| Total Nbr Volunteers | 4 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 17110663 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 14780171 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 144014296 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 151571465 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 50414 | InvestmentIncomePriorYear |
| Investment Income Current Year | 54771 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 165962 | OtherRevenuePriorYear |
| Other Revenue Current Year | 179963 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 161341335 | TotalRevenuePriorYear |
| Total Revenue Current Year | 166586370 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 6214 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 9200 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 112072711 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 118820961 | 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 | 46142671 | OtherExpensePriorYear |
| Other Expenses Current Year | 45759744 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 158221596 | TotalExpensesPriorYear |
| Total Expenses Current Year | 164589905 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3119739 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1996465 | RevenuesLessExpensesCY |
| Total Assets BOY | 36058547 | TotalAssetsBOY |
| Total Assets EOY | 35897814 | TotalAssetsEOY |
| Total Liabilities BOY | 26100503 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 23943305 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9958044 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11954509 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 156602754 | Expense |
| Grants | 9200 | Grants |
| Revenue | 151571465 | Revenue |
| Description | THE ORGANIZATION PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY. THIS INCLUDES HEALTHCARE EDUCATION AND RESEARCH, AS WELL AS PROVIDING HEALTH SERVICES TO THE UNINSURED AND UNDERINSURED. THE ORGANIZATION SUPPORTS PATIENTS WHO EXPRESS A WILLINGNESS TO PAY BUT ARE UNABLE TO DO SO DUE TO SOCIOECONOMIC FACTORS. THE ORGANIZATION PROVIDES A WIDE RANGE OF PRIMARY CARE AND SPECIALTY MEDICAL SERVICES THROUGH AN INTEGRATED MULTI-SPECIALITY CLINIC STRUCTURE.PATIENT ACTIVITIES FOR THE YEAR ENDED JUNE 30, 2012:LABORATORY: 583,971IMMUNIZATION & INJECTION: 576,113CLINIC VISITS: 298,303SURGICAL: 134,962HOSPITAL VISITS: 136,054PROFESSIONAL INTERPRETATION: 49,781RADIOLOGY: 27,574SURGERY (MINOR): 28,847SPECIAL PROCEDURES: 48,502RADIATION ONCOLOGY: 12,773NURSING HOME VISITS: 5,329 | Description |
| Total Program Service Expense | 156602754 | 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 | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 99 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 965 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | THOMAS FELDHEGE | NamePerson |
| 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 | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| GLENN FORBES MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| GENE WINDFELDT | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| DENISE ROSIN | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| BYRON JOHN MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| THOMAS W LEITHER MD | ||||||||
| DIRECTOR & BOARD CHAIR | 40.00 | X | 400201 | 1500 | 44080 | X | ||
| DEBORAH L MCCARL MD | ||||||||
| DIRECTOR & OBSTETRICIAN | 40.00 | X | 294744 | 0 | 56862 | |||
| DAVID ROBERTS MD | ||||||||
| DIRECTOR & GASTROENTEROLOGIST | 40.00 | X | 608540 | 0 | 43573 | |||
| KEITH LEAVELL MD | ||||||||
| DIRECTOR & PULMONOLOGIST | 40.00 | X | 431900 | 1500 | 65819 | |||
| KATHLEEN KULUS MD | ||||||||
| DIRECTOR & PEDIATRICIAN | 40.00 | X | 246381 | 0 | 39363 | |||
| ALLEN E HORN MD | ||||||||
| PRESIDENT & CEO | 40.00 | X | 587816 | 0 | 114083 | X | ||
| THOMAS M FELDHEGE | ||||||||
| TREASURER & CFO | 40.00 | 202551 | 0 | 53695 | X | |||
| MARK MURPHY | ||||||||
| VICE PRESIDENT OF OPERATIONS | 40.00 | 256576 | 0 | 61679 | X | |||
| DAVID TILSTRA MD | ||||||||
| MEDICAL DIRECTOR & GENETICIST | 40.00 | 328662 | 0 | 77235 | X | |||
| BERNARD R ERICKSON MD | ||||||||
| INTERNENTIONAL CARDIOLOGIST | 40.00 | 836197 | 0 | 41642 | X | |||
| HANI S AL-KHATIB MD | ||||||||
| MEDICAL ONCOLOGIST | 40.00 | 877668 | 0 | 45867 | X | |||
| RANDY C SALIARES MD | ||||||||
| GASTROENTEROLOGIST | 40.00 | 984192 | 0 | 44300 | X | |||
| MARK JOHNSON MD | ||||||||
| CARDIOLOGIST | 40.00 | 1024607 | 0 | 57989 | X | |||
| EITAN MEDINI MD | ||||||||
| RADIATION ONCOLOGIST | 40.00 | 856720 | 0 | 57778 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 7936755 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3000 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 803965 | TotalOtherCompensation |
| Number Individuals GT100 K | 237 | 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 | 55540 | LABORATORY SERVICES | 677459 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYSICIAN SERVICES | 564797 |
| REGIONAL DIAGNOSTICS | |||||
| 1990 CONNECTICUT AVE S STE 100 | ST CLOUD | MN | 56377 | RADIOLOGY SERVICES | 212950 |
| THE BLACKHAWK CONSULTING GROUP | |||||
| 25650 NETWORK PLACE | CHICAGO | IL | 60673 | PROCESSING SERVICES | 152953 |
| ENVIROTECH | |||||
| PO BOX 931 | ST CLOUD | MN | 56302 | HOUSEKEEPING SERVICES | 149860 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 14743421 | RelatedOrganizations |
| All Other Contributions | 36750 | AllOtherContributions |
| Total Contributions | 14780171 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REVENUES | 621110 | 130719885 | 130719885 |
| OTHER REVENUE | 900099 | 20851580 | 20851580 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 151571465 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 54771 | TotalRevenueColumn |
| Exclusion | $54,771 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 179963 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 179963 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 179963 | TotalRevenueColumn |
| Exclusion | $179,963 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 166586370 | TotalRevenueColumn |
| Related Or Exempt Function Income | 151571465 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $234,734 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9200 | Total |
| Program Services | 9200 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4025070 | Total |
| Program Services | 2602218 | ProgramServices |
| Management And General | 1422852 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94269394 | Total |
| Program Services | 93022578 | ProgramServices |
| Management And General | 1246816 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4837479 | Total |
| Program Services | 4816722 | ProgramServices |
| Management And General | 20757 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11054092 | Total |
| Program Services | 10863752 | ProgramServices |
| Management And General | 190340 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4634926 | Total |
| Program Services | 4517993 | ProgramServices |
| Management And General | 116933 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 406308 | Total |
| Management And General | 406308 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34160 | Total |
| Management And General | 34160 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8995271 | Total |
| Program Services | 7728795 | ProgramServices |
| Management And General | 1266476 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 314736 | Total |
| Program Services | 178585 | ProgramServices |
| Management And General | 136151 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2103188 | Total |
| Program Services | 1518707 | ProgramServices |
| Management And General | 584481 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2029803 | Total |
| Management And General | 2029803 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6443426 | Total |
| Program Services | 6443418 | ProgramServices |
| Management And General | 8 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 304543 | Total |
| Program Services | 304543 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 851606 | Total |
| Program Services | 851606 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1551706 | Total |
| Program Services | 1483309 | ProgramServices |
| Management And General | 68397 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 14532828 | 14532788 | 40 |
| BAD DEBT EXPENSE | 3122581 | 3122581 | |
| MN CARE TAX | 1649019 | 1649019 | |
| REPAIRS & MAINTENANCE | 1486327 | 1439759 | 46568 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1934242 | Total |
| Program Services | 1517181 | ProgramServices |
| Management And General | 417061 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 164589905 | Total |
| Program Services | 156602754 | ProgramServices |
| Management And General | 7987151 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5682 | BOY |
| EOY | 5724 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11211434 | BOY |
| EOY | 11576116 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14575217 | BOY |
| EOY | 13115328 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1172028 | BOY |
| EOY | 937861 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1067713 | BOY |
| EOY | 1256910 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 457507 | BOY |
| EOY | 458056 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17618661 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14366982 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2549878 | BOY |
| EOY | 3251679 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5019088 | BOY |
| EOY | 5296140 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36058547 | BOY |
| EOY | 35897814 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20080801 | BOY |
| EOY | 19640845 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6019702 | BOY |
| EOY | 4302460 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26100503 | BOY |
| EOY | 23943305 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9958044 | BOY |
| EOY | 11954509 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9958044 | BOY |
| EOY | 11954509 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36058547 | BOY |
| EOY | 35897814 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1996465 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 | $3,258 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3258 | 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 $3,258 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 | 3136968 | OtherCostOrOtherBasis |
| Depreciation | 1174562 | Depreciation |
| Book Value | 1962406 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14481693 | OtherCostOrOtherBasis |
| Depreciation | 13192420 | Depreciation |
| Book Value | 1289273 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3251679 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| FUNDS HELD BY TRUSTEE | 2242348 |
| DUE FROM RELATED ORGANIZATIONS | 3053792 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 5296140 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION PLAN OBLIGATIONS | $2,242,348 |
| DUE TO RELATED ORGANIZATIONS | $2,060,112 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4302460 | TotalOfAmounts |
| Total Revenue | 166586370 | TotalRevenue |
| Total Expenses | 164589905 | TotalExpenses |
| Excess Or Deficit For Year | 1996465 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 1996465 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 152336508 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 152336508 | RevenueSubtotal |
| Other Revenues Not Included | 14249862 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 14249862 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 166586370 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 164589905 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 164589905 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 164589905 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION FOLLOWS GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR EVALUATING UNCERTAIN TAX POSITIONS. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | INTEREST AND INVESTMENT INCOME 54,771. EQUITY TRANSFER FROM AFFILIATE 14,195,091. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
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 IS A NOT-FOR-PROFIT CORPORATION 501(C)(3)THAT PROVIDES A COMPREHENSIVE PROGRAM OF HEALTH CARE SERVICES TO THE RESIDENTS OF CENTRAL MINNESOTA. AS PART OF THIS HEALTHFOCUSED MISSION, CENTRACARE HEALTH SYSTEM PROVIDES A LIMITED NUMBER OF CHARITABLE CONTRIBUTIONS TO ORGANIZATIONS THAT IMPROVE THE HEALTH OF CENTRAL MINNESOTANS. THE MAJORITY OF CONTRIBUTIONS ARE MADE IN THE FORM OF GRANTS THROUGH THE CENTRACARE HEALTH FOUNDATION. THE FOUNDATION'S GRANTS COMMITTEE REVIEWS FUNDING APPLICATIONS FROM PROGRAMS THROUGHOUT THE REGION. HOWEVER, THE CENTRACARE CONTRIBUTIONS COMMITTEE FUNCTIONS TO STREAMLINE HEALTH-RELATED CHARITABLE CONTRIBUTIONS THAT DO NOT FALL WITHIN THE FOUNDATION'S GUIDELINES. THIS POLICY OUTLINES THE PROCEDURES TO BE FOLLOWED AND THE CRITERIA TO BE CONSIDERED IN EVALUATING REQUESTS FOR FUNDING. CONTRIBUTIONS MUST BE IN KEEPING WITH THE MISSION OF CENTRACARE HEALTH SYSTEM, 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 SYSTEM CONTRIBUTIONS COMMITTEE IS MADE UP OF: ONE REPRESENTATIVE FROM CENTRACARE HEALTH FOUNDATION; ONE REPRESENTATIVE FROM ST. CLOUD HOSPITAL HUMAN RESOURCES; THE DIRECTOR OF CENTRACARE HEALTH SYSTEM'S COMMUNICATIONS DEPARTMENT AND THE COMMUNICATIONS/MARKETING SPECIALIST RESPONSIBLE FOR CENTRACARE CLINIC; THE DIRECTOR OF CENTRACARE HEALTH SYSTEM'S MARKETING/PLANNING DEPARTMENT; THE DIRECTOR OF ST. CLOUD HOSPITAL VOLUNTEER SERVICES; AND SI. CLOUD HOSPITAL'S 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 SYSTEM - LONG PRAIRIE, CENTRACARE HEALTH SYSTEM - MELROSE, AND ST BENEDICT'S SENIOR COMMUNITY 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 SYSTEM EXECUTIVE COUNCIL. INDIVIDUALS AND DEPARTMENTS FROM THROUGHOUT ST CLOUD HOSPITAL AND THE CENTRACARE CLINIC SITES IN ST. CLOUD SHOULD FORWARD ALL OUTSIDE FUNDING REQUESTS TO A MEMBER OF THE COMMITTEE FOR THE FULL GROUP'S CONSIDERATION. THOSE REQUESTING FUNDS SHOULD BE ASKED TO SUBMIT THEIR REQUEST 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 | 1 | 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)
| 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 | |||||||||||||
| 343052 | 1500 | 55362 | 0 | 1787 | 0 | 18375 | 0 | 25705 | 0 | 444281 | 1500 | 0 | 0 |
| DEBORAH L MCCARL MD | |||||||||||||
| 245665 | 0 | 46717 | 0 | 2362 | 0 | 33762 | 0 | 23100 | 0 | 351606 | 0 | 0 | 0 |
| DAVID ROBERTS MD | |||||||||||||
| 540270 | 0 | 64823 | 0 | 3447 | 0 | 18375 | 0 | 25198 | 0 | 652113 | 0 | 0 | 0 |
| KEITH LEAVELL MD | |||||||||||||
| 369507 | 1500 | 60029 | 0 | 2364 | 0 | 34875 | 0 | 30944 | 0 | 497719 | 1500 | 0 | 0 |
| KATHLEEN KULUS MD | |||||||||||||
| 210969 | 0 | 35136 | 0 | 276 | 0 | 17469 | 0 | 21894 | 0 | 285744 | 0 | 0 | 0 |
| ALLEN E HORN MD | |||||||||||||
| 357539 | 0 | 94541 | 0 | 135736 | 0 | 86878 | 0 | 27205 | 0 | 701899 | 0 | 0 | 0 |
| THOMAS M FELDHEGE | |||||||||||||
| 180160 | 0 | 21552 | 0 | 839 | 0 | 31395 | 0 | 22300 | 0 | 256246 | 0 | 0 | 0 |
| MARK MURPHY | |||||||||||||
| 211601 | 0 | 42407 | 0 | 2568 | 0 | 36547 | 0 | 25132 | 0 | 318255 | 0 | 0 | 0 |
| DAVID TILSTRA MD | |||||||||||||
| 243864 | 0 | 65778 | 0 | 19020 | 0 | 51534 | 0 | 25701 | 0 | 405897 | 0 | 0 | 0 |
| BERNARD R ERICKSON MD | |||||||||||||
| 764818 | 0 | 67906 | 0 | 3473 | 0 | 18375 | 0 | 23267 | 0 | 877839 | 0 | 0 | 0 |
| HANI S AL-KHATIB MD | |||||||||||||
| 798945 | 0 | 74227 | 0 | 4496 | 0 | 18375 | 0 | 27492 | 0 | 923535 | 0 | 0 | 0 |
| RANDY C SALIARES MD | |||||||||||||
| 538672 | 0 | 64323 | 0 | 381197 | 0 | 18375 | 0 | 25925 | 0 | 1028492 | 0 | 0 | 0 |
| MARK JOHNSON MD | |||||||||||||
| 796857 | 0 | 70102 | 0 | 157648 | 0 | 34875 | 0 | 23114 | 0 | 1082596 | 0 | 0 | 0 |
| EITAN MEDINI MD | |||||||||||||
| 482088 | 0 | 57502 | 0 | 317130 | 0 | 34875 | 0 | 22903 | 0 | 914498 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: RANDY C. SALIARES, MD - $378,593 MARK JOHNSON, MD - $155,541 EITAN MEDININ, MD - $312,843 ALLEN E. HORN, MD - $73,055 |
| 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. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE BUSINESS AND AFFAIRS OF OF CENTRACARE CLINIC SHALL BE MANAGED BY A BOARD OF TEN DIRECTORS CONSISITING OF FOUR SEPARATE CLASSES, OF WHICH HAVE DIFFERENT VOTING RIGHTS AS FOLLOWS: (I) TWO MEMBERS WHO ARE DESIGNATED AS THE PRIMARY CARE PHYSICIAN DIRECTORS EACH WITH A VOTING POWER OF ONE VOTE. (II) TWO MEMBERS WHO ARE DESIGNATED AS THE SPECIALIST PHYSICIAN DIRECTORS EACH WITH A VOTING POWER OF ONE VOTE. (III) ONE MEMBER WHO IS DESIGNATED AS THE AT LARGE PHYSICIAN DIRECTOR WITH A VOTING POWER OF ONE. (IV) FOUR MEMBERS DESIGNATED AS CORPORATE DIRECTORS EACH WITH A VOTING POWER OF TWO VOTES. IN ADDITION NO PHYSICIAN DIRECTOR MAY VOTE ON COMPENSATION PAID TO, OR COMPENSATION PLANS OR PROGRAMS BENEFITTING, PHYSICIANS EMPLOYED BY CENTRACARE CLINIC. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS CENTRACARE HEALTH SYSTEM, A MINNESOTA NONPROFIT ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | PHYSICAN 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. | |
| 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 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 THE CENTRACARE HEALTH SYSTEM: (1) REVIEW AND APPROVE THE FOLLOWING: (I) THE ANNUAL OPERATING AND CAPITAL BUDGETS, (II) ANY CAPITAL EXPENDITURE IN EXCESS OF $1.0 $2.0 MILLION WHETHER BUDGETED OR NOT BUDGETED, AND (III) ANY DEBTS TO BE INCURRED. (2) APPROVE ANY ENCUMBRANCE OF THE 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 CENTRACARE CLINIC. (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 HOSPITAL, CLINIC OR PHYSICIAN PROVIDER GROUP. (13) OVERSEE AUDITING AND ACCOUNTING PRACTICES OF CENTRACARE CLINIC. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS REVIEWED IN DETAIL BY MANAGEMENT AND LEGAL COUNSEL. IN ADDITION, THE FULL BOARD HAD AN OPPORTUNITY TO REVIEW THE FORM 990 WITH STAFF, TO ASK QUESTIONS AND SEEK CLARIFICATIONS, AND TO APPROVE THE FINAL DOCUMENT PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICTS OF INTEREST QUESTIONNAIRE ON A TWICE-PER-YEAR BASIS. 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 THAT INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRES ARE REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE CENTRACARE HEALTH SYSTEM 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- OR HERSELF 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 PRESIDENT AND THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO BIENNIAL FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES BY AN OUTSIDE, INDEPENDENT CONSULTANT. THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR COMMITTEE AND BOARD REVIEW. THE LAST FULL REVIEW WAS DONE IN 2012; THE LAST COMPENSATION REVIEW IN 2012. 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. THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO BIENNIAL FULL COMPENSATION AND BENEFITS COMPARABILITY STUDIES PERFORMED BY AN OUTSIDE, INDEPENDENT CONSULTANT. THE COMPENSATION PORTION OF THE STUDY IS REVIEWED ANNUALLY BY THE CONSULTANT AND UPDATED FOR THE COMMITTEE AND BOARD REVIEW. THE LAST FULL REVIEW WAS DONE IN 2012; THE LAST COMPENSATION REVIEW IN 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 VII, SECTION A | THE COMPENSATED OFFICERS, BOARD MEMBERS AND KEY EMPLOYEES OF CENTRACARE CLINIC SERVE MULTIPLE RELATED ORGANIZATIONS. EACH INDIVIDUAL WORKS APPROXIMATELY 40 HOURS PER WEEK ACROSS THE RELATED ORGANIZATIONS. | AVERAGE WEEKLY HOURS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 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 AVENUE NORTH | 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 AVENUE WEST | MELROSE | MN | 56352 | 411865315 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | 3 | 0 | CCHS & CCHS-LP | |
| CENTRACARE HEALTH SERVICES - LONG PRAIRIE | |||||||||||
| 20 SOUTHEAST 9TH STREET | LONG PRAIRIE | MN | 56347 | 411924645 | ACUTE & LONG-TERM CARE | MN | 501(C)(3) | 3 | 0 | CCHS & CCHS-MELROSE | |
| CENTRACARE HEALTH FOUNDATION | |||||||||||
| 1406 6TH AVENUE NORTH | ST CLOUD | MN | 56303 | 411855173 | FUNDRAISING | MN | 501(C)(3) | 7 | N/A | 0 | |
| CENTRAL MINNESOTA EMERGENCY PHYSICIANS | |||||||||||
| 1406 6TH AVENUE NORTH | ST CLOUD | MN | 56303 | 411708142 | EMERGENCY PHYSICIAN PRACTICE | MN | 501(C)(3) | 3 | N/A | 0 | |
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 AVENUE 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 PHARMACY | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| 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 |
| 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 |