2026-08-17T12:03:26-05:00 2025-09-30 410746749 CLIFTONLARSONALLEN LLP 121 WEST BRIDGE STREET OWATONNA MN 55060 990 2024-10-01 410743546 COMMUNITY MEMORIAL HOSPITAL ASSOCIATION COMM 2188794641 512 SKYLINE BLVD CLOQUET MN 55720 KIRK JOHNSON CFO 2188794641 2026-08-14 1 0 JUSTIN HARTERT P02236744 5074467100 2026-08-13 2024 2025-03-06 01:10:19Z RICK BREUER 512 SKYLINE BLVD CLOQUET MN 55720 96119003 0 X WWW.CLOQUETHOSPITAL.COM X 1954 MN THE MISSION OF COMMUNITY MEMORIAL HOSPITAL IS TO IMPROVE AND ENHANCE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND OUR COMMUNITY THROUGH EDUCATION, PREVENTION AND INTERVENTION. 9 7 487 75 28981 18952 442580 609308 71667289 93958823 183997 -201311 664339 1355468 72958205 95722288 23595 28964 0 0 41643592 46174824 0 0 0 33280690 48187062 74947877 94390850 -1989672 1331438 47126932 55586395 33299838 40427863 13827094 15158532 X YOUR NEIGHBORS CARING FOR YOU. 0 0 87312315 28964 94316834 COMMUNITY MEMORIAL HOSPITAL ASSOCIATION (CMH) IS A CRITICAL ACCESS HOSPITAL LOCATED IN CLOQUET, MN IN CARLTON COUNTY. CMH SERVES PRIMARILY AN ELEVEN ZIP-CODE AREA WITH A POPULATION OF APPROXIMATELY 35,000 RESIDENTS. CMH OFFERS THE COMMUNITY A ROBUST SERVICE LINE OFFERING WHICH INCLUDES INPATIENT & OUTPATIENT SERVICES. COMMUNITY MEMORIAL HOSPITAL ASSOCIATION PROVIDES A NEWLY CONSTRUCTED STATE OF THE ART INPATIENT FACILITY HOUSING MED/SURG, ICU, OB, AND SWING BED SERVICES. CMH PROVIDES A FULL ARRAY OF OUTPATIENT SERVICES WHICH INCLUDE: A 24-HOUR E/R, A FULL SPECTRUM OF IMAGING SERVICES, LABORATORY, SURGERY, CHEMO/INFUSION, PHARMACY, R.T., CARDIAC REHAB, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIABETIC EDUCATION, SLEEP STUDIES, AND OTHER MEDICAL SERVICES NEEDED BY OUR COMMUNITY. CMH ALSO EMPLOYS A NUMBER OF PHYSICIANS IN SPECIALTIES THAT ARE IN HIGH DEMAND IN OUR SERVICE AREA. THESE INCLUDE GENERAL SURGEONS, ENT SURGEONS, AND ORTHOPEDIC SURGEONS.CMH HAS GROWN AT A FAST PACE TO MEET THE NEEDS OF OUR COMMUNITY. IN THE TAX YEAR ENDING SEPTEMBER 30, 2025, CMH PROVIDED 3,461 INPATIENT DAYS, 2,974 SURGERIES, 8,038 EMERGENCY ROOM VISITS, AND 52,913 OUTPATIENT VISITS. IN ADDITION, CMH REACHES OUT TO THE COMMUNITY TO ENHANCE THE HEALTH AND WELLBEING OF OUR SERVICE AREA BY OFFERING NUMEROUS EDUCATIONAL OPPORTUNITIES, HEALTH SCREENINGS, AND SUPPORT GROUPS. 87312315 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 64 0 1 487 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X KIRK JOHNSON 2188794641 512 SKYLINE BLVD CLOQUET MN 55720 KELLY JOHNSON CHAIR 2.00 0.00 X X 0 0 0 STEVE RISACHER VICE CHAIR 2.00 0.00 X X 0 0 0 RALPH HAMANN TREASURER 2.00 0.00 X X 0 0 0 JENNY BARTA SECRETARY 2.00 0.00 X X 0 0 0 RAY HATINEN DIRECTOR 2.00 0.00 X 0 0 0 BRITTANY BONK DIRECTOR 2.00 0.00 X 0 0 0 CHRIS DAVIS DIRECTOR 2.00 0.00 X 0 0 0 LEE OLSON DIRECTOR (THRU 12/24) 2.00 0.00 X 0 0 0 SAMUEL MOOSE DIRECTOR (THRU 4/25) 2.00 0.00 X 0 0 0 JOANNA ROBNIK MD DIRECTOR/PHYSICIAN 40.00 0.00 X 237879 0 37628 KARA UNDERWOOD MD DIRECTOR/PHYSICIAN 40.00 0.00 X 398928 0 20671 RICK BREUER CEO 40.00 4.00 X 449304 0 54602 KIRK JOHNSON CFO 40.00 2.00 X 217574 0 36061 BRAD ANDERSON COO 40.00 0.00 X 270107 0 48392 KYLE MENZEL MD PHYSICIAN 40.00 0.00 X 1110571 0 41244 ASMA KHAN PHYSICIAN 40.00 0.00 X 532942 0 13311 BRYAN HUNTER CRNA 40.00 0.00 X 445606 0 50801 SETH HEIKKILA PHYSICIAN 40.00 0.00 X 395466 0 41797 JEFF RAPP PHYSICIAN 40.00 0.00 X 362279 0 67453 4420656 0 411960 76 0 1 0 ORTHOPEDIC ASSOCIATES OF DULUTH PA 1000 E 1ST ST FL 4 DULUTH MN 55805 SURGICAL SERVICES 1901653 TEGRIA SERVICES GROUP - US INC 1255 FOURIER DRIVE SUITE 101 MADISON WI 53717 IT SERVICES 1259624 CENTRAL MINNESOTA DIAGNOSTIC INC 525 10TH ST NE MILACA MN 56353 IMAGING SERVICES 895305 NORTHLAND GASTROENTEROLOGY PA 1420 LONDON RD 202 DULUTH MN 55805 SURGICAL SERVICES 590441 SIGHTPATH MEDICAL LLC 5775 W OLD SHAKOPEE ROAD 90 BLOOMINGTON MN 55437 MEDICAL SERVICES 390587 14 266005 319040 24263 609308 PATIENT SERVICES 621500 93953978 93953978 OUTSIDE LAB SALES 621500 4845 4845 93958823 178071 24136 153935 200980 0 200980 200980 200980 17333 396715 -379382 -379382 -379382 INVESTMENT IN CMDI 622110 362856 362856 QUALITY INCENTIVE INCOME 900099 267417 267417 340B INCOME 456110 231655 231655 292560 292560 1154488 95722288 94316834 28981 767165 X 28964 28964 1116241 432885 683356 36862566 35114385 1748181 1209576 1150203 59373 4509061 4273548 235513 2477380 2334250 143130 53497 53497 112873 112873 11293939 11126223 167716 219223 219223 744280 564547 179733 1498226 1320471 177755 144620 130871 13749 9678 9678 1065477 1065477 3017890 2628869 389021 365025 40026 324999 MEDICAL SUPPLIES 19013071 18950856 62215 PHARMACEUTICAL DRUGS 3846581 3846581 BAD DEBT 3407198 3407198 REPAIRS AND MAINTENACE 1454850 1413758 41092 1940634 548680 1391954 94390850 87312315 7078535 0 186130 0 3901528 4722117 13298864 21439726 1937716 0 2143552 2408244 470215 456116 72298693 48142569 22464698 24156124 1726611 1594901 820597 664293 177021 144874 47126932 55586395 8540515 13359452 202363 200863 8607 0 23927843 25235498 620510 1632050 33299838 40427863 X 13827094 15158532 13827094 15158532 47126932 55586395 1331438 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5357 5357 0 PART II-B, LINE 1: COMMUNITY MEMORIAL HOSPITAL ASSOCIATION PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 0 1 X 301419 301419 296445 4974 301419 292457 2588 176 296445 417785 4135 129463 294869 659448 659448 51919455 35053701 16865754 1577518 1449218 128300 17906494 11639650 6266844 235778 235778 24156124 THIRD PARTY PAYOR SETTLEMENT 1488213 LEASE LIABILITIES 143837 1632050 X 92315090 0 92315090 3407198 3407198 95722288 90983652 0 90983652 3407198 3407198 94390850 PART IV, LINE 2B: THE HOSPITAL WAS THE CUSTODIAN OF FUNDS BELONGING TO FORMER RESIDENTS OF THE NURSING HOME. THE HOSPITAL WORKED TO RETURN THESE FUNDS TO THEIR LEGAL OWNERS. PART V, LINE 4: THE FUNDS WERE TO BE USED ONLY FOR EQUIPMENT NEEDS IN SUNNYSIDE (SNF) OR ICU AND TO BRING DIALYSIS INTO THE COMMUNITY. PART X, LINE 2: THE ASSOCIATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. NONPROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGE, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE ASSOCIATION HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE ASSOCIATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2021. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,407,198. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,407,198. 1 1 X 1 X 1 X 1 1 1 0 0 424233 424233 0.00470 11070016 6387661 4682355 0.05150 91875 102389 0 0.00000 11586124 6490050 5106588 0.05620 277686 78090 199596 0.00220 314704 314704 0.00350 592390 78090 514300 0.00570 12178514 6568140 5620888 0.06190 1 3407198 0 34692442 37003851 -2311409 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BLVD CLOQUET MN 55720 WWW.CLOQUETHOSPITAL.COM 419670 X X X X COMMUNITY MEMORIAL HOSPITAL 0 0 1 X X X X X X X X X 24 1 0 1 1 X SEE PART V, SECTION B, LINE 7D X X 1 24 1 SEE PART V, SECTION B, LINE 7D 0 1 X 200.000000000000 250.000000000000 X X X X 1 1 X X X 1 X SEE PART V, LINE 16J X SEE PART V, LINE 16J X SEE PART V, LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: TO SOLICIT INPUT FROM COMMUNITY STAKEHOLDERS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE SURVEY WAS IMPLEMENTED EARLY IN THE CHNA PROCESS. WHILE SPECIFIC INDIVIDUALS FROM CMH AND PARTNER AGENCIES WERE INVITED TO COMPLETE THE SURVEY, IT WAS OPEN TO THE ENTIRE COMMUNITY, AND OVER 100 PEOPLE PARTICIPATED IN THE PROCESS. INDIVIDUALS RESPONDING TO THE SURVEY INCLUDE HEALTHCARE PROVIDERS, PUBLIC HEALTH REPRESENTATIVES, LEADERS OF OTHER HEALTH AND SOCIAL SERVICES AGENCIES, AND OTHER COMMUNITY LEADERS.THE SURVEY ASKED INDIVIDUALS TO RATE VARIOUS HEALTH AND SOCIETAL ISSUES AS BEING PROBLEMATIC WITHIN THE COMMUNITY, AS WELL AS TO COMMENT ON THE ADEQUACY OF VARIOUS RESOURCES AND SERVICES. THESE SURVEY RESULTS WERE USED, ALONG WITH OTHER SECONDARY SURVEY AND PUBLICLY REPORTED DATASETS, TO INFORM AND GUIDE THE CHNA PROCESS. COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: COMMUNITY MEMORIAL HOSPITAL SOUGHT INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY THROUGH A MULTI-STEP COMMUNITY ENGAGEMENT PROCESS. IN PARTNERSHIP WITH CYCLE OF BUSINESS, THE HOSPITAL CONVENED AN INITIAL MEETING OF COMMUNITY REPRESENTATIVES, INCLUDING HEALTHCARE PROFESSIONALS AND INDIVIDUALS REFLECTING THE DEMOGRAPHIC MAKEUP OF CARLTON COUNTY, TO REVIEW COMMUNITY HEALTH DATA, DISCUSS COMMUNITY HEALTH NEEDS, AND PROVIDE INPUT ON THE DEVELOPMENT OF A COMMUNITY SURVEY.UNDER THE GUIDANCE OF AN OUTSIDE FACILITATOR, WE HOSTED STAKEHOLDER MEETINGS TO REVIEW COMMUNITY HEALTH DATA, CONSTRUCT A COMMUNITY SURVEY, REVIEW THOSE SURVEY RESULTS, AND MAKE RECOMMENDATIONS TO THE ORGANIZATION ON THE HEALTH PRIORITIES TO INCLUDE IN THE CHNA.WHILE CMH EMPLOYEES SPANNING NUMEROUS DEPARTMENTS AND FUNCTIONS ATTENDED THESE MEETINGS, WE ALSO HAD PARTICIPATION AND ENGAGEMENT FROM OUTSIDE AGENCIES. THOSE PARTNERS INCLUDE REPRESENTATIVES FROM THE FOLLOWING DEPARTMENTS AND FUNCTIONS THAT WERE EITHER CONTACTED INDIVIDUALLY OR THROUGH THEIR GROUPS:- CARLTON COUNTY COMMUNITY AND FAMILY INITIATIVES- CARLTON COUNTY COMMUNITY AND COLLABORATION SPECIALISTS- CARLTON-COOK-LAKE-ST. LOUIS COMMUNITY HEALTH BOARD- FOND DU LAC RESERVATION- STATEWIDE HEALTH IMPROVEMENT PROGRAM (SHIP) COMMUNITY LEADERSHIP TEAM- CARLTON COUNTY PUBLIC HEALTH ADVISORY COMMITTEE- CARLTON COUNTY CHILDREN AND FAMILY SERVICES COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON OUR WEBSITE AT: HTTPS://CLOQUETHOSPITAL.COM/ABOUT/CHNA AND IMPLEMENTATION PLAN DIRECT LINK:HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2026/01/COMMUNITY-MEMORIAL-HOSPITAL-CLOQUET-2025-CHNA.PDF COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: EACH OF THE PRIORITY AREAS IDENTIFIED IN THE PREVIOUS CHNA REQUIRE WORK BEYOND THE WALLS OF CMH. PARTNERSHIPS WITH LOCAL AGENCIES AND CONTRIBUTING TO THE WORK OF VARIOUS TASK FORCES ARE SOME OF THE WAYS WE CONTINUE TO ADDRESS IDENTIFIED NEEDS. THE PREVIOUSLY IDENTIFIED PRIORITY NEEDS INCLUDE:1. MENTAL HEALTH OUR GOALS HERE WERE AS FOLLOWS:- CREATE A ROSTER OF ALL RELATED RESOURCES AVAILABLE COUNTYWIDE. THIS HAS BECOME A BROADER PROJECT, SUPPORTED BY CMH, TAKEN ON BY PUBLIC HEALTH.- REPRESENT CMH AT CARLTON COUNTY SUICIDE PREVENTION TASK FORCE. WE HAVE PROVIDED SUCH REPRESENTATION.- IMPROVE COMPLETION RATE OF PATIENT DEPRESSION SCREENING TOOK WITHIN FAMILY MEDICINE BY 10%. RATES OF COMPLETION FOR THIS TOOL HAVE INCREASED OVER 25% DURING THIS TIME PERIOD.2. SUBSTANCE ABUSE OUR GOALS HERE WERE AS FOLLOWS:- REPRESENT CMH AT CARLTON COUNTY DRUG PREVENTION COALITION MEETINGS. WE HAVE PROVIDED SUCH REPRESENTATION.- PARTNER WITH CARLTON COUNTY PUBLIC HEALTH AND JAIL OFFICIALS TO IMPROVE PATIENT CARE PROTOCOLS FOR THOSE IN CUSTODY POTENTIALLY SUFFERING FROM ACUTE DRUG-RELATED HEALTH EVENTS. OUR CARE LEADERS HAVE MET WITH COUNTY OFFICIALS TO MAKE CHANGES IN CARE PROTOCOLS, ENSURING THOSE NEEDS ARE MORE FULLY MET.- OPERATIONALLY AND FINANCIALLY SUPPORT EFFORTS TO INCREASE THE AVAILABILITY OF NALOXONE AND OTHER HARM REDUCTION RESOURCES ACROSS CARLTON COUNTY. WE CONTINUE TO SUPPORT THESE COUNTYWIDE EFFORTS. DURING THIS TIME PERIOD, WE BECAME THE ONLY HOSPITAL IN THE REGION TO SET UP A CABINET WHERE ANY COMMUNITY MEMBER CAN TAKE KITS TO USE IN CASE OF AN OVERDOSE. IT IS RESTOCKED REGULARLY, AND IT DRAWS THE LARGEST USE OF ANY SUCH CABINET IN THE COUNTY. OBESITY OUR GOALS HERE WERE AS FOLLOWS:- DEVELOP A SPECIFIC WELLNESS PROGRAM AND SERVICES TO BE OFFERED BY ONE OR MORE PROVIDERS AT CMH RAITER FAMILY CLINIC. A WELLNESS AND WEIGHT-LOSS PROGRAM WAS INITIATED AT CMH DURING THIS TIME PERIOD. IT HAS HELPED MANY COMMUNITY MEMBERS AND CONTINUES TO GROW.- OFFER LOW-COST SPORTS PHYSICALS TO LOCAL KIDS, ENCOURAGING GREATER AND MORE AFFORDABLE ACCESS TO PHYSICAL ACTIVITIES. WE BEGAN OFFERING FREE SPORTS PHYSICALS TO KIDS DURING THIS TIME PERIOD, AND PARTICIPATION HAS GROWN EVERY YEAR.- INCREASE CMH EMPLOYEE MEMBERSHIP IN AREA FITNESS CENTERS BY 20%. WE HAVE NOT SEEN THIS GROWTH FIGURE ACHIEVED. EMPLOYEES CAN RECEIVE SUBSIDIES TO OFFSET PART OF THE COST OF MEMBERSHIP, BUT MEMBERSHIP HAS NOT GROWN. WE SPEAK AS A LEADERSHIP TEAM AND AT OUR HUMAN RESOURCES GOVERNANCE COMMITTEE ABOUT OTHER EFFORTS THAT CAN BE MADE TO INCREASE PARTICIPATION AND IMPROVE EMPLOYEE WELLNESS. COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT:HTTPS://CLOQUETHOSPITAL.COM/FINANCIAL-ASSISTANCE/FINANCIAL ASSISTANCE POLICY DIRECT LINK:HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2026/05/PFS-COMMUNITY-CARE-PROGRAM.PDFFINANCIAL ASSISTANCE POLICY APPLICATION DIRECT LINK:HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2026/05/COMMUNITY-CARE-PROGRAM-APPLICATION_4-2026_2.PDFPLAIN LANGUAGE SUMMARY DIRECT LINK:HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2026/04/FAP-PLAIN-LANGUAGE-SUMMARY_4-2026_1.PDF 1 1 - CMH RAITER FAMILY CLINIC 417 SKYLINE BLVD CLOQUET MN 55720 FAMILY MEDICINE CLINIC PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST-TO-CHARGE RATIO FROM THE AS-FILED 2025 MEDICARE COST REPORT (LINES 7A, 7B, 7C). LINE 7I IS LISTED AS ACTUAL WITH THE EXCEPTION OF AN ESTIMATE FOR SPACE UTILIZATION FOR VARIOUS COMMUNITY PROGRAMS. 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 $ 3,407,198. PART III, LINE 2: THE HOSPITAL GENERALLY ESTIMATES THE AMOUNT OF BAD DEBTS FOR THE CURRENT YEAR BY BY USING THE PERCENTAGE OF REVENUE SHOWN AS BAD DEBT IN SUPPLEMENTAL INFORMATION TO THE AUDITED FINANCIAL STATEMENT FROM THE PRIOR YEAR. PART III, LINE 3: AT COMMUNITY MEMORIAL HOSPITAL, BAD DEBT IS CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE REFLECT AN INABILITY TO PAY. PART III, LINE 4: SEE THE 'PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE' PARAGRAPH ON PAGES 10-11 OF THE ATTACHED FINANCIAL STATEMENTS FOR INFORMATION ABOUT BAD DEBT EXPENSE. PART III, LINE 8: THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6: THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COSTCENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: COMMUNITY MEMORIAL HOSPITAL HAS BOTH SELF-PAY COLLECTIONS AND COMMUNITYCARE PROGRAM (CHARITY CARE) POLICIES THAT ARE UTILIZED AND APPLIED FLUIDLY. SELF-PAY (MINNESOTA ATTORNEY GENERAL) DISCOUNTS ARE APPLIED IMMEDIATELY TO A SELF-PAY PATIENTS' LIABILITY. ALL INPATIENT AND OUTPATIENT ACCOUNTS ARE ELIGIBLE FOR CHARITY CARE. ALL PATIENTS ARE ADVISED OF THIS PROGRAM AND APPLICATIONS ARE MADE READILY AVAILABLE. ELIGIBILITY IS DETERMINED BY THE APPLICANTS INCOME (FEDERAL TAX RETURN AND OTHER FINANCIAL DISCLOSURES) COMPARED TO THE FEDERAL POVERTY GUIDELINES. QUALIFYING PATIENTS CAN RECEIVE A PARTIAL SLIDING SCALE REDUCTION UP TO 100%. PATIENTS WHO MAY QUALIFY BUT DO NOT COMPLETE THE COMMUNITY CARE APPLICATION WOULD BE MOVED TO OUR SELF-PAY COLLECTION POLICY. THIS POLICY OUTLINES THE SERIES OF STATEMENT MAILINGS, 30-60-90 DAY LETTERS, COURTESY CALLS AS WELL AS THE AVAILABILITY OF COMMUNITY CARE. THIS CYCLE IS PURSUED RATHER THAN THE ACCOUNT BEING CONSIDERED FOR BAD DEBT COLLECTION. COMMUNITY MEMORIAL HOSPITAL ASSOCIATION'S BILLING AND COLLECTIONS POLICY STATES:I. PURPOSE: THE COLLECTION OF PATIENT BALANCES IS INTENDED TO PRESERVE A SOUND FINANCIAL BASIS FOR OPERATIONS IN ORDER THAT VITAL ESSENTIAL SERVICES CONTINUE TO BE PROVIDED.II. POLICY: SELF-PAY BALANCES ARE DUE UPON RECEIPT OF AN ITEMIZED BILL OR STATEMENT WHEN THE ACCOUNT BALANCE IS DETERMINED TO BE THE PATIENT'S RESPONSIBILITY (AFTER THIRD-PARTY BENEFITS ARE EXHAUSTED). CMH IS OBLIGATED TO COLLECT FOR SERVICES PROVIDED FROM PATIENTS THAT HAVE THEABILITY TO PAY. PATIENTS UNABLE TO PAY BALANCES IN FULL MAY MAKE MINIMUM MONTHLY PAYMENTS. CMH WILL ASSIST PATIENTS IN OBTAINING PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. PRIOR TO ASSIGNING AN ACCOUNT TO A COLLECTION AGENCY FOR NON-PAYMENT OR INSUFFICIENT PAYMENT, THE BILLING CYCLE WILL BE FOLLOWED AND THE EVENTS AND ALL PATIENT/GUARANTOR COMMUNICATION MUST BE CLEARLY DOCUMENTED IN THE ACCOUNT NOTES.III. DEFINITIONS/SPECIAL CONSIDERATIONSA BAD DEBT IS AN ACCOUNT RECEIVABLE BASED ON SERVICES FURNISHED TO A PATIENT THAT IS REGARDED AS UNCOLLECTABLE FOLLOWING REASONABLE COLLECTION EFFORTS. ACCOUNTS WILL BE TRANSFERRED TO A COLLECTION AGENCY AS AUTHORIZED BY ADMINISTRATION. A GUARANTOR IS THE PERSON RESPONSIBLE FOR THE PAYMENT OF THE MEDICAL DEBT. THE GUARANTOR IS TYPICALLY THE SAME AS THE ADULT PATIENT. THE GUARANTOR FOR A MINOR CHILD IS TYPICALLY THE PARENT OR LEGAL GUARDIAN THAT BRINGSTHE CHILD IN FOR SERVICES. PAYMENTS MAY BE MADE BY CASH, CHECK OR CREDIT CARD (VISA, MASTERCARD OR DISCOVER). CHECKS RETURNED BY A FINANCIAL INSTITUTION WILL INCUR A $30 RETURN CHECK FEE.IV. PROCEDURE1. SELF-PAY/UNINSURED AT TIME OF SERVICE:A. SCHEDULED SURGICAL PROCEDURES REQUIRE A MINIMUM $500 PREPAYMENT ON OR BEFORE THE DATE OF SERVICE IF THE PATIENT/GUARANTOR DOES NOT QUALIFY FOR ANY OTHER PROGRAM. OTHER SCHEDULED OUTPATIENT SERVICES REQUIRE A MINIMUM 10% PREPAYMENT.B. AN ITEMIZED BILL IS MAILED APPROXIMATELY 7 - 10 DAYS AFTER SERVICE/DISCHARGE DATE ALONG WITH A SELF- PAY LETTER (NEWSP) REQUESTING ANY POSSIBLE HEALTH PLAN COVERAGE INFORMATION AND INFORMING THE GUARANTOR ABOUT THE SELF-PAY DISCOUNTS AND COMMUNITY CARE PROGRAM (POLICY BUS-2002). THE SELF PAY DISCOUNT FOR UNINSURED (POLICY BUS-2005) IS APPLIED TO THEACCOUNT IF APPROPRIATE.C. FIRST STATEMENT PRINTS APPROXIMATELY 14 DAYS LATER. A PROMPT PAY DISCOUNT (10%) IS OFFERED ON BALANCES OVER $50 IF PAID IN FULL WITHIN 30 DAYS. A COMMUNITY CARE APPLICATION WILL BE MAILED FOR ACCOUNT BALANCES OVER $1,500.D. SECOND STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH PAST DUE MESSAGE IF THERE HAS BEEN NO PAYMENT MADE OR NO CONTRACT FOR PAYMENTESTABLISHED.E. THIRD STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH FIRSTCOLLECTION LETTER (#55) IF NO PAYMENT OR CONTRACT.F. FOURTH STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH SECOND/LASTCOLLECTION LETTER (#25) STATING THEY HAVE 1O DAYS TO RESPOND OR THEACCOUNT WILL BE PLACED WITH A PROFESSIONAL COLLECTION AGENCY IF NO PAYMENTIS RECEIVED OR CONTRACT ESTABLISHED.G. APPROXIMATELY 10 -30 DAYS LATER THE ACCOUNT IS REVIEWED FOR PLACEMENTWITH AN AGENCY.A. ROUTINE REVIEWS INCLUDE BUT ARE NOT LIMITED TO:I. CHECKING MN-ITS FOR MEDICAID ELIGIBILITYII. CHECKING IF ALL THIRD PARTY PAYER PAYMENTS HAVE BEEN RECEIVED OR IF DENIED PENDING INFORMATION FROM PATIENT, INSURED OR PROVIDERIII. CHECKING FOR RECENT PAYMENTS ON ALL ACCOUNTS WITH THE SAME PATIENT/GUARANTORIV. DETERMINING IF PATIENT MAY QUALIFY FOR CONTRACT HEALTH SERVICE (PHS) COVERAGEV. CHECKING IF A COMMUNITY CARE APPLICATION IS PENDINGVI. NEWBORNS CHECKED IF THEY ARE ENROLLED ON PARENT(S) HEALTH PLAN OR STATE MEDICAIDVII. REVIEW ACCOUNT COMMENTS/NOTES FOR RECENT PATIENT COMMUNICATION2. SELF-PAY BALANCE AFTER THIRD PARTY PAYERS:A. FIRST SELF-PAY STATEMENT PRINTS APPROXIMATELY 3 DAYS AFTER FINAL THIRD PARTY PAYMENT IS POSTED TO ACCOUNT. PROMPT PAY DISCOUNT (10%) IS OFFERED ON BALANCES OVER $50 IF PAID IN FULL WITHIN 30 DAYS.B. SUBSEQUENT STATEMENTS AND LETTERS FOLLOW THE SAME PROCESS AS ABOVE IF NO PAYMENT OR CONTRACT IS ESTABLISHED.3. PLACEMENT OF BAD DEBT ACCOUNTS WITH AN AGENCY OR OTHER RESOLUTION:A. THE DECISION TO ADVANCE A DEBT TO AN AGENCY FOR COLLECTION WILL BE BASED ON SUCH FACTORS AS LACK OF PAYMENT, INSUFFICIENT PAYMENTS, FAILURE TO APPLY FOR AVAILABLE PROGRAMS, FAILURE TO RESPOND TO PROVIDER OR PAYER REQUESTS FOR INFORMATION, OR FAILURE TO CONTACT THE BUSINESS OFFICE AS REQUESTED.B. AN ACCOUNT MAY BE DETERMINED UNCOLLECTIBLE AND TRANSFERRED TO AN AGENCY IF MAIL HAS BEEN RETURNED FOR A BAD ADDRESS AND ATTEMPTS WERE UNSUCCESSFUL TO FIND A CURRENT ADDRESS FOLLOWING THE RETURNED MAIL PROCEDURE.C. MINIMUM PAYMENT GUIDELINES WERE ESTABLISHED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY THEIR ACCOUNT BALANCE IN FULL. A LETTER (INSUF) WILL BE SENT TO PATIENTS THAT ARE NOT MAKING MINIMUM PAYMENTS ACCORDING TO CMH GUIDELINES WHICH ARE PRINTED ON THE BACK OF STATEMENTS.A. IF MINIMUM PAYMENTS ARE NOT SUBSEQUENTLY RECEIVED, INFORMATION MUST BE PROVIDED JUSTIFYING WHY THE MINIMUM PAYMENT CANNOT BE MADE AND WHY THEY ARE NOT ELIGIBLE FOR OTHER PROGRAMS SUCH AS MEDICAID AND COMMUNITY CARE. IF A FINANCIAL HARDSHIP IS INDICATED, A REDUCED PAYMENT PLAN MAY BE ESTABLISHED WITH PERIODIC REVIEW IN SIX TO NINE MONTHS. FINANCIAL HARDSHIP WILL BE DETERMINED UPON REVIEW OF SUPPORTING DOCUMENTATION.B. IF THE PATIENT/GUARANTOR DOES NOT RESPOND TO THE INSUFFICIENT PAYMENT LETTER, CONTINUED COLLECTION ACTIVITY WILL BE PURSUED.C. IF THE PATIENT/GUARANTOR DOES NOT RESPOND TO ANY ATTEMPTS TO DISCUSS THE INSUFFICIENT PAYMENT PLAN, THE ACCOUNT MAY BE TURNED OVER TO AN AGENCY.D. TRANSFERRING SELF-PAY BALANCES ONTO ONE ACCOUNT MAY ONLY BE DONE IF THE MINIMUM PAYMENT IS MADE ON THE NEW COMBINED BALANCE.D. PATIENTS KNOWN OR REPORTED TO HAVE EXPIRED, WITHOUT AN ESTATE OR PROBATE FILED, WILL NOT BE TRANSFERRED TO AN AGENCY IF THERE IS NO INDICATION THAT THE ACCOUNT WILL BE PAID. BALANCES WILL BE A WRITE-OFF ADJUSTMENT WHEN DEEMED APPROPRIATE.E. ACCOUNT BALANCES LESS THAN $25 WILL FOLLOW NORMAL COLLECTION PROCEDURES BUT WILL NOT BE TRANSFERRED TO AN AGENCY. IF THERE IS NO OTHER PATIENT OR GUARANTOR ACCOUNT BALANCES TO COMBINE WITH, THE BALANCE MAY BE A WRITE-OFF ADJUSTMENT.F. SMALL BALANCE WRITE-OFF ADJUSTMENTS WILL BE DONE MONTHLY ON ACCOUNT BALANCES LESS THAN $4.99 IF THERE IS NOT OTHER SELF-PAY ACCOUNT BALANCES TO COMBINE WITH. STATEMENTS ARE NOT SENT OUT FOR BALANCES UNDER $3.00.G. COLLECTION AGENCIES ARE DIRECTED TO RETURN ANY UNCOLLECTIBLE ACCOUNTS WITHIN NINE MONTHS OF TRANSFER IF NO PAYMENTS HAVE BEEN MADE OR PROVIDE INFORMATION TO CMH THAT WARRANTS RETAINING SUCH ACCOUNTS. PART VI, LINE 2: COMMUNITY MEMORIAL HOSPITAL REGULARLY ASSESSES THE HEALTH NEEDS OF ITS COMMUNITY THROUGH A VARIETY OF DATA SOURCES AND COMMUNITY INPUT PROCESSES. AS PART OF ITS 2025 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL UTILIZED INFORMATION FROM COUNTY HEALTH RANKINGS, U.S. CENSUS DATA, A COMMUNITY HEALTH SURVEY, THE FOND DU LAC RESERVATION HOUSING AND COMMUNITY NEEDS ASSESSMENT, AND BRIDGE TO HEALTH, A LONG-STANDING SOURCE OF HEALTH INDICATOR DATA FOR ADULTS IN NORTHEASTERN MINNESOTA AND NORTHWESTERN WISCONSIN. THE HOSPITAL USES THESE DATA SOURCES, TOGETHER WITH INPUT FROM COMMUNITY MEMBERS, HEALTHCARE PROFESSIONALS, AND OTHER STAKEHOLDERS, TO IDENTIFY COMMUNITY HEALTH NEEDS, EVALUATE TRENDS, AND DEVELOP STRATEGIES TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. PART VI, LINE 3: SELF PAY PATIENTS ARE INFORMED AT THE TIME OF SERVICE THAT WE CAN PROVIDE COMMUNITY CARE SERVICES AND PROVIDE A FORM. WE ADVISE THE PATIENT TO APPLY FOR MEDICAL ASSISTANCE TO THE MINNESOTA COUNTY HUMAN SERVICES OFFICE WHERE THEY RESIDE SO THAT THEY CAN APPLY FOR ASSISTANCE. COMMUNITY CARE (CHARITY CARE) APPLICATIONS ARE PROVIDED IN OUR REGISTRATION OFFICES, WAITING ROOMS AND ON OUR WEBSITE. THE ORGANIZATION ALSO SENDS INFORMATIONTO PATIENTS WITH THEIR ITEMIZED BILLS. WE REQUEST THAT PATIENTS CALL US WITH QUESTIONS OR FOR HELP REGARDING MEDICAL ASSISTANCE OR OUR COMMUNITY CARE PROGRAM. PART VI, LINE 4: COMMUNITY MEMORIAL HOSPITAL (CMH) IS AN INDEPENDENT CRITICAL ACCESS HOSPITAL LOCATED IN CLOQUET, MINNESOTA, AND SERVES CARLTON COUNTY AND SURROUNDING COMMUNITIES IN NORTHEASTERN MINNESOTA. CMH'S COMMUNITY HEALTH NEEDS ASSESSMENT DEFINES ITS SERVICE AREA AS CARLTON COUNTY AND CERTAIN SURROUNDING COMMUNITIES INCLUDED IN ITS PRIMARY AND SECONDARY SERVICE AREAS. THE SERVICE AREA INCLUDES APPROXIMATELY 41,815 RESIDENTS, WITH CARLTON COUNTY HAVING AN ESTIMATED POPULATION OF 36,745. COMMUNITY MEMORIAL HOSPITAL USES DEMOGRAPHIC, PUBLIC HEALTH, AND COMMUNITY INPUT DATA TO EVALUATE THE HEALTH NEEDS OF THE POPULATION IT SERVES. ACCORDING TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE MEDIAN HOUSEHOLD INCOME IN CARLTON COUNTY IS $80,042, APPROXIMATELY 11.1% OF THE POPULATION LIVES IN POVERTY, AND 26% OF RESIDENTS ARE AGE 60 OR OLDER. THESE AND OTHER DEMOGRAPHIC AND HEALTH INDICATORS ARE USED BY CMH TO IDENTIFY COMMUNITY HEALTH NEEDS AND DEVELOP APPROPRIATE COMMUNITY HEALTH IMPROVEMENT STRATEGIES PART VI, LINE 5: COMMUNITY MEMORIAL HOSPITAL (CMH) CONTINUES TO HAVE A STRONG ECONOMIC IMPACT ON OUR SERVICE REGION. WE KNOW WE COULD NOT BE SUCCESSFUL WITHOUT THE SUPPORT OF OUR COMMUNITY. OUR BOARD OF DIRECTORS ARE COMPRISED OF COMMUNITY MEMBERS WITH DIVERSE BACKGROUNDS AND INTERESTS. WE HAVE AN OPEN MEDICAL STAFF POLICY THAT SHARES OUR INTEREST OF PROVIDING QUALITY HEALTH CARE LOCALLY.WE TAKE "COMMUNITY" IN OUR NAME SERIOUSLY. CMH REACHES OUT BY OFFERING SCREENINGS, EDUCATION GROUPS AND OTHER CONNECTIONS TO IMPROVE THE HEALTH OF OUR CITIZENS. EDUCATIONAL SEMINARS INCLUDE: DIZZINESS, DIABETES, CHILDBIRTH AND URINARY INCONTINENCE. ONGOING STROKE AND GRIEF SUPPORT GROUPS HELP FAMILIES DEALING WITH THESE ISSUES. CMH HOSTS EXERCISE PROGRAMS IN ARTHRITIS CARE AND PILATES. MANY CONSULTING SERVICES ARE OFFERED THROUGH OUR OCCUPATIONAL THERAPY DEPARTMENT. WE CAN ASSIST IN DESIGNING AND PERFORMING EMPLOYMENT SCREENINGS, FUNCTIONAL JOB DESCRIPTIONS, WORK-SITE EVALUATIONS, WORKER EDUCATION, ETC. COMMUNITY MEMORIAL HOSPITAL GOES OUT INTO THE AREA TO CONDUCT HEALTH FAIRS AND EXPOSE PROVIDING SCREENINGS FOR VISION, BLOOD GLUCOSE, BLOOD PRESSURE, GRIP STRENGTH AS WELL AS BODY FAT ANALYSIS.COMMUNITY MEMORIAL HOSPITAL WILL CONTINUE TO GROW THE PROMOTION OF HEALTH IN THE COMMUNITY AND FURTHER ITS PURPOSE AS A EXEMPT ORGANIZATION. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 MINNESOTA WILDERNESS PO BOX 139 CLOQUET MN 55720 920841088 N/A 11250 0 SPONSORSHIP CARLTON AREA DEVELOPMENT CORPORATION PO BOX 336 CARLTON MN 55718 334089440 501(C)(3) 8000 0 GENERAL SUPPORT 1 1 X X X 0 0 0 0 0 0 0 0 0 KYLE MENZEL MD PHYSICIAN 1110157 0 0 0 414 0 17250 0 23994 0 1151815 0 0 0 ASMA KHAN PHYSICIAN 532762 0 0 0 180 0 13311 0 0 0 546253 0 0 0 RICK BREUER CEO 448530 0 0 0 774 0 17250 0 37352 0 503906 0 0 0 BRYAN HUNTER CRNA 444832 0 0 0 774 0 17250 0 33551 0 496407 0 0 0 SETH HEIKKILA PHYSICIAN 395322 0 0 0 144 0 17250 0 24547 0 437263 0 0 0 JEFF RAPP PHYSICIAN 359993 0 0 0 2286 0 17250 0 50203 0 429732 0 0 0 KARA UNDERWOOD MD DIRECTOR/PHYSICIAN 398154 0 0 0 774 0 17250 0 3421 0 419599 0 0 0 BRAD ANDERSON COO 269333 0 0 0 774 0 13743 0 34649 0 318499 0 0 0 JOANNA ROBNIK MD DIRECTOR/PHYSICIAN 237699 0 0 0 180 0 12553 0 25075 0 275507 0 0 0 KIRK JOHNSON CFO 217160 0 0 0 414 0 1010 0 35051 0 253635 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY MEMORIAL HOSPITAL ASSOCIATION HAS MEMBERS. MEMBERSHIP IS AVAILABLE TO QUALIFYING DONORS AS PROVIDED IN THE ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION A, LINE 7A COMMUNITY MEMORIAL HOSPITAL ASSOCIATION HAS MEMBERS WHO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS COMPLETED BY AN INDEPENDENT CPA FIRM, REVIEWED BY ADMINISTRATION AND FINANCE FOR ACCURACY, AND PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST INDIVIDUAL ANNUAL STATEMENTS WILL BE SIGNED ANNUALLY BY BOARD MEMBERS, CORPORATE OFFICERS, EXECUTIVES, MEDICAL STAFF, PHYSICIANS, AND DEPARTMENT DIRECTORS. EDUCATION IS DONE ON A YEARLY BASIS FOR PHYSICIANS, DEPARTMENT DIRECTORS AND THE BOARD OF DIRECTORS. ITEMS LISTED ON THE STATEMENTS ARE REVIEWED BY THE CEO, COMPLIANCE OFFICER AND/OR THE CHAIRMAN OF THE BOARD TO SEE IF CONFLICTS EXIST. IF CONFLICTS EXIST, THE CEO, COMPLIANCE OFFICER AND/OR THE CHAIRMAN SHALL: 1. IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. 2. AFTER EXERCISING DUE DILIGENCE, THE BOARD SHALL DETERMINE WHETHER CMH CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 3. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE OR CEO OF CMH SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN CMH'S BEST INTEREST, IS FOR CMH'S OWN BENEFIT, AND IS FAIR AND REASONABLE TO CMH AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. FORM 990, PART VI, SECTION B, LINE 15 AN ORGANIZATIONAL POLICY "SALARY ADMINISTRATION POLICY - NON CONTRACT EMPLOYEES" IS FOLLOWED. ANNUALLY, AN INDUSTRY SALARY SURVEY IS COMPLETED AND RESULTS ARE USED TO SET WAGE SCALES FOR POSITIONS BY JOB CODE. ANY CHANGES TO WAGE SCALES ARE PRESENTED TO THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS WHICH REVIEWS AND MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS FOR APPROVAL. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2025. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT ON-SITE FOR REVIEW BY THE PUBLIC DURING NORMAL BUSINESS HOURS FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,920,725. MANAGEMENT AND GENERAL EXPENSES 153,100. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,073,825. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 5,927,701. MANAGEMENT AND GENERAL EXPENSES 14,616. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,942,317. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,277,797. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,277,797. CLOQUET COMMUNITY MEMORIAL HOSPITAL FOUNDATION 512 SKYLINE BLVD CLOQUET MN 55720 363588501 SUPPORT MN 501(C)(3) LINE 12C, III-FI N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0