2021-11-09T14:26:14-06:00 2020-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2020-01-01 410726171 INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION INTE 2182835431 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 MELISSA MARCOTTE CFO 2182835431 2021-11-09 1 MELISSA MARCOTTE 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2021-11-03 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z RAINY LAKE MEDICAL CENTER ROBERT PASTOR II 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 31278514 0 X WWW.RAINYLAKEMEDICAL.COM X 1945 MN TO PROMOTE AND PROVIDE HEALTH CARE AND WELLNESS SERVICES IN OUR REGION THAT EXCEED EXPECTATIONS. 7 7 229 29 925 0 374183 82823 29129592 29990698 56497 325791 63588 348015 29623860 30747327 0 20000 0 0 14164682 14668570 0 0 0 14835970 14849834 29000652 29538404 623208 1208923 26822079 38929757 10221433 21534050 16600646 17395707 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 23577067 20000 30167752 PROVIDED HEALTH CARE SERVICES TO THE COMMUNITY OF INTERNATIONAL FALLS AND SURROUNDING AREA. IN ADDITION TO PROVIDING DIRECT PATIENT CARE AND IN FURTHERANCE OF ITS CHARITABLE PURPOSE, RAINY LAKE MEDICAL CENTER (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.THE DECISION WAS MADE TO SUSPEND OB SERVICES AT RLMC HOSPITAL. 23577067 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 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 74 0 229 1 0 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 MELISSA MARCOTTE CFO 2182835431 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 DANIEL MARGO GENERAL SURGEON 20.00 X 307747 0 28828 JAY KNAAK PHYSICIAN 40.00 X 264230 0 35960 DAVID MOYER PHYSICIAN 40.00 X 208728 0 7788 JULIE DOLPHIN HOSPITALIST 40.00 X 176828 0 12437 KATIE CHEZICK PHARMACIST 40.00 X 158628 0 17395 ROBERT PASTOR II CEO 40.00 1.00 X 276948 0 24189 MELISSA MARCOTTE CFO 40.00 1.00 X 164048 0 3475 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 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 1557157 0 130072 30 0 1 0 ACUTE CARE INC 1609 N ANKENY BLVD SUITE 200 ANKENY IA 50023 PHYSICIAN FEES 1765662 R C SHEFLAND ANESTHESIA LTD 27040 CTY RD 9 BEMIDJI MN 56601 ANESTHESIOLOGIST FEES 503104 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 57117 PROVIDING MEAL SERVICE AND SOFTWARE MAIN 395109 SANFORD LABORATORIES PO BOX 5056 SIOUX FALLS SD 57117 LAB TESTING SERVICE 352652 CPSIEVIDENT PO BOX 850309 MOBILE AL 36685 FACILITY WIDE COMPUTER SYSTEM, MAINTENAN 286113 17 60850 21973 82823 PATIENT SERVICE REVENUE 621990 29533259 29533259 457439 456514 925 29990698 145820 145820 63057 0 63057 63057 63057 711158 526215 4972 184943 -4972 179971 179971 CMDI EARNINGS 900099 177979 177979 106979 106979 284958 30747327 30167752 925 495827 X 20000 20000 468661 468661 11652366 9480426 2171940 152568 119048 33520 1526714 993094 533620 868261 793477 74784 34121 34121 36513 36513 4763311 4229956 533355 163936 134455 29481 87903 70581 17322 345002 224063 120939 27487 17852 9635 2358 1531 827 261910 170098 91812 1504923 977378 527545 125348 81408 43940 MEDICAL SUPPLIES 4241954 3711933 530021 EQUIPMENT RENTAL 828210 537884 290326 REPAIRS & MAINTENANCE 665559 432250 233309 BAD DEBT EXPENSE 636014 636014 1125285 945619 179666 29538404 23577067 5961337 0 90427 12377 5742961 13550500 4986322 3349885 572729 665866 146179 653579 27673598 14427095 13400063 13246503 1146629 6754071 736769 670623 0 26353 26822079 38929757 3298914 2357209 4437328 6507233 6595151 415286 8144362 10221433 21534050 X 16509294 17287447 91352 108260 16600646 17395707 26822079 38929757 X 1208923 -95751 -318111 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 498 0 0 0 498 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO VARIOUS PROFESSIONAL ORGANIZATIONS. A PORTION OF THESE DUES ARE USED TOWARDS LOBBYING EXPENSES. THE LOBBYING EXPENSES GO TOWARDS ADVOCATING FOR THE ORGANIZATION'S PURPOSE AND MISSION. 87371 87371 17804170 7071014 10733156 9315833 7356081 1959752 466224 466224 13246503 PAYROLL PROTECTION PROGRAM LOAN PAYABLE 2337500 DEFERRED COMPENSATION PLAN LIABILITIES 26353 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 5761959 OTHER ACCRUED LIABILITIES 18550 8144362 1 1 X 1 X 1 X 1 1 0 1 1 72981 72981 0.00250 711263 341114 370149 0.01280 784244 341114 443130 0.01530 11088 11088 0.00040 12635 12635 0.00040 12420206 7317189 5103017 0.17660 575 575 0.00000 12444504 7317189 5127315 0.17740 13228748 7658303 5570445 0.19270 46827 46827 0.00160 20250 20250 0.00070 67077 67077 0.00230 1 368888 0 8843058 8796815 46243 X 1 1 1 1 RAINY LAKE MEDICAL CENTER 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 WWW.RAINYLAKEMEDICAL.COM 394716 X X X X 2 RURAL HEALTH CLINICS/SPECIALTY PROVIDER-BASED CLINIC RAINY LAKE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X SEE SUPPLEMENTAL INFORMATION X 1 19 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X HTTPS://WWW.RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/ X HTTPS://WWW.RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/ X HTTPS://WWW.RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/ 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 GATHERING DATA FROM SECONDARY SOURCES, A CHNA SURVEY WAS DEPLOYED TO OUR LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. COMMUNITY INPUT FROM 25 LOCAL EXPERT ADVISORS WAS RECEIVED. SURVEY RESPONSES STARTED SEPTEMBER 22ND, 2019 AND ENDED ON OCTOBER 14TH, 2019. HAVING TAKEN STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THEN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A "WISDOM OF CROWDS" METHOD WHERE EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. A LIST OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA WAS DEVELOPED. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE LIST OF HEALTH NEEDS, INCLUDING THE OPPORTUNITY TO LIST ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. THE RANKED NEEDS WERE DIVIDED INTO TWO GROUPS: "SIGNIFICANT AND "OTHER IDENTIFIED NEEDS." THE LOCAL EXPERT ADVISORS WERE ASKED TO SELF IDENTIFY THEMSELVES INTO ANY REPRESENTATIVE CLASSIFICATIONS WITH THE FOLLOWING RESULTS: PUBLIC HEALTH EXPERTISE (8) DEPARTMENTS AND AGENCIES WITH RELEVANT DATA/INFORMATION REGARDING HEALTH NEEDS (8) PRIORITY POPULATIONS (12) REPRESENTATIVE/ MEMBER OF CHRONIC DISEASE GROUP OR ORGANIZATION (3) REPRESENTS THE BROAD INTEREST OF THE COMMUNITY (21). RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 6B: QUORUM HEALTH RESOURCES ASSISTED WITH THE DEVELOPMENT OF RLMC'S COMMUNITY HEALTH NEEDS ASSESSMENT. 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 THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS HEALTHCARE AFFORDABILITY/ACCESSIBILITY, HEALTHCARE EDUCATION/PREVENTATIVE CARE, AND EMERGENCY ROOM SERVICES:- 16 HYPERTENSIVE PATIENTS WITH ELEVATED B/P WERE FOLLOWED IN 2020 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. - 43 DIABETIC PATIENTS WERE FOLLOWED IN 2020 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. - AN RFP WAS CREATED AND DISTRIBUTED IN 2020 TO SEVERAL ER STAFFING COMPANIES. OUR CURRENT PROVIDER SUBMITTED THE MOST FAVORABLE RESPONSE SO RLMC ENTERED INTO SUCCESSFUL BUT PROLONGED NEGOTIATIONS TO BRING ABOUT A NUMBER OF CONTRACTUAL CHANGES TO IMPROVE THE QUALITY OF THE SERVICE PROVIDED. - DURING 2020 CONTRACT RENEWAL NEGOTIATIONS, RLMC WAS ABLE TO NEGOTIATE FOR THE ABILITY TO STAFF THE ER WITH LOCAL PROVIDERS AT OUR OPTION WITHOUT ADDITIONAL CHARGES.- IN THE SPRING OF 2020, THE ED STAFFING COMPANY WORKED WITH THE SULLIVAN GROUP TO DELIVER PATIENT SATISFACTION TRAINING FOR THEIR PROVIDERS. IN ADDITION, THE STAFFING COMPANY HAS UNDERTAKEN QUALITY INITIATIVES TO TRAIN THEIR PROVIDERS ON MANAGING UP AND SCRIPTING TO DELIVER KEY WORDS AT THE END OF THE ED VISIT. THE STAFFING COMPANY'S CMO IS PERFORMING MONTHLY RANDOM CHART REVIEWS TO ASSESS AND IMPROVE THE QUALITY OF THEIR PROVIDER'S DOCUMENTATION. RLMC IS SHARING ED PROVIDER-SPECIFIC SATISFACTION DATA AND PATIENT SURVEY COMMENTS WITH THE ED PROVIDERS. 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. SCHEDULE H, PART V, LINE 7A PART V, LINE 7A:HTTPS://WWW.RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2020/09/RLMC-2019-CHNA.PDF SCHEDULE H, PART V, LINE 10A PART V, LINE 10A:HTTPS://WWW.RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2016/06/IMPLEMENTATION-STRATEGY-1.PDF 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 $ 636,014. PART II, COMMUNITY BUILDING ACTIVITIES: RAINY LAKE MEDICAL CENTER SUPPORTS EFFORTS TO ENSURE THE SAFE REMOVAL AND TREATMENT OF GARBAGE AND WASTE PRODUCTS. RAINY LAKE MEDICAL CENTER ALSO PROVIDES SUPPORT TO AN EDUCATIONAL INSTITUTION IN THE AREA TO HELP TRAIN HEALTH PROFESSIONALS. 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: SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, WAS NOT SIGNIFICANT. PART III, LINE 8: RLMC IS A CRITICAL ACCESS HOSPITAL. THERE WAS A SURPLUS IN 2020, 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 2020 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 ALSO HAS REPRESENTATION AT THE QUARTERLY COMMUNITY MENTAL HEALTH MEETING, WHICH ALSO INCLUDES SOCIAL SERVICES, LOCAL MENTAL HEALTH PROVIDERS AND LAW ENFORCEMENT. THE GOAL OF THE GROUP IS TO SHARE RESOURCES AND ADDRESS THE LOCAL MENTAL HEALTH NEEDS. 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 4.3 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 LESS THAN 13,000 AND POPULATION DECLINE IS PROJECTED TO CONTINUE WHILE THE NUMBER OF PERSONS OVER 65 IS EXPECTED TO 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 SERVICES OF CHEMOTHERAPY AND LABOR/DELIVERY WERE NOT OFFERED IN THE COMMUNITY, RESIDENTS WOULD HAVE TO TRAVEL 100+ MILES TO RECEIVE THESE CRITICAL SERVICES. THE ORGANIZATION RECENTLY ESTABLISHED A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) TO ALLOW FOR COMMUNITY INPUT. PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 RAINY RIVER COMMUNITY COLLEGE 1501 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 411687554 GOVERNMENT 20000 SUPPORT FOR NURSING PROGRAM AT RRCC 1 0 PART I, LINE 2: THE HOSPITAL DOES NOT SEEK APPLICANTS FOR GRANTS, NOR DOES IT ACTIVELY ENGAGE IN GRANT MAKING. HOWEVER, THERE WAS A NEED LOCALLY THAT THE HOSPITAL DEDICATED DOLLARS TO SUPPORTING DURING THE YEAR. FROM TIME TO TIME, THE HOSPITAL MAY ENGAGE IN DIALOGUE WITH THE COMMUNITY COLLEGE, HOWEVER, THEY DO NOT INTEND TO MONITOR THE USE OF FUNDS IN DETAIL OR FORMALLY. THE GIFT WAS RESTRICTED TO SUPPORT THE NURSING PROGRAM BUT WILL OTHERWISE BE CONSIDERED GENERAL SUPPORT. X 0 0 X X 0 0 0 0 0 0 0 0 0 DANIEL MARGO GENERAL SURGEON 307603 0 144 0 0 0 5700 0 23128 0 336575 0 0 0 JAY KNAAK PHYSICIAN 258312 0 5144 0 774 0 4953 0 31007 0 300190 0 0 0 DAVID MOYER PHYSICIAN 207812 0 142 0 774 0 1077 0 6711 0 216516 0 0 0 JULIE DOLPHIN HOSPITALIST 176286 0 142 0 400 0 785 0 11652 0 189265 0 0 0 KATIE CHEZICK PHARMACIST 145095 0 5076 0 8457 0 3158 0 14237 0 176023 0 0 0 ROBERT PASTOR II CEO 266134 0 10544 0 270 0 5134 0 19055 0 301137 0 0 0 MELISSA MARCOTTE CFO 152110 0 5860 0 6078 0 3176 0 299 0 167523 0 0 0 PART I, LINE 1A DISCRETIONARY COVID BONUS PAID TO ALL EMPLOYEES IN 2020 WAS GROSSED UP. ANDREA PASTOR FAMILY MEMBER OF CEO 51145 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 COMPENSATION FOR THE CEO IS SET BY THE BOARD OF DIRECTORS AND IS DOCUMENTED IN THE BOARD MINUTES AND CEO'S WRITTEN CONTRACT. TO SET THE CEO'S COMPENSATION, RLMC USES TWO EXTERNAL REPORTS FOR DETERMINING AND SETTING SALARY RANGES. THESE INCLUDE 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 REVIEWED AND APPROVED BY THE CEO. HHRAM SALARY SURVEY IS USED IN DETERMINING THESE SALARIES AS WELL AS LONGEVITY AND PERFORMANCE EVALUATIONS. THESE DECISIONS ARE DOCUMENTED IN THE EMPLOYEE'S PERSONNEL FILE. ALL REVIEWS ARE PERFORMED AT LEAST ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT OPEN TO THE PUBLIC. FORM 990, PART IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,266,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,266,378. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 259,217. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 259,217. ANESTHESIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 503,104. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 503,104. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 491,951. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 491,951. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 132,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,943. OTHER SERVICES: PROGRAM SERVICE EXPENSES 576,363. MANAGEMENT AND GENERAL EXPENSES 533,355. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,109,718. FORM 990, PART XI, LINE 9: CHANGE IN UNRECOGNIZED PENSION COSTS -322,453. OTHER ADJUSTMENT 4,342. 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