2019-05-14T08:26:38-05:00 2018-06-30 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-07-01 390890676 ST CROIX REGIONAL MEDICAL CENTER STCR 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 SALLY BAJAK CFO 7154830556 2019-05-10 1 HOLLY POKRANDT CPA P00449155 7158323407 2019-05-10 137.26.200.211 2019-05-10 12:04:46 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E4255D669FE7A429B540D12C0E645A16D05D3497 2017 2019-02-21 02:37:17Z DAVE DOBOSENSKI 235 STATE STREET ST CROIX FALLS WI 54024 111261656 0 X WWW.SCRMC.ORG X 1954 WI TO PROVIDE QUALITY HEALTHCARE SERVICES TO ALL RESIDENTS OF THE SERVICE AREA. 9 8 852 150 2974846 -289642 102598 69506 97845725 110689632 26315 38432 1433681 415843 99408319 111213413 17111 21765 0 0 41714600 53777033 0 0 0 51616203 51773879 93347914 105572677 6060405 5640736 76821979 84083896 17944604 18016091 58877375 66067805 X TO IMPROVE HEALTH AND WELLNESS BY PROVIDING CONVENIENT ACCESS TO HIGH QUALITY AFFORDABLE HEALTH CARE. 0 0 70213682 21765 78339793 OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. DURING FISCAL YEAR 2018, THERE WERE 9,804 EMERGENCY ROOM VISITS RECORDED, 2,021 OUTPATIENT SURGERIES, AND 117,603 CLINICAL VISITS.INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2018, THERE WERE 278 BIRTHS, 1,553 INPATIENT ADMISSIONS, AND A TOTAL OF 4,671 INPATIENT DAYS FOR AN AVERAGE LENGTH OF 3.01 DAYS. 18142709 0 20242438 ST. CROIX REGIONAL MEDICAL CENTER OPERATES FOUR PROVIDER BASED CLINICS AND ONE FREE STANDING CLINIC. TOGETHER, THE CLINICS STRIVE TO MEET THE HEALTHCARE NEEDS OF PATIENTS AND FAMILIES WHO LIVE AND WORK IN THE COMMUNITIES THEY SERVE. A TOTAL OF 117,603 CLINIC VISITS OCCURED IN FISCAL YEAR 2018. 4497173 0 5017649 CONTRACT PHARMACY - ST. CROIX REGIONAL MEDICAL CENTER BECAME ELIGIBLE TO PARTICIPATE IN THE 340B DRUG PRICING PROGRAM, WHICH IS MANAGED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OFFICE OF PHARMACY AFFAIRS (OPA), RESULTING IN THE REALIZATION OF A CONTRACT PHARMACY SERVICE. PARTICIPATION IN THE 340B DRUG PRICING PROGRAM RESULTS IN SIGNIFICANT SAVINGS, ESTIMATED TO BE 20-50%, ON THE COST OF PHARMACEUTICALS FOR USE BY OUTPATIENTS OF THE FACILITY. THROUGH THIS PROGRAM, ST. CROIX REGIONAL MEDICAL CENTER IS ABLE TO REACH MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICES. 3361533 0 3750577 ST. CROIX VALLEY PHARMACIES PROVIDE LOCAL PHARMACY CARE TO THE SERVICE AREA OF ST. CROIX REGIONAL MEDICAL CENTER. ST. CROIX VALLEY PHARMACIES IS THE SOLE MEMBER OF THE FOLLOWING COMMUNITY PHARMACIES: UNITY PHARMACY LOCATED IN THE UNITY CLINIC BUILDING NEAR BALSAM, WI, FREDERIC PHARMACY LOCATED IN THE FREDERIC CLINIC BUILDING IN FREDERIC, WI, AND, ST. CROIX FALLS PHARMACY LOCATED IN THE ST. CROIX FALLS CLINIC BUILDING IN ST. CROIX FALLS, WI. 3361533 0 3750577 96215097 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 73 0 852 1 1 1 0 0 0 0 0 0 0 0 0 X 9 8 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X SALLY BAJAK 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 JOHN DRISCOLL TRUSTEE 0.50 X 0 0 0 CONNIE ERICKSON TRUSTEE 0.50 X 0 0 0 DANA FREY TRUSTEE 4.00 X 0 0 0 ALLISON KARUN MD PHYSICIAN/TRUSTEE (THRU SEPTEMBER) 40.00 X 304978 0 43870 PATRICK MCDONOUGH MD PHYSICIAN/TRUSTEE 40.00 X 182898 0 16480 STEVE TESCH TRUSTEE (THRU SEPTEMBER) 0.50 X 0 0 0 JOE THIMM CHAIR 0.50 X X 0 0 0 KRISTINE FUGE CHAIR (SEPT - MAR) 0.50 X X 0 0 0 HARLEN HEGDAL CHAIR (THRU SEPTEMBER) 2.00 X X 0 0 0 SARAH CORMELL VICE-CHAIR 0.50 X X 0 0 0 MICHAEL BUCHITE TREASURER 0.50 X X 0 0 0 GURDESH BEDI SECRETARY/PHYSICIAN 40.00 X X 818766 0 15600 DAVE DOBOSENSKI CEO 40.00 X 375124 0 43686 SALLY BAJAK CFO 40.00 X 174661 0 38399 CLAUDIO NUNES PHYSICIAN 40.00 X 436009 0 64740 MUHAMMAD KHAN PHYSICIAN 40.00 X 576507 0 52725 DANIELLE REDBURN MD PHYSICIAN 40.00 X 480530 0 41258 JILL TIES PHYSICIAN 40.00 X 372353 0 46762 VICKI SKARDA PHYSICIAN 40.00 X 345196 0 21860 4067022 0 385380 64 0 1 0 RIVER VALLEY MEDICAL CENTER 208 SOUTH ADAMS STREET ST CROIX FALLS WI 54024 PHYSICIAN SERVICES 3457101 ST CROIX VALLEY ANESTHESIA PO BOX 45 OSCEOLA WI 54024 CRNA SERVICES 1717203 REGIONS HOSPITAL PO BOX 64059 ST PAUL MN 55164 PHYSICIAN SERVICES 1555311 VOYAGEUR RADIOLOGY LLC 9975 DELLWOOD ROAD STILLWATER MN 55082 RADIOLOGY SERVICES 1541301 CMDI PO BOX 158 MILACA MN 56353 RADIOLOGY SERVICES 827594 16 69506 69506 PATIENT SERVICES 624100 97477388 97477388 CONTRACT PHARMACY 624100 5017649 5017649 FREDERIC PHARMACY 624100 2919508 1404929 1514579 SCF PHARMACY 624100 2407033 1561254 845779 UNITY PHARMACY 624100 1398882 784394 614488 1469172 1011281 457891 110689632 69024 69024 107879 14901 92978 92978 92978 2750 33342 -30592 -30592 -30592 CMDI REVENUE 900099 229303 229303 EHR PAYMENTS 900099 93562 93562 322865 111213413 107350457 2974846 818604 X 21765 21765 700019 700019 43601570 39245429 4356141 1869538 1686200 183338 4642970 4162461 480509 2962936 2629406 333530 235542 235542 59456 59456 14206644 12675407 1531237 231043 86043 145000 442433 271615 170818 2025843 1886965 138878 2264305 1806940 457365 152508 85384 67124 350231 290275 59956 114030 105670 8360 3742051 3742051 395449 388600 6849 MEDICAL SUPPLIES 24277895 24277895 PROVISION FOR BAD DEBTS 2239975 2239975 DUES AND PUBLICATIONS 727052 303594 423458 EQUIPMENT RENTAL 105458 105458 203964 203964 105572677 96215097 9357580 0 21153955 18266088 372844 4782700 14155480 14514800 40035 94604 3038662 3063261 496199 496712 68630695 35004397 30605676 33626298 1604742 3256357 575000 575000 4779386 5408076 76821979 84083896 11642443 12634128 2715233 1084060 209000 171000 3377928 4126903 17944604 18016091 X 58877375 66067805 58877375 66067805 76821979 84083896 5640736 1549694 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8954 8954 0 PART II-B, LINE 1: ST CROIX REGIONAL MEDICAL CENTER (THE ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. A PORTION OF THE FEES PAID BY THE ORGANIZATION IN FY2017 WERE RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. THE ORGANIZATION IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO ENSURE THEIR MEMBERS' PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. THE ORGANIZATION IS ALSO A MEMBER OF THE NATIONAL RURAL HEALTH ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO SUPPORT RURAL HEALTH ISSUES THROUGH ADVOCACY, COMMUNICATIONS, EDUCATION AND RESEARCH. 1491495 1491495 38182172 20271522 17910650 43170 35375 7795 22870297 14697500 8172797 6043561 6043561 33626298 DEBT SERVICE RESERVE FUND 1619500 UNEMPLOYMENT RESERVE FUND 346311 DEFERRED COMPENSATION PLAN 3442265 5408076 ASSET RETIREMENT OBLIGATION 218611 DEFERRED COMPENSATION PLAN 3908292 4126903 108854187 0 108854187 2359226 2359226 111213413 103213451 0 103213451 2359226 2359226 105572677 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,239,975. EXPENSES RECORDED AS REVENUE 119,251. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,239,975. EXPENSES RECORDED AS REVENUE 119,251. 1 1 X 1 X 1 X 1 1 0 1 1 315017 315017 0.00300 11921671 7351300 4570371 0.04420 12236688 7351300 4885388 0.04720 12236688 7351300 4885388 0.04720 0 1145007 572503 31730978 31552092 178886 X 1 1 1 1 ST CROIX REGIONAL MEDICAL CENTER 235 STATE STREET ST CROIX FALLS WI 54024 WWW.SCRMC.ORG 1043240922 X X X X ST CROIX REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X WWW.SCRMC.ORG X WWW.HEALTHYPOLKCOUNTY.COM X 1 15 0 1 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X 1 X HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ X HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ X HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X X 1 X 0 0 ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: IN THE COLLECTION OF DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE MEDICAL CENTER UTILIZED HEALTH AND LIFESTYLE COMMUNITY SURVEYS. A COUNTY WIDE SURVEY OF THE HEALTH OF POLK COUNTY RESIDENTS WAS MADE AVAILABLE TO THE PUBLIC TO PARTICIPATE. THIS SURVEY WAS MADE AVAILABLE AT ALL OF THE LOCAL MEDICAL CENTERS AND THE HEALTH DEPARTMENT AS WELL AS ADVERTISED IN THE LOCAL NEWSPAPERS AND POSTED ON ALL FOUR OF THE PARTNER'S ORGANIZATION'S WEBSITES. ONCE THE DATA WAS COLLECTED FROM THE SURVEYS, FOUR COMMUNITY FORUMS WERE SPONSORED IN BALSAM LAKE, ST. CROIX FALLS, AMERY AND OSCEOLA. THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. IN ADDITION, A PARTNER MEETING WAS HELD TARGETING KEY ORGANIZATIONS AS WELL AS LOCAL HEALTH-RELATED COALITIONS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE 10 HEALTH FOCUS AREAS AS WELL AS VOTE FOR THEIR TOP FIVE. ON APRIL 12, 2016, A PARTNER MEETING CONVENED AND PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF POLK COUNTY CITIZENS, AS WELL AS VOTING RESULTS FROM THE COMMUNITY FORUMS. DURING THIS MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP FOUR HEALTH FOCUS AREAS FOR POLK COUNTY, WI. THE COLLABORATIVE GROUP OF THE POLK COUNTY HEALTH DEPARTMENT, THE THREE MEDICAL CENTERS AND MANY OTHER COMMUNITY ORGANIZATIONS ENGAGES COMMUNITY MEMBERS AND WORKS COLLECTIVELY WITH PARTNERS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH ASSESSMENT, PRIORITIZATION, EFFECTIVE PLANNING, COLLABORATIVE IMPLEMENTATION AND EVALUATION. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: THE MEDICAL CENTER WORKED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT, AMERY HOSPITAL AND CLINIC AND OSCEOLA MEDICAL CENTER WITH THE ULTIMATE GOAL TO IDENTIFY PRIORITY HEALTH ISSUES AND TO DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: AS STATED ABOVE, THE MEDICAL CENTER WORKED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT FOR THEIR COMMUNITY HEALTH NEEDS ASSESSMENT. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE TOP HEALTH FOCUS AREAS. THE FINAL TOP HEALTH FOCUS AREAS SELECTED WERE:1. MENTAL HEALTH2. SUBSTANCE ABUSE3. ACCESS TO CARE4. OBESITY AFTER REVIEWING THE DATA AND MAPPING EXISTING RESOURCES, SCRMC DEVELOPED AN IMPLEMENTATION STRATEGY. THE SCRMC GOVERNING BOARD APPROVED THE IMPLEMENTATION STRATEGY ON OCTOBER 25, 2016. THE ABOVE NEEDS WERE PRIORITIZED BASED ON SIZE, SEVERITY, AVAILABLE DATA, AND THE HOSPITAL'S ABILITY TO HAVE AN IMPACT. IN ORDER TO ADDRESS PRIORITY NEEDS, SCRMC WILL ENGAGE KEY COMMUNITY PARTNERS IN IMPLEMENTING STRATEGIES ACROSS THE SERVICE AREA. THESE STRATEGIES INCLUDE MODIFYING POLICIES, PROVIDING SUPPORT, ENHANCING ACCESS, CHANGING CONSEQUENCES AND INCENTIVES, PROVIDING INFORMATION, AND ENHANCING SKILLS. SCRMC WORKS COLLABORATIVELY WITH OSCEOLA MEDICAL CENTER, AMERY MEDICAL CENTER, THE POLK COUNTY HEALTH DEPARTMENT, AND OTHER COMMUNITY MEMBERS TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC WOULD ALSO LIKE TO CONTRIBUTE EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. 1. NUTRITION - NUTRITION NOW FALLS UNDER OBESITY. BECAUSE OBESITY WAS RANKED AS ONE OF THE MOST IMPORTANT HEALTH NEEDS, NUTRITION WILL BE ADDRESSED INDIRECTLY THROUGH MANY OF THE STRATEGIES AND ACTIVITIES AIMED AT REDUCING OBESITY. 2. PHYSICAL ACTIVITY - PHYSICAL ACTIVITY NOW FALLS UNDER OBESITY. BECAUSE OBESITY WAS RANKED AS ONE MORE THE MOST IMPORTANT HEALTH NEEDS, PHYSICAL ACTIVITY WILL BE ADDRESSED INDIRECTLY THROUGH MANY OF THE STRATEGIES AND ACTIVITIES AIMED AT REDUCING OBESITY. 3. REPRODUCTIVE AND SEXUAL HEALTH: THOUGH NOT VOTED AS ONE OF THE TOP SIGNIFICANT HEALTH NEEDS OF POLK COUNTY, SCRMC IS COMMITTED TO PLAYING AN ACTIVE ROLE IN REPRODUCTIVE AND SEXUAL HEALTH. SCRMC IS CURRENTLY WORKING TOWARD RE-DESIGNING PATIENT EDUCATION MATERIALS TO BETTER SUIT PATIENT UNDERSTANDING. IF A PATIENT IS DEEMED SEXUALLY ACTIVE AND IS BETWEEN THE AGE OF 16-24, ALL PRIMARY CARE PROVIDERS SCREEN THE PATIENT FOR CHLAMYDIA AND GONORRHEA. FOR ALL TEEN PRIMARY CARE VISITS, "TEEN HEALTH" INFORMATION IS INCLUDED IN THE AFTER VISIT SUMMARY FOR THE PATIENT. DURING A PATIENT VISIT PRIMARY CARE, COUNSELING IS OFFERED FOR ANY ISSUE IN REPRODUCTIVE AND SEXUAL HEALTH. SCRMC ACKNOWLEDGES THE WIDE RANGE OF SIGNIFICANT HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. SCRMC WILL NOT TAKE NEW OR ADDITIONAL ACTIONS ON THE FOLLOWING HEALTH NEEDS AT THIS TIME: 1. UNINTENTIONAL INJURY: BECAUSE SUBSTANCE ABUSE WAS RANKED AS ON OF THE MOST IMPORTANT HEALTH NEEDS, UNINTENTIONAL INJURY WILL BE ADDRESSED INDIRECTLY THROUGH MANY OF THE STRATEGIES AND ACTIVITIES AIMED AT REDUCING SUBSTANCE ABUSE. 2. DENTAL HEALTH SERVICES AND ORAL HEALTH: MANY OF THE KEY STAKEHOLDERS REPORTED ACCESS TO AFFORDABLE DENTAL CARE AS A NEED AMONG THE LOW-INCOME AND MEDICALLY UNDERSERVED POPULATIONS. SCRMC PROVIDERS PROMOTE THE POSITIVE HEALTH BENEFITS OF GOOD ORAL HEALTH AT PATIENT VISITS AND ALLOW DENTAL SERVICE PROMOTION AT SUITABLE SCRMC SPONSORED COMMUNITY AND EMPLOYEE EVENTS THROUGHOUT THE YEAR. DUE TO LIMITED RESOURCES AND SPACE, SCRMC IS UNABLE, AT THIS TIME, TO ADDRESS THIS MATTER. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13H: SCRMC MAY PRESUMPTIVELY DETERMINE ELIGIBILITY OF PATIENTS BASED ON EXTERNAL SOURCES AND DATABASES WITHOUT A FAP-APPLICATION. 5 1 - FREDERIC CLINIC 107 OAK STREET E FREDERIC WI 54837 PROVIDER BASED CLINIC 2 - INGALLS CLINIC 7456 MAIN STREET WEBSTER WI 54893 PROVIDER BASED CLINIC 3 - UNITY CLINIC 1482 190TH AVE BALSAM LAKE WI 54024 PROVIDER BASED CLINIC 4 - ST CROIX FALLS CLINIC 235 STATE STREET ST CROIX FALLS WI 54024 PROVIDER BASED CLINIC 5 - LINDSTROM CLINIC 12375 LINDSTROM LANE LINDSTROM MN 55045 FREE STANDING CLINIC PART I, LINE 3C: ST. CROIX REGIONAL MEDICAL CENTER, THROUGH ITS PATIENT ADVOCATES,EVALUATES EACH APPLICANT'S SITUATION IN ACCORDANCE WITH CRITERIAESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE CRITERIA INCLUDES:{1) INDIVIDUAL OR FAMILY INCOME{2) FAMILY SIZE{3) OTHER SOURCES OF PAYMENT FOR SERVICES.QUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE,FAMILY SIZE, AND INCOME LEVELS BASED ON 100% OF THE FEDERAL POVERTYGUIDELINES AS PUBLISHED ANNUALY BY THE FEDERAL GOVERNMENT.IN ADDITION TO THE ABOVE LISTED ELIGIBILITY REQUIREMENTS DEPENDENT UPONINCOME, SCRMC MAY ALSO PRESUMTIVELY DETERMINE ELIGIBILITY FOR FINANCIALASSISTANCE. PORTIONS OF OR THE ENTIRE FINANCIAL APPLICATION PROCESS MAY BEWAIVED FOR CERTAIN PATIENTS/GUARANTORS WHO PRESUMPTIVELY QUALIFY FORFINANCIAL ASSISTANCE AND ARE SUBSEQUENTLY VERIFIED BASED ON SCRMC POLICIESAND PROCEDURES. EXAMPLES MAY INCLUDE PATIENTS/GUARANTORS WHO ARE HOMELESS, DECEASED WITHOUT AN ESTATE, BANKRUPTCY, FOOD STAMPS AND/ORPATIENTS/GUARANTORS WHO QUALIFY BY EXTERNAL AVAILABLE DATA SOURCES SUCH ASCREDIT AGENCIES OR SOCIAL ECONOMIC STATUS OF QUALIFYING FOR FINANCIALASSISTANCE. PART I, LINE 6A: ST. CROIX REGIONAL MEDICAL CENTER PARTICIPATES IN AN ANNUAL COMMUNITY BENEFIT REPORT PRODUCED BY THE WISCONSIN HOSPITAL ASSOCIATION. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FROM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. 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 $ 2,239,975. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: SEE THE "PATIENT RECEIVABLES AND CREDIT POLICY" SECTION IN NOTE 1 TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBTS. PART III, LINE 8: THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE FOLLOWING PROCEDURES ARE SECTION 8 IN SCRMC'S BILLING AND COLLECTION POLICY INCLUDED ON THEIR WEBSITE AND DESCRIBE THE POLICY AND PROCEDURES USED FOR PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. ST. CROIX REGIONAL MEDICAL CENTER WILL MAKE REASONABLE EFFORTS TO PATIENT/GUARANTORS THAT FINANCIAL ASSISTANCE IS AVAILABLE, WHERE TO GET THE INFORMATION, HOW TO APPLY, AND ASSISTANCE AVAILABLE WITH APPLYING. ST. CROIX REGIONAL MEDICAL CENTER WILL ALLOW AND PROCESS A FINANCIAL ASSISTANCE APPLICATION UP TO 240 DAYS AFTER THE PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. ST. CROIX REGIONAL MEDICAL CENTER WILL TAKE STEPS TO NOTIFY PATIENT/GUARANTOR ABOUT OUR FINANCIAL ASSISTANCE POLICY AND WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS BEFORE 120 DAYS FROM PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. IF A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, ST. CROIX REGINAL MEDICAL CENTER WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT, MAKE AN ELIGIBILITY DETERMINATION AS TO WHETHER THE PATIENT/GUARANTOR IS ELIGIBLE FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT/GUARANTOR IN WRITING. IF ELIGIBLE, THE FINAL NOTIFICATION PERIOD WILL BE RESET FOR ANOTHER 30 DAY PERIOD. IF A PATIENT/GUARANTOR DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY BY THE LAST DAY OF THE FINAL NOTIFICATION PERIOD, AND THE PATIENT/GUARANTOR HAS RECEIVED THE 30-DAY NOTICE DESCRIBED IN FINAL NOTIFICATION PERIOD, THEN ST. CROIX REGIONAL MEDICAL CENTER MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF A PATIENT/GUARANTOR HAS APPLIED FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY IN THE LAST SIX MONTHS, AND IT WAS DETERMINED THAT THE PATIENT/GUARANTOR IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY, THEN SCRMC MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION UNDER THE FINANCIAL ASSISTANCE POLICY IS RECEIVED PRIOR TO THE FINAL NOTICE, THEN EXTRAORDINARY COLLECTION ACTIONS WILL BE SUSPENDED AND PATIENT/GUARANTOR WILL BE PROVIDED A WRITTEN NOTICE THAT DESCRIBES ADDITIONAL INFORMATION REQUIRED UNDER THE FINANCIAL ASSISTANCE POLICY. IF ADDITIONAL INFORMATION REQUESTED IS NOT PROVIDED, THEN THE FINAL NOTIFICATION PERIOD WILL BE RESET. PART VI, LINE 2: OVERALL MARKETPLACE DEMOGRAPHICS AND COMPETITIVE ANALYSIS IS CONDUCTED ON A REGULAR BASIS. WHEN DEMAND FOR NEW SERVICE LINES IS INTENSIFIED, THEY ARE ADDED SLOWLY UNTIL DEMAND CAPACITY REACH CRITICAL LEVELS. PART VI, LINE 3: ALL PATIENTS HAVE ACCESS TO WRITTEN MATERIALS AND PAMPHLETS AT OR NEAR THE POINT OF REGISTRATION. IN ADDITION, PATIENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURCES AVAILABLE. PART VI, LINE 4: SCRMC SERVICES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST. CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBURG IN WISCONSIN AND TAYLOR FALLS AND LINDSTROM IN EASTERN MINNESOTA. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 TUITION REIMBURSEMENT 10 21765 PART I, LINE 2: THE ORGANIZATION'S PROCEDURES INCLUDE SUBSTANTIATION OF EXPENSES, GRADES, TRANSCRIPTS AND RECEIPTS, AS WELL AS FOLLOW UP WITH COMMUNITY ORGANIZATIONS AND LEADERS. X X X X 0 1 0 0 0 0 0 0 0 ALLISON KARUN MD PHYSICIAN/TRUSTEE (THRU SEPTEMBER) 304978 0 0 0 0 0 18000 0 25870 0 348848 0 0 0 PATRICK MCDONOUGH MD PHYSICIAN/TRUSTEE 182898 0 0 0 0 0 0 0 16480 0 199378 0 0 0 GURDESH BEDI SECRETARY/PHYSICIAN 812340 0 4500 0 1926 0 15600 0 0 0 834366 0 0 0 DAVE DOBOSENSKI CEO 298299 0 35000 0 41825 0 15600 0 28086 0 418810 0 40457 0 SALLY BAJAK CFO 164313 0 10000 0 348 0 11094 0 27305 0 213060 0 0 0 CLAUDIO NUNES PHYSICIAN 428469 0 7000 0 540 0 15600 0 49140 0 500749 0 0 0 MUHAMMAD KHAN PHYSICIAN 569021 0 7000 0 486 0 15600 0 37125 0 629232 0 0 0 DANIELLE REDBURN MD PHYSICIAN 473044 0 7000 0 486 0 16200 0 25058 0 521788 0 0 0 JILL TIES PHYSICIAN 364867 0 7000 0 486 0 16200 0 30562 0 419115 0 0 0 VICKI SKARDA PHYSICIAN 337386 0 7000 0 810 0 16200 0 5660 0 367056 0 0 0 PART I, LINE 4B CONTRIBUTIONS TO A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: DAVE DOBOSENSKI - $40,457 A POLK COUNTY 396005730 2006-05-11 13000000 REFUND SERIES 2000 BONDS, FACILITY CONSTRUCTION AND EQUIPMENT PURCHASES 0 0 0 B POLK COUNTY 396005730 2006-12-27 3683432 FACILITY CONSTRUCTION 0 0 0 A 12269825 13000000 13000000 2008 0 0 1 1 B 3330472 3683432 3683432 2008 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS HAVE BEEN UPDATED FOR THE FOLLOWING: -THE ORGANIZATION ADDED A COMPENSATION COMMITTEE. -THE ORGANIZATION WENT FROM 3 CLASSES OF MEMBERSHIP TO 1 CLASS OF MEMBERSHIP. -THE BOARD OF TRUSTEES STILL REQUIRES 9 VOTING MEMBERS, HOWEVER THE 9 VOTING MEMBERS NO LONGER HAVE A DISTINCTION BETWEEN PROVIDER TRUSTEES AND COMMUNITY TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONE CLASS OF MEMBERSHIP IN THE CORPORATION. MEMBERSHIP WILL EXPIRE ON SEPTEMBER 1 OF EACH YEAR, UNLESS PRIOR TO THAT DATE THE MEMBERSHIP IS RENEWED BY TURNING IN THE COMPLETED ANNUAL MEMBERSHIP RENEWAL FORM PRIOR TO THE SEPTEMBER 1 EXPIRATION DATE. AN ANNUAL $5.00 HANDLING FEE MAY BE DONATED ON AN OPTIONAL BASIS. MEMBERSHIP MAY NOT BE TRANSFERRED OR ASSIGNED DURING THE LIFE OF THE MEMBER. MEMBERSHIP SHALL NOT PASS BY INHERITANCE OR BEQUEST UPON THE DEATH OF THE MEMBER. A SINGLE MEMBERSHIP MAY BE HELD JOINTLY BY SPOUSES, BUT ONLY ONE SHALL BE ENTITLED TO VOTE AT ANY TIME. OTHERWISE, A MEMBERSHIP IS NOT DIVISIBLE INTEREST AND MAY NOT BE HELD BY MORE THAN ONE PERSON. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS HAVE THE ABILITY TO VOTE IN THE ELECTION OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF THE GOVERNING BOARD HAS DELEGATED OPERATIONAL LEADERSHIP AND OVERSIGHT TO THE EXECUTIVE COUNCIL, THE PRACTICE MANAGEMENT COUNCIL (PMC) AND THE MEDICAL EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COUNCIL IS COMPRISED OF THE SENIOR LEADERSHIP TEAM INCLUDING THE CEO, CMO, CFO, CNO, CAO|GC AND VP OF PRACTICE ADMINISTRATION. THIS TEAM IS STRATEGIC IN NATURE AND REQUIRES SHORT AND LONG TERM DECISION-MAKING THAT ALIGNS WITH THE ORGANIZATION'S VALUES, MISSION AND VISION. THE PMC COUNCIL IS COMPRISED OF THE CMO, THE VP OF PRACTICE ADMINISTRATION, SPECIALTY AND PRIMARY CARE DIRECTORS AND 4 PROVIDER LEADERS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE CLINICAL OPERATIONS OF THE ORGANIZATION. THE MEDICAL EXECUTIVE COMMITTEE IS COMPRISED OF THE CMO, CHIEF OF STAFF AND THE MEDICAL COMMITTEE CHAIRS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE HOSPITAL MEDICAL OPERATIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO, ELECTRONIC APPROVAL WAS RECEIVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. UPON APPROVAL, THE FORM 990 WAS THEN FILED ELECTRONICALLY. A COPY OF THE FILED FORM 990 WAS PROVIDED FOR REVIEW AND APPROVAL TO THE ORGANIZATION'S BOARD OF DIRECTORS AT THE NEXT BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DETERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THE TOPIC. FORM 990, PART VI, SECTION B, LINE 15 CEO - ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED BY THE BOARD OF DIRECTORS USING SUCH OUTSIDE INFORMATION AS DEEMED NECESSARY. REVIEWS ARE CONDUCTED EACH JUNE. THE PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION. OTHER OFFICERS - THE HUMAN RESOURCE DEPARTMENT CONDUCTS OUTSIDE RESEARCH TO DETERMINE REASONABLE COMPENSATION. THE CEO THEN DETERMINES THE COMPENSATION OF THESE INDIVIDUALS. REVIEWS ARE CONDUCTED EACH NOVEMBER. FORM 990, PART VI, SECTION C, LINE 19 THE MEDICAL CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,809,787. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,809,787. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,589,350. MANAGEMENT AND GENERAL EXPENSES 1,060,992. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,650,342. THERAPISTS & OTHER PHY FEES: PROGRAM SERVICE EXPENSES 105,561. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,561. INDEPENDENT CONTRACTORS: PROGRAM SERVICE EXPENSES 977,195. MANAGEMENT AND GENERAL EXPENSES 8,981. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 986,176. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 193,514. MANAGEMENT AND GENERAL EXPENSES 461,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 654,778. PART XII, LINE 2C, SELECTION OF INDEPENDENT ACCOUNTANT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE BOARD OF DIRECTORS MEETS WITH INDEPENDENT ACCOUNTANT FOLLOWING THE AUDIT EACH YEAR TO REVIEW THE FINANCIAL STATEMENTS. MEMBERS OF THE BOARD OF DIRECTORS ALSO HAVE THE CONTACT INFORMATION OF THE INDEPENDENT ACCOUNTANT AND ARE ENCOURAGED TO CONTACT THE ACCOUNTANTS DURING THE YEAR WHEN QUESTIONS ARISE. THERE HAS BEEN NO CHANGE TO THESE PROCEDURES DURING THE PAST YEAR. UNITY PHARMACY LLC 1504 190TH AVENUE SUITE 100 BALSAM LAKE WI 54810 454471131 PHARMACEUTICALS WI 1398919 359354 SCV PHARMACIES FREDERIC PHARMACY LLC 201 OAK STREET WEST FREDERIC WI 54837 464469897 PHARMACEUTICALS WI 2919508 1054833 SCV PHARMACIES ST CROIX VALLEY PHARMACY LLC 235 STATE STREET ST CROIX FALLS WI 54024 464463191 PHARMACEUTICALS WI 1 5563 ST CROIX REGIONAL MEDICAL CENTER ST CROIX FALLS PHARMACY LLC 216 SOUTH ADAMS STREET ST CROIX FALLS WI 54024 464487348 PHARMACEUTICALS WI 2407080 458459 SCV PHARMACIES ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC 235 EAST STATE STREET ST CROIX FALLS WI 54024 452872803 TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE WI 501(C)(3) LINE 10 ST CROIX REGIONAL MEDICAL CENTER 1 CANCER CENTER OF WESTERN WISCONSIN 501 HOSIPTAL ROAD NEW RICHMOND WI 54017 273238660 TO PROVIDE CARE TO CANCER PATIENTS WI 501(C)(3) LINE 12A, I N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0