2012-05-09T11:38:10-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 411806657 CENTRACARE CLINIC CENT 3202525131 1200 6TH AVENUE NORTH ST CLOUD MN 56303 ALLEN E HORN MD 3202525131 2012-05-01 1 6123764500 2010 2016-02-24 21:20:13Z ALLEN E HORN MD 1200 6TH AVENUE NORTH ST CLOUD MN 56303 161341335 0 X WWW.CENTRACARE.COM X 1995 MN WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. 10 4 1030 4 0 0 14010411 17110663 139022444 144014296 60976 50414 162535 165962 153256366 161341335 8020 6214 0 0 108090034 112072711 0 0 0 44352423 46142671 152450477 158221596 805889 3119739 30905388 36058547 24067083 26100503 6838305 9958044 X WE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE. 0 0 140833436 6214 144014296 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, 2011:LABORATORY: 556,910IMMUNIZATION & INJECTION: 536,888CLINIC VISITS: 268,383SURGICAL: 132,876HOSPITAL VISITS: 125,328PROFESSIONAL INTERPRETATION: 53,359RADIOLOGY: 29,588SURGERY (MINOR): 29,611OUTREACH: 16,884SPECIAL PROCEDURES: 40,444RADIATION ONCOLOGY: 14,406NURSING HOME VISITS: 5,090 140833436 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 101 0 1 1030 1 0 0 0 0 0 0 0 0 0 0 X 10 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X THOMAS FELDHEGE 3202402152 1200 SIXTH AVENUE NORTH ST CLOUD MN 56303 ALLEN E HORN MD 40.00 X X 472107 0 111677 THOMAS CRESS MD 1.00 X 0 3500 0 KEITH LEAVELL MD 40.00 X 455933 0 65365 THOMAS W LEITHER MD 40.00 X X 373382 0 44293 DEBORAH L MCCARL MD 40.00 X 280818 0 57173 DAVID ROBERTS MD 40.00 X 615682 0 42618 DENISE ROSIN 1.00 X 0 0 0 GENE WINDFELDT 1.00 X 0 1000 0 KATHLEEN KULUS MD 40.00 X 225806 0 38311 GLEN FORBES 1.00 X 0 0 0 THOMAS M FELDHEGE 40.00 X 176869 0 53752 MARK J MURPHY 40.00 X 255444 0 63035 DAVID J TILSTRA MD 40.00 X 290518 0 76666 BERNARD R ERICKSON MD 40.00 X 850719 0 41687 HANI S AL-KHATIB MD 40.00 X 931384 0 41738 RANDY C SALIARES MD 40.00 X 927765 0 46308 JOHN TESKEY MD 40.00 X 835545 0 64240 RACHEL SCHUNEMAN MD 40.00 X 811507 0 33054 7503479 4500 779917 218 0 1 0 DERMATOPATHOLOGY ASSOCIATES 7205 UNIVERSITY AVE NE MINNEAPOLIS MN 55540 LABORATORY SERVICES 606391 MEDICAL DOCTOR ASSOCIATES PO BOX 277185 ATLANTA GA 303847185 PHYSICIAN SERVICES 407154 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 365311 COMPHEALTH MEDICAL STAFFING PO BOX 972651 DALLAS TX 753972651 PHYSICIAN SERVICES 315997 WHITESELL MEDICAL STAFFING LTD 1630 ANDERSON AVENUE SUITE 100 BUFFALO MN 55313 PHYSICIAN SERVICES 285727 11 17110663 17110663 PATIENT REVENUES 621110 128181923 128181923 OTHER REVENUE 900099 15832373 15832373 144014296 50414 50414 165962 165962 165962 165962 161341335 144014296 0 216376 6214 6214 3312268 2593964 718304 88856152 87132696 1723456 4558191 4463387 94804 10926730 10735207 191523 4419370 4307377 111993 402357 402357 31660 31660 8389431 7329984 1059447 257875 138964 118911 3411936 1962207 1449729 1999891 1999891 6284724 384517 5900207 187759 187759 1056608 1056608 1172043 1172043 1721554 1649258 72296 MEDICAL SUPPLIES 12584847 12584847 BAD DEBT EXPENSE 4286851 4286851 OTHER EXPENSES 1530959 1020844 510115 MN CARE TAX 1509915 1509915 REPAIRS & MAINTENANCE 1305793 1305793 8468 8468 158221596 140833436 17388160 0 598851 5682 5107061 11211434 14337566 14575217 945717 1172028 1156750 1067713 481582 457507 16076734 13526856 3617012 2549878 4660849 5019088 30905388 36058547 18653324 20080801 5413759 6019702 24067083 26100503 X 6838305 9958044 6838305 9958044 30905388 36058547 3119739 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 500 0 0 0 0 1 3172 3672 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: AMOUNTS ARE EXPENDED FOR CONTACT WITH LEGISLATORS RELATING TO GOVERNMENTAL REIMBURSEMENTS FOR HEALTH CARE SERVICES. CENTRACARE CLINIC PAID $3,172 TO STATE AND NATIONAL ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON ITS BEHALF AS A MEMBER OF THE ASSOCIATIONS. 1910804 1003867 906937 14080435 12522989 1557446 85495 85495 2549878 FUNDS HELD BY TRUSTEE 3282780 DUE FROM RELATED ORGANIZATIONS 1736308 5019088 DEFERRED COMPENSATION PLAN OBLIGATIONS 3282780 DUE TO RELATED ORGANIZATIONS 2736922 6019702 161341335 158221596 3119739 0 3119739 144850401 0 144850401 16490934 16490934 161341335 158221596 0 158221596 0 158221596 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTEREST AND INVESTMENT INCOME 50,414. EQUITY TRANSFER FROM AFFILIATE 16,440,520. 1 X PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. X X X X X 0 1 0 0 0 1 1 0 0 ALLEN E HORN MD 333845 0 114022 0 24240 0 81010 0 30667 0 583784 0 18646 0 KEITH LEAVELL MD 396496 0 57981 0 1456 0 34875 0 30490 0 521298 0 0 0 THOMAS W LEITHER MD 317019 0 52874 0 3489 0 18980 0 25313 0 417675 0 0 0 DEBORAH L MCCARL MD 233022 0 45974 0 1822 0 33024 0 24149 0 337991 0 0 0 DAVID ROBERTS MD 549043 0 63887 0 2752 0 18375 0 24243 0 658300 0 0 0 KATHLEEN KULUS MD 184619 0 40911 0 276 0 16171 0 22140 0 264117 0 0 0 THOMAS M FELDHEGE 159077 0 17353 0 439 0 30848 0 22904 0 230621 0 0 0 MARK J MURPHY 203895 0 49406 0 2143 0 36331 0 26704 0 318479 0 0 0 DAVID J TILSTRA MD 221786 0 66864 0 1868 0 50593 0 26073 0 367184 0 0 0 BERNARD R ERICKSON MD 781413 0 66577 0 2729 0 18375 0 23312 0 892406 0 0 0 HANI S AL-KHATIB MD 854325 0 74814 0 2245 0 14700 0 27038 0 973122 0 0 0 RANDY C SALIARES MD 544482 0 63387 0 319896 0 18375 0 27933 0 974073 0 0 0 JOHN TESKEY MD 770308 0 63415 0 1822 0 34875 0 29365 0 899785 0 0 0 RACHEL SCHUNEMAN MD 741627 0 69604 0 276 0 18375 0 14679 0 844561 0 0 0 PART I, LINE 4B 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: RANDY C. SALIARES, MD - $316,989 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. FORM 990, PART VI, SECTION A, LINE 1 BOARD MEMBERS DO NOT HAVE EQUAL VOTING RIGHTS. THE FOUR CORPORATE DIRECTORS EACH HAVE TWO VOTES. THE FIVE PHYSICIAN DIRECTORS EACH HAVE ONE VOTE. ADDITIONALLY, 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 THE FOUR CORPORATE DIRECTORS ARE APPOINTED BY THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B CENTRACARE HEALTH SYSTEM, THE SOLE CORPORATE MEMBER, RESERVES ACTION ON THE FOLLOWING ITEMS: ADOPTION AND AMENDMENT TO THE ARTICLES AND BYLAWS; APPOINTMENT OF DIRECTORS; APPROVAL OF THE CORPORATION'S OPERATING AND CAPITAL BUDGETS; APPROVAL OF STRATEGIC PLANS; DISSOLUTION OR DISCONTINUATION OF THE BUSINESS; APPROVAL OF ANY TRANSACTION THAT MAY AFFECT THE CORPORATIONS EXEMPT STATUS; APPROVAL OF THE APPOINTMENT OF THE CORPORATION; APPROVAL OF ANY USE OF TRADE NAMES OR INTELLECTUAL PROPERTY OF THE CORPORATION; AND APPROVAL OF THE MERGER, ACQUISITION OR AFFILIATION OF ANY HOSPITAL, CLINIC OR PHYSICIAN PROVIDER GROUP. 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 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 2011; THE LAST COMPENSATION REVIEW IN 2011. THE ORGANIZATION'S EMPLOYED 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 2011. THE VICE PRESIDENTS (NON-MEDICAL PROVIDERS) ARE SUBJECT TO BIENNUAL 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 2010; THE LAST COMPENSATION REVIEW IN 2011. 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. AVERAGE WEEKLY HOURS 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. 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 CCHS & CCHS-LP 0 CENTRACARE HEALTH SERVICES - LONG PRAIRIE 20 SOUTHEAST 9TH STREET LONG PRAIRIE MN 56347 411924645 ACUTE & LONG-TERM CARE MN 501(C)(3) 3 CCHS & CCHS-MELROSE 0 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 CENTRACARE PHARMACY SERVICES INC 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411620618 RETAIL PHARMACY MN N/A C 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1