2025-05-15T09:50:27-05:00 2024-06-30 411334380 MILLER WELLE HEISER & CO LTD 4170 THIELMAN LANE PO BOX 159 ST CLOUD MN 563020159 990 2023-07-01 411855173 CENTRACARE HEALTH FOUNDATION CENT 3202512700 1406 6TH AVE NORTH ST CLOUD MN 56303 HOLLY M GULDEN VICE PRESIDENT FOUNDATION 3202512700 2025-05-06 1 1 TRINA PEETERS CPA P01625727 3202539505 2025-04-30 2023 2025-03-06 01:10:19Z HOLLY M GULDEN 1406 6TH AVE NORTH ST CLOUD MN 56303 24433815 0 X WWW.CENTRACARE.COM/FOUNDATION X 1996 MN THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR RELIGIOUS, EDUCATIONAL AND CHARITABLE PURPOSES, AS CONTEMPLATED AND PERMITTED BY SECTIONS 170(C)(2) AND 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986. WITHIN THE FRAMEWORK OF THE FOREGOING, THE PURPOSE FOR WHICH THE CORPORATION IS FORMED, AND THE BUSINESS AND THE OBJECTS TO BE CARRIED ON BY IT, IS TO PROVIDE A MEANS OF IMPROVING THE HEALTH OF THE COMMUNITIES SERVED BY CENTRACARE, PRINCIPALLY AS FOLLOWS: (A) ENGAGING IN ACTIVITIES TO PROMOTE THE GENERAL HEALTH OF ALL MEMBERS OF THE COMMUNITY AND IMPROVE THE DELIVERY OF HEALTH CARE SERVICES. (B) PROMOTING AND FURTHERING THE PROVISION OF HEALTH AND MEDICAL CARE SERVICES TO INDIVIDUALS WITH LIMITED OR NO FINANCIAL ABILITY TO PAY FOR SUCH SERVICES. (C) PROMOTING HEALTH EDUCATION. (D) PROMOTING MEDICAL AND ALLIED HEALTH EDUCATION. (E) SOLICITING GIFTS FROM PRIVATE AND PUBLIC. 16 14 0 150 0 0 6981208 9462039 0 0 4705480 14066210 -21180 73502 11665508 23601751 3809157 5948033 0 0 0 0 0 0 1462472 2779679 3173494 6588836 9121527 5076672 14480224 80467755 88754200 2285424 5069294 78182331 83684906 X THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR RELIGIOUS, EDUCATIONAL AND CHARITABLE PURPOSES, AS CONTEMPLATED AND PERMITTED BY SECTIONS 170(C)(2) AND 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986. WITHIN THE FRAMEWORK OF THE FOREGOING, THE PURPOSE FOR WHICH THE CORPORATION IS FORMED, AND THE BUSINESS AND THE OBJECTS TO BE CARRIED ON BY IT, IS TO PROVIDE A MEANS OF IMPROVING THE HEALTH OF THE COMMUNITIES SERVED BY CENTRACARE, PRINCIPALLY AS FOLLOWS: (A) ENGAGING IN ACTIVITIES TO PROMOTE THE GENERAL HEALTH OF ALL MEMBERS OF THE COMMUNITY AND IMPROVE THE DELIVERY OF HEALTH CARE SERVICES. (B) PROMOTING AND FURTHERING THE PROVISION OF HEALTH AND MEDICAL CARE SERVICES TO INDIVIDUALS WITH LIMITED OR NO FINANCIAL ABILITY TO PAY FOR SUCH SERVICES. (C) PROMOTING HEALTH EDUCATION. (D) PROMOTING MEDICAL AND ALLIED HEALTH EDUCATION. (E) SOLICITING GIFTS FROM PRIVATE AND PUBLIC. 0 0 6399921 5948033 ACTIVITIES INCLUDED CHARITABLE, EDUCATIONAL, AND SCIENTIFIC ACTIVITIES FOR THE BENEFIT OF THE COMMUNITIES SERVED BY THE ST. CLOUD HOSPITAL AND CENTRACARE. 6399921 1 1 0 0 0 1 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 13 0 1 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 X 16 14 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X HOLLY M GULDEN 3202512700 1406 6TH AVE NORTH ST CLOUD MN 56303 KELLY O'FARRELL CHAIR 1.00 X X 0 0 0 RICK BUTTE DIRECTOR 1.00 X 0 0 0 DR EDWARD MARTIN-CHAFFEE MD DIRECTOR 1.00 40.00 X 0 674537 75467 TAMARA CONGDON MD DIRECTOR 1.00 40.00 X 0 333074 52567 MIKE STOEBE DIRECTOR 1.00 X 0 0 0 JENNY BAUERLY DIRECTOR 1.00 X 0 0 0 JIM JOHNSON DIRECTOR 1.00 X 0 0 0 LARA DUININCK DIRECTOR 1.00 X 0 0 0 PAT LYNCH DIRECTOR 1.00 X 0 0 0 PETER SPANIOL DIRECTOR 1.00 X 0 0 0 HOLLY GULDEN VICE PRESIDENT, FOUNDATION 40.00 X X 0 0 0 LAURA WARNE DIRECTOR 1.00 X 0 0 0 JOE FRANCIS DIRECTOR 1.00 X 0 0 0 MELISSA WEBER DIRECTOR 1.00 X 0 0 0 TOM D ST HILAIRE VICE CHAIR 1.00 X X 0 0 0 JOHN WOLAK DIRECTOR 1.00 X 0 0 0 KENNETH HOLMEN MD PRESIDENT/CEO 0.00 40.00 X 0 1554927 74447 THOMAS SCHRUP CHIEF PHYSICIAN OFFICER/EVP 0.00 40.00 X 0 702713 60865 AMY M PORWOLL CHIEF INFORMATION SYSTEM OFFICER/SR VP 0.00 40.00 X 0 514086 63189 JOSEPH M BLONSKI VICE PRESIDENT 0.00 40.00 X 0 528517 57972 ULRIKA WIGERT VICE PRESIDENT 0.00 40.00 X 0 421686 58717 CHRISTOPHER BOELTER VICE PRESIDENT 0.00 40.00 X 0 604159 4244 JOSEPH H KALKMAN CHIEF ADMINISTRATIVE OFFICER/SR VP 0.00 40.00 X 0 620417 78241 JOSEPH D HELLIE VICE PRESIDENT 0.00 40.00 X 0 381667 56911 BRYAN LYDICK VICE PRESIDENT 0.00 40.00 X 0 402969 65116 CINDY SMITH VICE PRESIDENT 0.00 40.00 X 0 716391 78002 DEBRA G PETERSON VICE PRESIDENT 0.00 40.00 X 0 446317 43325 LYNN MCFARLING VICE PRESIDENT 0.00 40.00 X 0 579919 65147 MARIA MALLORY VICE PRESIDENT 0.00 40.00 X 0 500547 57535 BRYAN BAUCK VICE PRESIDENT 0.00 40.00 X 0 346261 77948 DAVID LARSON VICE PRESIDENT 0.00 40.00 X 0 367580 51902 MATTHEW KUNKEL VICE PRESIDENT 0.00 40.00 X 0 342513 76472 ANTHONY GARDENER CHIEF MARKETING & COMMUNICATIONS 0.00 40.00 X 0 360511 45575 JOY PLAMANN CHIEF OPERATING OFFICER/SR VP 0.00 40.00 X 0 801092 49364 MICHAEL BLAIR CHIEF FINANCIAL OFFICER/SR VP/TREASURER 0.00 40.00 X 0 754895 79410 SANTO CRUZ CHIEF LEGAL OFFICER/SR VP/SECRETARY 0.00 40.00 X 0 567364 53699 LAUREL WESSMAN PHYSICIAN 0.00 40.00 X 0 997125 25905 NATHANIAL J SLINKARD PHYSICIAN 0.00 40.00 X 0 1088771 51617 LEAH SCHAMMEL PHYSICIAN 0.00 40.00 X 0 1098198 77482 SASAN MOSHIRZADEH PHYSICIAN 0.00 40.00 X 0 1020887 57091 DEXTER CASTA PHYSICIAN 0.00 40.00 X 0 941151 43786 JOHN R HERING FORMER KEY EMPLOYEE 0.00 40.00 X 0 431649 84438 MICHAEL SCHRAMM FORMER KEY EMPLOYEE 0.00 40.00 X 0 434556 56470 0 18534479 1722904 0 1 1 0 0 660316 451311 8350412 465575 9462039 14073269 14073269 292713 299772 -7059 -7059 -7059 605794 660316 532292 73502 73502 23601751 0 0 14139712 5831978 5831978 116055 116055 5774 941 2525 2308 108624 108624 53468 8710 23381 21377 12777 12777 3753 3753 FEES FOR EMPLOYEES OF A 2714779 442237 1187173 1085369 CONTRACTED SERVICES 244794 244794 OTHER 29525 29525 9121527 6399921 1259134 1462472 5447065 1929653 3428940 6354315 202325 202325 3753 0 70371289 79165443 1216708 1304789 80467755 88754200 2133205 4971375 152219 97919 2285424 5069294 X 70344222 72028897 7838109 11656009 78182331 83684906 80467755 88754200 X 14480224 -5091978 -3885671 X X 0 1 X 1 0 X 4096950 7822773 4794222 6981208 9462039 33157192 4096950 7822773 4794222 6981208 9462039 33157192 749685 32407507 1935846 3576019 8771355 4723200 14073269 33079689 66236881 0.48930 0.55000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27 13786 169598 2746933 1 1 3711227 1080412 4791639 3524432 186795 3711227 356357 3168075 3524432 270110 86247 356357 270110 270110 1.00000 0 0 202325 202325 0 0 CASH & CASH EQUIVALENTS 7464 F IRREVOCABLE TRUSTS 828050 F REAL ESTATE PARTNERSHIPS 1203673 F CORPORATE DEBT SECURITIES 7115 F HEDGE FUND PARTNERSHIPS 7874131 F EQUITY MUTUAL FUNDS 46951049 F FIXED INCOME MUTUAL FUNDS 22293961 F 79165443 ANNUITIES PAYABLE 97919 97919 X 18530728 -5091978 21980 -1025 -5071023 23601751 0 23601751 9143507 21980 21980 9121527 0 9121527 PART V, LINE 4: BENEFACTORS ENTRUST THE CENTRACARE HEALTH FOUNDATION WITH CHARITABLE FUNDS. THE BOARD BY POLICY AND AT ITS DISCRETION DESIRES TO EFFECTIVELY SECURE, MANAGE AND DISTRIBUTE THESE CHARITABLE FUNDS OF THE FOUNDATION. THIS POLICY GOVERNS THE DISTRIBUTION FROM ALL COMPONENT FUNDS OF THE FOUNDATION. STAFF SHALL ADOPT PROCEDURES TO CARRY OUT THE STATED FUND DISTRIBUTION POLICY. A BENEFACTOR OR THE BOARD OF DIRECTORS MAY CHOOSE TO CREATE EITHER A GROWTH OR EXPENDABLE FUND. A. GROWTH FUND - THE PRINCIPAL IS ENDOWED OR AVAILABLE, BUT INTENDED TO BE HELD ON A LONG-TERM BASIS TO PRODUCE INCOME. THE FOUNDATION BOARD OF DIRECTORS HAS ESTABLISHED A "SPENDING POLICY" FOR GROWTH FUNDS. THE SPENDING POLICY OUTLINES THE PERCENTAGE THAT WILL BE TRANSFERRED ANNUALLY FROM THE GROWTH FUND. B. EXPENDABLE FUND - THE PRINCIPAL IS INTENDED TO BE SPENT FOR THE STATED CHARITABLE PURPOSE. FUNDS FOR DISTRIBUTION ARE AVAILABLE UNDER FOUR PRIMARY CATEGORIES: 1.) UNRESTRICTED, 2.) FIELD OF INTEREST, 3.) ADVISED AND 4.) DESIGNATED. THESE CATEGORIES OF FUNDS ARE EITHER GROWTH OR EXPENDABLE. A DEFINITION OF EACH FUND CATEGORY IS PROVIDED: 1. UNRESTRICTED: CENTRACARE HEALTH FOUNDATION BOARD OF DIRECTORS HAS COMPLETE DISCRETION TO MAKE CHARITABLE GRANTS TO MEET THE GREATEST NEEDS THAT THE FOUNDATION IDENTIFIES. 2. FIELD OF INTEREST: DISTRIBUTIONS ARE RESTRICTED TO A CHARITABLE PURPOSE SPECIFIED BY THE BENEFACTOR (FOR EXAMPLE, A FUND FOR MEDICAL MISSION WORK OR A PEDIATRIC FUND TO HELP ALL CHILDREN WHO ARE ILL). 3. ADVISED FUND: THE BENEFACTOR (OR PERSON OR COMMITTEE DESIGNATED BY THE BENEFACTOR) CAN ADVISE CENTRACARE HEALTH FOUNDATION ON CHARITABLE DISTRIBUTIONS). THE RECOMMENDATIONS ARE ONLY ADVISORY. THE BOARD OF DIRECTORS OF THE FOUNDATION HAS LEGAL CONTROL OVER ALL DISTRIBUTIONS. 4. DESIGNATED: DISTRIBUTIONS ARE RESTRICTED TO A SPECIFIC PROGRAM, SERVICE OR PURPOSE THAT WAS NAMED BY THE BENEFACTOR AT THE TIME THE CONTRIBUTION WAS MADE TO THE FOUNDATION (FOR EXAMPLE, THE CENTRAL MINNESOTA HEART CENTER FUND OR BREAST CENTER FUND). PART X, LINE 2: THE FOUNDATION IS SUBJECT TO THE ACCOUNTING STANDARD ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE FOUNDATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE-LIKELY-THAN-NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ALSO ADDRESSES DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS. MANAGEMENT EVALUATED THE TAX POSITIONS FOR THE FOUNDATION AND CONCLUDED THAT THE FOUNDATION HAD TAKEN NO UNCERTAIN INCOME TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THIS GUIDANCE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF TRUSTS -1,025. HOLLY BALL 897878 451500 446378 130543 68275 130369 10805 110922 GALA 280401 144191 136210 17673 2950 16022 1300 27209 1 87831 64625 23206 824 1000 14400 1266110 660316 605794 148216 72049 147391 12105 152531 532292 73502 1 CENTRACARE CLINIC 1200 6TH AVENUE NORTH ST CLOUD MN 56303 411806657 501(C)(3) 242834 0 GENERAL SUPPORT CENTRACARE HEALTH - MELROSE 525 MAIN STREET WEST MELROSE MN 56352 411865315 501(C)(3) 46247 0 GENERAL SUPPORT CENTRACARE HEALTH SYSTEM 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411813221 501(C)(3) 1205223 0 GENERAL SUPPORT ST CLOUD HOSPITAL 1406 6TH AVENUE NORTH ST CLOUD MN 56303 410695596 501(C)(3) 4049188 0 GENERAL SUPPORT ALL ABOUT BOOKS PO BOX 266 CANANDAIGUA NY 14424 020660094 5449 0 PATIENT ITEMS INTERSTATE BOOKS4SCHOOL 201 E BADGER RD MADISON WI 53713 390785123 33575 0 PATIENT ITEMS KWIK TRIP INC PO BOX 1597 LACROSSE WI 546021597 391036365 33988 0 PATIENT ITEMS CENTRACARE HOLDINGS INC 1406 6TH AVENUE NORTH ST CLOUD MN 56303 472688595 11941 0 GENERAL SUPPORT 4 4 SCHOLARSHIPS FOR HEALTH CARE EDUCATION 42 51277 PATIENT MEDICAL EXPENSE ASSISTANCE 101 64778 PART I, LINE 2: THE CENTRACARE HEALTH FOUNDATION REVIEWS GRANT APPLICATIONS AND MAKES AWARDS THREE TIMES A YEAR. GRANTS ARE REVIEWED BY THE GRANTS COMMITTEE AND RECOMMENDATIONS ARE SUBMITTED TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. THE FOUNDATION BOARD OF DIRECTORS, IN EVALUATING GRANT APPLICATIONS, WILL BE GUIDED BY THE FOLLOWING GENERAL PRINCIPLES: 1. APPLICANTS MUST BE ELIGIBLE NOT-FOR-PROFIT OR GOVERNMENT AGENCIES. 2. PROPOSALS MUST BE CONSISTENT WITH THE MISSION STATEMENT OF THE CENTRACARE HEALTH FOUNDATION. 3. GRANTS WILL BE MADE TO PROJECTS WHICH WILL HAVE PRIMARY IMPACT IN THE FOLLOWING CENTRAL MINNESOTA COUNTIES: BENTON, CROW WING, DOUGLAS, KANDIYOHI, MEEKER, MILLE LACS, MORRISON, POPE, SHERBURNE, STEARNS, TODD, WADENA AND WRIGHT. 4. THE FOUNDATION IS RELUCTANT TO PROVIDE FUNDING FOR: ONGOING OPERATIONAL SUPPORT OR GENERAL ADMINISTRATIVE EXPENSES FOR EXISTING PROGRAMS AND CAPITAL RELATED EXPENSES. PROPOSALS THAT ADDRESS HEALTH ISSUES THROUGH PARTNERSHIPS WITH MULTIPLE INDIVIDUALS AND ORGANIZATIONS ARE ENCOURAGED. ORGANIZATIONS ARE ALLOWED ONE ACTIVE GRANT AT A TIME. FINAL REPORT MUST BE IN AND APPROVED PRIOR TO SUBMITTING A LETTER OF INQUIRY FOR A NEW PROJECT. 5. ALL DECISIONS REGARDING FUNDING WILL BE MADE WITHOUT REGARD TO RACE, COLOR, CREED, SEX, HANDICAP, RELIGION, OR NATIONAL ORIGIN OF THE GRANT SEEKER, AND WITHOUT REGARD TO AN APPLICANT'S RELATIONSHIP WITH THE CENTRACARE SYSTEM OR ITS SUBSIDIARIES. ADDITIONAL SPECIFIC ACTIONS ARE TAKEN TO REVIEW AND MONITOR SPECIFIC REQUESTS INCLUDING: 1. AT THE MEETING OF THE BOARD OF DIRECTORS, COMMITTEE MINUTES AND RECOMMENDATION VIA MINUTES WILL BE MADE BY THE GRANTS COMMITTEE. 2. NOTIFICATION WILL BE MADE FOLLOWING THE BOARD DECISION. 3. IF A GRANT APPLICATION IS APPROVED, A GRANT AGREEMENT WILL BE E-MAILED TO THE ORGANIZATION FOR REVIEW AND SIGNATURES, AND ARRANGEMENTS FOR PAYMENT AND OTHER DETAILS WILL BE ARRANGED BY THE GRANT RECIPIENT WITH THE FOUNDATION'S ADMINISTRATIVE OFFICE. 4. PROGRESS REPORTS WILL BE REQUIRED ON AT LEAST A SEMI-ANNUAL BASIS, WITH A FINAL REPORT REQUIRED AT THE CONCLUSION OF THE PROJECT. 5. IN THE EVENT A GRANT APPLICATION IS ACCEPTED, AND THE APPLICANT IS NOTIFIED, BUT THE APPLICANT MAKES NO REQUEST FOR THE FUNDS OR FOR THE DEFERRAL OF THE PROJECT IN THE SUCCEEDING 12 MONTHS, THEN THE APPLICANT MUST RESUBMIT A NEW PROPOSAL FOR CONSIDERATION. 6. IF AN ACCEPTED PROJECT IS TO HAVE TWO SEPARATE YEARLY GRANTS, THE SECOND ALLOCATION WILL NOT BE MADE WITHOUT ADEQUATE REPORTING OF THE FIRST YEAR'S ACTIVITY AND THE USE OF GRANT MONEYS. A FORMAL GRANT APPLICATION TO CCHF WILL INCLUDE THE FOLLOWING INFORMATION: 1. THE NAME OF THE APPLICANT, ADDRESS, TELEPHONE NUMBER, NAME OF PERSON PREPARING THE APPLICATION, AND THE NAME OF THE PERSON RESPONSIBLE FOR CARRYING OUT THE PROJECT. 2. A BRIEF HISTORY OF THE ORGANIZATION OR THE BACKGROUND AND RELEVANT EXPERIENCE OF AN INDIVIDUAL APPLICANT. 3. A DETAILED DESCRIPTION OF THE PROPOSED PROJECT WITH A NEEDS ASSESSMENT, AN OUTLINE OF THE PROJECT GOALS AND OBJECTIVES, AND THE PLAN FOR MEETING THOSE GOALS AND OBJECTIVES. 4. THE GEOGRAPHIC AND POPULATION SCOPE OF THE PROJECT. 5. A DESCRIPTION OF THE ANTICIPATED IMPACT THE PROJECT WILL HAVE ON THE REGION. 6. A DESCRIPTION OF THE ORGANIZATION'S RELATIONSHIP WITH OTHER ORGANIZATIONS WORKING WITH SIMILAR MISSIONS AND HOW YOU WORK TOGETHER TO AVOID DUPLICATION OF EFFORTS. 7. LIST INDIVIDUALS OR ORGANIZATIONS THAT ARE PARTNERS WITH YOUR PROJECT. 8. THE TIME PERIOD TO BE COVERED BY THE GRANT. 9. THE PROJECT BUDGET, INCLUDING SOURCES OF INCOME AND ANTICIPATED COSTS. THE GRANTS COMMITTEE MAY REQUEST AN ANNUAL AUDIT, IF APPROPRIATE. 10. POTENTIAL FOR SUSTAINABILITY OF THE PROJECT AND LONG-TERM FUNDING STRATEGIES. 0 1 0 0 0 0 0 0 0 KENNETH HOLMEN MD PRESIDENT/CEO 0 1241865 0 0 0 313062 0 39768 0 34679 0 1629374 0 311826 LEAH SCHAMMEL PHYSICIAN 0 1056572 0 41446 0 180 0 43230 0 34252 0 1175680 0 0 NATHANIAL J SLINKARD PHYSICIAN 0 1070693 0 17898 0 180 0 22500 0 29117 0 1140388 0 0 SASAN MOSHIRZADEH PHYSICIAN 0 1004244 0 16373 0 270 0 45000 0 12091 0 1077978 0 0 LAUREL WESSMAN PHYSICIAN 0 451456 0 545525 0 144 0 22500 0 3405 0 1023030 0 0 DEXTER CASTA PHYSICIAN 0 932149 0 8822 0 180 0 30225 0 13561 0 984937 0 0 JOY PLAMANN CHIEF OPERATING OFFICER/SR VP 0 754410 0 0 0 46682 0 17550 0 31814 0 850456 0 46268 MICHAEL BLAIR CHIEF FINANCIAL OFFICER/SR VP/TREASU 0 668440 0 0 0 86455 0 52500 0 26910 0 834305 0 85681 CINDY SMITH VICE PRESIDENT 0 620355 0 0 0 96036 0 48000 0 30002 0 794393 0 94848 THOMAS SCHRUP CHIEF PHYSICIAN OFFICER/EVP 0 599464 0 0 0 103249 0 30000 0 30865 0 763578 0 102475 DR EDWARD MARTIN-CHAFFEE MD DIRECTOR 0 648300 0 25049 0 1188 0 52500 0 22967 0 750004 0 0 JOSEPH H KALKMAN CHIEF ADMINISTRATIVE OFFICER/SR VP 0 548359 0 0 0 72058 0 51330 0 26911 0 698658 0 70845 LYNN MCFARLING VICE PRESIDENT 0 375771 0 0 0 204148 0 52120 0 13027 0 645066 0 202960 SANTO CRUZ CHIEF LEGAL OFFICER/SR VP/SECRETARY 0 516575 0 0 0 50789 0 23700 0 29999 0 621063 0 50609 CHRISTOPHER BOELTER VICE PRESIDENT 0 529320 0 0 0 74839 0 0 0 4244 0 608403 0 74065 JOSEPH M BLONSKI VICE PRESIDENT 0 457673 0 0 0 70844 0 30000 0 27972 0 586489 0 69656 AMY M PORWOLL CHIEF INFORMATION SYSTEM OFFICER/SR 0 452945 0 0 0 61141 0 43000 0 20189 0 577275 0 60367 MARIA MALLORY VICE PRESIDENT 0 485410 0 14363 0 774 0 33752 0 23783 0 558082 0 0 JOHN R HERING FORMER KEY EMPLOYEE 0 391253 0 0 0 40396 0 52386 0 32052 0 516087 0 39982 MICHAEL SCHRAMM FORMER KEY EMPLOYEE 0 378797 0 0 0 55759 0 25097 0 31373 0 491026 0 55345 DEBRA G PETERSON VICE PRESIDENT 0 437092 0 8006 0 1219 0 30000 0 13325 0 489642 0 0 ULRIKA WIGERT VICE PRESIDENT 0 405755 0 15517 0 414 0 30000 0 28717 0 480403 0 0 BRYAN LYDICK VICE PRESIDENT 0 402699 0 0 0 270 0 36148 0 28968 0 468085 0 0 JOSEPH D HELLIE VICE PRESIDENT 0 341074 0 0 0 40593 0 30000 0 26911 0 438578 0 39819 BRYAN BAUCK VICE PRESIDENT 0 321083 0 0 0 25178 0 39626 0 38322 0 424209 0 25016 DAVID LARSON VICE PRESIDENT 0 328487 0 0 0 39093 0 22500 0 29402 0 419482 0 38913 MATTHEW KUNKEL VICE PRESIDENT 0 342333 0 0 0 180 0 45000 0 31472 0 418985 0 0 ANTHONY GARDENER CHIEF MARKETING & COMMUNICATIONS 0 305965 0 0 0 54546 0 30000 0 15575 0 406086 0 53358 TAMARA CONGDON MD DIRECTOR 0 322139 0 10521 0 414 0 22500 0 30067 0 385641 0 0 PART I, LINE 4B FURTHER EXPLANATION OF THE OFFICERS' COMPENSATION LISTED IN SECTION VII OF FORM 990 AND ON SCHEDULE J: THE CORPORATIONS' EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN BENEFIT PLANS WHICH INCLUDE TAX DEFERRED NON QUALIFIED INVESTMENT ACCOUNTS. THESE PLANS MAY PROVIDE, BUT ARE NOT CERTAIN TO PROVIDE, FOR PAYMENT OF TAX DEFERRED COMPENSATION TO THESE EXECUTIVES AT SOME TIME IN THE FUTURE. THE EXECUTIVE HAS NO LEGAL RIGHT TO THESE DOLLARS UNTIL, AND UNLESS, CERTAIN FUTURE EVENTS OCCUR. IN ACCORDANCE WITH THE INSTRUCTIONS TO THE FORM 990, THE AMOUNTS LISTED IN SECTION VII AND IN SCHEDULE J REFLECT THIS TAX DEFERRED COMPENSATION. THIS COMPENSATION IS POTENTIALLY REPORTED TWICE ON THE FORM 990; ONCE WHEN THE COMPENSATION IS DEFERRED OR ACCRUED AND AGAIN IF IT IS PAID TO THE EXECUTIVE. X 7769 COST X 10 299772 STOCK MKT HISTORICAL COS X SILENT AUCTION ITEMS, JEWELRY AND GIFT CARDS FOR EVENTS 174 115345 COST X FOOD AND BEVERAGES FOR HEALTH CARE WORKERS & EVENTS 9 37539 COST X GIFT CARDS 8 5150 COST 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS USING THE NUMBER OF CONTRIBUTIONS RECEIVED AS THE NUMBER OF CONTRIBUTIONS OR ITEMS CONTRIBUTED. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES INVESTMENTS TO AN INVESTMENT COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION WAS CREATED WITH CENTRACARE HEALTH SYSTEM AS ITS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A WE HAVE CERTAIN CENTRACARE HEALTH SYSTEM MEMBERS ON THE FOUNDATION BOARD PURPOSEFULLY. THESE ARE APPOINTED BY THE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B WE HAVE CERTAIN CENTRACARE HEALTH SYSTEM POLICIES THAT APPLY TO ALL ORGANIZATIONS UNDER THE HEALTH SYSTEM, INCLUDING THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY THE ORGANIZATION'S PUBLIC ACCOUNTANT WITH THE ASSISTANCE OF THE ORGANIZATION'S PERSONNEL. ONCE COMPLETE, THE 990 IS PRESENTED TO THE BOARD MEMBERS WHERE IT IS REVIEWD, APPROVED, AND SIGNED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE ONCE A YEAR. ALL STAFF SIGN CONFLICT OF INTEREST FORMS ON AN ANNUAL BASIS FACILITATED BY CENTRACARE HEALTH SYSTEM. THE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AS WELL AS THE CORPORATE COMPLIANCE GROUP (A COMPLIANCE COMMITTEE WHICH INCLUDES INTERNAL MEMBERS AND OUTSIDE COUNSEL). THE RESPONSES TO THE QUESTIONNAIRE ARE THEN REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE 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/HER SELF 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 C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF TRUSTS -1,025. NET ASSETS TRANSFER FROM DIVESTITURE -3,884,646. FORM 990, PART XII, LINE 2C THERE HAS BEEN NO CHANGE IN THE PROCESS FROM THE PRIOR YEAR. FORM 990, PART I, LINE 1 & FORM 990, PART III, LINE 1, MISSION CONTINUE: (G) PROMOTING THE MEDICAL, NURSING, SPIRITUAL, PHYSICAL, SOCIAL, OR PSYCHOLOGICAL CARE AND SERVICES, INCLUDING HOUSING AND OUTREACH SERVICES, FOR THE ELDERLY AND OTHER PERSONS WHO DO NOT REQUIRE ACUTE HOSPITAL CARE. (H) PROMOTING THE INTERESTS OF ANY NONPROFIT AND FEDERALLY TAX-EXEMPTED ORGANIZATION, PROVIDED HOWEVER, THE PURPOSES OF SUCH ORGANIZATION ARE CONSISTENT WITH THOSE OF THE CORPORATION. CENTRACARE HEALTH SYSTEM 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411813221 TO OPERATE AN INTEGRATED MULTI-ORGANIZATIONAL HEALTH SYSTEM MN 501(C)(3) LINE 3 N/A 0 CENTRACARE HEALTH - LONG PRAIRIE 20 SE 9TH SE LONG PRAIRIE MN 56347 411924645 OPERATION OF ACUTE AND LONG TERM CARE FACILITIES MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH - MELROSE 11 NORTH 5TH AVE WEST MELROSE MN 56352 411865315 OPERATION OF ACUTE AND LONG TERM CARE FACILITIES MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE CLINIC 1406 6TH AVENUE NORTH ST CLOUD MN 56303 411806657 OPERATION OF A MULTI SPECIALTY PHYSICIAN CLINIC MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CENTRACARE HEALTH - SAUK CENTRE 425 ELM STREET NORTH SAUK CENTRE MN 56378 452438973 OPERATION OF ACUTE AND LONG TERM CARE FACILITIES MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 ST CLOUD HOSPITAL 1406 6TH AVENUE NORTH ST CLOUD MN 56303 410695596 ACUTE/LT CARE MN 501(C)(3) LINE 3 CENTRACARE HEALTH SYSTEM 0 CUSHMAN ALBERT RICE TRUST 1100 WEST ST GERMAIN STREET ST CLOUD MN 56303 416019335 SUPPORT FOR CENTRACARE RICE MEMORIAL HOSPITAL MN 501(C)(3) LINE 12A, I CENTRACARE RICE MEMORIAL HOSPITAL 0 MONTICELLO CANCER CENTER 1001 HART BOULEVARD SUITE 50 MONTICELLO MN 55362 261909519 RADIATION & ONCOLOGY SERVICES MN CENTRACARE HEALTH - MONTICELLO N/A 0 0 CENTRAL IMAGING LLC 1406 6TH AVENUE NORTH ST CLOUD MN 56303 852580688 IMAGING SERVICES MN CENTRACARE HEALTH SYSTEM N/A 0 0 CENTRACARE HOLDINGS INC 1406 6TH AVENUE NORTH ST CLOUD MN 56303 472688595 INVESTMENTS MN CENTRACARE HEALTH SYSTEM C 0 AFFILIATED COMMUNITY MEDICAL CENTERS PA 301 BECKER AVENUE SOUTHWEST WILLMAR MN 56201 410850702 INVESTMENTS MN CENTRACARE RICE MEMORIAL C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 CENTRACARE HEALTH SYSTEM B 1205223 FMV CENTRACARE CLINIC B 242834 FMV ST CLOUD HOSPITAL B 4049188 FMV CENTRACARE HEALTH SYSTEM P 2714780 FMV