2012-08-13T14:18:21-05:00 2011-09-30 EIDE BAILLY LLP 3999 PENNSYLVANIA AVE SUITE 100 DUBUQUE IA 52002 990 2010-10-01 362167884 ST MARGARET'S HOSPITAL STMA 8156642700 600 EAST FIRST STREET SPRING VALLEY IL 61362 TIMOTHY MUNTZ 8156642700 2012-08-03 1 CARMEN KRANTZ 5635561790 2012-08-03 2010 2016-02-24 21:20:13Z ST MARGARET'S HEALTH TIMOTHY MUNTZ 600 EAST FIRST STREET SPRING VALLEY IL 61362 67717965 0 0928 X WWW.ABOUTSMH.ORG X 1903 IL PROVIDE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITY 11 5 755 200 25006 0 462783 774842 65824872 66138811 507894 429547 209954 245511 67005503 67588711 42450 48536 0 0 32550815 33197188 0 0 0 32281557 33635530 64874822 66881254 2130681 707457 58828529 61477042 17482761 18617661 41345768 42859381 X ST. MARGARET'S HEALTH, IN UNION WITH THE SISTERS OF MARY OF THE PRESENTATION, IS COMMITTED TO THE VALUES OF CATHOLIC HEALTH CARE IN CARING FOR THE NEEDS OF OUR PATIENTS AND THEIR FAMILIES, THE COMMUNITY AND ONE ANOTHER. THROUGH OUR BELIEF IN GOD AND OUR RESPECT FOR LIFE, WE PROVIDE HOLISTIC QUALITY HEALTH CARE WITH DIGNITY AND COMPASSION. 0 0 59455914 48536 66257816 ST. MARGARET'S HEALTH HAS A TRADITION OF SERVING THE POOR AND OTHERS IN THE AREA SURROUNDING SPRING VALLEY FOR OVER 100 YEARS. THIS REPORT SUMMARIZES HOW, FOLLOWING IN THE FOOTSTEPS OF JESUS CHRIST, ST. MARGARET'S HOSPITAL IS REACHING OUT TO THE POOR AND THOSE MOST IN NEED. THE PRESENCE OF ST. MARGARET'S HOSPITAL MEANS MUCH MORE THAN DOLLARS AND CENTS. THE VALUE OF SERVICES TO THOSE IN NEED HAS BEEN MORE THAN A FINANCIAL SHEET CAN DESCRIBE, BECAUSE SOMETIMES THE SMALLER PROGRAMS DO THE MOST GOOD AND BECAUSE THE ORGANIZATION CANNOT POSSIBLY COUNT UP ALL THE SERVICES. ST. MARGARET'S HOSPITAL HAS BEEN A LEADER IN THE COMMUNITY, HELPING OTHERS TO SEE THE NEED TO RESPOND TO THE NEEDS OF THE POOR.ST. MARGARET'S HOSPITAL HAD 9,618 PATIENT DAYS IN FISCAL YEAR 2011 WITH 3,118 ADMISSIONS AND 3,133 DISCHARGES. TOTAL CLINIC VISITS WERE 94,640 AND OUTPATIENT VISITS WERE 225,377.THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE AMOUNT OF CHARGES FOREGONE FOR THE YEAR ENDED SEPTEMBER 30, 2011 WERE $1,293,975. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BY USING METHODOLOGY OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES, FOR THE YEAR ENDED SEPTEMBER 30, 2011 WERE $550,000.IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS, AND FOR SOME SERVICES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED. THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. 59455914 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 77 0 1 755 1 1 1 0 0 0 0 0 0 0 0 0 X 11 5 1 1 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 1 1 X KIM SANTMAN 8156641328 600 EAST FIRST STREET SPRING VALLEY IL 61362 X DR FRANK ZELLER 0.50 X X 0 0 0 DR RICHARD TWANOW 40.00 X X 305597 0 27399 AARON ALTON 1.00 X 0 486486 43432 JIM BRADY 0.50 X 0 0 0 DICK KOONTZ 0.50 X 0 0 0 DAN FITZGERALD 0.50 X 0 0 0 SHARON KUNKEL 0.50 X 0 0 0 SR ELAINE LANGE 0.50 X 0 0 0 SR ANNE GERMAINE PICARD 0.50 X 0 0 0 DR ROBERT MORROW 0.50 X 250119 0 22714 TIMOTHY MUNTZ 40.00 X X 0 352962 41615 KIM SANTMAN 40.00 X 0 199387 31400 JASON DOTSON 40.00 X 0 173733 26411 DR PAUL PERONA 40.00 X 1126239 0 41264 DR DALE CHILSON 40.00 X 1046446 0 24664 DR THAW TUN 40.00 X 473735 0 21674 DR SHAWN BAILEY 40.00 X 370364 0 41300 DR MIKE SHIN 40.00 X 503039 0 22983 4075539 1212568 344856 28 0 1 0 PHALEN STEEL CONSTRUCTION CO 200 N 4453RD RD MENDOTA IL 61342 CONSTRUCTION 4754083 SMP HEALTH CORPORATION 1202 PAGE DRIVE SW FARGO ND 58106 FACILITIES MANAGEMENT 1365144 ARAMARK FACILITIES SERVICES 1101 MARKET STREET PHILADELPHIA PA 19107 FACILITIES MANAGEMENT 938001 ST FRANCIS INC 8001 NORTH UNIVERSITY ST SUITE O PEORIA IL 61615 BIOMED, MRI AND PET SERVICES 790700 EMPIRE EMERGENCY PHYSICIANS 2020 N LINCOLN PARK WEST 37H CHICAGO IL 60614 CONTRACT PHYSICIANS 531571 19 629273 121104 24465 774842 PATIENT SERVICE REVENU 622110 65353896 65353896 SUPPORTING REVENUE 900099 422773 422773 EMPLOYEE RETAIL PHARMA 446110 362142 362142 66138811 419007 419007 374765 129254 245511 245511 119005 25006 101500 10540 10540 10540 10540 67588711 66257816 25006 531047 48536 48536 647659 647659 476300 476300 27092954 24798495 2294459 622090 553256 68834 2601651 2370555 231096 1756534 1581008 175526 39181 39181 47535 47535 11571618 8466877 3104741 725837 725837 11897394 11243240 654154 1092511 1066859 25652 93488 50198 43290 106141 91215 14926 511953 511953 3078121 3078121 698866 698866 BAD DEBT EXPENSE 3772776 3772776 109 109 66881254 59455914 7425340 0 872121 370621 168895 168895 9144852 10624827 594616 72006 2596404 1193454 419437 465940 77037831 47852597 26293646 29185234 18084180 15132454 556261 2009208 12176 547117 85941 1707286 58828529 61477042 3653338 4247946 10322885 10855925 3506538 3513790 17482761 18617661 X 41053583 41115433 255185 1706948 37000 37000 41345768 42859381 58828529 61477042 X 707457 806156 X X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 353357 2696 4223 351830 352802 885 330 353357 356434 1407 5039 352802 1.00000 0 0 385690 2654274 3039964 1257275 45135349 26643396 19749228 15303 24534337 19678614 4871026 85526 2970077 1530587 1525016 29185234 DEFERRED COMPENSATION OBLIGATION 464318 ESTIMATED HEALTH CLAIMS 314000 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2585000 CONSTRUCTION ACCOUNTS PAYABLE 150472 3513790 67588711 66881254 707457 -498668 1304824 806156 1513613 66684364 -498668 -94740 -593408 67277772 310939 310939 67588711 66881254 0 66881254 0 66881254 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: FUNDS ARE USED FOR CANCER SPECIFIC PURPOSES. THIS YEAR THE 4,222.46 IN FUND EXPENDITURES WERE USED EXCLUSIVELY FOR A FREE MAMMOGRAPHY PROGRAM FOR PATIENTS UNABLE TO PAY FOR THE MAMMOGRAPHY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN EQUITY OF INVESTMENT IN ST. MARGARET'S HEALTH ORGANIZATION 4,401. EQUITY TRANSFER TO SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION -53,064. CHANGE IN INTEREST IN NET ASSETS OF ST. MARGARET'S HOSPITAL FOUNDATION 1,452,947. CHANGE IN EQUITY IN INVESTMENT OF VALLEY REGIONAL HEALTH SERVICES -99,460. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 319. CHANGE IN EQUITY IN GAINS OF INVESTEES -95,059. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS RESTRICTED BY DONORS INCLUDED IN REVENUE PER FORM 990 50. CAPITAL CONTRIBUTIONS AND GRANTS INCLUDED IN REVENUE PER FORM 990 310,889. 1 1 X 1 X 1 X 1 1 1 0 1 1 1335 550000 550000 0.00870 6683 9154743 5302629 3852114 0.06100 8018 9704743 5302629 4402114 0.06970 162 7508 41272 5460 35812 0.00060 1 8000 8000 0.00010 2 459 682520 385570 296950 0.00470 32 1966 70864 70864 0.00110 197 9933 802656 391030 411626 0.00650 197 17951 10507399 5693659 4813740 0.07620 4 16 15653 15653 0.00020 6 20 11449 11449 0.00020 1 2535 2535 0.00000 6 12883 12883 0.00020 3 2029 2029 0.00000 20 36 44549 44549 0.00060 0 1310141 10950 16521968 20088545 -3566577 X 1 1 1 1 ST MARGARET'S HOSPITAL

600 EAST FIRST STREET SPRING VALLEY IL 61362

X X X NOT REQUIRED 1 15 ST MARGARET'S EAR NOSE & THROAT CENTER

4040 PROGRESS BLVD PERU IL 61354

OUTPATIENT PHYSICIAN CLINIC HAZEL MARIE BOYLE WOMEN'S HEALTH CENTER

600 EAST FIRST STREET SPRING VALLEY IL 61362

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S GRANVILLE CLINIC

309 SOUTH MCCOY STREET GRANVILLE IL 61326

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S HENRY CLINIC

528 EDWARD STREET HENRY IL 61537

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S MIDTOWN HEALTH

1650 MIDTOWN ROAD PERU IL 61354

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S OGLESBY CLINIC

402 WALNUT STREET OGLESBY IL 61348

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S SPRING VALLEY CLINIC

1515 36TH STREET SPRING VALLEY IL 61362

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S FAMILY HEALTH CENTER

415 EAST SECOND STREET SPRING VALLEY IL 61362

OUTPATIENT PHYSICIAN CLINIC VALLEY ORTHOPEDICS & SPORTS MEDICINE

600 EAST FIRST STREET SPRING VALLEY IL 61362

ORTHOPEDIC & SPORTS MEDICINE CLINIC ST MARGARET'S FAMILY ORTHOPEDIC CENTER

600 EAST FIRST STREET SPRING VALLEY IL 61362

ORTHOPEDIC CLINIC ST MARGARET'S HENNEPIN CLINIC

220 EAST HIGH STREET SUITE 101 HENNEPIN IL 61327

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S LASALLE CLINIC

535 3RD STREET LASALLE IL 61301

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S PERU MALL CLINIC

1515 36TH STREET PERU IL 61354

OUTPATIENT PHYSICIAN CLINIC ST MARGARET'S OCCUPATIONAL HEALTH CENTE

600 EAST FIRST STREET SPRING VALLEY IL 61362

OCCUPATIONAL HEALTH & WELLNESS CLINIC ST MARGARET'S DME

600 EAST FIRST STREET SPRING VALLEY IL 61362

DURABLE MEDICAL EQUIPMENT PART I, LINE 3C: IN KEEPING WITH THE MISSION, VISION AND VALUES OF ST. MARGARET'S HOSPITAL, OUR ORGANIZATION IS COMMITTED TO GIVING A PATIENT EVERY OPPORTUNITY TO PAY THEIR MEDICAL DEBT IN FULL OR TO MAKE ARRANGEMENTS BASED ON ORGANIZATIONAL POLICY. PATIENTS ARE REQUIRED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE HOWEVER, PATIENTS ELIGIBLE FOR ILLINOIS MEDICAID THAT RECEIVE SERVICES NOT COVERED BY THE PROGRAM, MAY BE GRANTED 100% FINANCIAL ASSISTANCE FOR THOSE NON-COVERED SERVICES. PATIENTS THAT ARE HOMELESS ARE GRANTED 100% FINANCIAL ASSISTANCE. EFFORTS ARE MADE TO HAVE A COMPLETED APPLICATION. IF INFORMATION CANNOT BE OBTAINED, VERIFICATION FROM THE POLICE DEPARTMENT, OR OTHER OFFICIAL MUST BE OBTAINED VERIFYING THE PATIENT IS HOMELESS. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST TO CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND DONATIONS, LINE 7I WERE REPORTED FROM ACTUAL EXPENSES IN THE GENERAL LEDGER. THE COST FOR PARATRANSIT, A SUBSIDIZED HEALTH SERVICE, REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. THE COST FOR SKILLED NURSING, A SUBSIDIZED HEALTH SERVICE, REPORTED ON LINE 7G WAS DETERMINED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $3,772,776. PART II: INDIVIDUALS FROM ST. MARGARET'S HOSPITAL ATTENDED COMMUNITY BUILDING EVENTS AT THE ILLINOIS VALLEY AREA CHAMBER AND MONTHLY MEETINGS FOR COMMUNITY BETTERMENT ACTIVITIES AT THE NORTH CENTRAL REGIONAL BETTERMENT COALITION (NCRBC). MEETINGS WERE ATTENDED FOR ECONOMIC DEVELOPMENT AT THE LASALLE BUSINESS ASSOCIATION AND MEETINGS TO ADDRESS LABOR NEEDS OF THE NORTH CENTRAL ILLINOIS REGION AT NCIWORKS. ST. MARGARET'S PROVIDES COMMUNITY SUPPORT THROUGH ATTENDING IEMA MEETINGS AND WORKING ON PARTNERSHIPS FOR STATE WIDE EMERGENCY RESPONSE EFFORTS. THE ORGANIZATION MET WITH MULTIPLE COMMUNITY PARTNERS TO PLAN EMERGENCY RESPONSE EXERCISES INVOLVING THE ENTIRE COMMUNITY AND PLAN TRAINING AND EDUCATION OF VOLUNTEER RESPONDERS. TOGETHER WITH THE LOCAL EMS SYSTEM AND VOLUNTEERS, THE HOSPITAL WAS ABLE TO PROVIDE EDUCATION, TRAINING, AND PROBLEM RESOLUTION FOR EMERGENCY CARE ISSUES. ENVIRONMENTAL IMPROVEMENTS INCLUDE MEETINGS WITH MULTIPLE COMMUNITY PARTNERS TO DEVELOP RESPONSE PLANS, PROVIDE COMMUNITY EDUCATION, AND DEVELOP WORKING RELATIONSHIPS WITH LOCAL BUSINESSES THAT USE, STORE, OR SHIP CHEMICALS HAZARDOUS TO THE COMMUNITY.INDIVIDUALS FROM ST. MARGARET'S HOSPITAL WERE ON THE LOCAL ADVISORY COUNCIL THAT PLANS LOCAL TRAINING, RESPONSE AND FUNDRAISING FOR THE RED CROSS THROUGH THE BUREAU COUNTY AMERICAN RED CROSS ADVISORY COUNCIL. THESE INDIVIDUALS WERE ALSO ON SEVERAL OTHER COMMUNITY BOARDS TO PROVIDE A HEALTHCARE PERSPECTIVE IN THE PLANNING OF EMERGENCY MEDICAL RESPONSE FOR SPRING VALLEY AND THE SURROUNDING COMMUNITIES.THE HOSPITAL WAS INVOLVED IN COMMUNITY PARTNERS AGAINST SUBSTANCE ABUSE (CPASA) REPRESENTING HEALTHCARE ISSUES RELATED WITH SUBSTANCE ABUSE. THE GROUP WORKS ON PREVENTION STRATEGIES, COMMUNITY AWARENESS AND EDUCATION, AND COMMUNITY PARTNERSHIPS. THE GOAL IS TO REDUCE SUBSTANCE ABUSE IN OUR COMMUNITY.INDIVIDUALS FROM THE HOSPITAL WORKED WITH LOCAL HEALTH DEPARTMENTS AND COMMUNITY PARTNERS TO PROVIDE EDUCATION AWARENESS PROGRAMS TO THE COMMUNITY AND ASSISTED IN LINKING LOW INCOME OR UNDERINSURED WOMEN WITH RESOURCES SO THEY MAY OBTAIN PREVENTIVE HEALTHCARE. AWARENESS FOR THESE INDIVIDUALS IS ESSENTIAL TO PREVENTING DISEASE.THROUGH THE REGIONAL 3 TRANSPORTATION ADVISORY COMMITTEE THE HOSPITAL PROVIDED INPUT TO PLANNING OF REGIONAL TRANSPORTATION SERVICES AND ACCESS TO HEALTHCARE ISSUES. ST. MARGARET'S HOSPITAL WORKED TOWARD A COORDINATED TRANSPORTATION SYSTEM IN BUREAU AND PUTNAM COUNTIES THAT PROVIDES LOW COST RIDES TO THE ELDERLY, LOW INCOME, AND SPECIAL NEEDS POPULATIONS. ALSO, ASSISTANCE WAS PROVIDED IN LINKING LOW INCOME AND UNDERINSURED WOMEN WITH RESOURCES SO THEY ARE ABLE TO OBTAIN PREVENTIVE HEALTHCARE. PROVIDING THESE SERVICES INCREASES ACCESS TO HEALTH CARE FOR THESE INDIVIDUALS. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE EXPENSE REPORTED ON THE FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2.ST. MARGARET'S HOSPITAL DETERMINES BAD DEBT EXPENSE BY ESTIMATING WHAT MAY NOT BE COLLECTIBLE FROM PATIENT BALANCES AFTER TAKING INTO ACCOUNT APPROPRIATE DISCOUNTS AND PAYMENTS (UNINSURED DISCOUNT, ELIGIBLE CHARITY CARE DISCOUNTS/ADJUSTMENTS, AND PAYMENTS RECEIVED AND EXPECTED TO BE RECEIVED). PAYMENTS ON ACCOUNTS THAT WERE WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN ESTIMATE OF CHARGES FOREGONE TO GROSS PATIENT CHARGES. THE AMOUNT ON LINE 3 IS AN ESTIMATE AMOUNT THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM IF SUFFICIENT INFORMATION HAD BEEN OBTAINED TO MAKE A DETERMINATION OF THEIR ELIGIBILITY.FOOTNOTE TO FINANCIAL STATEMENTS:THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. MANAGEMENT ALSO REVIEWS ACCOUNTS TO DETERMINE IF CLASSIFICATION AS CHARITY CARE IS APPROPRIATE. PART III, LINE 8: TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: HOMELESS PATIENTS AND ILLINOIS MEDICAID PATIENTS WILL NOT BE SUBJECT TO ANY COLLECTION EFFORTS. WHEN A PATIENT IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE THERE WILL BE NO COLLECTION EFFORTS. AFTER A DETERMINATION OF FINANCIAL ASSISTANCE, ANY PERSONAL PORTION DUE FOLLOWS THE SAME COLLECTION PROCEDURES AS OTHER ACCOUNTS. COLLECTION PROCEDURES INCLUDES PAST DUE NOTICES AND PHONE CALLS AND THEN THE ACCOUNT IS REFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: ST. MARGARET'S HOSPITAL IDENTIFIES UNMET COMMUNITY HEALTH NEEDS BY PARTICIPATING IN COMMUNITY COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS, AND PANELS. FOR EXAMPLE, HOSPITAL REPRESENTATIVES MET WITH THE LOCAL HEALTH DEPARTMENT TO JOINTLY EVALUATE THE NEEDS OF THE COMMUNITY. IN PARTICULAR, HOSPITAL STAFF MET WITH LOCAL MENTAL HEALTH SERVICE PROVIDERS TO DISCUSS UNMET MENTAL HEALTH NEEDS IN THE COMMUNITY. ON A MONTHLY BASIS, THE HOSPITAL REVIEWS ITS INTERNAL PATIENT SURVEYS. ON A TRI-ANNUAL BASIS, THE BOARD MEETS WITH SELECT MEDICAL STAFF MEMBERS AND HOSPITAL STAFF TO DEVELOP A STRATEGIC PLAN, WHICH ADDRESSES THE DEMOGRAPHICS OF THE COMMUNITIES SERVED. THE HOSPITAL PROVIDES HEALTH EDUCATION AND OUTREACH AT VARIOUS LOCATIONS OUT IN THE COMMUNITY, WHERE PARTICIPANTS ARE EDUCATED ON THE IMPORTANCE OF DISEASE PREVENTIONS AND EARLY DETECTION. THE HOSPITAL SUPPORTS A LOCAL FREE CLINIC BY PROVIDING FREE LAB SERVICES. THIS ALLOWS EMPLOYED PHYSICIANS TO DONATE THEIR SERVICES AND PROVIDE FINANCIAL ASSISTANCE. PART VI, LINE 3: ST. MARGARET'S HOSPITAL POSTS ITS CHARITY CARE POLICY IN THE ADMISSIONS/REGISTRATION AREAS, WAITING ROOMS, EMERGENCY ROOMS, AND OTHER AREAS THE ORGANIZATION FINDS BENEFICIAL TO PATIENTS. THE POLICY AND CONTACT INFORMATION ON FINANCIAL ASSISTANCE IS PROVIDED AND DISCUSSED DURING THE ADMISSION AND DISCHARGE PROCESS. UPON NOTIFICATION FROM REGISTRATION REGARDING SELF PAY ADMISSIONS, THE PATIENT ACCOUNT CLERK OR STAFF MEMBER FROM ANOTHER DEPARTMENT TRIES TO CONTACT THE PATIENT TO DISCUSS AVAILABILITY OF FINANCIAL ASSISTANCE. ALSO, INFORMATION ON OTHER PROGRAMS, SUCH AS GOVERNMENT BENEFITS, MEDICAID OR STATE PROGRAMS, IS DISCUSSED WITH PATIENTS. ASSISTANCE IS ALSO PROVIDED FOR INDIVIDUALS APPLYING FOR GOVERNMENT BENEFITS. PATIENTS ARE ENCOURAGED TO EXPLORE THEIR OPTIONS AND USE OUR RESOURCES TO OBTAIN ASSISTANCE WITH THEIR BILLS. EACH PATIENT BILL INCLUDES AN EXPLANATION ON HOW TO INQUIRE ABOUT FINANCIAL ASSISTANCE OR AN UNINSURED DISCOUNT. PART VI, LINE 4: ST. MARGARET'S HOSPITAL IS A 69-BED ACUTE CARE HOSPITAL LOCATED IN SPRING VALLEY, IL. SPRING VALLEY, IL IS A CITY SITUATED ON THE ILLINOIS RIVER IN THE SOUTHEASTERN CORNER OF BUREAU COUNTY, IL. BUREAU COUNTY IS LOCATED IN THE NORTHCENTRAL REGION OF ILLINOIS. THE POPULATION IS APPROXIMATELY 5,400 PEOPLE. SPRING VALLEY IS PART OF THE "ILLINOIS VALLEY MICROPOLITAN" (LA SALLE, PERU, AND SPRING VALLEY) WHICH TOTAL APPROXIMATELY 25,000 PEOPLE. WAL-MART IS THE LARGEST EMPLOYER AND HAS A LABOR FORCE FROM OVER 100 DIFFERENT ZIP CODES THAT EASILY COMMUTE TO SPRING VALLEY. IN 2009 THE MEDIAN HOUSEHOLD INCOME WAS $44,177, THE UNEMPLOYMENT RATE WAS 11.2%, AND 9.1% OF PEOPLE WERE LIVING IN POVERTY. OVER 6,500 OF OUR PATIENTS WERE LOW-INCOME MEDICAID PARTICIPANTS. MEDICARE AND PUBLIC AID MAKE UP 52% OF OUR NET REVENUES. THE NEAREST CITY WITH A POPULATION GREATER THAN 50,000 IS PEORIA, IL LOCATED 47 MILES SW OF SPRING VALLEY. PART VI, LINE 6: ST. MARGARET'S HOSPITAL BOARD IS COMPRISED OF 11 MEMBERS: TIMOTHY MUNTZ, CEO, TWO SISTERS FROM THE SISTERS OF MARY OF THE PRESENTATION, TWO HOSPITAL PHYSICIANS, THE PRESIDENT OF THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, A RELATED, CONTROLLING ORGANIZATION, AND FIVE COMMUNITY MEMBERS. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOSPITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED AND LICENSED. OUR ORGANIZATION IS COMMITTED TO BE INVOLVED AND HELPFUL TO THE COMMUNITY. OUR EMPLOYEES SERVE ON SEVERAL COMMITTEES WORKING TO IMPROVE THE HEALTH AND LIVES OF THE COMMUNITY. THE EMERGENCY ROOM IS OPEN 24 HOURS A DAY AND EVERYONE IS TREATED REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OPERATES A SEPARATE FOUNDATION WHICH CONDUCTS FUNDRAISING ACTIVITIES AND SOLICITS FUNDS THAT ARE UTILIZED TO FURTHER THE EXEMPT PURPOSE OF THE HOSPITAL. THE FOUNDATION MAKES REGULAR CONTRIBUTIONS TO THE HOSPITAL FOR ITEMS THAT DIRECTLY IMPROVE PATIENT CARE. SURPLUS FUNDS ARE REINVESTED IN PATIENT CARE AND FACILITY UPGRADES.DURING THE PAST YEAR, WE PROVIDED 1,335 PATIENTS WITH FREE OR REDUCED CHARITY CARE, INCLUDING OUR FREE MAMMOGRAM PROGRAM AND LAB SERVICES FOR PATIENTS TREATED AT BUREAU COUNTY HEALTH & WELLNESS, A FREE CLINIC IN PRINCETON. IN ADDITION TO OUR CHARITY CARE, WE ALSO SAW $3.8 MILLION IN HOSPITAL BILLS GO UNPAID. THIS AMOUNT WAS WRITTEN OFF AS BAD DEBT. THESE FIGURES SHOW THAT DESPITE OUR NATION'S COMPLEX SYSTEM OF PAYING FOR HEALTH CARE THROUGH THE GOVERNMENT, INSURANCE COMPANIES, AND THIRD-PARTY PAYORS, THERE ARE STILL MANY WHO ARE NOT COVERED BY THESE PROGRAMS. THEY ARE THE POOR WHO ARE INELIGIBLE FOR GOVERNMENTAL SUPPORT, THE UNEMPLOYED, AND THOSE EMPLOYED BY COMPANIES THAT DON'T OFFER ADEQUATE MEDICAL INSURANCE.WE ARE COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. SOME OF THE SERVICES WE PROVIDE TO THE COMMUNITY AT A REDUCED PRICE OR FREE OF CHARGE INCLUDE THE FOLLOWING:* WE PARTICIPATE IN VARIOUS HEALTH FAIRS THROUGHOUT THE AREA, PROVIDING INFORMATION ON HEALTH ISSUES.* TO HELP IN THE EARLY DETECTION OF ILLNESS, WE PROVIDE A NUMBER OF HEALTH SCREENINGS AT NO COST OR AT PRICES LESS THAN OUR COST FOR SERVICES, SUCH AS BLOOD PRESSURE, BLOOD SUGAR, AND CHOLESTEROL.WE ALSO HELP SUPPORT OTHER GROUPS IN OUR EFFORTS TO SERVE OUR COMMUNITY.* WE DONATED MONEY TO BUREAU COUNTY HEALTH & WELLNESS, A FREE CLINIC LOCATED IN PRINCETON.* WE PROVIDE FREE FOOD TO THE AREA HOMELESS SHELTER.WE ALSO WORK WITH OTHER ORGANIZATIONS TO HELP SERVE OUR COMMUNITY. SOME EXAMPLES INCLUDE THE FOLLOWING:* WE WORK EMS SERVICES IN THE AREA TO HELP COORDINATE SERVICES* WE WORK WITH THE COUNTY HEALTH DEPARTMENT TO HELP WITH EMERGENCY PREPAREDNESS. PART VI, LINE 7: WE ARE AN AFFILIATE OF THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. ST. MARGARET'S HOSPITAL OPERATES IN ACCORDANCE WITH THE MISSION, VISION, AND VALUES OF THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. OUR ANNUAL BUDGETING PROCESS INCLUDES AN ASSESSMENT OF HOW OUR BUDGET DEMONSTRATES A COMMITMENT TO THE VALUES OF THE SYSTEM AND THE SYSTEM WORKS TO ENSURE WE ARE ALWAYS MINDFUL OF OUR DUTY TO CARE FOR THE POOR AND THOSE IN NEED. ST. MARGARET'S HOSPITAL HAS A STRATEGIC PLAN DEVELOPED FROM THEMES SET FORTH BY THE HEALTH SYSTEM FOR ALL AFFILIATES. THE STRATEGIC PLAN IS AN ACTIVE DOCUMENT WHICH ST. MARGARET'S HOSPITAL WORKS ON CONTINUOUSLY AND REPORTS BACK TO THE HEALTH SYSTEM ON OUR PROGRESS TOWARD ESTABLISHED GOALS WHICH AGAIN, ALIGN WITH THE MISSION, VISION, AND VALUES OF THE ORGANIZATION. 1 DRUM CORPS INTERNATIONAL INC 100 W WASHINGTON STREET SUITE C INDIANAPOLIS IN 46204 830581521 501(C)(3) 5000 SPRING VALLEY DRUMFEST SPONSORSHIP LASALLE BUSINESS ASSOCIATION PO BOX 182 LASALLE IL 61301 262000923 501(C)(6) 5000 LASALLE JAZZFEST SPONSORSHIP MARCH OF DIMES PO BOX 173 LASALLE IL 61301 131846366 501(C)(3) 10000 CORPORATE SPONSORSHIP FOR FUNDRAISING EVENTS BUREAU COUNTY HEALTH & WELLNESS 500 ELM PLACE PRINCETON IL 61356 300129789 501(C)(3) 17000 FREE CLINIC SUPPORT ILLINOIS VALLEY COMMUNITY COLLEGE 815 NORTH ORLANDO SMITH STREET OGLESBY IL 61348 362614257 501(C)(3) 8000 NURSING EDUCATION SUPPORT 4 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ST. MARGARET'S HOSPITAL PROVIDES DONATIONS AND SPONSORSHIPS TO LOCAL ORGANIZATIONS. ORGANIZATION'S MAKE REQUESTS AND THE BOARD MAKES A DETERMINATION OF FUNDING. EACH ORGANIZATION PROVIDES DOCUMENTATION OF WHAT THE FUNDING WAS USED FOR. X 1 1 0 0 0 0 0 0 0 0 0 DR RICHARD TWANOW 168901 0 60252 0 76444 0 21300 0 6099 0 332996 0 0 0 AARON ALTON 0 383390 0 56358 0 46738 0 25876 0 23082 0 535444 0 0 DR ROBERT MORROW 156629 0 51624 0 41866 0 4800 0 18929 0 273848 0 0 0 TIMOTHY MUNTZ 0 290885 0 39269 0 22808 0 25448 0 19425 0 397835 0 0 KIM SANTMAN 0 168900 0 18579 0 11908 0 15405 0 18209 0 233001 0 0 JASON DOTSON 0 149970 0 11998 0 11765 0 10311 0 18380 0 202424 0 0 DR PAUL PERONA 789578 0 327188 0 9473 0 21300 0 20450 0 1167989 0 0 0 DR DALE CHILSON 289697 0 744389 0 12360 0 4800 0 20955 0 1072201 0 0 0 DR THAW TUN 167658 0 123687 0 182390 0 4800 0 17965 0 496500 0 0 0 DR SHAWN BAILEY 169581 0 100321 0 100462 0 21300 0 21331 0 412995 0 0 0 DR MIKE SHIN 474052 0 5500 0 23487 0 4800 0 19063 0 526902 0 0 0 PART I, LINE 1A ST. MARGARET'S HOSPITAL PROVIDES TRAVEL FOR BOARD MEMBER COMPANIONS IN THE YEARS BOARD MEMBERS ARE REQUIRED TO ATTEND A RETREAT. THE RETREAT IS INTENDED FOR EDUCATION ON ETHICS, FINANCE AND HEALTHCARE. PART I, LINE 7 THE BONUS AMOUNTS FOR AARON ALTON, TIMOTHY MUNTZ, KIM SANTMAN, AND JASON DOTSON ARE DETERMINED BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, A RELATED ORGANIZATION. SUPPLEMENTAL INFORMATION PART III PART I, QUESTION 3: ST. MARGARET'S HOSPITAL DOES NOT PAY COMPENSATION TO TIMOTHY MUNTZ, PRESIDENT/CEO. THIS INDIVIDUAL IS COMPENSATED BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, A RELATED ORGANIZATION, FOR HIS SERVICES AT THE HOSPITAL. SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION USES ONE OR MORE OF THE METHODS ON PART I, QUESTION 3 TO DETERMINE HIS COMPENSATION. JB CONTRACTING CORP BOARD MEMBER JIM BRADY IS THE OWNER 198597 COMPENSATION FOR CONSTRUCTION SERVICES 0 CHRISTINE SLINGSBY SISTER TO BOARD MEMBER ROBERT MORROW, MD 105460 COMPENSATION AND BENEFITS AS AN EMPLOYEE 0 CINDY MUNTZ WIFE TO TIMOTHY MUNTZ, PRESIDENT/CEO 38627 COMPENSATION AND BENEFITS AS AN EMPLOYEE 0 SUE MAY SISTER-IN-LAW TO BOARD MEMBER DAN FITZGERALD 40705 COMPENSATION AND BENEFITS AS AN EMPLOYEE 0 DR MICHAEL MORROW BROTHER TO BOARD MEMBER ROBERT MORROW, MD 291508 COMPENSATION AND BENEFITS AS AN EMPLOYEE 0 FORM 990, PART VI, SECTION A, LINE 2 OFFICERS TIMOTHY MUNTZ AND KIM SANTMAN ARE COMPENSATED BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, A RELATED EXEMPT ORGANIZATION. AARON ALTON, BOARD MEMBER FOR ST. MARGARET'S HOSPITAL, IS THE PRESIDENT OF SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION AND IS COMPENSATED FOR HIS SERVICES TO THAT ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. THEREFORE, BUSINESS RELATIONSHIPS EXIST BETWEEN THESE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 3 SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, A RELATED ORGANIZATION, FACILITATES THE MANAGEMENT AND OPERATIONS OF ST. MARGARET'S HOSPITAL. THE OFFICERS OF THE ORGANIZATION ARE DIRECTLY COMPENSATED BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER IS ENTITLED TO VOTE IN THE ELECTION OF DIRECTORS AND TO CAST ONE VOTE FOR EACH DIRECTOR TO BE ELECTED. THE MEMBER IS ALSO ENTITLED TO ONE VOTE ON EVERY OTHER MATTER TO BE VOTED ON BY THE MEMBER. VOTES CAST ON BEHALF OF THE MEMBER ARE CAST BY THE CHIEF EXECUTIVE OFFICER OF SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE AUTHORITY TO ACT ON THE FOLLOWING MATTERS ARE EXCLUSIVELY VESTED IN THE MEMBER OF THE ORGANIZATION: 1. ANY CHANGE IN THE PHILOSOPHY, OBJECTIVES AND PURPOSES OF THE ORGANIZATION; 2. AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; 3. THE ELECTION OR REMOVAL OF THE DIRECTORS; 4. MERGER OR CONSOLIDATION WITH ANY OTHER ORGANIZATION; 5. DISSOLUTION OF THE ORGANIZATION OR THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF ITS PROPERTY OR ASSETS; 6. THE SALE, LEASE, TRANSFER OR ENCUMBRANCE OF ANY LAND, BUILDINGS OR OTHER ASSETS OWNED BY THE ORGANIZATION OR IN WHICH THE ORGANIZATION HAS OR WILL HAVE EQUITABLE OR LEGAL TITLE; 7. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS; 8. APPOINTMENT OF THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 EACH BOARD MEMBER IS NOTIFIED WHEN THE FORM 990 IS AVAILABLE FOR REVIEW. BOARD MEMBERS ARE ENCOURAGED TO REVIEW THE FORM 990 BEFORE IT IS FILED. THE PRESIDENT AND VICE PRESIDENT OF FINANCE REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR MUST SUBMIT IN WRITING TO THE CHAIRPERSON OF THE BOARD AND THE CEO A LIST OF ALL BUSINESS OR OTHER ORGANIZATIONS OF WHICH THE INDIVIDUAL IS AN OFFICER, DIRECTOR, TRUSTEE, MEMBER, OWNER (EITHER AS A SOLE PROPRIETOR OR PARTNER), SHAREHOLDER WITH A 5% OR GREATER INTEREST IN ALL OUTSTANDING VOTING SHARES, EMPLOYEE OR AGENT, WITH WHICH THE ORGANIZATION HAS, OR MIGHT REASONABLY IN THE FUTURE ENTER INTO, A RELATIONSHIP OR A TRANSACTION IN WHICH THE DIRECTOR WOULD HAVE CONFLICTING INTERESTS. EACH WRITTEN STATEMENT IS RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR. THE CHAIRPERSON OF THE BOARD REVIEWS THE STATEMENTS OF THE DIRECTORS AND THE VICE CHAIRPERSON OF THE BOARD REVIEWS THE STATEMENT FILED BY THE CHAIRPERSON. WHEN A CONFLICT ARISES THE AFFECTED DIRECTOR MAKES KNOWN THE POTENTIAL CONFLICT, WHETHER DISCLOSED BY WRITTEN STATEMENT OR NOT, AND AFTER ANSWERING ANY QUESTIONS, WILL WITHDRAW FROM THE MEETING FOR AS LONG AS THE MATTER CONTINUES UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO A VOTE, THE AFFECTED DIRECTOR WILL NOT VOTE ON IT. IN THE EVENT THE DIRECTOR DOES NOT WITHDRAW VOLUNTARILY, THE CHAIRPERSON OF THE BOARD AS AUTHORITY TO REQUIRE THE DIRECTOR TO REMOVE HIMSELF FROM THE ROOM DURING BOTH THE DISCUSSION AND VOTE ON THE MATTER. IN THE EVENT THE CONFLICT OF INTEREST AFFECTS THE CHAIRPERSON, THE VICE CHAIRPERSON HAS AUTHORITY TO REQUIRE THE CHAIRPERSON REMOVE HIMSELF IN THE SAME MATTER. IF THE MATTER IS THE ITEM OF BUSINESS FOR WHICH A SPECIAL MEETING OF THE BOARD WAS CALLED, THE AFFECTED DIRECTOR WILL NOT BE COUNTED TO ESTABLISH A QUORUM, AND HE/SHE WILL NOT PARTICIPATE IN THE DELIBERATIONS OR VOTE ON IT. FORM 990, PART VI, SECTION B, LINE 15: THE ORGANIZATION'S PRESIDENT/CEO, OTHER OFFICERS, AND KEY EMPLOYEES ARE COMPENSATED BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, A RELATED ORGANIZATION. THE COMPENSATION PROCESS IS DETERMINED BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND KEY EMPLOYEES. THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION BOARD OF TRUSTEES APPROVES ALL COMPENSATION BASED ON COMPARABLE DATA AND DOCUMENTS THEIR DECISION IN THE MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FINANCIAL INFORMATION IS AVAILABLE THROUGH THE PUBLIC DISCLOSURE COPY OF THE 990. FORM 990, PART VII, SECTION A: AARON ALTON, PRESIDENT/CEO, PERFORMS SERVICES FOR THE RELATED HOSPITALS, HOME HEALTH AGENCY, AND FIVE RELATED LONG-TERM CARE FACILITIES. AARON DEDICATES A MINIMUM OF 40 HOURS PER WEEK TO THE RELATED ORGANIZATIONS. THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO THE FOLLOWING RELATED ORGANIZATIONS. ST. MARGARET'S HOSPITAL FOUNDATION TIMOTHY MUNTZ .16 HOURS PER WEEK SMP ENTERPRISEES TIMOTHY MUNTZ .3 HOURS PER WEEK SISTERS OF MARY OF THE PRESENTATION MARYVALE PROVINCIAL CENTER SR. ELAINE LANGE 40 HOURS PER WEEK SR. ANNE GERMAINE PICARD 40 HOURS PER WEEK CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -498,668. CHANGE IN EQUITY OF INVESTMENT IN ST. MARGARET'S HEALTH ORGANIZATION 4,401. EQUITY TRANSFER TO SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION -53,064. CHANGE IN INTEREST IN NET ASSETS OF ST. MARGARET'S HOSPITAL FOUNDATION 1,452,947. CHANGE IN EQUITY IN INVESTMENT OF VALLEY REGIONAL HEALTH SERVICES -99,460. TOTAL TO FORM 990, PART XI, LINE 5: 806,156. FORM 990, PART XII, LINE 2C: THE GOVERNING BOARD OF SISTERS OF MARY OF THE PRESENTATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT FOR ST. MARGARET'S HOSPITAL. SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION 1202 PAGE DRIVE SW FARGO ND 58103 450359620 FACILITATES MANAGEMENT AND OPERATIONS OF TEN RELATED FACILITIES ND 501(C)(3) LINE 11A, I SMP MARYVALE PROVINCIAL CENTER 0 ST MARGARET'S HOSPITAL FOUNDATION 600 EAST FIRST STREET SPRING VALLEY IL 61362 364042262 PROVIDE SUPPORT TO ST. MARGARET'S HOSPITAL IL 501(C)(3) LINE 11A, I SMP HEALTH CORPORATION 0 SMP PRAIRIELAND HOME HEALTH AGENCY 1102 PAGE DRIVE SW FARGO ND 581060007 450391192 HOME HEALTH AND SUPPORTIVE SERVICES ND 501(C)(3) LINE 9 SMP HEALTH CORPORATION 0 PRESENTATION MEDICAL CENTER 213 2ND AVENUE NE ROLLA ND 583670759 450227391 ACUTE CARE HOSPITAL ND 501(C)(3) LINE 3 SMP HEALTH CORPORATION 0 ST ALOISIUS HOSPITAL 325 EAST BREWSTER STREET HARVEY ND 58341 450226729 PROVISION OF HEALTH CARE SERVICES ND 501(C)(3) LINE 3 SMP HEALTH CORPORATION 0 ST ANDREW'S HOSPITAL 316 OHMER STREET BOTTINEAU ND 58318 450226426 ACUTE CARE CRITICAL ACCESS HOSPITAL ND 501(C)(3) LINE 3 SMP HEALTH CORPORATION 0 ST ANDREW'S HOSPITAL FOUNDATION 316 OHMER STREET BOTTINEAU ND 58318 450413201 PROVIDE SUPPORT TO ST. ANDREW'S HOSPITAL ND 501(C)(3) LINE 11A, I SMP HEALTH CORPORATION 0 SISTERS OF MARY OF THE PRESENTATION LONG TERM CARE 1202 PAGE DR SW FARGO ND 581060007 752999939 PROVIDE EXTENDED CARE AND MEDICALLY RELATED SERVICES ND 501(C)(3) LINE 9 SMP HEALTH CORPORATION 0 ST ANDREW'S BOTTINEAU CLINIC LLC 316 OHMER STREET BOTTINEAU ND 58318 450451306 PROVISION OF HEALTH CARE SERVICES ND N/A SMP ENTERPRISES PO BOX 10007 FARGO ND 581060007 363486506 HOME HEALTH CARE SERVICES ND N/A C ROLETTE CLINIC INC PO BOX 759 ROLLA ND 58367 450308335 LEASING ND N/A C 0 0 1 0 0 0 0 0 1 0 1 1 1 1 1 1 1 0