Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 10-01-2012 , 2012, and ending 09-30-2013
BCheck if applicable:
CName of organization
REGINA MEDICAL CENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 43 MR 10890
 
Room/suite
City or town, state or country, and ZIP + 4
MINNEAPOLIS, MN554400043
D Employer identification number

41-0740678
E Telephone number

G Gross receipts $ 62,792,202
F Name and address of principal officer:
TY ERICKSON
PO BOX 43 MR 10890
MINNEAPOLIS,MN554400043
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.REGINAMEDICAL.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet5578
K Form of organization:
 
L Year of formation: 1946
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: FAITHFUL TO ITS CHRISTIAN TRADITION OF RESPECT FOR HUMAN LIFE, PROMOTES THE HEALTH OF THE WHOLE PERSON.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 3
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 872
6 Total number of volunteers (estimate if necessary) ............. 6 285
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 75,030
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -358,299
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 466,056 894,139
9 Program service revenue (Part VIII, line 2g) ......... 87,162,967 48,040,129
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,140,474 1,133,217
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 113,001 106,623
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 88,882,498 50,174,108
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 10,000 20,000
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 50,081,864 31,134,659
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet39,056    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 38,566,671 29,076,412
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 88,658,535 60,231,071
19 Revenue less expenses. Subtract line 18 from line 12....... 223,963 -10,056,963
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 81,277,381 77,983,298
21 Total liabilities (Part X, line 26)............. 38,373,193 36,018,137
22 Net assets or fund balances. Subtract line 21 from line 20..... 42,904,188 41,965,161
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: REGINA MEDICAL CENTER, FAITHFUL TO ITS CHRISTIAN TRADITION OF RESPECT FOR HUMAN LIFE, PROMOTES THE HEALTH OF THE WHOLE PERSON.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 48,019,222 including grants of $ 20,000 ) (Revenue $ 47,965,099 )
TO HELP THE RESIDENTS OF HASTINGS, MINNESOTA AND THE SURROUNDING AREAS TO STAY HEALTHY BY PROVIDING EMERGENCY ROOM, ACUTE CARE INPATIENT, SURGICAL, DIAGNOSTIC, REHABILITATIVE AND OTHER OUTPATIENT SERVICES. IN ADDITION REGINA MEDICAL CENTER PROVIDES REDUCED HEALTH CARE, FREE MEDICAL SCREENINGS, HEALTH FAIRS AND COMMUNITY PROGRAMS/SUPPORT GROUPS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet48,019,222
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
1,212
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
872
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
3
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletTAX SERVICES MAIL ROUTE 108902925 CHICAGO AVENUEMINNEAPOLISMN554071321 (612) 262-0660
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) FR WILLIAM BEUCHE........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 0 0
(2) CHRISTINA PIEPER-BIGELOW MD........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 513,225 76,319
(3) BERNADETTE ESTENSON........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 0 0
(4) DUNCAN GALLAGHER........................................................................
DIRECTOR/EVP/CFO-AHS
 2.00
.......................40.00 		X   X       0 1,019,396 359,254
(5) DAN GREIL........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 0 0
(6) MICHAEL MARSHALL MD........................................................................
DIRECTOR
 2.00
.......................40.00 		X           0 421,839 87,413
(7) LYNN MORATZKA........................................................................
DIRECTOR/CHAIRMAN
 2.00
.......................0.00 		X           0 0 0
(8) TOM NOVAK........................................................................
DIRECTOR/VICE CHAIR
 2.00
.......................0.00 		X           0 0 0
(9) THOMAS O'CONNOR........................................................................
DIRECTOR
 2.00
.......................40.00 		X   X       0 818,266 265,364
(10) LON PETERSON MD........................................................................
DIRECTOR
 2.00
.......................40.00 		X           0 239,423 48,901
(11) JIM POEPL........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 0 0
(12) KEVIN TRI DDS........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 0 0
(13) DEANN WAGNER........................................................................
DIRECTOR/VP CLINIC OPS-AHS
 2.00
.......................40.00 		X   X       0 315,982 55,278
(14) PAUL YELLIN MD........................................................................
DIRECTOR
 2.00
.......................0.00 		X           0 0 0
(15) TY ERICKSON........................................................................
PRESIDENT/CEO
 40.00
.......................2.00 		    X       252,459 0 20,417
(16) GREG KOPP........................................................................
CFO
 40.00
.......................2.00 		    X       130,256 0 14,794
(17) KAREN STRAUMAN........................................................................
CNO
 40.00
.......................0.00 		    X       139,241 0 11,025
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) PAM KOCHENDORFER........................................................................
SECRETARY
 40.00
.......................2.00 		    X       56,521 0 31,835
(19) TAMMY BUMGARNER........................................................................
PHARMACIST
 40.00
.......................0.00 		        X   120,607 0 19,487
(20) JAMES KORSON........................................................................
PHARMACIST
 40.00
.......................0.00 		        X   109,973 0 21,768
(21) GWEN NOBLE........................................................................
RN
 40.00
.......................0.00 		        X   148,940 0 8,053
(22) LINDSEY THOMAS........................................................................
PHYSICIAN
 40.00
.......................0.00 		        X   161,817 0 47,151
(23) JENIFER WATTERS........................................................................
DIRECTOR OF PHARMACY
 40.00
.......................0.00 		        X   118,708 0 63,407














1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,238,522 3,328,131 1,130,466
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet21
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
KRAUS ANDERSONPO BOX 158CIRCLE PINESMN55014 CONSTRUCTION SERVICES 2,734,219
HORIZON HEALTH6640 CAROTHERS PARKWAY SUITE 500FRANKLINTN37067 PROFESSIONAL SERVICES - MEDICAL 2,089,440
REGIONAL ANETHESIA PA13911 RIDGEDALE DRIVE SUITE 350MINNETONKAMN55345 PROFESSIONAL SERVICES - MEDICAL 1,287,882
SHARED MEDICAL SERVICES INC209 LIMESTONE PASSCOTTAGE GROVEMN53527 PROFESSIONAL SERVICES - MEDICAL 541,719
XYGENT INC9961 VALLEY VIEW ROADEDEN PRAIRIEMN55344 PROFESSIONAL SERVICES - MEDICAL 276,786
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet17
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 694,334
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		199,805
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 894,139
Program Service Revenue Business Code
2a PATIENT REVENUE 623000 47,546,941 47,546,941    
b ANCILLARY REVENUE 621500 2,973,304 2,898,274 75,030  
c BAD DEBT 623000 -2,480,116 -2,480,116    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 48,040,129
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 467,885     467,885
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 12,785  
b Less: rental expenses 253,821  
c Rental income or (loss) -241,036  
d Net rental income or (loss).......MediumBullet -241,036     -241,036
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 13,002,401 27,204
b Less: cost or other basis and sales expenses 12,339,206 25,067
c Gain or (loss) 663,195 2,137
d Net gain or (loss)..........MediumBullet 665,332     665,332
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a CAFETERIA REVENUE 722210 347,659     347,659
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 347,659
12 Total revenue. See Instructions......MediumBullet 50,174,108 47,965,099 75,030 1,239,840
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 20,000 20,000
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 4,802,813 3,752,124 1,050,689  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 20,475,148 15,995,895 4,479,253  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 773,812 671,368 102,444  
9 Other employee benefits ....... 3,255,187 2,222,084 1,032,971 132
10 Payroll taxes ........... 1,827,699 1,598,763 228,936  
11 Fees for services (non-employees):        
a Management ...... 525,436   525,436  
b Legal ......... 93,332   93,332  
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 75,424   75,424  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 9,553,474 8,272,010 1,281,464  
12 Advertising and promotion .... 129,968 10,332 99,253 20,383
13 Office expenses ....... 4,033,958 2,140,391 1,875,098 18,469
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 1,108,145 715,925 392,220  
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 1,296,310 1,296,310    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 3,908,886 3,058,143 850,671 72
23 Insurance .............. 61,333 14,868 46,465  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 6,165,671 6,165,671    
b MN CARE AND SURCHARGE 1,129,813 1,129,813    
c FOOD SERVICE 795,200 795,200    
d
e All other expenses 199,462 160,325 39,137  
25 Total functional expenses. Add lines 1 through 24e 60,231,071 48,019,222 12,172,793 39,056
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .............   1  
2 Savings and temporary cash investments ......... 8,230,838 2 793,172
3 Pledges and grants receivable, net ........... 599,668 3 245,503
4 Accounts receivable, net ............. 9,986,817 4 8,353,067
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ............. 1,200,078 7 1,494,533
8 Inventories for sale or use .............. 1,196,805 8 1,105,797
9 Prepaid expenses and deferred charges .......... 647,127 9 556,873
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 79,021,511
b Less: accumulated depreciation ..... 10b 42,860,360 40,395,798 10c 36,161,151
11 Investments—publicly traded securities .......... 15,626,192 11 16,339,783
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 ..... 2,699,323 13 5,697,432
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 694,735 15 7,235,987
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 81,277,381 16 77,983,298
Liabilities 17 Accounts payable and accrued expenses ......... 6,180,432 17 5,074,394
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 31,357,686 20 30,212,043
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties .... 103,375 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 731,700 25 731,700
26 Total liabilities. Add lines 17 through 25......... 38,373,193 26 36,018,137
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 39,604,483 27 39,206,910
28 Temporarily restricted net assets ........... 3,299,705 28 2,758,251
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 42,904,188 33 41,965,161
34 Total liabilities and net assets/fund balances ........ 81,277,381 34 77,983,298
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
50,174,108
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
60,231,071
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-10,056,963
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
42,904,188
5
Net unrealized gains (losses) on investments ...............
5
-25,332
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
9,143,268
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
41,965,161
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
REGINA MEDICAL CENTER
  		Employer identification number

41-0740678
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
REGINA MEDICAL CENTER
  		Employer identification number

41-0740678
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
REGINA MEDICAL CENTER
  		Employer identification number

41-0740678
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   550,575 550,575
b Buildings ................   43,375,995 25,087,843 18,288,152
c Leasehold improvements ............   663,309 383,794 279,515
d Equipment ................   29,177,273 17,388,723 11,788,550
e Other .................   5,254,359   5,254,359
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 36,161,151
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) BENEFICIAL INTEREST IN REGINA FOUNDATION 2,585,342 F
(2) CASH AND MONEY MARKET FUNDS 44,998 F
(3) CERTIFICATES OF DEPOSIT 725,986 F
(4) EQUITY SECURITIES 1,174,704 F
(5) RESTRICTED FUNDS - CASH AND MONEY MARKET FUNDS 72,644 F
(6) ASSETS LIMITED AS TO USE - CASH AND MONEY MARKET FUNDS 1,093,758 F



Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 5,697,432
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) ASSETS TO BE TRANSFERRED TO BENEDICTINE HEALTH SYSTEM AT 12/31/2013 6,471,553
(2) DEFERRED FINANCING COSTS 490,345
(3) INVESMENT IN JOINT VENTURE 274,089






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 7,235,987
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
PAYMENTS DUE TO THIRD-PARTY PAYOR 731,700








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 731,700
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 48,402,710
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1..................... 3 48,402,710
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b 1,771,398
c Add lines 4a and 4b....................... 4c 1,771,398
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 50,174,108
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 48,950,917
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d -11,184,730
e Add lines 2a through 2d...................... 2e -11,184,730
3 Subtract line 2e from line 1..................... 3 60,135,647
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 75,424
b Other (Describe in Part XIII.) ............ 4b 20,000
c Add lines 4a and 4b....................... 4c 95,424
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 60,231,071
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: REGINA MEDICAL CENTER FIN 48 (ASC 740) FOOTNOTE : (1) INCOME TAXES - THE CORPORATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE CORPORATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE CORPORATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES.
PART XI, LINE 4B - OTHER ADJUSTMENTS:   RENTAL EXPENSES -253,821. DONATION FOR CAPITAL 13,980. RESTRICTED CONTRIBUTIONS 185,825. REALIZED GAIN ON INVESTMENTS 663,195. NET ASSET TRANSFER FROM FOUNDATION 694,334. INTEREST INCOME 467,885.
PART XII, LINE 2D - OTHER ADJUSTMENTS:   DISCONTINUED OPERATIONS - OPERATING EXPENSES -11,438,551. RENTAL EXPENSES 253,821.
PART XII, LINE 4B - OTHER ADJUSTMENTS:   NET ASSET TRANSFER TO REGINA HEALTHCARE, INC 20,000.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    450,208   450,208 0.750 %
b Medicaid (from Worksheet 3,
column a) .... 		    8,202,718 3,908,725 4,293,993 7.130 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    8,652,926 3,908,725 4,744,201 7.880 %
Other Benefits
     2,113,700   2,113,700 3.510 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		           
j Total. Other Benefits ..     2,113,700   2,113,700 3.510 %
k Total. Add lines 7d and 7j .     10,766,626 3,908,725 6,857,901 11.390 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,480,116
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
1,054,793
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
10,327,738
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
11,761,838
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-1,434,100
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

 

No
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 REGINA MEDICAL CENTER
PO BOX 43 MR 10890
MINNEAPOLIS,MN554400043
WWW.REGINAMEDICAL.ORG 		X X         X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
REGINA MEDICAL CENTER
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
    PART I, LINE 3C: THE INCOME BASE FOR ESTABLISHING CHARITY CARE ELIGIBILITY IS BASED ON THE FEDERAL POVERTY LEVELS. AN ASSET TEST IS ALSO TAKEN INTO CONSIDERATION.
    PART I, LINE 7: THE ORGANIZATION USED THE FOLLOWING METHODS TO DETERMINE COSTS FOR PART I, LINE 7: LINE A - CHARITY CARE WAS CONVERTED TO COST USING THE COST TO CHARGE RATIO FROM IRS WORKSHEET 2; LINE B MEDICAID WAS DERIVED FROM INTERNAL REPORTS AND THEN COSTS WERE CALCULATED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2. LINE E - COMMUNITY HEALTH IMPROVEMENT SERVICES ARE BASED ON THE ACTUAL DOLLARS SPENT FOR THESE ACTIVITIES.
    PART I, L7 COL(F): BAD DEBT EXPENSE HAS NOT BEEN INCLUDED IN FORM 990, PART IX, LINE 25 AND HAS NOT BEEN USED FOR THE PURPOSE OF CALCULATING THE AMOUNTS REPORTED IN COLUMN 7F. IT HAS BEEN REPORTED AS A REDUCTION TO PATIENT SERVICE REVENUE ON FORM 990, PART VIII, LINE 2C.
    PART III, LINE 4: FOOTNOTES TO AUDITED FINANCIAL STATEMENT THAT DESCRIBE BAD DEBT EXPENSE ARE AS FOLLOWS:1. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES/ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTSPATIENT ACCOUNT RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRCTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKES THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS(WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL THE REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. NET PATIENT SERVICE REVENUENET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSED AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. THE BAD DEBT REPORTED IN PART III, LINE 2 IS THE TOTAL AMOUNT WRITTEN OFF TO BAD DEBT. CHARITY CARE ELIGIBILITY AND UNINSURED DISCOUNTS ARE TAKEN PRIOR TO BAD DEBT WRITE OFF. THE PORTION OF BAD DEBT REGINA MEDICAL CENTER ESTIMATED WOULD BE ELIGIBLE UNDER ITS FINANCIAL ASSISTANCE POLICY INCLUDED IN PART III, LINE 3 WAS DETERMINED INTERNALLY BY APPLYING A RANGE OF PERCENTAGES BASED ON THE AGE OF THE RECEIVABLE.
    PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS OF CARE REPORTED ON PART III, LINE 6 WAS DERIVED FROM THE 2013 FILED MEDICARE COST REPORT. REGINA MEDICAL CENTER CONSIDERS THE MEDICARE SHORTFALL OF $ 1,434,100 TO BE A COMMUNITY BENEFIT BECAUSE IT IS A SUBSIDY PROVIDED TO MEDICARE BENEFICIARIES IN OUR COMMUNITY. THIS COST WOULD HAVE TO BE FUNDED BY MEDICARE IF REGINA MEDICAL CENTER DID NOT PROVIDE THE SUBSIDY.
REGINA MEDICAL CENTER   PART V, SECTION B, LINE 3: REGINA MEDICAL CENTER CONDUCTED EXTENSIVE RESEARCH AND MET WITH KEY HEALTHCARE LEADERS AND OTHER COMMUNITY STAKEHOLDERS IN THE HASTINGS AREA TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH NEEDS IN HASTINGS. INPUT FROM COMMUNITY MEMBER GROUPS INFORMED THE DEVELOPMENT OF REGINA MEDICAL CENTER'S COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT. THE COMMUNITY MEETINGS INCLUDED REVIEW AND PRIORITIZATION OF COMMUNITY HEALTH ISSUES HIGHLIGHTED IN DATA SETS AND HEALTH INDICATORS FOUND IN PEOPLE QUICKFACTS (DEMOGRAPHICS FROM THE 2010 U.S. CENSUS) FOR THE HASTINGS AREA, DAKOTA COUNTY PUBLIC HEALTH DEPARTMENT'S 2013 COMMUNITY HEALTH OPINION SURVEY RESULTS, COUNTY HEALTH RANKINGS & ROAD MAPS - ROBERT WOOD JOHNSON FOUNDATION, AND THE MINNESOTA DEPARTMENT OF HEALTH LEADING HEALTH INDICATORS.
REGINA MEDICAL CENTER   PART V, SECTION B, LINE 7: THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2012 IS REGINA MEDICAL CENTER'S FIRST FORMAL ASSESSMENT UNDER THE NEW REQUIREMENTS AND COMPLETED AT THE SAME TIME THE REGINA MEDICAL CENTER FORM 990 IS DUE. THE ASSESSMENT WAS CONDUCTED TOWARD THE END OF 2013 WITH THE INTENT TO ADDRESS THE COMMUNITY HEALTH NEEDS IDENTIFIED THEREIN OVER THE COMING THREE YEARS, 2014 THROUGH 2016. THEREFORE, REGINA MEDICAL CENTER HAS JUST BEGUN FORMALLY ADDRESSING THE ISSUES IDENTIFIED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT AND WILL CONTINUE DOING SO 2014 THROUGH 2016.
    PART VI, LINE 2: THROUGH THE USE OF FOCUS GROUPS AND TRUTHPOINT SURVEYS.
    PART VI, LINE 3: PATIENTS ARE CONTACTED AT THE PRE-REGISTRATION REGARDING THEIR FINANCIAL RESPONSIBILITY AND DIRECTED TO FINANCIAL COUNSELOR FOR INFORMATION ON ASSISTANCE PROGRAMS INCLUDING CHARITY CARE AND UNINSURED DISCOUNT. ALL UNINSURED PATIENTS ARE PROVIDED HELP AND ASSISTANCE IN QUALIFYING FOR GOVERNMENTAL PROGRAMS.
    PART VI, LINE 4: THE ORGANIZATION SERVICES THE HASTINGS AND SURROUNDING COMMUNITIES WHICH IS ABOUT 20 MILES SOUTHEAST OF ST.PAUL, MINNESOTA LOCATED ON THE MISSISSIPPI RIVER.
REPORTS FILED WITH STATES PART VI, LINE 7 MN
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number
41-0740678
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) REGINA HEALTHCARE INC
1175 NININGER ROAD
HASTINGS,MN55033 		41-1660207 501(C)(3) 20,000       TRANSFER OF ASSETS FOR GENERAL OPERATIONS.






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
SCHEDULE I, PART I, LINE 2   THE GRANTS INCLUDED ABOVE WERE TRANSFERS TO A RELATED PARTY UNDER COMMON MANAGEMENT. FUNDS ARE TRACKED THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
Yes
 
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)CHRISTINA PIEPER-BIGELOW MDDIRECTOR (i)
(ii)		 0
505,862 		0
0 		0
7,363 		0
50,947 		0
25,372 		0
589,544 		0
0
(2)DUNCAN GALLAGHERDIRECTOR/EVP/CFO-AHS (i)
(ii)		 0
569,104 		0
261,876 		0
188,416 		0
329,168 		0
30,086 		0
1,378,650 		0
0
(3)MICHAEL MARSHALL MDDIRECTOR (i)
(ii)		 0
357,939 		0
0 		0
63,900 		0
85,656 		0
1,757 		0
509,252 		0
0
(4)THOMAS O'CONNORDIRECTOR (i)
(ii)		 0
423,549 		0
263,458 		0
131,259 		0
242,241 		0
23,123 		0
1,083,630 		0
0
(5)LON PETERSON MDDIRECTOR (i)
(ii)		 0
220,553 		0
0 		0
18,870 		0
24,464 		0
24,437 		0
288,324 		0
0
(6)DEANN WAGNERDIRECTOR/VP CLINIC OPS-AHS (i)
(ii)		 0
220,565 		0
70,894 		0
24,523 		0
41,295 		0
13,983 		0
371,260 		0
0
(7)TY ERICKSONPRESIDENT/CEO (i)
(ii)		 252,137
0 		0
0 		322
0 		6,023
0 		14,394
0 		272,876
0 		0
0
(8)KAREN STRAUMANCNO (i)
(ii)		 139,139
0 		0
0 		102
0 		3,282
0 		7,743
0 		150,266
0 		0
0
(9)GWEN NOBLERN (i)
(ii)		 148,874
0 		0
0 		66
0 		837
0 		7,216
0 		156,993
0 		0
0
(10)LINDSEY THOMASPHYSICIAN (i)
(ii)		 161,473
0 		0
0 		344
0 		27,837
0 		19,314
0 		208,968
0 		0
0
(11)JENIFER WATTERSDIRECTOR OF PHARMACY (i)
(ii)		 118,671
0 		0
0 		37
0 		47,903
0 		15,504
0 		182,115
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 4B DUNCAN GALLAGHER - $81,896; THOMAS O'CONNOR - $51,144; DEANN WAGNER - $21,435.
  PART I, LINE 6 DEFERRED COMPENSATION PLANS TERMS AND CONDITIONS: MANAGEMENT INCENTIVE PLAN (MIP) ALLINA PROVIDES AN ANNUAL INCENTIVE COMPENSATION OPPORTUNITY TO MOST MANAGERS, SOME HIGH-LEVEL INDIVIDUAL CONTRIBUTORS AND EXECUTIVES. UNDER THIS PLAN, THE TARGET AWARD IS EXPRESSED AS A FUNCTION OF THE PARTICIPANT'S SALARY PAID DURING THE CALENDAR YEAR AND REQUIRES AT LEAST FOUR MONTHS OF SERVICE IN AN ELIGIBLE POSITION DURING THE YEAR. ACTUAL AWARDS CAN RANGE FROM 0% TO 150% OF THE TARGET AWARD, BASED ON ALLINA'S PERFORMANCE OVER THE CALENDAR YEAR. PERFORMANCE MEASURES INCLUDE FINANCIAL PERFORMANCE, SERVICE QUALITY, PATIENT SATISFACTION, PATIENT SAFETY AND COMMUNITY SERVICE. NO AWARDS ARE PROVIDED UNLESS THRESHOLD FINANCIAL PERFORMANCE IS ACHIEVED. PARTICIPANTS WHO HAVE LEFT EMPLOYMENT PRIOR TO THE END OF THE YEAR AS THE RESULT OF VOLUNTARY TERMINATION OR TERMINATION FOR POOR PERFORMANCE ARE NOT ELIGIBLE FOR AN AWARD. LONG-TERM INCENTIVE PLAN (LTIP) ALLINA HAS A LONG-TERM INCENTIVE PLAN THAT PROVIDES A CASH AWARD OPPORTUNITY TO A SMALL NUMBER OF TOP EXECUTIVES APPROVED FOR PARTICIPATION BY THE COMPENSATION COMMITTEE OF THE BOARD. THE AWARD OPPORTUNITY IS BASED ON ALLINA PERFORMANCE DURING OVERLAPPING THREE-YEAR CYCLES. PERFORMANCE MEASURES AND TARGETS ARE DEFINED BY THE COMMITTEE FOR EACH THREE-YEAR PERIOD AND CAN VARY FROM ONE PERIOD TO ANOTHER DEPENDING ON THE COMMITTEE'S JUDGMENT OF THE MOST IMPORTANT MEASURES OF SUCCESS. AWARDS CAN RANGE FROM 0% TO 150% OF TARGET AWARDS.
SUPPLEMENTAL INFORMATION PART III ADDITIONAL DISCLOSURES: DEFERRED COMPENSATION PLANS - TERMS AND CONDITIONS: ALLINA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) THIS PLAN WAS AMENDED EFFECTIVE DECEMBER 31, 2008, SUCH THAT NO FUTURE BENEFITS ACCRUE FOR SERVICE AFTER THAT DATE. ELIGIBLE ALLINA EXECUTIVES PARTICIPATED IN A DEFINED CONTRIBUTION SERP. EMPLOYER CREDITS WERE MADE EACH YEAR TO THEIR SERP BALANCE ACCORDING TO THE FOLLOWING SCHEDULE: EXEC YRS OF SERVICE CONTRIBUTION % OF PENSIONABLE EARNINGS 0-5 2.75% 6-10 3.50% 11+ 4.75% EXECUTIVES WERE ALSO CREDITED AN AMOUNT EQUAL TO THE EXCESS AMOUNT THAT WOULD HAVE BEEN CREDITED TO THE PENSION ACCOUNT PLAN WERE IT NOT FOR THE QUALIFIED PLAN COMPENSATION LIMITS. DEPOSITS EARN THE INVESTMENT RATE OF RETURN EQUAL TO THE PENSION ACCOUNT PLAN CREDITING RATE AS DECLARED BY ALLINA. THE CURRENT RATE IS 4%. THE PARTICIPANT VESTS AFTER THREE YEARS OF EXECUTIVE SERVICE PROVIDED THAT IF THE PARTICIPANT TERMINATES EMPLOYMENT WITH ALLINA PRIOR TO AGE 65 FOR ANY REASON OTHER THAN ELIMINATION OF POSITION, THE PARTICIPANT MUST FULFILL THE TERMS OF A COVENANT NOT TO COMPETE BENEFITS ARE PAID AS A SINGLE LUMP-SUM AMOUNT UPON AGE 65 RETIREMENT OR JOB POSITION ELIMINATION. IN THE CASE OF OTHER VOLUNTARY TERMINATIONS, PAYMENT IS DELAYED UNTIL COMPLETION OF THE TWO-YEAR NON-COMPETE PERIOD. THE SERP IS PAYABLE FROM ALLINA'S GENERAL ASSETS. IF ALLINA BECOMES INSOLVENT, THE PARTICIPANT WILL BE AN UNSECURED CREDITOR AND WILL HAVE NO PREFERRED CLAIM TO ANY ASSETS. ALLINA EXECUTIVE RETIREMENT BENEFIT RESTORATION PLAN ELIGIBLE ALLINA EXECUTIVES PARTICIPATE IN A DEFERRED COMPENSATION RETIREMENT PLAN. EXECUTIVES ARE CREDITED AN AMOUNT EQUAL TO THE EXCESS AMOUNT THAT WOULD HAVE BEEN CREDITED TO THE ALLINA RETIREMENT SAVINGS PLAN WERE IT NOT FOR THE QUALIFIED PLAN COMPENSATION LIMITS. EMPLOYER CREDITS ARE MADE EACH YEAR TO THEIR ACCOUNT BALANCE ACCORDING TO THE FOLLOWING SCHEDULE AS OF THE END OF THE PLAN YEAR: PARTICIPANT'S YEARS OF VESTING SERVICE APPLICABLE PERCENTAGE LESS THAN 1 0% 1-5 5.0% 6-10 5.5% 11-15 6.0% 16 OR MORE 6.5% DEPOSITS EARN THE INVESTMENT RATE OF RETURN EQUAL TO THE INVESTMENT OPTIONS SELECTED BY THE PARTICIPANT WHICH ARE THE SAME OPTIONS AVAILABLE UNDER THE QUALIFIED PLAN. A PARTICIPANT WHO HAS COMPLETED AT LEAST TWO YEARS OF SERVICE BECOMES VESTED IN THE PORTION OF HIS OR HER ACCOUNT ATTRIBUTABLE TO THE ANNUAL CREDIT FOR A PARTICULAR YEAR AS OF JANUARY 15 OF THE YEAR FOLLOWING THE CALENDAR YEAR IN WHICH THE ANNUAL CREDIT IS EARNED. IN THE EVENT OF TERMINATION (OTHER THAN BECAUSE OF DEATH) PRIOR TO AGE 67, THE DISTRIBUTION DATE SHALL BE AS SOON AS ADMINISTRATIVELY POSSIBLE AFTER TERMINATION IN THE FORM OF A LUMP SUM PAYMENT. THE PLAN IS PAYABLE FROM ALLINA'S GENERAL ASSETS. IF ALLINA BECOMES INSOLVENT, THE PARTICIPANT WILL BE AN UNSECURED CREDITOR AND WILL HAVE NO PREFERRED CLAIM TO ANY ASSETS. THIS PLAN WAS EFFECTIVE JANUARY 1, 2009. EXECUTIVE MUTUAL FUND ACCOUNT PLAN PHYSICIAN MUTUAL FUND ACCOUNT PLAN THESE ACCOUNTS GIVE THE PARTICIPANT THE OPPORTUNITY FOR CAPITAL ACCUMULATION NOT FULLY AVAILABLE TO THEM THROUGH SOCIAL SECURITY OR THE GENERAL EMPLOYEE RETIREMENT PLANS BECAUSE OF MAXIMUMS PLACED ON COMPENSATION THAT CAN BE RECOGNIZED UNDER FEDERAL LAW FOR PURPOSES OF CONTRIBUTIONS. THEY ALSO SERVE AS AN IMPORTANT NON-COMPETE INCENTIVE TO PARTICIPANTS. PRIOR TO THE YEAR IN WHICH CONTRIBUTIONS ARE MADE, THE PARTICIPANT MUST DESIGNATE A VESTING/PAYOUT DATE CONSISTENT WITH THE CONSTRAINTS OF THE PLANS AND FEDERAL DEFERRED COMPENSATION REGULATIONS. AFTER THE CONTRIBUTIONS ARE MADE, THE PARTICIPANT HAS A ONE-TIME LIMITED OPPORTUNITY TO EXTEND THE ELECTED PAYMENT DATE FOR AT LEAST FIVE YEARS. ONCE THE VESTING/PAYOUT DATE HAS BEEN REACHED, ALLINA WILL WITHHOLD THE APPROPRIATE TAXES AND THE BALANCE WILL BE PAID TO THE PARTICIPANT ON THEIR PAYCHECK AS SOON AS ADMINISTRATIVELY FEASIBLE. IF THE PARTICIPANT TERMINATES EMPLOYMENT VOLUNTARILY BEFORE AN AMOUNT IS PAID, PAYMENT WILL BE SUBJECT TO THE PARTICIPANT'S COMPLIANCE WITH A NON-COMPETE AGREEMENT WITH ALLINA FOR TWO YEARS AFTER TERMINATION. THE PARTICIPANT MAY ELECT FROM AMONG INVESTMENT ALTERNATIVES THAT ARE SIMILAR TO THOSE AVAILABLE IN THE RETIREMENT SAVINGS PLAN. UNLIKE THE RETIREMENT SAVINGS PLAN, THE PARTICIPANT HAS THE STATUS AN UNSECURED CREDITOR OF ALLINA AND WILL NOT HAVE A PREFERRED CLAIM TO PAYMENT IN THE CASE OF THE COMPANY'S INABILITY TO PAY. HOWEVER, THE COMPANY DOES SET ASIDE ASSETS FOR ITS OBLIGATIONS BY ACTUALLY INVESTING THE PROMISED ASSETS CONSISTENT WITH PARTICIPANT ELECTIONS. EXECUTIVE SEVERANCE PLAN ALLINA PROVIDES SALARY CONTINUATION FOR EXECUTIVES WHOSE EMPLOYMENT HAS BEEN INVOLUNTARILY TERMINATED FOR REASONS OTHER THAN CAUSE OR POOR PERFORMANCE. THE LENGTH OF THE SEVERANCE PAY PERIOD IS DEFINED BY THE PLAN AND DEPENDS ON THE LEVEL OF THE EXECUTIVE POSITION. UNDER THE PLAN THE SEVERED EXECUTIVE ALSO COULD CONTINUE CERTAIN BENEFITS FOR A LIMITED PERIOD OF TIME. IN 2009 THE PLAN WAS AMENDED TO FURTHER RESTRICT SEVERANCE BENEFITS IN THE CASE THAT THE EXECUTIVE OBTAINS OTHER EMPLOYMENT DURING THE SEVERANCE PERIOD.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number
41-0740678
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A THE CITY OF HASTINGS
  		41-6005220   12-22-2010 22,040,000 REFINANCE 2002 & 2007 NOTES;FINANCE MEDICAL SOFTWARE & CAPITAL EXPENDITURE   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 2,075,000      
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 22,040,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 341,500      
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 6,329,672      
11 Other spent proceeds . . . . . . . . . . . . . . 15,368,828      
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . .   X            
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.00000%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
  X            
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . . . .
  X            
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Identifier Return Reference Explanation
  FORM 990, PART VI, SECTION A, LINE 1 AS IN PRIOR YEARS, REGINA MEDICAL CENTER DELEGATED CERTAIN AUTHORITY TO AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS (SEE 2011 FORM 990, SCHEDULE O FOR ADDITIONAL DETAIL). ON SEPTEMBER 1, 2013 ALLINA HEALTH SYSTEM BECAME THE SOLE MEMBER OF REGINA MEDICAL CENTER. ALLINA HEALTH SYSTEM APPOINTED A THREE MEMBER BOARD OF DIRECTORS [SEE ALSO RESPONSE TO FORM 990, PART VI, SECTION A, LINE 4].
  FORM 990, PART VI, SECTION A, LINE 4 ON SEPTEMBER 1, 2013 REGINA MEDICAL CENTER'S ARTICLES OF INCORPORATION, BYLAWS AND OTHER ORGANIZING DOCUMENT WERE AMENDED TO FACILIATE A TRANSACTION IN WHICH ALLINA HEALTH SYSTEM, A NON-PROFIT TAX-EXEMPT ORGANIZATION, BECAME THE SOLE MEMBER ORGANIZATION OF REGINA MEDICAL CENTER. MANY GOVERNANCE CHANGES WERE MADE. HOWEVER, THE ORGANIZATION'S EXEMPT PURPOSE AND MISSION REMAINED THE SAME. ON DECEMBER 31, 2013, REGINA MEDICAL CENTER MERGED WITH AND INTO ALLINA HEALTH SYSTEM.
  FORM 990, PART VI, SECTION A, LINE 6 FROM OCTOBER 1, 2012 TO SEPTEMBER 1, 2103 REGINA MEDICAL CENTER'S CORPORATE MEMBERS WERE REGINA HEALTHCARE, INC., WHICH HAD A 75 PERCENT CORPORATE MEMBERSHIP AND ALLINA HEALTH SYSTEM WHICH HAD A 25 PERCENT CORPORATE MEMBERSHIP. ON SEPTEMBER 1, 2013 ALLINA HEALTH SYSTEM BECAME THE SOLE CORPORATE MEMBER OF REGINA MEDICAL CENTER. ON DECEMBER 31, 2013 REGINA MEDICAL CENTER MERGED WITH AND INTO ALLINA HEALTH SYSTEM [SEE ALSO RESPONSE TO FORM 990, PART VI, SECTION A, LINE 4].
  FORM 990, PART VI, SECTION A, LINE 7A FROM OCTOBER 1, 2012 TO SEPTEMBER 1, 2013, REGINA MEDICAL CENTER'S CORPORATE MEMBERS WERE REGINA HEALTHCARE, INC., WHICH HAD A 75 PERCENT CORPORATE MEMBERSHIP AND ALLINA HEALTH SYSTEM WHICH HAD A 25 PERCENT CORPORATE MEMBERSHIP. EACH MEMBER HAD AUTHORITY TO APPOINT A CERTAIN NUMBER OF DIRECTORS AND HAD CERTAIN RESERVE POWERS [SEE THE 2011 FORM 990 SCHEDULE O FOR ADDITIONAL DETAILS]. ON SEPTEMBER 1, 2013 ALLINA HEALTH SYSTEM BECAME THE SOLE CORPORATE MEMBER OF REGINA MEDICAL CENTER. ON DECEMBER 31, 2013 REGINA MEDICAL CENTER MERGED WITH AND INTO ALLINA HEALTH SYSTEM. PRIOR TO REGINA MEDICAL CENTER'S DECEMBER 31, 2103 MERGER WITH AND INTO ALLINA HEALTH SYSTEM, AS THE SOLE CORPORATE MEMBER ORGANIZATION, ALLINA HEALTH SYSTEM HELD CERTAIN RESERVE POWERS OVER REGINA MEDICAL CENTER. THE RESERVE POWERS ARE FULLY DESCRIBED IN REGINA MEDICAL CENTER'S GOVERNING DOCUMENTS IN EFFECT AT THAT TIME AND INCLUDED SUCH POWERS AS ELECTION AND APPROVAL OF DIRECTORS, APPROVAL OF AMENDMENTS TO ARTICLES OF INCORPORATION OR BYLAWS, APPROVAL OF STRATEGIC PLANS AND CAPTIAL AND OPERATING BUDGETS, APPROVAL OF PLANS OF MERGER OR CONSOLIDATION, APPROVAL OF DEBT OR EXPENDITURES, AND VARIOUS OTHER RESERVED POWERS AS DESCRIBED THEREIN.
  FORM 990, PART VI, SECTION A, LINE 7B SEE RESPONSE TO FORM 990, PART VI, SECTION A, LINE 7A.
  FORM 990, PART VI, SECTION B, LINE 11 THE REGINA MEDICAL CENTER FORM 990 WAS PREPARED BY THE TAX SERVICES FUNCTION OF ALLINA HEALTH SYSTEM. THE FORM 990 FILING WAS SUBJECTED TO A RIGOROUS REVIEW PROCESS BY ALLINA'S TAX MANAGER AND TAX DIRECTOR. ALLINA'S VICE PRESIDENT OF FINANCE & TREASURY ALSO PERFORMED AN EXECUTIVE REVIEW OF THE FORM 990. AFTER THE MANAGEMENT REVIEW PROCESS DESCRIBED ABOVE WAS COMPLETED, THE FINAL FORM 990, AS ULTIMATELY FILED WITH THE INTERNAL REVENUE SERVICE [IRS], WAS PROVIDED TO EACH VOTING MEMBER OF THE ALLINA HEALTH SYSTEM BOARD OF DIRECTORS. THE ALLINA HEALTH SYSTEM BOARD OF DIRECTORS REVIEWED THE FORM 990, APPROVED THE FILING, AND AUTHORIZED AND DIRECTED THE OFFICERS TO FILE THE FORM 990 WITH THE IRS AND THE MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT TO BE FILED WITH THE MINNESOTA ATTORNEY GENERAL. THE BOARD OF DIRECTORS RESOLUTION ALSO DIRECTED OFFICERS TO FILE THE FORM 990 WITH THE IRS, THE CHARITABLE ANNUAL REPORT WITH THE CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL. THE ABOVE STATED REVIEW AND APPROVAL PROCESS OCCURRED PRIOR TO FILING THE REGINA MEDICAL CENTER FORM 990 WITH THE IRS, THE MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE MINNESOTA ATTORNEY GENERAL.
  FORM 990, PART VI, SECTION B, LINE 11 THIS REGINA MEDICAL CENTER FORM 990 WAS PREPARED BY THE TAX SERVICES FUNCTION OF ALLINA HEALTH SYSTEM. THE FORM 990 FILING WAS SUBJECTED TO A RIGOROUS REVIEW PROCESS BY ALLINA'S TAX MANAGER AND TAX DIRECTOR. ALLINA'S VICE PRESIDENT OF FINANCE & TREASURY ALSO PERFORMED AN EXECUTIVE REVIEW OF THE FORM 990. AFTER THE REVIEW PROCESS DESCRIBED ABOVE WAS COMPLETED, A COMPLETE COPY OF THE FINAL FORM 990 AS ULTIMATELY FILED WITH THE INTERNAL REVENUE SERVICE [IRS] WAS PROVIDED TO A MANAGING GROUP CONSISTING OF EACH VOTING MEMBER OF THE REGINA MEDICAL CENTER BOARD OF DIRECTORS THAT EXISTED IMMEDIATELY PRIOR TO ITS DECEMBER 31, 2013 MERGER WITH ALLINA HEALTH SYSTEM [SEE ALSO RESPONSE TO FORM 990, PART VI, SECTION A, LINE 4]. THE MANAGING GROUP REVIEWED AND APPROVED THE FILING, AND AUTHORIZED AND DIRECTED ALLINA OFFICERS TO FILE THE FORM 990 WITH THE IRS AND ALSO FILE THE MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT WITH CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL. THE ABOVE STATED REVIEW AND APPROVAL PROCESS OCCURRED PRIOR TO FILING THE REGINA MEDICAL CENTER FORM 990 WITH THE IRS AND THE MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE MINNESOTA ATTORNEY GENERAL. A COMPLETE COPY OF THE FINAL FORM 990 AS ULTIMATELY FILED WITH THE INTERNAL REVENUE SERVICE [IRS] WAS ALSO PROVIDED TO EACH VOTING MEMBER OF ALLINA HEALTH SYSTEM'S BOARD OF DIRECTORS ON AUGUST 5, 2014 FOR THEIR REVIEW AND BEFORE ITS FILING WITH THE IRS. THE ALLINA HEALTH SYSTEM BOARD OF DIRECTORS SHALL APPROVE THE FORM 990 AT ITS SEPTEMBER 10, 2014 MEETING.
  FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST QUESTIONNAIRES ARE COMPLETED ANNUALLY. POTENTIAL CONFLICTS ARE REPORTED TO THE BOARD CHAIR. MEMBERS WITH POSSIBLE CONFLICTS ARE PERMITTED TO PARTICIPATE IN DISCUSSION, BUT NOT VOTE IN A MATTER THAT IS A POTENTIAL MATTER OF CONFLICT OF INTEREST.
  FORM 990, PART VI, SECTION B, LINE 15 A REVIEW OF ALL ASPECTS OF COMPENSATION IS CONDUCTED ON AN ANNUAL BASIS. ANY RECOMMENDED CHANGES DUE TO INTERNAL ORGANIZATION MODIFICATIONS, EXTERNAL MARKET CONDITIONS, OR ADMINISTRATIVE REQUIREMENTS WILL BE PROPOSED TO THE CHIEF EXECUTIVE OFFICER FOR IMPLEMENTATION DURING THE NEXT PLAN YEAR. THE COMPENSATION REVIEW IS USED BY THE CHIEF EXECUTIVE OFFICER TO BUDGET FOR THE UPCOMING YEAR. ULTIMATELY, THE BUDGET IS APPROVED BY THE BOARD OF DIRECTORS. THE CHIEF EXECUTIVE'S COMPENSATION IS BASED UPON MARKET CONDITIONS GATHERED FROM STATE AND NATIONAL WAGE SURVEYS AND IS APPROVED BY THE BOARD OF DIRECTORS.
  FORM 990, PART VI, SECTION C, LINE 19 REGINA MEDICAL CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. TO ARRANGE AN INSPECTION OR RECEIVE A COPY, PLEASE CONTACT THE FOLLOWING: REGINA MEDICAL CENTER TAX SERVICES MAIL ROUTE 10890 P.O. BOX 43 MINNEAPOLIS, MN 55407-0043 TELEPHONE: 612-262-0660 PHYSICAL ADDRESS: 2925 CHICAGO AVENUE MINNEAPOLIS, MN 55407-1321 THE FORM 990 AND FORM 1023 ARE ALSO AVAILABLE DIRECTLY FROM THE INTERNAL REVENUE SERVICE. THE FORM 990 AND FINANCIAL STATEMENTS ARE ALSO AVAILABLE FROM THE CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL.
OVERLAP OF OFFICER AND BOARD MEMBERS PART VII, SECTION A, LINE 1A THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ALLOCATED TIME BETWEEN REPORTING ENTITY AND RELATED ORGANIZATIONS. SEE BELOW FOR ALLOCATION OF HOURS: CEO: 40 HOURS REGINA MEDICAL CENTER 1 HOUR REGINA HEALTHCARE, INC. 1 HOUR REGINA FOUNDATION CFO: 40 HOURS REGINA MEDICAL CENTER 1 HOUR REGINA HEALTHCARE, INC. 1 HOUR REGINA FOUNDATION IN ADDITION, THE FOLLOWING BOARD MEMBERS ALLOCATED THEIR TIME BETWEEN REPORTING ENTITY AND REGINA FOUNDATION: - BERNADETTE ESTENSON IN ADDITION, THE FOLLOWING BOARD MEMBERS ALLOCATED THEIR TIME BETWEEN THE REPORTING ENTITY AND REGINA HEALTHCARE, INC.: - LYNN MORATZKA
OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 92,367. MANAGEMENT AND GENERAL EXPENSES 410,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 503,239. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 7,659,312. MANAGEMENT AND GENERAL EXPENSES 870,592. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,529,904. MRI: PROGRAM SERVICE EXPENSES 520,331. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 520,331.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: DISCONTINUED OPERATIONS 9,684,722. CHANGE IN RESIDENTS FUNDS 23,838. RESTRICTED CONTRIBUTIONS AND GRANTS 28,938. DONATIONS FOR CAPITAL 38,692. NET ASSETS RELEASED FROM RESTRICTION -94,471. CHANGE IN BENEFICIAL INTEREST -538,451.
  PART XII, LINE 2C AS A RESULT OF ALLINA HEALTH SYSTEM BECOMING THE SOLE MEMBER ORGANIZATION ON SEPTEMBER 1, 2013 AND THE SUBSEQUENT MERGER OF REGINA MEDICAL CENTER WITH AND INTO ALLINA HEALTH SYSTEM ON DECEMBER 31, 2013 [SEE ALSO RESPONSE TO FORM 990, PART VI, SECTION A, LINE 4], THE ALLINA HEALTH SYSTEM AUDIT AND COMPLIANCE COMMITTEE ASSUMED AUTHORITY, RESPONSIBILITY AND OVERSIGHT, INCLUDING THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT ENGAGED TO PEROFORM THE INDEPENDENT AUDIT OF THE REGINA MEDICAL CENTER FINANCIAL STATEMENTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
REGINA MEDICAL CENTER
 
Employer identification number

41-0740678
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) REGINA HEALTHCARE INC

1175 NININGER ROAD

HASTINGS,MN55033
41-1660207 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11B, II N/A
 
No
(2) REGINA MEDICAL CENTER AUXILIARY

1175 NININGER ROAD

HASTINGS,MN55033
23-7428560 		TRUST MN 501(C)(3) LINE 9 N/A
 
No
(3) REGINA FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
41-1987372 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(4) ALLINA HEALTH SYSTEM

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
36-3261413 		HEALTHCARE SERVICES MN 501(C)(3) LINE 3 N/A
 
No
(5) ABBOTT NORTHWESTERN HOSPITAL FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
04-3643816 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(6) MERCY & UNITY HOSPITALS FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
30-0086426 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(7) PHILLIPS EYE INSTITUTE FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
41-1613017 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(8) COURAGE KENNY FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
41-1952989 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(9) UNITED HOSPITAL FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
23-7420998 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(10) CENTER FOR HEALTHCARE INNOVATION FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
26-3553868 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(11) ALLINA ASSOCIATED FOUNDATION

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
27-4116873 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(12) ASPEN MEDICAL GROUP

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
41-1452624 		HEALTHCARE SERVICES MN 501(C)(4)   ALLINA HEALTH SYSTEM
 
 
No
(13) ALLINA INTEGRATED MEDICAL NETWORK

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
27-5129095 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM
 
 
No
(14) UNITED AND CHILDRENS AMBULATORY SURGERY CENTER ASSOCIATION

310 NORTH SMITH AVENUE

ST PAUL,MN55102
41-1694626 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I N/A
 
No
(15) MBP FACILITY LLC

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
45-4078371 		SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I N/A
 
No
(16) WESTHEALTH INC

PO BOX 43 MAIL ROUTE 10890

MINNEAPOLIS,MN554400043
41-1768814 		HEALTHCARE SERVICES MN 501(C)(3) LINE 3 ALLINA HEALTH SYSTEM
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) APPLE VALLEY BUILDING ASSOCIATES LLC

14655 GALAXIE AVENUE
APPLE VALLEY,MN55124
41-1677072 		RENTAL REAL ESTATE MN N/A
                  
(2) METROPOLITAN INTEGRATED CANCER CARE LLC

ONE POST ST35TH FL
SAN FRANCISCO,CA94104
20-5068485 		RADIOLOGY DE N/A
                  
(3) SOUTHWEST SURGICAL CENTER LLC

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
41-2013700 		SURGICAL SERVICES MN N/A
                  
(4) MAGNETO LEASING LLC

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
20-1582501 		RENTAL EQUIPMENT MN N/A
                  
(5) ASPEN SLEEP CENTER LLC

1010 BANDANA BOULEVARD WEST
ST PAUL,MN55108
26-1850227 		HEALTHCARE SERVICES MN N/A
                  
(6) GERIATRIC SERVICES OF MINNESOTA LLC

3366 OAKDALE AVE NORTH SUITE 551
ROBBINSDALE,MN55422
45-3357936 		HEALTHCARE SERVICES MN N/A
                  
(7) NORTHSTAR SLEEP CENTER LLC

920 EAST 28TH STREET SUITE 700
MINNEAPOLIS,MN55407
45-2532456 		HEALTHCARE SERVICES MN N/A
                  
(8) DISTRICT ONE CANCER CENTER LLC

200 STATE AVENUE
FAIRBAULT,MN55021
45-1258847 		HEALTHCARE SERVICES MN N/A
                  
(9) CROSBY CARDIOVASCULAR SERVICES LLC

920 E 28TH STREET SUITE 500
MINNEAPOLIS,MN55407
41-2010368 		HEALTHCARE SERVICES MN N/A
                  
(10) MOBILE IMAGING SERVICES LLC

1221 NICOLLET MALL SUITE 600
MINNEAPOLIS,MN55403
41-1883212 		RADIOLOGY MN N/A
                  
(11) BPA HEALTH LLC

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
35-2490984 		HEALTHCARE SERVICES MN N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTHSPAN SERVICES COMPANY

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
41-1249999 		DEBT COLLECTION MN N/A
 C         No
(2) ALLINA SPECIALTY ASSOCIATES INC

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
41-1802815 		HEALTHCARE SERVICES MN N/A
 C         No
(3) ALLINA CLINIC HOLDINGS LTD

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
26-3954371 		HOLDING COMPANY MN N/A
 C         No
(4) QUELLO CLINIC LIMITED

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
41-0874754 		HEALTHCARE SERVICES MN N/A
 C         No
(5) ALLINA HEALTH SYSTEM TRUST

PO BOX 535007
PITTSBURGH,PA15253
27-6712988 		TRUST PA N/A
 T         No
(6) ALLINA HEALTH SYSTEM DEFINED BENEFIT MASTER TRUST

500 GRANT STREET SUITE 0625
PITTSBURGH,PA15258
37-6520273 		TRUST PA N/A
 T         No
(7) ALLINA HEALTH SYSTEM KEYSHARE PLAN

PO BOX 535007
PITTSBURGH,PA15253
27-6678945 		TRUST PA N/A
 T         No
(8) LIFESPAN AFFILIATES DEFERRED COMPENSATION PLAN

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
41-1720860 		TRUST MN N/A
 T         No
(9) CREATEHEALTH INC

PO BOX 43 MAIL ROUTE 10890
MINNEAPOLIS,MN55440
26-0594364 		HEALTHCARE SERVICES MN N/A
 C         No
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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