2012-11-15T13:11:09-06:00 2011-12-31 990 2011-01-01 411293970 RANGE REGIONAL HEALTH SERVICES RANG 2183626657 750 EAST 34TH STREET HIBBING MN 55746 JOHN KRITZ 2183626657 2012-11-15 2011 2016-02-24 21:20:13Z JOHN KRITZ 750 East 34th Street Hibbing MN 55746 92218090 0 X www.range.fairview.org X 1998 MN To provide a regional integrated network of health care services through physicians, ambulatory care, and hospital facilites. 15 9 1026 200 3188506 -28739 156153 821177 90396482 90893889 517611 323029 461035 111323 91531281 92149418 0 0 0 0 58142233 59613681 0 0 0 36918640 36277354 95060873 95891035 -3529592 -3741617 80410378 72445113 45500652 49776398 34909726 22668715 Range Regional Health Care is an integrated health care system meeting the needs of our patients in an exemplary manner. 0 0 86308417 90893889 Range maintains and operates a hospital to provide medical and surgical care to the sick, infirm, aged, or injured. 86308417 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 1 133 0 1 1026 1 1 1 0 0 0 0 0 0 0 X 15 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JOHN D KRITZ 2183626657 750 E 34TH STREET HIBBING MN 55746 Charlie Crep 5.00 X 0 0 0 Kathy Sterk 4.00 X 0 0 0 Mike Raich 4.00 X 0 0 0 Dr Susan Rudberg 4.00 X 0 186132 22687 Brad Anderson 4.00 X 0 0 0 Dan Aageness 4.00 X 0 0 0 Scott Maki 4.00 X 0 0 0 Shelly Valentini 4.00 X 0 0 0 Rachel Sullivan 4.00 X 0 0 0 Dr Kristin Fredrickson 4.00 X 0 581729 45025 Dan Anderson 4.00 X 0 607046 48514 John Doherty 4.00 X 0 394760 51957 Debra Rudquist 4.00 X 0 0 0 Beth Gohdes 4.00 X 0 171130 20065 Mike Fay 4.00 X 0 0 0 Debra Boardman 40.00 X 0 300692 9296 John Kritz 40.00 X 191745 0 14858 Jim Bymark 40.00 X 150047 0 16944 David Hohl 40.00 X 144295 0 1021 Vicky Korynta 40.00 X 107800 0 5693 John Berland 40.00 X 228336 0 2459 Shelly A Maki 40.00 X 151583 0 881 Dr Richard Dinter 33.00 X 243107 0 15217 Dr Thomas Micka 24.00 X 219713 0 3885 Paula Lundell 40.00 X 183893 0 19443 Michael Patregani 40.00 X 184075 0 15025 John Buria 40.00 X 175105 0 11998 Gina Claugherty 40.00 X 163656 0 14447 Kenneth Klos 40.00 X 183597 0 6654 2326952 2241489 326069 13 0 1 0 Central Minnesota Diagnostic Inc 150 10th Street NW PO Box 158 Milaca MN 56353 Purchased Services 1924093 Emergency Practice Associates Inc 3840 W 9th Street Waterloo IA 50702 Professional Fees 1545087 Fairview Health Services 400 Stinson Blvd NE Minneapolis MN 55413 Professional Fees 988849 Max Gray Construction Inc 2501 5th Avenue W PO Box 689 Hibbing MN 55746 Construction Company 672570 Weatherby Locums Inc P O Box 972633 Dallas TX 75398 Professional Fees 586172 42 8542 41650 523827 247158 821177 NET PATIENT SERVICE RE 621500 87180932 87180932 HEALTHLINE 900099 3188506 3188506 CAFERERIA REVENUE 722210 524451 524451 90893889 377306 377306 111323 0 111323 111323 111323 14395 68672 -54277 -54277 -54277 92149418 87651106 3188506 488629 973806 829877 143929 44883865 38250030 6633835 3100916 2642601 458315 7338343 6253736 1084607 3316751 2826536 490215 40096 40096 67210 67210 10917995 10917995 3865616 3865616 725376 725376 5130311 5130311 SUPPLIES 10176606 10176606 BAD DEBT 2348200 2348200 TAXES 1946081 1921268 24813 OTHER 914207 914207 145656 124128 21528 95891035 86308417 9582618 0 4037863 1155957 7779398 2719537 13019283 11933488 1985220 2027895 1103646 1440861 94973995 55362366 39442413 39611629 337013 0 12705542 13555746 80410378 72445113 22874677 29238507 4188 10603 17578233 17255439 5043554 3271849 45500652 49776398 X 34909726 22360631 308084 34909726 22668715 80410378 72445113 X -3741617 -8499394 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 374539 374539 35799844 25865741 9934103 57230475 28299272 28931203 1569137 1197353 371784 39611629 Asset Limited As To Use 12332026 Diagnostic, Inc 1083168 Deferred Debt Acquisition 140552 13555746 1 1 X 1 X 120.000000000000 1 X 275.000000000000 1 1 1 0 1 1 2710616 2710616 0.02900 21704143 11851751 9852392 0.10530 24414759 11851751 12563008 0.13430 258441 258441 0.00280 517663 517663 0.00550 0 79184 79184 0.00080 855288 855288 0.00910 25270047 11851751 13418296 0.14340 1 2348200 46964 17506664 24580251 -7073587 X 1 0 1 1 Range Regional Health Services

750 East 34th St Hibbing MN 55746

X X X Range Regional Health Services 1 1 1 120.000000000000 1 275.000000000000 0 1 1 X X X X X X 1 X X 1 X X X X X 1 X 1 1 Part I, Line 3c: In support of our values and mission and in compliance with the Minnesota Attorney General Agreement signed by Fairview, Fairview is providing uninsured patients with a household income below $125,000 an uninsured discount on billed charges equivalent to Fairview's highest revenue private payer contracted rate for medically necessary services. Part I, L7 Col(f): The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. The amount of bad debt expense included on form 990, Part IX, line 25, column (A) but subtracted for purposes of calculating the percentages in column (f) is $2,348,200. Part II: Range Regional Health Services is a regional health care system based out of Hibbing, Minnesota and is comprised of Fairview University Medical Center - Mesabi, Fairview Mesaga Clinics, and Fairview Healthline. Fairview Range has clinics, medical supply stores, and provides home care/hospice/transportation services throughout the region.Range Regional Health Services is located in Northeastern Minnesota approximately 72 miles Northwest of Duluth and 190 miles due North of Minneapolis/St. Paul, Minnesota on what is called Minnesota's famed "Iron Range".For many of its services, Range Regional Health Services, serves a population base of over 133,000 residents. It covers a geographic range of 45 miles to the West, 100 miles to the North and 70 miles to the East and 30 miles to the South. Fairview Range is a true regional referral center for radiation, oncology and behavioral health services with patients coming from across North East Minnesota.The population Fairview Range serves is made up of approximately 66,080 males and 67,000 females with the mediam family annual income ranging from $33,500 to $37,000. Fairview Range has a diverse population made up of a variety of races and ethnic groups.With more than 60 local physicians and over 1,000 employees, Fairview Range has the largest active medical staff on the Iron Range and is the area's 2nd largest employer. Range Regional Health Services offers highly-advanced inpatient and outpatient medical services, and along with our professional staff, provides the most comprehensive health care services on the Iron Range and North to the Canadian Border.Range Regional Health Services utilizes true state-of-the-art technology, with some of the newest equipment and facilities in the region. With the installation of the most advanced CT Scanner in the area, a newly expanded and enhanced radiation oncology center, a new comprehensive breast center, and a new constructed and expanded emergency and urgent care center, Fairview Range truly provides the latest in high quality healthcare right in, or close by, your home community. Part III, Line 4: The provision for bad debts is based on management's assessment of historical and expected net collections considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. Fairview uses the cost to charge ratio method for determining expenses. Part III, Line 8: Range Regional Health Services uses the cost to charge ratio method for determining expenses. The Medicare cost to charge ratio reporting is calculated service line by service line. Other expenses are calculated using the overall cost to charge ratio.Medicare Advantage patients and not cost report services, plus non-allowable costs allocated to Medicare patients also generate a shortfall of $22,794,809 not included in Part III, Sec. B Line 7 or reported elsewhere. Part III, Line 9b: After our patients have received services, it is the policy of Range Regional Health Services to bill patients and their applicable payors on a timely and accurate basis. During this billing and collection process, Fairview staff committed to providing quality customer service and timely follow up on all outstanding accounts. Billing: It is the goal of Range Regional Health Services to bill all claims accurately and on a timely basis. Although dependent on information and communications from patients and payors, Range Regional Health Services will provide sufficient follow up service to ensure that patients receive accurate account and billing information and have the opportunity to make payment and/or apply for community care. Fairview Health Services has agreed to certain billing and collection practices by an agreement with the Minnesota Attorney General's office and Range Regional Health Services follows this agreement. There are financial counselors at every entity Monday through Friday who interact with the patients in person and over the phone to tell them about programs that are available as well as help them apply for the programs. The information about needing help paying the bill is on signs in the hospitals and materials are distributed to self pay patients by registration staff. The statements sent out after the visit provide this information too. If a patient/family member calls the Central Business Office customer service staff to say they need assistance paying the bill they are informed about options at that time as well. Range provides a service that you call and this service interprets conversaton over the phone. This service can be used either as a three way phone call or the Financial Counselor, in a room with the patient or family can make the call together to the interpreter phone service. The interpreter services has close to 200 languages.The billing process will be assisted by the following guidelines:1) For all insured patients, Range will bill all third party payor information (as provided by or verified by the patient) on a timely and accurate basis.2) For all uninsured patients with Minnesota residency receiving hospital based services deemed medically necessary. Fairview will apply an uninsured discount equal to the discount provider to our largest contracted non-government payor, any remaining balance will be billed to the patient in a timely and manner.3) All billed patients have the opportunity to contact Range regarding financial assistance for their accounts. Financial assistance may include Community Care, payment arrangements, medical assistance or other applicable programs.4) If a patient contacts Range Regional Health Services regarding Community Care, the account will not be referred to a collection agency or attorney. Once the application and required documentation is received (income verification etc.), the account will then be processed based on the outcome of the Community Care determination.5) If a patient contacts Range Regional Health Services regarding Community Care after their account has been referred to a collection agency or attorney, Fairview will send an application to the patient provided the account meets the Community Care requirements. If the completed application with required documents (income verification, etc.) is submitted, all collection action will be suspended until the patient is notified of Range's determination. Range Regional Health Services Part V, Section B, Line 9: In support of our values and mission and in compliance with the Minnesota Attorney General Agreement signed by Range Regional Health Services, Range Regional Health Services is providing uninsured patients with a household income below $125,000 an uninsured discount on billed charges equivalent to Range Regional Health Services' highest revenue private payer contracted rate for medically necessary services. Range Regional Health Services Part V, Section B, Line 10: Patients with incomes up to 275% of the federal poverty level qualify for a 100% discount on total charges. Therefore, no determination has to be made on the maximum amount that can be charged to FAP-eligible individuals for emergency or other medically necessary care. Range Regional Health Services Part V, Section B, Line 15e: It is the goal of Range Regional Health Services to bill all claims accurately and on a timely basis. Although dependent on information and communication from patients and payors, Range Regional Health Services will provide sufficient follow up service to ensure that patients receive accurate account and billing information and have the opportunity to make payment and or apply for Community Care. Range Regional Health Services Part V, Section B, Line 19d: Fairview Range Community Care Program, Discount program, and other charity care plans do not cover the following: Those procedures that are not medically necessary, cosmetic, pharmacy, hearing aids, chiropractic services, services not covered by Minnesota Medical Assistance and other insurances, services which you may be responsible for if you do not receive county assistance, professional services rendered at our facilities by independent physicians, out-of-network services, hospice, homecare, DME, Greenview alzheimer's, retail store, foreign or out of state services, services that would have qualified for insurance coverage if received at another facility or services not billed or received at Fairview Range. Range Regional Health Services Part V, Section B, Line 21: Patients who do not comply with the Community Care application process may be denied Community Care. Patients who have insurance and payment has not been received from the insurance company will be denied Community Care if the applicant fails to cooperate with claims filing or collecting from potential third party resources. Other exclusions include services from non-Range Regional Health Services providers, other Range Regional Health Services providers not covered by the Charity Care policy and expenses related to transportation or personal living expenses. Non-US Citizens are not eligible for Community Care unless they are an undocumented alien and have established residence in the United States. Out-of-state residents are not eligible for 100 percent Community Care Discount. Part VI, Line 2: Community needs assessments are conducted by Fairview corporate community health department staff every year on a rolling three year cycle for the primary service areas within Fairview Health Services. Year 1: Basic Demographic Assessments Year 2: Adolescent Assessments Year 3: Site or Issue Specific Assessments (e.g. analysis of charity care patients). Staff begin with existing community documents to build a baseline of information. This information may include patient data, existing recent social and cultural reports, education and business reports, new demographic information about income, housing, education and more. Next, staff conduct key interviews with community leaders from diverse sectors: social services, philanthrophy, government, health, education, business, minority groups, faith groups. Interviews allow assumptions to be validated and new information to be gathered. In addition, site community health staff partner with local public health departments and other community groups as part of their supplemental assessment of community need and/or to utilize the findings from their groups to better understand their communities. Fairview Health Services and Range Regional Health Services participate in the State Health Improvement Program (SHIP) community assessments. Range Regional Health Services financially sponsored the Bridge to Health Survey which is a population-based health status survey conducted in Northeastern Minnesota and Northwestern Wisconsin. Data from this survey is utilized in program planning.Identified needs include adolescent health based on the assessment of diet, nutrition and exercise. Part VI, Line 4: Beyond the formal needs assessments, Fairview leadership is engaged in their respective communities. Involvement includes participation on community boards, foundations, schools and more. Fairview also seeks community involvement through, community leaders serving on hospital boards and committees. Information gleaned through these connections are equally as important as the formal needs assessments. These connections can often identify emerging issues. Part VI, Line 5: Range Regional Health Services is governed by an unpaid Board of Directors. The majority of the directors are community members who represent the various service areas and entities within the system.As a nonprofit health system Fairview Range reinvests and excess revenues beyond expenses into the core operations of the organization. In 2009, Fairview Range started a three-year project to immplement an integrated electronic medical record across thecontinuum. This is a significant investment in critical quality and efficiency. Fairview Range partners with Myriad higher education institutions to provide clinical hand-on training for future nurses, pharmacists, laboratory professionals and more.Fairview Range is an active community member. Leaders from Range Hospital and Clinics are involved in their community through leadership on community boards,legislative and regulatory boards and much more.When someone is sick or injured, the emergency departments (ED) at Fairview Range serve as front door for all individuals seeking medical care. The EDs are part of a critical safety net of services for uninsured individuals and families. For individuals who are unable to pay for their care, Fairview Range offers charity care on a sliding fee based on income. Fairview Range also provides an automatic discount on all bills for uninsured individuals. The discount is equal to the discount provided to the organization's largest commercial insurer.Range Hospital and Clinics participate in government programs such as medicare, medicaid, general assistance and tricare. Range Regional Health Services provides for a large number of individuals covered by medicaid. The amount of medicaid volume make Range Hospital a disproportionate share recipient. Part VI, Line 6: Range Regional Health Services is an affiliate of Fairview Health Services, an integrated health care system headquartered in Minneapolis, Minnesota. Based on the health care needs in that service area, community benefit activity is carried out by staff/leadership at that facility. The Fairview Health Services Corporate Community Health Department supports the local effort by sharing best practices, finding efficiencies amoung hospital community health leaders as appropriate, coordinating the formal community needs assessments and more including medical staff that provide services at Project Care-Free Clinics. These same efforts take place at Range Regional Health Services. Reports Filed With States Part VI, Line 7 MN X X X X 0 0 0 0 0 1 0 0 0 Dr Susan Rudberg 0 186132 0 0 0 0 0 21405 0 1282 0 208819 0 0 Dr Kristin Fredrickson 0 581729 0 0 0 0 0 28175 0 16850 0 626754 0 0 Dan Anderson 0 504393 0 99063 0 3590 0 28479 0 20035 0 655560 0 0 John Doherty 0 323460 0 71300 0 0 0 19116 0 32841 0 446717 0 0 Beth Gohdes 0 163497 0 7633 0 0 0 1785 0 18280 0 191195 0 0 Debra Boardman 0 260599 0 40093 0 0 0 2800 0 6496 0 309988 0 0 John Kritz 191745 0 0 0 0 0 0 0 14858 0 206603 0 0 0 Jim Bymark 150047 0 0 0 0 0 0 0 16944 0 166991 0 0 0 John Berland 67009 0 0 0 161327 0 0 0 2459 0 230795 0 0 0 Shelly A Maki 151583 0 0 0 0 0 0 0 881 0 152464 0 0 0 Dr Richard Dinter 243107 0 0 0 0 0 0 0 15217 0 258324 0 0 0 Dr Thomas Micka 219713 0 0 0 0 0 0 0 3885 0 223598 0 0 0 Paula Lundell 183893 0 0 0 0 0 5655 0 13788 0 203336 0 0 0 Michael Patregani 184075 0 0 0 0 0 0 0 15025 0 199100 0 0 0 John Buria 175105 0 0 0 0 0 5300 0 6698 0 187103 0 0 0 Gina Claugherty 163656 0 0 0 0 0 4858 0 9589 0 178103 0 0 0 Kenneth Klos 183597 0 0 0 0 0 5483 0 1171 0 190251 0 0 0 CITY OF MINNEAPOLIS 616005375 60374VCH4 2008-11-12 8868000 REFUNDED 2005B REFUNDING 2000A 0 0 0 CITY OF MINNEAPOLIS 616005375 60374VCH4 2008-10-29 7870000 AMBULATORY SERVICES CONSTRUCTION 0 0 0 8868000 919000 7821000 128000 8740000 0 0 0 0 7870000 69000 7801000 2011 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 1 Michael Fay Board Member 38633 Insurance Commission 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the Board of Directors before it is filed. Form 990, Part VI, Section B, line 12c The board annually completes a conflict of interest statement. The CFO discloses the conflicts to the entire board. The CFO montors board motions to ensure disclosure of potential conflicts with votes. Form 990, Part VI, Section B, line 15 Compensation is market based and based on data compiled by Fairview Health Services Corporate Human Resources. Form 990, Part VI, Section C, line 18 The documents are available upon request in the organization's administration office. Form 990, Part VI, Section C, line 19 The documents are available upon request in the organization's administration office. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -602,851. Additional Liability Due to Health Insurance Reserves -7,117,413. Additional Liability Third Party Payable -112,191. Additional Liability Associated With Benefit Plan -666,939. Total to Form 990, Part XI, Line 5: -8,499,394. Form 990, Part X1, Line 2C The organization has a committee that assumes responsibility of the Audit of its financial statements and the selection of an independent accountant. Healthline LLC 750 East 34th Street Hibbing MN 55746 Hospice Home Care DE 0 University Medical Center - Mesabi Auxiliary 750 East 34th Street Hibbing MN 55746 411452117 Auxiliary MN Fairview Health Services 2450 Riverside Avenue Minneapolis MN 55454 410991680 Health Care MN 501(c)(3) 170(B)(1)(A) N/A 0 Mesaba Clinic 3605 Mayfair Avenue Hibbing MN 55746 411805715 Medical Services MN C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0