2011-08-15T09:14:58-05:00 2010-09-30 Eide Bailly LLP 5601 Green Valley Drive Ste 700 Minneapolis MN 554371145 990 2009-10-01 411804205 LifeCare Medical Center LIFE 2184632500 715 Delmore Drive Roseau MN 56751 Keith Okeson 2184632500 2011-08-11 1 Kim Hunwardsen CPA 9529446166 2011-08-11 2009 2016-02-24 21:20:13Z Keith Okeson 715 Delmore Drive Roseau MN 56751 36274832 0 X www.lifecaremedicalcenter.org X 1995 MN Promotion of Health 13 13 526 300 1981 78 130354 451009 36183210 35090595 699926 447121 -8081 -1171 37005409 35987554 4500 3000 0 18881597 19494452 0 0 13270981 13260272 32157078 32757724 4848331 3229830 48389278 50605471 12827607 11813970 35561671 38791501 To provide care for a healthy life 0 0 27431575 3000 35088614 LifeCare Medical Center operates a 25-bed acute care hospital, including a 64-bed nursing facility, home health, hospice, and public health in Roseau, Minnesota. The organization also operates a 50-bed nursing home in Greenbush, Minnesota. The purpose of the organization is to own, maintain, and operate a hospital, nursing homes, furnish medical and surgical care to the sick, infirmed, or injured.Acute Care Hospital (Inpatient and Outpatient)Inpatient days: 2,142Outpatient visits: 33,626Long Term CareLifeCare Roseau Manor Resident Days: 22,560LifeCare Greenbush Manor Resident Days: 16,676Home Health/Public Health Visits: 15,922Hospice Clients Served: 24To fulfill its mission of community service, LifeCare Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The amount of charges foregone, based on established rates, was $428,929 for the year ended September 30, 2010. 27431575 1 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 75 0 1 526 1 1 1 0 0 0 0 0 0 0 0 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Cathy Huss 2184634763 715 Delmore Drive Roseau MN 56751 Cory Vatnsdal 1.00 X X 2025 0 0 Carolyn Eeg 1.00 X X 600 0 0 Carmen Przekwas 1.00 X X 1875 0 0 Therese McBride 1.00 X X 975 0 0 Brenda Sather 1.00 X 1050 0 0 Ralph Herseth MD 1.00 X 1050 0 0 Paul Everson 1.00 X 975 0 0 Jon Johnson 1.00 X 900 0 0 Mark Wilson 1.00 X 1200 0 0 Pete Granger 1.00 X 900 0 0 Steve Haugen 1.00 X 750 0 0 Pete Helgeson 1.00 X 600 0 0 Chuck Lindner 1.00 X 1050 0 0 Cathy Huss 40.00 X 142414 0 29930 Keith Okeson 40.00 X 186430 0 39837 Gordon Streiff 40.00 X 121291 0 34583 Sue Lisell 40.00 X 142747 0 17129 Shannon D Carlson 40.00 X 103902 0 27836 Judy K Mattson 40.00 X 109892 0 33408 820626 0 182723 6 0 1 0 Olaf Anderson & Son Construction Inc PO Box 2766 Fargo ND 58108 Construction 2660639 Wapiti Medical Group PO Box 92 Newell SD 57760 Locum Physicians 1088549 Grand Forks Heating AC and Sheet Metal 2800 Gateway Dr Grand Forks ND 58203 Construction 1077369 CMDI 150 10th St NW Milaca MN 56353 Radiology Services 598250 Falls Electric 720 Dawn Ave Thief River Falls MN 56701 Construction 500476 15 38908 412101 451009 Net Patient Service re 622110 34327953 34327953 Other Revenue 621500 762642 760661 1981 35090595 451950 451950 281278 282449 -1171 -1171 -1171 4829 -4829 -4829 -4829 35987554 35088614 1981 445950 3000 3000 448611 448611 14447129 12578495 1868634 475795 422283 53512 3067109 2630455 436654 1055808 895054 160754 64151 64151 3436707 3216223 220484 140821 140821 5064563 4202627 861936 209 209 523230 515236 7994 420958 380539 40419 64848 26478 38370 318946 318946 1497775 1497775 133342 133342 Surcharge Fees 586704 586704 Bad Debt Expense 371523 371523 MN Care Tax 322004 322004 0 Miscellaneous 314491 50937 263554 32757724 27431575 5326149 0 5874615 6049003 5697094 4613215 429614 422852 158455 121217 39274362 17698979 16435937 21575383 18768594 16357120 580723 605941 160409 224931 283837 635809 48389278 50605471 4779016 4616864 7693634 7187725 11362 9381 343595 0 12827607 11813970 X 35561671 38791501 35561671 38791501 48389278 50605471 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 31240 31240 20140851 10396321 9744530 9534479 6881204 2653275 9567792 421454 9146338 21575383 35987554 32757724 3229830 0 3229830 36270003 0 36270003 -282449 -282449 35987554 33040173 282449 282449 32757724 0 32757724 Part IV, Line 2b: The Medical Center acts as custodian for the funds of the residents. These funds are included with cash and cash equivalents and accounts payable - trade in these financial statements. Funds for residents and others totaled $9,381 at September 30,2010. Part X: Description of Uncertain Tax Positions Under FIN 48: The Medical Center undergoes an annual analysis of its various tax positions, assessing the likelihood of those positions being upheld upon examination with relevant tax authorities. No amounts were recorded as a result of this analysis during the years ended September 30, 2010 and 2009. If the Medical Center is subject to interest or penalties related on underpaid income taxes, they will be recorded as income tax expense. Under normal circumstances, the Corporation is no longer subject to Federal and state tax examinations by tax authorities for years before 2007. Part XII, Line 4b - Other Adjustments: Rental Expense Recorded in Expense for Financial Statements: -282449. Part XIII, Line 2d - Other Adjustments: Rental Expense Recorded in Expense for Financial Statements: 282449. 1 1 X 1 X 0 1 1 1 0 1 1 221387 221387 0.00680 4527681 4563918 -36237 0.00000 4749068 4563918 185150 0.00680 165931 565 165366 0.00510 53930 53930 0.00170 10470193 7347973 3122220 0.09640 8770 8770 0.00000 10698824 7348538 3350286 0.10320 15447892 11912456 3535436 0.11000 19612 19612 0.00060 4288 4288 0.00010 125535 125535 0.00390 149435 149435 0.00460 0 191758 2080 5252171 5200169 52002 X 1 0 LifeCare Medical Center

715 Delmore Drive Roseau MN 56751

X X X X X Urgent Care LifeCare Roseau Manor

715 Delmore Drive Roseau MN 56751

Skilled Nursing Facility LifeCare Greenbush Manor

19120 290th Street Greenbush MN 56726

Skilled Nursing Facility LifeCare Home Care and Hospice

715 Delmore Drive Roseau MN 56751

Home Health and Hospice Part I, Line 3c: The organization does not provide discounted care. Part I, Line 6a: Part I, Line 7: Charity care was converted to cost using the cost-to-charge ratio derived from Worksheet 2. Medicaid was converted to cost using the cost-to-charge ratio derived from Worksheet 2. Community health improvements and cash and in-kind contributions are calculated at actual costs recorded in the general ledger. Education costs are based on estimated time and wages to manage students and interns at the facilities. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare Cost Report. Part I, Line 7g: Costs related to a physician's clinic is $184,674. Part I, Line 7f: The amount of bad debt expense removed from total expenses to determine the percentage was $371,523. Part III, Line 4: Bad debt was converted to cost using the cost-to charge ratio derived from Worksheet 2.The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is calculated by using gross charity care at charge as a percentage of total gross hospital revenue. It is reasonable to assume that charity care as a percentage of gross revenue can also be applied to bad debt.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Financial Statement Note:The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third-party payors. Management reviews patient and resident 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 and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Part III, Line 8: Medicare allowable costs of care are based on Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. Part V: Part I, Line 6b: The organization's community benefit report can be found on its website at lifecaremedicalcenter.org and is shared with service area residents in an annual newsletter that focuses on community benefit. Part VI, Line 2: LifeCare provides the Public Health functions for the Roseau County. Through this role, we participate in a community needs assessment through Quinn County to assess the needs of our service area. Part VI, Line 3: We have financial counselors who have phone conversations with patients during our collections process. We guide patients to other financial programs as well as our own charity care program. Brochures are available in the admitting area which is in the same location as the Emergency Room. Information is also sent to our patients via patient bills. Our website does have a brief description of our charity care program and a phone number to reach a financial counselor. Our new website will also have the charity care application and brochure. Part VI, Line 4: Roseau County is a rural area with a population of approximately 17,000 people. We are the sole hospital located in Roseau County and the nearest tertiary hospital is two hours away. We are a federally-designated medically underserved area. In 2009, approximately 12.7% of the population was age 65 or older. The average per capita income is 23,061 and approximately 9.7% of the population is below the federal poverty level. Part VI, Line 5: Community support includes donations to local community organizations and employee staff time donated to local community committees. Environmental improvements include employee time called the Green Team. Employees of the Green Team managed the process for creating other recycling opportunities for its employees that would not otherwise be available to the them. The Hospital also had a couple of employees who met with the City of Greenbush to discuss water treatment and improvements of the city. By being involved in the community through the above activities, we are able to increase health awareness.Roseau County is considered a Health Professional Shortage Area and therefore is including the costs of recruitment in workforce development. This promotes better care for our patients. Part VI, Line 6: The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay. MN X X X X 0 0 0 0 0 0 0 0 0 Cathy Huss 142414 0 0 0 0 0 9098 0 20832 0 172344 0 0 0 Keith Okeson 186430 0 0 0 0 0 11980 0 27857 0 226267 0 0 0 Gordon Streiff 121291 0 0 0 0 0 8011 0 26572 0 155874 0 0 0 Sue Lisell 142747 0 0 0 0 0 8725 0 8404 0 159876 0 0 0 Form 990, Part VI, Section A, line 1 The organization has an Executive Committee which has the authority to act on behalf of the Board of Trustees between regularly scheduled board meetings. The Executive Committee consists of the board's officers (Chair, Vice Chair, Secretary and Treasurer) as well as one member-at-large from the Board of Trustees. Form 990, Part VI, Section B, line 11 The return is made available to the Board of Trustees before it is filed. The return is reviewed initially by the CFO. Form 990, Part VI, Section B, line 12c All officers, trustees, and key employees are required to complete a conflict of interest form annually. The form is reviewed by the Board of Trustees to determine if any conflicts exist. If there are any conflicts, the Board of Trustees will discuss the restrictions that should be placed on the person with the conflict. Restrictions are typically related to voting and discussion of matters related to the conflict. Form 990, Part VI, Section B, line 15 The compensation for the CEO and CFO is approved by the Executive Committee based on comparability data. The CEO and CFO both have employment contracts. The deliberation and discussion of compensation is documented in the board meeting minutes. This process takes place on an annual basis. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available upon request.