2023-11-13T13:09:12-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 411801967 SIBLEY MEDICAL CENTER SIBL 5079642271 601 WEST CHANDLER STREET ARLINGTON MN 55307 AARON BLOOMQUIST CFO 5079642271 2023-11-13 1 AARON BLOOMQUIST XXX-XX-XXXX 1 KURT BENNION CPA P01469618 4252506100 2023-11-13 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z RIDGEVIEW SIBLEY MEDICAL CENTER MICHAEL PHELPS 500 SOUTH MAPLE ST WACONIA MN 55387 22229011 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1948 MN RIDGEVIEW SIBLEY MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF THE PEOPLE WE SERVE WITH A CULTURE THAT NURTURES THE WHOLE PERSONMIND, BODY AND SPIRIT. 8 8 110 8 0 0 33702 661276 18005049 19367924 124756 353273 136852 165093 18300359 20547566 70863 2970 0 0 7024611 7159238 0 0 0 7507219 8298668 14602693 15460876 3697666 5086690 31684088 30969790 9983374 5651198 21700714 25318592 RIDGEVIEW SIBLEY MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF PEOPLE IT SERVES WITH A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. 0 0 11436009 2970 19367924 LOCATED IN ARLINGTON, MINNESOTA, RIDGEVIEW SIBLEY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL -- PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY ALSO HAS CLINIC LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON, AND WINTHROP.RIDGEVIEW SIBLEY MEDICAL CENTER BELIEVES EVERYONE DESERVES TOP-QUALITY MEDICAL CARE AND THAT THE PEOPLE OF SIBLEY COUNTY SHOULDN'T HAVE TO TRAVEL FAR TO GET THE LATEST MEDICAL ADVANCEMENTS. IT'S THIS BELIEF THAT DRIVES US TO BRING SPECIALTY CARE TO OUR COMMUNITY. IT'S WHY WE CONSTANTLY PURSUE THE TECHNOLOGIES, RECRUIT THE EXPERTS, AND EXPAND AND IMPROVE THE FACILITIES THAT MAKE GREAT HEALTH CARE POSSIBLE. 11436009 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 1 110 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X AARON BLOOMQUIST 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 MICHAEL PHELPS PRESIDENT/CEO 2.00 48.00 X 0 1274183 64040 GORDON GABLENZ CIO 4.00 46.00 X 0 794145 89439 AARON BLOOMQUIST CFO 4.00 46.00 X 0 490798 61669 BENJAMIN NIELSEN COO 1.00 49.00 X 0 363774 18024 JEFF NELSON BOARD MEMBER 0.40 2.40 X 1200 6200 0 LISA PFARR CHAIR 0.40 0.00 X X 1800 0 0 DEE THOMAS TREASURER 0.40 0.00 X X 1200 0 0 DIANE BIAS-MOSEL SECRETARY 0.40 0.00 X X 1200 0 0 TIMOTHY DOLAN BOARD MEMBER 0.40 0.00 X 1200 0 0 JAMES KREFT BOARD MEMBER 0.40 0.00 X 1200 0 0 NANCY MATHWIG BOARD MEMBER 0.40 0.00 X 1200 0 0 LYLE RUD BOARD MEMBER 0.40 0.00 X 1200 0 0 10200 2929100 233172 0 0 1 0 EMPAC 500 S MAPLE STREET WACONIA MN 55387 EMERGENCY DEPARTMENT PHYSICIAN SERVICES 1276549 AYA HEALTHCARE 5930 CORNERSTONE CT W 300 SAN DIEGO CA 92121 NURSING SERVICES 308073 CMDI 525 10TH STREET NE MILACA MN 56353 IMAGING SERVICES 146282 3 103250 558026 661276 NET PATIENT REVENUE 621610 19367924 19367924 19367924 87753 87753 36299 0 36299 36299 36299 1946965 1681445 265520 265520 265520 1739 0 1739 1739 MISCELLANEOUS INCOME 900099 89508 89508 JOINT VENTURE INCOME 900099 37547 37547 127055 20547566 19367924 0 518366 X 2970 2970 5972308 4888406 1083902 185056 150520 34536 577504 434721 142783 424370 351412 72958 61873 61873 12433 12433 3196045 2420642 775403 13605 13605 95842 80134 15708 300430 175193 125237 21527 17396 4131 13105 8315 4790 94117 94117 1342089 100440 1241649 51076 51076 MEDICAL SUPPLIES 1983649 1960888 22761 BAD DEBT EXPENSE 580015 580015 OTHER EXPENSES 348063 243967 104096 MINNESOTA CARE TAX 155881 155881 28918 7385 21533 15460876 11436009 4024867 0 7109796 5855362 1646605 1785199 6315330 3392617 440000 477151 192669 224548 14766377 5822855 11091075 8943522 4595793 4318238 5298 11048 287522 273929 0 5688176 31684088 30969790 557792 762414 820129 216142 2873855 5731598 4672642 9983374 5651198 X 21700714 25318592 21700714 25318592 31684088 30969790 5086690 -1468812 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 294 294 0 PART II-B, LINE 1: SIBLEY MEDICAL CENTER PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE USED FOR LOBBYING EXPENSES. 36332 61277 -24945 7128178 1288380 5839798 7346126 4473198 2872928 255741 255741 8943522 DUE FROM AFFILIATE 2045740 RIGHT-OF-USE LEASE ASSETS 3642436 5688176 THIRD PARTY PAYOR SETTLEMENTS 1828274 RIGHT-OF-USE LEASE LIABILITIES 2844368 4672642 X 19614313 0 19614313 12433 920820 933253 20547566 14868428 0 14868428 12433 580015 592448 15460876 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE IRC THAT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 75,285. REALIZED GAINS 265,520. BAD DEBT EXPENSE 580,015. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 580,015. 1 1 X 1 X 1 X 1 1 0 1 1 20721 20721 0.00140 2583345 1891943 691402 0.04650 2604066 1891943 712123 0.04790 2 96 1385 1385 0.00010 1 450 450 0.00000 3 96 1835 1835 0.00010 3 96 2605901 1891943 713958 0.04800 1 580015 112008 7251550 7107219 144331 X 1 1 1 1 RIDGEVIEW SIBLEY MEDICAL CENTER 601 WEST CHANDLER STREET ARLINGTON MN 55307 WWW.RIDGEVIEWMEDICAL.ORG HFID-00618 X X X X RIDGEVIEW SIBLEY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 0 1 X WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ X 1 22 1 WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 5: RIDGEVIEW COLLECTED ITS OWN PRIMARY DATA FOR THE 2022 CHNA, USING ITS ELECTRONIC AND OTHER HEALTH RECORDS. THIS INCLUDED DATA ANALYSIS, VALIDATION AND PRIORITIZATION, AND ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS. TO SPECIFICALLY IDENTIFY NEEDS IN RIDGEVIEW'S MOST RURAL COUNTIES, COMMUNITY INPUT WAS PROVIDED IN AUGUST 2022 BY FOCUS GROUPS COMPOSED OF RESIDENTS OF LE SUEUR AND SIBLEY COUNTIES. RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 6A: THE 2022 CHNA WAS CONDUCTED WITH RIDGEVIEW MEDICAL CENTER AND RIDGEVIEW LE SUEUR MEDICAL CENTER. RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 11: RIDGEVIEW SIBLEY MEDICAL CENTER CONTINUES TO DEVELOP BROAD COMMUNITY STRATEGIES THAT FOCUS ON THREE HEALTH ISSUES THAT WERE IDENTIFIED AND PRIORITIZED IN THE CHNA AND IMPLEMENTATION PLAN: 1) PREVENTION, CLINICAL CARE, AND DISEASE MANAGEMENT (PREVENTATIVE SCREENINGS, TOBACCO CESSATION, OBESITY), 2) ACCESS TO CARE (PRIMARY AND URGENT CARE, RURAL SERVICE AREA), AND 3) MENTAL AND BEHAVIORAL HEALTH (EMERGENCY SERVICES, ADULT BEHAVIORAL HEALTH). RIDGEVIEW WILL CONTINUE TO OFFER CARE AND SERVICES TO ADDRESS THESE PRIORITY HEALTH ISSUES. THE INFORMATION FROM THE CHNA WILL FURTHER INFORM ORGANIZATIONAL LEADERSHIP IN DECISION-MAKING PROCESSES TO EXPAND, REFINE, AND DIRECT SERVICES, COMMUNICATION, COLLABORATION, EDUCATION AND OUTREACH ACTIVITIES. ADDRESSING THE PRIORITY HEALTH ISSUES INVOLVES MANY FACTORS OUTSIDE THE CLINICAL SETTING. RIDGEVIEW WILL CONTINUE TO WORK TO ENHANCE THE IMPACT OF BROADER COMMUNITY HEALTH EFFORTS TO ADDRESS THESE ISSUES. BY FACILITATING SYSTEM-WIDE AND CROSS-COMMUNITY COMMUNICATION AND COLLABORATION, EXISTING EFFORTS WILL RESULT IN IMPROVED SUCCESS AND IMPACT. WHILE EMPHASIS IS PLACED ON THE THREE HEALTH ISSUES DETAILED IN THE CHNA REPORT DOCUMENT, RIDGEVIEW AS A COMMUNITY HEALTH PROVIDER, WILL CONTINUE TO FOCUS RESOURCES ON OTHER LONG-STANDING INITIATIVES AND SERVICES THAT HELP IMPROVE OVERALL HEALTH. RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT WWW.RIDGEVIEWMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL/. 4 1 - RIDGEVIEW ARLINGTON CLINIC 601 WEST CHANDLER STREET ARLINGTON MN 55307 CLINIC 2 - RIDGEVIEW GAYLORD CLINIC 660 3RD STREET GAYLORD MN 55334 CLINIC 3 - RIDGEVIEW HENDERSON CLINIC 505 MAIN STREET HENDERSON MN 56044 CLINIC 4 - RIDGEVIEW WINTHROP CLINIC 223 NORTH CARVER STREET WINTHROP MN 55396 CLINIC PART I, LINE 3C: TO QUALIFY FOR FINANCIAL ASSISTANCE, THE FOLLOWING CONDITIONS MUST BE MET:(A) THE MEDICAL CARE PROVIDED BY SIBLEY MEDICAL CENTER IS MEDICALLY NECESSARY;(B) THE INDIVIDUAL SUBMITS A COMPLETED APPLICATION;(C) THE INDIVIDUAL COOPERATES WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE, IF NECESSARY (INCLUDING SSI, DISABILITY, MEDICARE AND MEDICAID); AND(D) THE INDIVIDUAL'S FAMILY INCOME IS LESS THAN 250% OF FEDERAL POVERTY GUIDELINES ("FPG"). FREE CARE IS OFFERED FOR FEDERAL ADJUSTED GROSS INCOME UP TO 200% OF FPG. 75% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 200% AND 225% OF FPG. 56% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 225% AND 250% OF FPG.IN ADDITION, PATIENTS SEEKING FINANCIAL ASSISTANCE MAY BE ASKED FIRST TO APPLY FOR OTHER EXTERNAL PROGRAMS (SUCH AS MEDICAID OR INSURANCE THROUGH THE PUBLIC MARKETPLACE).SIBLEY MEDICAL CENTER MAY RELY ON EXTERNAL SOURCES TO DETERMINE ELIGIBILITY WHEN:(A) THE PATIENT IS HOMELESS;(B) THE PATIENT IS ELIGIBLE FOR OTHER UNFUNDED STATE OR LOCAL ASSISTANCE PROGRAMS;(C) THE PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH;(D) THE PATIENT IS ELIGIBLE FOR STATE-FUNDED PRESCRIPTION MEDICATION;(E) THE PATIENT'S VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING; OR(F) THE PATIENT RECEIVES FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL FOR FURTHER TREATMENT.SIBLEY MEDICAL CENTER ALSO USES CHANGE HEALTHCARE, AN ELIGIBILITY VENDOR, TO HELP IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE COSTING METHODOLOGY USED BY SIBLEY MEDICAL CENTER TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON SMC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 580,015. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS CALCULATED BY RIDGEVIEW AS FOLLOWS: PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF THE INVOICE OR CLAIM SUBMITTED. PATIENT ACCOUNTS THAT ARE MORE THAN 90 DAYS PAST DUE ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE ORGANIZATION. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE. PART III, LINE 3: SIBLEY MEDICAL CENTER ESTIMATES THAT APPROXIMATELY 25% OF ITS TOTAL COST OF CHARITY CARE IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE BUT DID NOT COMPLETE AN APPLICATION AND WERE ULTIMATELY INCLUDED IN BAD DEBT EXPENSE REPORTED IN PART III, LINE 2. PART III, LINE 4: SEE NOTE 2, "PATIENT SERVICE REVENUE", ON PAGES 10-14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF SIBLEY MEDICAL CENTER'S BAD DEBT EXPENSE. PART III, LINE 8: SIBLEY MEDICAL CENTER USED THE 2022 FILED MEDICARE COST REPORT TO CALCULATE THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6. APPLIED AGAINST ACTUAL RECEIPTS, SIBLEY EXPERIENCED COSTS COVERED BY MEDICARE IN THE AMOUNT OF A $144,331 SURPLUS IN 2022. THIS IS A DIRECT BENEFIT TO THE MEDICARE POPULATION OF OUR COMMUNITY. PART III, LINE 9B: RIDGEVIEW'S CHARITY PROGRAM ALLOWS FOR ACCOUNTS IN BAD DEBT STATUS TO COMPLETE A CHARITY CARE APPLICATION. IF APPROVED, THE ACCOUNT WILL BE RETURNED FROM BAD DEBT AND APPLIED TO OUR CHARITY CARE PROGRAM. ALL PATIENTS ARE ADVISED OF OUR CHARITY CARE PROGRAM THROUGH OUR MONTHLY BILLING PROCESS. RIDGEVIEW MEDICAL CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING PATIENT ACCOUNT BALANCES. PART VI, LINE 2: SIBLEY MEDICAL CENTER ASSESSES THE CURRENT HEALTH STATUS, HEALTH OUTCOMES, AND UNMET NEEDS IN THE COMMUNITIES IT SERVES THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS. COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND PUBLIC REPORTING ENSURES THAT SIBLEY MEDICAL CENTER IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH COMMUNITY HEALTH PRIORITIES.SIBLEY MEDICAL CENTER HAS AND WILL CONTINUE TO USE A CHNA AND OTHER INTERNAL AND EXTERNAL INFORMATION (INCLUDING DISCHARGE, QUALITY MEASURES, PREDICTIVE, AND POPULATION DATA) TO AID STRATEGIC PLANNING PROCESSES AND ALIGN ORGANIZATIONAL SERVICES/RESOURCES ACCORDINGLY. PART VI, LINE 3: AT THE TIME OF SCHEDULING, PRE-REGISTRATION, REGISTRATION, OR DISCHARGE (WHICHEVER IS APPLICABLE), THE PATIENT WILL BE ASKED FOR INSURANCE COVERAGE, AND THE PATIENT WILL BE INFORMED OF ANY CO-PAYMENTS THAT WILL BE EXPECTED AT THE TIME OF PAYMENT. IF THE PATIENT WISHES TO APPLY FOR COMMUNITY CARE, HE OR SHE WILL BE GIVEN OR MAILED AN APPLICATION; THE APPLICATION IS ALSO AVAILABLE FOR DOWNLOAD FROM THE RMC WEBSITE. A PATIENT MAY NOT QUALIFY FOR COMMUNITY CARE UNTIL HE OR SHE HAS COMPLETED THE APPLICATION. AFTER COMPLETING THE COMMUNITY CARE APPLICATION (INCLUDING SUPPORTING DOCUMENTATION), THE ACCOUNT REPRESENTATIVE WILL ASSESS THE APPLICATION AND DETERMINE WHETHER THE PATIENT QUALIFIES FOR COMMUNITY CARE OR ANY OTHER GOVERNMENTAL HEALTH CARE COVERAGE. IF THE PATIENT IS LIKELY TO QUALIFY FOR THE HOSPITAL PRESUMPTIVE ELIGIBILITY PROGRAM OTHER GOVERNMENTAL HEALTH CARE COVERAGE, THE ACCOUNT REPRESENTATIVE WILL DETERMINE APPROPRIATE COVERAGE AND REFER THE PATIENT AS APPROPRIATE. IF AN UNINSURED PATIENT IS UNLIKELY TO QUALIFY FOR GOVERNMENTAL HEALTHCARE COVERAGE, OR DENIED HOSPITAL PRESUMPTIVE ELIGIBILITY, AND THE PATIENT DOES NOT QUALIFY FOR COMMUNITY CARE, APPROPRIATE PAYMENT ARRANGEMENTS MUST BE MADE WITH THE ACCOUNT REPRESENTATIVE BASED UPON RMC'S UNINSURED PAYMENT POLICY. SHOULD THE PATIENT SUBSEQUENTLY QUALIFY FOR GOVERNMENTAL HEALTH CARE COVERAGE OR ANY OTHER HEALTH INSURANCE, ANY PAYMENTS RECEIVED WILL BE REFUNDED LESS ANY CO-PAYMENTS DUE. THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT HTTPS://WWW.RIDGEVIEWMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL/. PART VI, LINE 4: SIBLEY COUNTY, A COUNTY MADE UP OF SEVEN CITIES, IS LOCATED IN SOUTH CENTRAL MINNESOTA. IN AGGREGATE, THE LAND SIZE IS 601 SQUARE MILES. SIBLEY COUNTY IS CONSIDERED A "FRINGE" COUNTY AND IS ON THE WESTERN BOUNDARY OF THE SEVEN-COUNTY TWIN CITIES METROPOLITAN AREA. AGRICULTURE IN SIBLEY COUNTY IS A MAIN SOURCE OF EMPLOYMENT AND INCOME. THERE ARE 350,000 ACRES DEDICATED TO FARMING. OF THESE FARMS, 10.69% OF THEM ARE INDIVIDUALLY/FAMILY OWNED AND OPERATED. THE AVERAGE VALUE OF THE AGRICULTURAL PRODUCTS SOLD PER FARM IS $354,924. ALONG WITH THE PRODUCTION OF CROPS, A LARGE NUMBER OF FARMS RAISE LIVESTOCK, POULTRY, AND DAIRY CATTLE. ACCORDING TO THE 2022 US CENSUS, THERE ARE AN ESTIMATED 14,955 PEOPLE LIVING IN SIBLEY COUNTY. THE POPULATION BREAKDOWN SHOWS THOSE AGED 65+ AT 18.1%, 24-64 AT 51.3%, AND 0-23 AT 30.6%. THE POPULATION HAS DECREASED 3.33% SINCE 2010, BUT OVERALL THE POPULATION HAS STAYED CONSISTENT OVER THE LAST DECADE. 95.7% OF THE TOTAL POPULATION ARE OF CAUCASIAN DESCENT, 9.3% OF HISPANIC DESCENT, 1.1% OF BLACK/AFRICAN AMERICAN DESCENT, AND 0.9% ARE OF ASIAN DESCENT. SIBLEY COUNTY MEDIAN HOUSEHOLD INCOME IS $67,412 AND 9% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PART VI, LINE 5: SIBLEY MEDICAL CENTER PROVIDES COMMUNITY EDUCATION AND WORKS WITH HEALTH CARE PROVIDERS IN MEEKER, MCLEOD AND SIBLEY COUNTIES TO IMPROVE THE HEALTH OF OUR COMMUNITY. PART VI, LINE 6: SIBLEY MEDICAL CENTER IS A SUBSIDIARY OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW MEDICAL CENTER IS A 120-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE: RIDGEVIEW CLINICS PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA. TWO CRITICAL ACCESS HOSPITALS, SIBLEY MEDICAL CENTER AND RIDGEVIEW LE SUEUR MEDICAL CENTER. CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST. IT OPERATES AN AMBULATORY SURGICAL CENTER. MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST. WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS. RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS. RIDGEVIEW COMMUNITY NETWORK OPERATES A AN ACCOUNTABLE CARE ORGANIZATION. RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW FOUNDATION OPERATES FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS PRESIDENT/CEO 0 1270809 0 0 0 3374 0 26074 0 37966 0 1338223 0 135723 GORDON GABLENZ CIO 0 789842 0 0 0 4303 0 28440 0 60999 0 883584 0 50956 AARON BLOOMQUIST CFO 0 488856 0 0 0 1942 0 14169 0 47500 0 552467 0 45465 BENJAMIN NIELSEN COO 0 338638 0 0 0 25136 0 17240 0 784 0 381798 0 41722 PART I, LINE 3 THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICAL CENTER TO DETERMINE THE PRESIDENT/CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) PART I, LINE 4B MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $397,642 WAS CONTRIBUTED TO THE PLAN, $68,254 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $395,053 WAS CONTRIBUTED TO THE PLAN, $50,590 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. AARON BLOOMQUIST PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $125,556 WAS CONTRIBUTED TO THE PLAN, $0 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. PART I, LINE 6 THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2022 AND PAID IN 2023. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW SIBLEY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY THE RIDGEVIEW MEDICAL CENTER BOARD. ANY DIRECTOR MAY ALSO BE REMOVED BY THE RIDGEVIEW MEDICAL CENTER BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS WILL CARRY OUT THE DUTIES NORMALLY ASSOCIATED WITH A NONPROFIT HOSPITAL BOARD OF DIRECTORS, SUBJECT TO THE RESERVED POWERS OF THE MEMBER AND THE CITY BELOW. THE MEMBER RESERVES AUTHORITY WITH REGARD TO THE MATTERS LISTED BELOW, SUBJECT TO THE RESERVED POWERS OF THE CITY INCLUDED THEREAFTER. THE MEMBER WILL LOOK TO THE BOARD TO MAKE RECOMMENDATIONS ON DECISIONS ON MATTERS LISTED BELOW, BUT THE MEMBER IS NOT REQUIRED TO ACCEPT SUCH RECOMMENDATIONS, AND THE MEMBER MAY TAKE ACTION ON ITS OWN IN SUCH AREAS, SUBJECT TO THE CITY'S RESERVED POWERS. THE MEMBER'S APPROVAL WILL BE REQUIRED FOR ANY ACTION PROPOSED BY THE BOARD IN THESE AREAS: (A) FINAL APPOINTMENT OF BOARD MEMBERS; (B) ISSUANCE OF DEBT BY THE CORPORATION; (C) SALE OF SUBSTANTIAL ASSETS OF THE CORPORATION; (D) CHANGES IN THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS; (E) ESTABLISHMENT OF ANOTHER MEMBER RELATIONSHIP BY THE CORPORATION OR ANOTHER FORM OF AFFILIATION; (F) STRATEGIC PLAN FOR THE CORPORATION; (G) OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (H) UNBUDGETED TOTAL ANNUAL CAPITAL EXPENDITURES; (I) AUDIT AND COMPLIANCE PROGRAMS; (J) ACCREDITATION PROGRAMS; (K) GROUP EMPLOYEE BENEFITS; (L) MANAGING THE CORPORATION'S CASH AND INVESTMENTS (THE MEMBER MAY MOVE FUNDS BETWEEN THE ORGANIZATIONS FREELY, SUBJECT TO BOND COVENANT OR TRUSTEE REQUIREMENTS); (M) THIRD PARTY PAYER CONTRACTING; (N) INSURANCE; (O) INFORMATION SYSTEM DESIGN AND IMPLEMENTATION; AND (P) GROUP PURCHASING. THE CITY'S APPROVAL WILL BE REQUIRED FOR THE DECISIONS OF THE BOARD IN THE FOLLOWING AREAS: (A) SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (B) SALE OF ASSETS ABOVE THRESHOLDS ALLOWED BY BOND COVENANTS; (C) ISSUANCE OF DEBT WHICH WOULD OBLIGATE THE CORPORATION IN EXCESS OF LEVELS ALLOWED BY BOND COVENANTS; AND (D) CHANGES TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANY COMPENSATION RECEIVED BY OFFICERS OR BOARD MEMBERS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES AND OTHER MISCELLANEOUS SERVICES: PROGRAM SERVICE EXPENSES 2,420,642. MANAGEMENT AND GENERAL EXPENSES 775,403. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,196,045. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 RIDGEVIEW FOUNDATION 500 SOUTH MAPLE STREET WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW INSURANCE COMPANY 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 MINNESOTA VALLEY HEALTH CENTER 621 SOUTH 4TH STREET LE SUEUR MN 56058 410837659 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LLC 500 S MAPLE ST WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A 0 0 CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK RD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A 0 0 EXECUTIVE HEALTH MANAGEMENT SERVICES 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0