2023-11-07T11:35:15-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 410726171 INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION INTE 2182834481 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 CRAIG BOYER CFO 2182834481 2023-11-07 1 CRAIG BOYER 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2023-11-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RAINY LAKE MEDICAL CENTER CRAIG BOYER 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 37642110 0 X WWW.RAINYLAKEMEDICAL.COM X 1945 MN PROVIDE ACCESSIBLE, HIGH-QUALITY HEALTHCARE TO OUR COMMUNITIES. 7 7 240 22 1011 0 4895311 688959 33310872 34022783 354380 82278 269815 228318 38830378 35022338 20000 0 0 0 16180556 16240251 0 0 0 15762668 17303812 31963224 33544063 6867154 1478275 41507642 35634235 17131238 10727616 24376404 24906619 X PROVIDE ACCESSIBLE QUALITY HEALTHCARE TO OUR COMMUNITIES USING VALUES OF INTEGRITY AND RESPECT, COMPASSION AND EXCELLENCE THROUGH TEAMWORK (ICE) IN SUPPORT OF THE VISION COMPRISED OF THE FOLLOWING ELEMENTS: PROVIDER OF CHOICE OF OUR COMMUNITIES, PATIENT AND FAMILY-CENTERED CARE, EXPANDING SERVICES, REGIONAL SPECIALTY RELATIONSHIPS AND PREFERRED HEALTHCARE EMPLOYER. 0 0 24951145 0 31564346 RAINY LAKE MEDICAL CENTER (RLMC) PROVIDES INPATIENT AND OUTPATIENT HOSPITAL SERVICES. IN 2022, RLMC HAD 1,999 INPATIENT DAYS AND HAD 5,885 EMERGENCY ROOM VISITS. IN ADDITION, RLMC PROVIDES GENERAL, ORTHOPEDIC, AND OPHTHALMOLOGY SURGERY, VARIOUS IMAGING MODALITIES, LABORATORY SERVICES, THERAPY SERVICES, AND OTHER HOSPITAL ANCILLARY SERVICES. 2065242 0 2612626 RLMC PROVIDES CLINIC BASED SERVICES AT TWO LOCATIONS, INTERNATIONAL FALLS, MN AND LITTLE FORK, MN. IN ADDITION TO PRIMARY CARE VISITS, A NUMBER OF SPECIALTY SERVICES ARE OFFERED SUCH AS RHEUMATOLOGY, ORTHOPEDIC, OB/GYN, DERMATOLOGY, OPTHALMOLOGY, AND ONCOLOGY. IN TOTAL, 12,692 CLINIC VISITS OCCURRED IN 2022. 0 0 0 IN ADDITION TO PROVIDING DIRECT PATIENT CARE AND IN FURTHERANCE OF ITS CHARITABLE PURPOSE, RLMC PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY INCLUDING OFFERING VARIOUS COMMUNITY BASED SERVICE PROGRAMS, CASH CONTRIBUTIONS TO NON-PROFIT AGENCIES, THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS, AND STAFF TIME TO MENTORING/JOB SHADOWING. ADDITIONALLY, A NUMBER OF HEALTH RELATED EDUCATION PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. RLMC ALSO ACTIVELY PROMOTES ITS COMMUNITY CARE PROGRAM, WHICH PROVIDES FREE OR REDUCED COST HEALTHCARE TO PATIENTS WHO ARE UNABLE TO PAY FULLY FOR SERVICES RECEIVED. 27016387 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 83 0 240 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X CRAIG BOYER 2182834481 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 X RICHARD PETERSON CHAIR 4.00 X X 0 0 0 JON TALSNESS VICE CHAIR 4.00 X X 0 0 0 STEVEN LINDBERG TREASURER 4.00 X X 0 0 0 BRIAN BRIGGS SECRETARY 4.00 X X 0 0 0 SUSAN CONGRAVE MEMBER 4.00 X 0 0 0 SHERRI MANNAUSAU MEMBER 4.00 X 0 0 0 DON BILLIG MEMBER 4.00 X 0 0 0 ROBERT PASTOR II CEO 40.00 1.00 X 305731 0 52437 MIKE KATIGBAK CFO (THRU OCT) 40.00 1.00 X 87112 0 6840 MELISSA MARCOTTE CFO (THRU FEB) 40.00 1.00 X 107153 0 1256 DAVID MOYER PHYSICIAN 40.00 X 356798 0 20243 DANIEL MARGO GENERAL SURGEON 20.00 X 313866 0 37291 JAY KNAAK PHYSICIAN 40.00 X 254464 0 43255 SCOTT JOHNSON PHYSICIAN 40.00 X 162036 0 23287 AMBER BIONDICH NURSE PRACTITIONER 40.00 X 161707 0 5016 1748867 0 189625 25 0 1 0 ACUTE CARE INC 1609 N ANKENY BLVD SUITE 200 ANKENY IA 50023 PHYSICIAN FEES 2092168 RC SHEFLAND ANESTHESIA LTD PO BOX 7 INTERNATIONAL FALLS MN 56649 ANESTHESIOLOGIST FEES 524762 ONE NECK 625 JUNCTION ROAD MADISON WI 53717 IT SOLUTIONS SERVICES 487290 KRAUS ANDERSON 206 BELTRAMI AVE SW BEMIDJI MN 56601 CONSTRUCTION 451867 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 57117 PROVIDING MEAL SERVICE AND SOFTWARE MAIN 363887 15 66973 225468 396518 688959 PATIENT SERVICE REVENUE 621110 28714334 28714334 CLINIC REVENUE 621110 2612626 2612626 PHARMACY REVENUE 456110 2161722 2161722 534101 533090 1011 34022783 208339 208339 73118 0 73118 73118 73118 2493711 2619772 -126061 -126061 -126061 CMDI EARNINGS 155200 155200 155200 35022338 34176972 1011 155396 X 512914 512914 12939410 10562045 2377365 240476 194322 46154 1637616 1250189 387427 909835 677937 231898 18566 18566 139254 139254 447 447 4987844 4501206 486638 94213 82408 11805 63856 56446 7410 349466 305678 43788 466251 302037 164214 41074 27087 13987 23129 20231 2898 208877 135319 73558 1480372 959044 521328 174550 113080 61470 MEDICAL SUPPLIES 6020173 5265708 754465 EQUIPMENT RENTAL 769058 498226 270832 REPAIRS & MAINTENANCE 687704 445495 242209 BAD DEBT EXPENSE 618605 618605 1160373 1001324 159049 33544063 27016387 6527676 0 1487187 1275289 13125476 8726437 4843347 4032713 644788 741913 519908 542797 28878522 15936808 13221141 12941714 6914808 5891672 677878 643613 73109 838087 41507642 35634235 3468382 2705505 1036907 601326 20000 0 6266680 5852718 6339269 1568067 17131238 10727616 X 24223794 24594393 152610 312226 24376404 24906619 41507642 35634235 X 1478275 -1006108 58048 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 447 447 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF MINNESOTA HOSPITAL ASSOCIATION AND A PERCENTAGE OF MEMBERSHIP FEE WAS RELATED LOBBYING ACTIVITIES. MINNESOTA HOSPITAL ASSOCIATION (MHA) IS AN ORGANIZATION OF 142 MEMBER HOSPITALS AND HEALTH SYSTEMS. MHA ADVOCATES ON BEHALF OF ITS MEMBERS WITH LAWMAKERS, EDUCATING THEM ON COMPLEX ISSUES IN HEALTH CARE AND ENSURING THEY HAVE THE TOOLS THEY NEED TO MAKE INFORMED DECISIONS. THE MISSION OF MHA IS TO ADVOCATE SO THEIR MEMBERS CAN ACHIEVE THEIR MISSIONS BETTER. 168954 168954 19587489 9047589 10539900 8786620 6889219 1897401 335459 335459 12941714 DEFERRED COMPENSATION PLAN LIABILITIES 98219 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 711550 OTHER ACCRUED LIABILITIES 18550 OPERATING LEASE LIABILITY 739748 1568067 1 1 X 1 X 1 X 1 1 0 1 1 86311 86311 0.00260 5036790 4175867 860923 0.02610 5123101 4175867 947234 0.02870 6900 6900 0.00020 15981034 10388779 5592255 0.16980 2140 2140 0.00010 15990074 10388779 5601295 0.17010 21113175 14564646 6548529 0.19880 8436 8436 0.00030 54105 54105 0.00160 62541 62541 0.00190 1 338237 9465739 9455572 10167 X 1 1 1 1 RAINY LAKE MEDICAL CENTER 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 WWW.RAINYLAKEMEDICAL.COM 406047 X X X X RAINY LAKE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 5: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED EVERY 3 YEARS DURING WHICH EXTRA CARE IS TAKEN TO ENSURE THE PARTICIPATION OF LOCAL PUBLIC HEALTH AND OTHER COMMUNITY HEALTHCARE PROVIDERS, COMMUNITY HEALTH FAIRS ARE HELD WHERE COMMUNITY MEMBERS CAN PROVIDE FEEDBACK ON THEIR HEALTH CARE NEEDS. A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) HAS ALSO BEEN FORMED WHICH PROVIDES A LINK BETWEEN THE COMMUNITY AND THE ORGANIZATION. RLMC HAS A LARGE FOOTPRINT WITHIN THE COMMUNITY WITH INVOLVEMENT IN MANY SERVICE AND COMMUNITY BASED GROUPS, SPONSORING THE COMMUNITY CHRISTMAS PARADE, PLANNING ASSISTANCE WITH THE FOURTH OF JULY PARADE, SPONSORING HALLOWEEN PUMPKINPALOOSA, AND CONTRIBUTING SUPPORT TO MANY LOCAL HEALTH AND EDUCATION RELATED PROGRAMS. RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7A & 10A:HTTPS://RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2023/01/2022-CHNA-WITH-IMPLEMENTATION-REPORT.PDF RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING NEEDS WERE IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA:- HEALTHCARE AFFORDABILITY/ACCESSIBILITY- MENTAL HEALTH- HEALTHCARE EDUCATION/PREVENTATIVE CARE- EMERGENCY ROOM SERVICES- DRUG/SUBSTANCE/ALCOHOL ABUSE- OBESITY/OVERWEIGHTTHE ORGANIZATION WILL NOT ADDRESS THE FOLLOWING NEEDS IDENTIFIED IN ITS MOST RECENT CHNA BECAUSE OF RESOURCE CONSTRAINTS AND THE AVAILABILITY OF OTHER RESOURCES IN THE COMMUNITY:- MENTAL HEALTH;- DRUG/SUBSTANCE/ALCOHOL ABUSE: DUE TO THE SIMILAR SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO ADDRESS THESE THREE NEEDS, WE GROUPED THESE NEEDS TOGETHER. - OBESITY/OVERWEIGHT.IN 2022 THE FACILITY TOOK THE FOLLOWING ACTIONS TO ADDRESS HEALTHCARE AFFORDABILITY/ACCESSIBILITY, HEALTHCARE EDUCATION/PREVENTATIVE CARE, AND EMERGENCY ROOM SERVICES:-13 HYPERTENSIVE PATIENTS WITH ELEVATED B/P WERE FOLLOWED IN 2022 AND LOANED A CUFF FOR ONE OR MORE TWO WEEK MONITORING PERIODS. THE RESULTS WERE MONITORED BY THE POPULATION HEALTH NURSE EVERY 2 WEEKS AND THE PCP WAS PROVIDED THE RESULTS AT THE END OF THE MONITORING PERIOD OR SOONER IF NEEDED. - 22 DIABETIC PATIENTS WERE FOLLOWED IN 2022 TO PROVIDE EDUCATION ON DIABETES MANAGEMENT, OVERSITE OF BLOOD SUGAR RESULTS, A1C GOALS, DIETARY EDUCATION, AND FOOD DIARY MONITORING. PCP RECEIVED REPORTS OF PATIENT PROGRESS VIA EMR DOCUMENTATION AND REPORTING IN PERSON AS NEEDED. - THE CONTRACTUAL CHANGES THAT WERE BROUGHT ABOUT IN 2020 AS A RESULT OF PROLONGED NEGOTIATION WITH OUR ER STAFFING COMPANY ALLOWED US TO DEVELOP A CORE GROUP OF RELIABLE ER MEDICAL PROVIDERS, RESULTING IN IMPROVED SERVICE, CARE, AND CUSTOMER SATISFACTION FROM OUR ER STAFFING COMPANY AS EVIDENCED THROUGH OUR PATIENT SATISFACTION SCORES WHICH IMPROVED ON THE QUESTION OF "WOULD YOU RECOMMEND OUR EMERGENCY ROOM TO OTHERS" FROM A MEAN SCORE OF 63 (N=212) IN 2021 TO 88.49 (N=241) IN 2022. THE STAFFING COMPANY'S CMO CONTINUED TO PERFORM MONTHLY RANDOM CHART REVIEWS TO ASSESS AND IMPROVE THE QUALITY OF THEIR PROVIDER'S DOCUMENTATION. RLMC CONTINUED TO SHARE ED PROVIDER-SPECIFIC SATISFACTION DATA AND PATIENT SURVEY COMMENTS WITH THE ED PROVIDERS TO PROMOTE SELF-IMPROVEMENT.- A WELL-ATTENDED COMMUNITY HEALTH FAIR WAS HOSTED BY OUR ORGANIZATION IN SEPTEMBER OF 2022 WITH PARTICIPATION FROM MANY CARE COMMUNITY CARE PROVIDERS. THE FAIR INCLUDED SCHEDULED "DOC TALKS" DURING WHICH OUR PHYSICIANS GAVE PRESENTATIONS ON THE IMPORTANCE OF PREVENTATIVE CARE SUCH AS COLONOSCOPIES. RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT PHONE NUMBER IS LISTED ON THE WEBSITE AND PROVIDED IN ALL STATEMENTS AND LETTERS MAILED, AND A BUSINESS CARD IS INCLUDED IN THE APPLICATION PACKET. RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 16J: WORK CLOSELY WITH COUNTY SERVICES AND COMMUNITY SENIOR ADVOCATE. PART V, SECTION B, LINE 16A HTTPS://RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2022/10/FINANCIAL-ASSISTANCE-POLICY-CHARITY-CARE.PDF PART V, SECTION B, LINE 16B HTTPS://RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2022/11/FILLABLE-NEW-RLMC-COMMUNITY-CARE-APPLICATION-EFFECTIVE-11-30-2021.PDF PART V, SECTION B, LINE 16C HTTPS://VIEW.OFFICEAPPS.LIVE.COM/OP/VIEW.ASPX?SRC=HTTPS%3A%2F%2FRAINYLAKEMEDICAL.COM%2FWP-CONTENT%2FUPLOADS%2F2022%2F11%2FPLAIN-LANGUAGE-SUMMARY-COMMUNITY-CARE-UPDATED-11-07-2022-002-1.DOCX&WDORIGIN=BROWSELINK PART I, LINE 7: THE ORGANIZATION USES THE COST TO CHARGE RATIO RECOMMENDED BY WORKSHEET 2 OF THE IRS FORM 990, SCHEDULE H INSTRUCTIONS. PART I, LINE 7G: AMOUNTS USED FOR SUBSIDIZED SERVICES WERE CALCULATED USING DETAILED REPORT DATA KEPT BY THE ORGANIZATION. DATA INCLUDED THE TOTAL CHARGES, LESS ALLOWANCES AND DISCOUNTS, MEDICAID; AND ACTUAL COST OF SERVICES PROVIDED. SUBSIDIZED SERVICES INCLUDED ADULTS AND PEDIATRICS IN PATIENT, SPECIALTY CLINIC, ANESTHESIA, OPERATING ROOM AND CHEMOTHERAPY UNIT IN 2022. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 618,605. PART II, COMMUNITY BUILDING ACTIVITIES: RLMC INVESTS RESOURCES TOWARDS EMERGENCY PREPAREDNESS, PARTICULARLY A "DECONTAMINATION TEAM" THAT CONDUCTS DRILLS THROUGHOUT THE YEAR. THE TEAM IS SKILLED IN SETTING UP A PORTABLE DECONTAMINATION TENT, DRESSING IN AN APPROPRIATE LEVEL OF PPE AND PRACTICING DECONTAMINATION PATIENTS. RLMC ALSO SUPPORTS EFFORTS TO HAVE THE SAFE REMOVAL AND TREATMENT OF GARBAGE AND WASTE PRODUCTS. PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PATIENTS. PART III, LINE 3: THE HOSPITAL DOES NOT HAVE A WAY TO REASONABLY ESTIMATE THE AMOUNT OF IMPLICIT PRICE CONCESSIONS THAT ARE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY FOOTNOTE (PAGE 11 OF AUDITED FS) -PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE CENTER EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE CENTER ESTIMATES THE TRANSACTION PRICE BASED ON, NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.THE CENTER DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. PART III, LINE 8: RLMC IS A CRITICAL ACCESS HOSPITAL. THERE WAS A SURPLUS IN 2022, HOWEVER, REGARDLESS OF SHORTFALL OR SURPLUS, THE HOSPITAL PROVIDES SERVICES TO THESE PATIENTS BECAUSE ACCESS TO HEALTHCARE AND INDIVIDUAL'S HEALTH IS IMPORTANT TO THE HOSPITAL. MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE 2022 MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: RLMC WILL NOT REFER AN ACCOUNT TO A THIRD-PARTY DEBT COLLECTION AGENCY UNLESS RLMC HAS GIVEN THE PATIENT REASONABLE OPPORTUNITY TO SUBMIT A FINANCIAL ASSISTANCE APPLICATION IF THE FACTS AND CIRCUMSTANCES SUGGEST THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. INCLUDING FOR EXAMPLE, IF THE PATIENT IS UNINSURED OR IS ON MINNESOTA CARE, MEDICAL ASSISTANCE, OR OTHER RELIEF BASED ON NEED. IF A PATIENT SUBMITS AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, RLMC WILL SUSPEND ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND THE PATIENT HAS BEEN NOTIFIED OF THE DECISION. PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED EVERY 3 YEARS, COMMUNITY HEALTH FAIRS ARE HELD WHERE COMMUNITY MEMBERS CAN PROVIDE FEEDBACK ON THEIR HEALTH CARE NEEDS. A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) HAS ALSO BEEN FORMED WHICH PROVIDES A LINK BETWEEN THE COMMUNITY AND THE ORGANIZATION. RLMC HAS A LARGE FOOTPRINT WITHIN THE COMMUNITY WITH INVOLVEMENT IN MANY SERVICE AND COMMUNITY BASED GROUPS, SPONSORING THE COMMUNITY CHRISTMAS PARADE, PLANNING ASSISTANCE WITH THE FOURTH OF JULY PARADE, SPONSORING HALLOWEEN "PUMPKINPALOOSA", AND CONTRIBUTING SUPPORT TO MANY LOCAL HEALTH AND EDUCATION RELATED PROGRAMS. PART VI, LINE 3: RLMC HAS STAFF THAT ARE CERTIFIED MNSURE NAVIGATORS, WHICH ENABLES US TO ASSIST OUR PATIENTS IN COMPLETING THE APPLICATION PROCESS ON THE HEALTH EXCHANGE TO SEE IF THEY QUALIFY FOR INSURANCE OR A MEDICAID PLAN. RLMC COMMUNICATES OUR FINANCIAL ASSISTANCE PROGRAM TO PATIENTS IN THE FOLLOWING MANNER: 1. PATIENTS ARE GIVEN A FINANCIAL ASSISTANCE BROCHURE WITH A MNSURE HEALTH EXCHANGE INSERT AT THE TIME OF SERVICE. 2. STATEMENTS AND LETTERS ARE SENT TO PATIENTS OFFERING FINANCIAL ASSISTANCE. 3. PHONE CALLS ARE MADE TO PATIENTS TO DISCUSS AND OFFER FINANCIAL ASSISTANCE AND ASSISTANCE WITH THE MNSURE APPLICATION PROCESS. 4. ALL EMPLOYEES ARE EDUCATED ANNUALLY ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND THREE EMPLOYEES ARE EDUCATED TO COMPLETE AND SUBMIT MNSURE APPLICATIONS TO THE STATE FOR PROCESSING. 5. UPON REQUEST, FINANCIAL ASSISTANCE PACKETS WITH APPLICATIONS FOR BOTH OUR FINANCIAL ASSISTANCE PROGRAM AND THE MNSURE PROGRAM ARE SENT OR GIVEN TO PATIENTS. 6. THE RLMC WEBSITE DISPLAYS PAYMENT OPTIONS WHERE OUR FINANCIAL ASSISTANCE PROGRAM IS DISCUSSED. 7. ONE OF THE REQUIREMENTS FOR RLMC FINANCIAL ASSISTANCE IS A DENIAL FROM THE COUNTY IN REGARD TO FINANCIAL ASSISTANCE UNLESS THEY ARE ENROLLED IN THE MN SENIOR PROGRAM. WE OFFER TO ASSIST THEM WITH THEIR MEDICAL ASSISTANCE APPLICATION. 8. SIGNAGE COMMUNICATING THE PROGRAM TO PATIENTS IS DISPLAYED IN MANY AREAS OF THE PATIENT CARE AREA OF THE FACILITY. 9. FINANCIAL COUNSELORS ATTEND HEALTH FAIRS AND OTHER EVENTS IN THE COMMUNITY TO PROMOTE THE PROGRAM AND ANSWER ANY QUESTIONS. 10. RLMC HAS PARTNERED WITH NUMEROUS COMMUNITY SERVICE PARTNERS TO PROMOTE OUR FINANCIAL ASSISTANCE PROGRAM AND MNSURE NAVIGATOR AVAILABILITY. THE COMMUNITY SERVICE PARTNERS ARE GIVEN FINANCIAL ASSISTANCE AND MNSURE INFORMATION TO SHARE WITH THEIR PATRONS AND BUSINESS CARDS OF OUR FINANCIAL COUNSELING STAFF. RLMC STAFF MEETS WITH OUR SERVICE PARTNERS FOR INPUT REGARDING OUR PROGRAMS, TO REPLENISH BROCHURES AND INFORMATION AND TO UPDATE THEM WITH ANY CHANGES. PART VI, LINE 4: RLMC'S PRIMARY SERVICE AREA (PSA) IS KOOCHICHING COUNTY, MINNESOTA. THE COUNTY IS LARGE AND SPARSELY POPULATED (LESS THAN 3.9 PERSONS PER SQUARE MILE) WITH MOST OF THE POPULATION CENTERED IN INTERNATIONAL FALLS. OTHER NEARBY COMMUNITIES INCLUDE LITTLEFORK, BIG FALLS, RANIER, BIRCHDALE AND LOMAN. THE PSA HAS AN ESTIMATED POPULATION OF APPROXIMATELY 12,000 AND POPULATION DECLINE IS PROJECTED TO CONTINUE WHILE THE NUMBER OF PERSONS OVER 65 IS EXPECTED TO REMAIN SIMILAR OF RISE EVEN MORE. PART VI, LINE 5: REPRESENTATION ON THE BOARD OF TRUSTEES IS 100% LOCAL AS ALL TRUSTEES ARE ACTIVE AND INVOLVED MEMBERS OF THE LOCAL COMMUNITY. RLMC HAS IN PLACE AN OPEN MEDICAL STAFF MODEL AND HAS SPECIALISTS FROM SEVERAL DIFFERENT HEALTH CARE SYSTEMS PROVIDING CARE TO PATIENTS. THE ORGANIZATION HAS RECENTLY INVESTED OVER $8 MILLION IN EXPANSION AND RENOVATION OF THE CURRENT FACILITY IN ORDER TO PROVIDE BETTER PATIENT CARE AND MORE LOCAL CARE, ELIMINATING THE NEED TO TRAVEL 100+ MILES TO RECEIVE CARE. THE ORGANIZATION ALSO CONTINUES TO EXPAND THE BREADTH OF SPECIALTY SERVICES OFFERED LOCALLY ON AN OUTREACH BASIS. EMERGENCY SERVICES ARE OFFERED 24/7, 365 DAYS A YEAR TO ALL NEEDING CARE. BECAUSE OF ITS REMOTE LOCATION, IF CHEMOTHERAPY SERVICES WERE NOT OFFERED IN THE COMMUNITY, RESIDENTS WOULD HAVE TO TRAVEL 100+ MILES TO RECEIVE THIS CRITICAL SERVICE. THE ORGANIZATION RECENTLY ESTABLISHED A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) TO ALLOW FOR COMMUNITY INPUT. EACH FALL A COMMUNITY HEALTH FAIR IS CONDUCTED IN CONJUNCTION WITH OTHER HEALTHCARE PROVIDERS WITHIN THE COMMUNITY TO ENCOURAGE VACCINATIONS, WELLNESS, AND OTHER PREVENTATIVE SERVICES. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES MN X X 0 0 0 0 0 0 0 0 0 DAVID MOYER PHYSICIAN 355084 0 1000 0 714 0 6746 0 13497 0 377041 0 0 0 ROBERT PASTOR II CEO 286579 0 13000 0 6152 0 17912 0 34525 0 358168 0 0 0 DANIEL MARGO GENERAL SURGEON 313366 0 500 0 0 0 8158 0 29133 0 351157 0 0 0 JAY KNAAK PHYSICIAN 247949 0 5800 0 715 0 6715 0 36540 0 297719 0 0 0 SCOTT JOHNSON PHYSICIAN 161536 0 500 0 0 0 23287 0 0 0 185323 0 0 0 AMBER BIONDICH NURSE PRACTITIONER 109267 0 39752 0 12688 0 3705 0 1311 0 166723 0 0 0 ANDREA PASTOR FAMILY MEMBER OF CEO 82346 EMPLOYEE/COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE SAME ACCOUNTING FIRM WHICH PREPARES THE AUDIT AND THEN IT IS REVIEWED BY THE CFO AND CEO. IN ADDITION, A COPY OF THE RETURN IS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REMINDED OF THE CONFLICT OF INTEREST POLICY AND MUST SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. WHEN A CONFLICT OF INTEREST EXISTS, THE INTERESTED TRUSTEE MAY BE PRESENT FOR DISCUSSION TO ANSWER QUESTIONS BUT MAY NOT ADVOCATE FOR THE ACTION TO BE TAKEN AND MAY BE ASKED TO LEAVE THE ROOM WHILE A VOTE IS TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S INITIAL COMPENSATION FOR THE CURRENT CONTRACT AND ANY SUBSEQUENT ANNUAL INCREASES BASED ON PERFORMANCE ARE SET BY THE BOARD OF DIRECTORS AND IS DOCUMENTED IN THE BOARD MINUTES. CEO COMPENSATION RATE AND INCREASES ARE DETERMINED USING EXTERNAL SALARY RANGE REPORTS: THE MINNESOTA HOSPITAL ASSOCIATION SALARY SURVEY REPORT, THE "HHRAM" (HEALTHCARE HUMAN RESOURCES ASSOCIATION OF MINNESOTA) SALARY SURVEY BOOK, AND THE MEDICAL GROUP MANAGEMENT ASSOCIATE (MGMA) PHYSICIAN COMPENSATION REPORT SURVEY. THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS ALSO DETERMINED USING AT LEAST AT LEAST ONE OF THE ABOVE MENTIONED EXTERNAL SALARY RANGE REPORTS AS APPLICABLE TO THE POSITION. THESE RATES AND ANY INCREASES ARE APPROVED BY THE CEO AND PRESENTED TO THE BOARD OF DIRECTORS FOR THEIR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT OPEN TO THE PUBLIC. PART VII, SECTION A, LINE 1A MELISSA MARCOTTE SERVED AS THE CFO THROUGH FEBRUARY OF 2022 FOR A PARTIAL YEAR AS AN OFFICER. THE AMOUNT REFLECTED IN PAGE 7, COLUMN D INCLUDES HER TIME BOTH DEVOTED AS AN OFFICER, AND NOT AS AN OFFICER, TO TIE TO HER REPORTABLE COMPENSATION PER BOX 5 OF FORM W-2. FORM 990, PART IX, LINE 11G ANESTHESIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 524,762. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 524,762. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 136,199. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,199. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 288,149. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 288,149. OTHER SERVICES: PROGRAM SERVICE EXPENSES 835,810. MANAGEMENT AND GENERAL EXPENSES 486,638. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,322,448. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,631,703. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,631,703. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 84,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,583. FORM 990, PART XI, LINE 9: CHANGE IN UNRECOGNIZED PENSION COSTS 58,048. OTHER ADJUSTMENT FALLS MEMORIAL HOSPITAL FOUNDATION INC 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 204585807 SUPPORT MN 501(C)(3) LINE 12A, I INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCATION 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0 FALLS MEMORIAL HOSPITAL FOUNDATION INC C 66973 CASH