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CENTRACARE CLINIC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CENTRACARE CLINIC (EIN 41-1806657)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-03
IRS object ID
201111239349300011
Schema version
2009v1.7
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-03T09:41:55-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN411806657EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Centracare ClinicBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCENTNameControl
Phone3202525131Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11200 6th Avenue NorthAddressLine1
CitySt CloudCity
StateMNState
ZIP Code56303ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameAllen E Horn MDName
TitlePresident & CEOTitle
Phone3202525131Phone
Date Signed2011-04-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonAllen E Horn MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11200 6th Avenue NorthAddressLine1
CitySt CloudCity
StateMNState
ZIP Code56303ZIPCode
FieldValueIRS element (for citing)
Gross Receipts153328105GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.CENTRACARE.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionWE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees1000TotalNbrEmployees
Total Nbr Volunteers4TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year11731160ContributionsGrantsPriorYear
Contributions Grants Current Year14010411ContributionsGrantsCurrentYear
Program Service Revenue Prior Year132484813ProgramServiceRevenuePriorYear
Program Service Revenue CY139022444ProgramServiceRevenueCY
Investment Income Prior Year65754InvestmentIncomePriorYear
Investment Income Current Year60976InvestmentIncomeCurrentYear
Other Revenue Prior Year168409OtherRevenuePriorYear
Other Revenue Current Year162535OtherRevenueCurrentYear
Total Revenue Prior Year144450136TotalRevenuePriorYear
Total Revenue Current Year153256366TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year5151GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY8020GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year102724573SalariesEtcPriorYear
Salaries Etc Current Year108090034SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year41927980OtherExpensePriorYear
Other Expenses Current Year44352423OtherExpensesCurrentYear
Total Expenses Prior Year144657704TotalExpensesPriorYear
Total Expenses Current Year152450477TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-207568RevenuesLessExpensesPriorYear
Revenues Less Expenses CY805889RevenuesLessExpensesCY
Total Assets BOY28458289TotalAssetsBOY
Total Assets EOY30905388TotalAssetsEOY
Total Liabilities BOY22425873TotalLiabilitiesBOY
Total Liabilities EOY24067083TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6032416NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6838305NetAssetsOrFundBalancesEOY
Mission DescriptionWE ARE DEDICATED TO PROVIDING EXCELLENT SERVICE AND THE HIGHEST QUALITY OF CARE TO THOSE WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense135930480Expense
Grants8020Grants
Revenue139022444Revenue
DescriptionTHE ORGANIZATION PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY. THIS INCLUDES HEALTHCARE EDUCATION AND RESEARCH, AS WELL 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, 2010:LABORATORY: 617,869IMMUNIZATION & INJECTION: 587,700CLINIC VISITS: 298,303SURGICAL: 132,041HOSPITAL VISITS: 122,736PROFESSIONAL INTERPRETATION: 70,201RADIOLOGY: 35,118SURGERY (MINOR): 25,439OUTREACH: 25,982SPECIAL PROCEDURES: 25,562RADIATION ONCOLOGY: 13,480NURSING HOME VISITS: 8,200Description
Total Program Service Expense135930480TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096101NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1000NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTHOMAS FELDHEGENamePerson
Telephone Number3202402152TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11200 SIXTH AVENUE NORTHAddressLine1
CitySt CloudCity
StateMNState
ZIP Code56303ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Allen E Horn MD
PRESIDENT & CEO40.00XX484497094073
Scot W Hutton MD
VP & GastroentEROLOGIST40.00XX5489610102270
THOMAS M FELDHEGE
TREASURER & CFO40.00XX171352052333
THOMAS CRESS MD
CHAIR1.00XX040000
KEITH LEAVELL MD
DIRECTOR & PULMONOLOGIST40.00X435061062753
Thomas W Leither MD
Director & Nephrologist40.00X368628150042068
DEBORAH L MCCARL MD
DIRECTOR & OBSTETRICIAN40.00X267753057231
DAVID ROBERTS MD
DIRECTOR & GASTROENTEROLOGIST40.00X610034041506
DENISE ROSIN
DIRECTOR1.00X000
Gene Windfeldt
Director1.00X000
KATHLEEN KULUS MD
PEDIATRICIAN & DIRECTOR40.00X237906037325
Glen Frobes
Director1.00X000
Mark J Murphy
VP - OPERATIONS40.00265471060070X
DAVID J TILSTRA MD
MEDICAL DIRECTOR & GENETICIST40.00293355079553X
BERNARD R ERICKSON MD
INTERVENT. CARDIOLOGIST40.00928120041969X
HANI S AL-kHATIB MD
MEDICAL oncologist40.00913800038130X
BARBI KAPLAN-FRENKEL DO
RADIATION ONCOLOGIST40.00843150046515X
Wade T Schmidt MD
CARDIOLOGIST40.00836404049383X
MARK J MARTONE MD
CARDIOLOGIST40.00825056062217X
FieldValueIRS element (for citing)
Total Reportable Comp From Org8029548TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs5500TotalReportableCompFrmRltdOrgs
Total Other Compensation867396TotalOtherCompensation
Number Individuals GT100 K213NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
DERMATOPATHOLOGY ASSOCIATES
7205 UNIVERSITY AVE NEMINNEAPOLISMN55540LABORATORY SERVICES588899
MEDICAL DOCTOR ASSOCIATES
PO BOX 277185ATLANTAGA303847185PHYSICIAN SERVICES468216
COMPHEALTH MEDICAL STAFFING
PO BOX 972651DALLASTX753972651PHYSICIAN SERVICES441827
REGIONAL DIAGNOSTIC RADIOLOGY
1406 SIXTH AVENUE NORTHST CLOUDMN56303RADIOLOGY SERVICES229570
WEATHERBY LOCUMS INC
PO BOX 972633DALLASTX753972633PHYSICIAN SERVICES184458
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
Related Organizations14010411RelatedOrganizations
Total Contributions14010411TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Revenues621110129801982129801982
OTHER REVENUE90009992204629220462
FieldValueIRS element (for citing)
Total Program Service Revenue139022444TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column58546TotalRevenueColumn
Exclusion$58,546ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real162535Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real162535Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column162535TotalRevenueColumn
Exclusion$162,535ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other74169Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other71739Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other2430Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2430TotalRevenueColumn
Exclusion$2,430ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column153256366TotalRevenueColumn
Related Or Exempt Function Income139022444RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$223,511ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total8020Total
Program Services8020ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4020493Total
Program Services3058329ProgramServices
Management And General962164ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total84402914Total
Program Services83156311ProgramServices
Management And General1246603ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4392567Total
Program Services4328145ProgramServices
Management And General64422ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10965515Total
Program Services10829154ProgramServices
Management And General136361ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4308545Total
Program Services4208508ProgramServices
Management And General100037ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total157157Total
Management And General157157ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total31694Total
Management And General31694ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8971627Total
Program Services7839395ProgramServices
Management And General1132232ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total324975Total
Program Services167805ProgramServices
Management And General157170ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3668265Total
Program Services2097711ProgramServices
Management And General1570554ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1942373Total
Management And General1942373ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5844431Total
Program Services377781ProgramServices
Management And General5466650ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total218212Total
Management And General218212ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total926014Total
Program Services926014ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1619564Total
Program Services1619564ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1428190Total
Program Services1354764ProgramServices
Management And General73426ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES1199937711999377
BAD DEBT EXPENSE29656192965619
MN CARE TAX16617711661771
OTHER EXPENSES1344774987869356905
REPAIRS & MAINTENANCE12422661242266

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total6114Total
Program Services6114ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total152450477Total
Program Services135930480ProgramServices
Management And General16519997ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY953607BOY
EOY598851EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3629976BOY
EOY5107061EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY12815574BOY
EOY14337566EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY732937BOY
EOY945717EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1008155BOY
EOY1156750EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY635774BOY
EOY481582EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16758069LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec13141057LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4708665BOY
EOY3617012EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3973601BOY
EOY4660849EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY28458289BOY
EOY30905388EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY17827018BOY
EOY18653324EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4598855BOY
EOY5413759EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY22425873BOY
EOY24067083EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6032416BOY
EOY6838305EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6032416BOY
EOY6838305EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY28458289BOY
EOY30905388EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members1MailingsMembers
Mailings Members$500MailingsMembersAmount
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$2,965OtherActivitiesAmount
Total Lobbying Expenditures IIB3465TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationAMOUNTS ARE EXPENDED FOR CONTACT WITH LEGISLATORS RELATING TO GOVERNMENTAL REIMBURSEMENTS FOR HEALTH CARE SERVICES. CENTRACARE CLINIC PAID $2,965 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

FieldValueIRS element (for citing)
Other Cost Or Other Basis1831630OtherCostOrOtherBasis
Depreciation901006Depreciation
Book Value930624BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis14926439OtherCostOrOtherBasis
Depreciation12240051Depreciation
Book Value2686388BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3617012TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
funds held by trustee3222316
due from related organizations1438533
FieldValueIRS element (for citing)
Total Book Value Other Assets4660849TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
deferred compensation plan obligations$3,222,316
due to related organizations$2,191,443
FieldValueIRS element (for citing)
Total Of Amounts5413759TotalOfAmounts
Total Revenue153256366TotalRevenue
Total Expenses152450477TotalExpenses
Excess Or Deficit For Year805889ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS805889ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt139187409TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal139187409RevenueSubtotal
Other Revenues Not Included14068957OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt14068957RevenueNotRptdOnFinStmt
Total Revenue Per Form990153256366TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt152450477TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal152450477ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990152450477TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XII, Line 4b - Other Adjustments:Identifier
ExplanationIneterest and investment income: 58546. EQUITY TRANSFER FROM AFFILIATE: 14010411.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000
Total Nbr Of501 C3 And Govt Grants0TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule 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

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Allen E Horn MD
3603360118672054890705640235090578570000
Scot W Hutton MD
480885064710033660785730236970651231000
THOMAS M FELDHEGE
15230601863204140303020220310223685000
KEITH LEAVELL MD
375170058490014010348750278780497814000
Thomas W Leither MD
313657150053784011870183750236930410696150000
DEBORAH L MCCARL MD
213771052213017690348750223560324984000
DAVID ROBERTS MD
542082065210027420183750231310651540000
KATHLEEN KULUS MD
19578604184902710167730205520275231000
Mark J Murphy
211880051465021260374350226350325541000
DAVID J TILSTRA MD
222367069083019050514100281430372908000
BERNARD R ERICKSON MD
855489068666039650183750235940970089000
HANI S AL-kHATIB MD
83758007526309570147000234300951930000
BARBI KAPLAN-FRENKEL DO
80338103927604930183750281400889665000
Wade T Schmidt MD
769367063321037160183750310080885787000
MARK J MARTONE MD
753489067333042340348750273420887273000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 4a457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: RANDY C. SALIARES, MD - $132,996
Part I, Line 6The 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)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 1BOARD 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 6THE SOLE MEMBER OF THE ORGANIZATION IS CENTRACARE HEALTH SYSTEM, A MINNESOTA NONPROFIT ORGANIZATION.
Form 990, Part VI, Section A, line 7aTHE FOUR CORPORATE DIRECTORS ARE APPOINTED BY THE MEMBER.
Form 990, Part VI, Section A, line 7bCentraCare 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 11THE 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 12cThe 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 15The 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 May 2009; the last compensation review in May 2010. 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 2010. 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 2010.
Form 990, Part VI, Section C, line 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT OPEN TO THE PUBLIC.
FORM 990, PART VII, SECTION ATHE 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/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
CENTRACARE HEALTH SYSTEM
1406 6TH AVENUE NORTHST CLOUDMN56303411813221HEALTH CAREMN501(C)(3)11 - TYPE 3 FIN/A
CENTRACARE HEALTH SERVICES - MELROSE
11 NORTH 5TH AVENUE WESTMELROSEMN56352411865315ACUTE & LONG-TERM CAREMN501(C)(3)3N/A
CENTRACARE HEALTH SERVICES - LONG PRAIRIE
20 SOUTHEAST 9TH STREETLONG PRAIRIEMN56347411924645ACUTE & LONG-TERM CAREMN501(C)(3)3N/A
CENTRACARE HEALTH FOUNDATION
1406 6TH AVENUE NORTHST CLOUDMN56303411855173FUNDRAISINGMN501(C)(3)7N/A
CENTRAL MINNESOTA EMERGENCY PHYSICIANS
1406 6TH AVENUE NORTHST CLOUDMN56303411708142EMERGENCY PHYSICIAN PRACTICEMN501(C)(3)3N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CENTRACARE PHARMACY SERVICES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11406 6TH AVENUE NORTHAddressLine1
CityST CLOUDCity
StateMNState
ZIP Code56303ZIPCode
FieldValueIRS element (for citing)
EIN411620618EIN
Primary ActivityRETAIL PHARMACYPrimaryActivity
Legal Domicile StateMNLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg