2018-05-15T10:33:14-05:00 2017-06-30 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy Eau Claire WI 54701 990 2016-07-01 390890676 St Croix Regional Medical Center STCR 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 Sally Bajak CFO 7154830556 2018-05-14 1 HOLLY POKRANDT CPA P00449155 7158323407 2018-05-14 2016 2022-09-23 18:48:47Z Dave Dobosenski 235 STATE STREET ST CROIX FALLS WI 54024 99433910 0 X www.scrmc.org X 1954 WI To provide quality healthcare services to all residents of the service area. 9 9 741 150 1468131 -252252 127257 102598 96341956 97845725 -124934 26315 2931234 1433681 99275513 99408319 10744 17111 0 0 33681157 41714600 0 0 0 53533691 51616203 87225592 93347914 12049921 6060405 69017853 76821979 16200883 17944604 52816970 58877375 X The mission of SCRMC is to provide the highest quality, accessible, integrated, cost effective care for individuals and families served. 1 0 60417690 17111 64858224 Outpatient services - surgical, laboratory, basic, and advanced radiology procedures. During Fiscal Year 2017, there were 9,784 emergency room visits recorded, and 1,714 outpatient surgeries. Inpatient services - obstetric, medical-surgical, intensive care, and short stay inpatient care. During Fiscal Year 2017, there were 279 births, 1,490 inpatient admissions, and a total of 4,955 inpatient days for an average length of 3.33 days. 15236910 22316522 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 115,994 clinic visits occured in fiscal year 2017. 2830267 4249062 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. 7022117 4603815 St. Croix Valley Regional 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. 7022117 4603815 85506984 1 1 0 1 0 0 0 0 1 0 1 0 0 0 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 66 0 741 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X SALLY BAJAK 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 Kristine Fuge Chair 4.00 X X 0 0 0 Patrick McDonough MD Vice-Chair 0.50 X X 0 0 0 Michael Buchite Treasurer 0.50 X X 0 0 0 April Wallace PsyD Secretary 0.50 X X 0 0 0 Steve Tesch Trustee 0.50 X 0 0 0 Allison Karun MD Trustee 0.50 X 0 0 0 Danielle Redburn MD Trustee 0.50 X 0 0 0 Sarah Cormell Trustee 0.50 X 0 0 0 Dana Frey Trustee 0.50 X 0 0 0 Dave Dobosenski CEO 40.00 X 319653 0 51985 Sally Bajak CFO 40.00 X 149253 0 36701 Gurdesh Bedi Physician 40.00 X 808710 0 15300 Claudio Nunes Physician 40.00 X 400590 0 55128 Muhammad Khan Physician 40.00 X 345804 0 44962 Pradeep Wardhan Physician 40.00 X 278299 0 23257 William Schultz Physician 40.00 X 291875 0 25940 2594184 0 253273 34 0 1 0 River Valley Medical Center 208 South Adams Street St Croix Falls WI 54024 Physician Services 8843673 Voyageur Radiology LLC 9975 Dellwood Road Stillwater MN 55082 Radiology Services 1193704 St Croix Valley Anesthesia PO Box 45 Osceola WI 54024 CRNA Services 1115669 Regions Hospital PO Box 64059 St Paul MN 55164 Physician Services 1021802 CMDI PO Box 158 Milaca MN 56353 RAdiology Services 946618 15 102598 102598 Patient Services 624100 87174746 87174746 Contract Pharmacy 624100 4249062 4249062 Frederic Pharmacy 624100 2614064 1838114 775950 SCR Pharmacy 624100 2084874 1783084 301790 Unity Pharmacy 624100 1373008 982617 390391 349971 349971 97845725 39251 39251 69361 9155 60206 60206 60206 3500 16436 -12936 -12936 -12936 Miscellaneous 900099 1026168 1026168 Joint Venture Revenue 900099 177107 177107 EHR Payments 900099 170200 170200 1373475 99408319 96027623 1468131 1809967 X 17111 17111 613867 613867 33398339 29429587 3968752 1442637 1271207 171430 3928674 3461826 466848 2331083 2021115 309968 131528 131528 72226 72226 3000 3000 18704218 17420984 1283234 330189 143615 186574 710848 393597 317251 1505586 1380129 125457 1940454 1847299 93155 174256 126286 47970 296394 260516 35878 167829 157949 9880 3450290 3450290 237964 234052 3912 Medical Supplies 20852284 20852284 Provision for Bad Debts 2944835 2944835 MN Care & ACA Taxes 49673 49673 Equipment Rental 44629 44629 93347914 85506984 7840930 0 15726092 21153955 515988 372844 15855947 14155480 75589 40035 2635121 3038662 633444 496199 62598077 31992401 28430881 30605676 3023771 4779386 1477331 1604742 623689 575000 20000 0 69017853 76821979 9372223 11642443 4175606 2715233 247000 209000 2406054 3377928 16200883 17944604 X 52816970 58877375 52816970 58877375 69017853 76821979 6060405 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 3000 1 0 3000 0 Part II-B, Line 1: We have hired Strategic Healthcare to assist us in discussing Critical Access Hospital (CAH) designation for 10 mile hospitals. 0 0 1502879 1502879 36426088 17553306 18872782 1462075 962100 499975 20474884 13476995 6997889 2732151 2732151 30605676 Asset Retirement Obligation 219938 Payable to third-party reimbursement programs 180000 Deferred Compensation Plan 2977990 3377928 1 1 1 X 1 X 1 1 0 1 1 463029 463029 0.00500 11425272 7586297 3838975 0.04110 11888301 7586297 4302004 0.04610 11888301 7586297 4302004 0.04610 0 1484703 742352 26120954 26161666 -40712 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/contact/insurance/financial-assistance/ X http://scrmc.org/contact/insurance/financial-assistance/ X http://scrmc.org/contact/insurance/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 collobration 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 collobration 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 acces, changing consequenses and incentives, providing information, and enhancing skills. SCRMC works collaboratively with Osceola Medical Center, Amery Medical Center, the Polk County Health Department, and other 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. Physicial 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 signifcant health needs of Polk County, SCRMC is commited to playing an active role in reporductive 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 nad gonorrhea. For all teen primary care cistis, "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 reporductive and sexual health. SCRMC acknowledges the wide range of signficant 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 additonal 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 activites 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 criteria established 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 poverty guidelines as published annualy by the federal government. In addition to the above listed eligibility requirements dependent upon income, SCRMC may also presumtively determine eligibility for financial assistance. Portions of or the entire financial application process may be waived for certain patients/guarantors who presumptively qualify for financial assistance and are subsequently verified based on SCRMC policies and procedures. Examples may include patients/guarantors who are homeless, deceased without an estate, bankruptcy, food stamps and/or patients/guarantors who qualify by external available data sources such as credit agencies or social economic status of qualifying for financial assistance. 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 provsision 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 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 REPONSIBLE 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 COMMMUNITY, 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 eligibilty 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 extraoridnary 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 demorgraphics and competitive analysis is conducted on a regular basis. When demand for new servivce lines is intensified, they are added slowly until demand capcacity 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 servces 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 7 17111 0 FMV Tuition Reimbursement 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 Dave Dobosenski CEO 284369 0 0 0 35284 0 15300 0 36685 0 371638 0 0 0 Sally Bajak CFO 149037 0 0 0 216 0 9741 0 26960 0 185954 0 0 0 Gurdesh Bedi Physician 800000 0 7000 0 1710 0 15300 0 0 0 824010 0 0 0 Claudio Nunes Physician 393290 0 7000 0 300 0 15300 0 39828 0 455718 0 0 0 Muhammad Khan Physician 338534 0 7000 0 270 0 15162 0 29800 0 390766 0 0 0 Pradeep Wardhan Physician 275535 0 2625 0 139 0 0 0 23257 0 301556 0 0 0 William Schultz Physician 287307 0 4190 0 378 0 0 0 25940 0 317815 0 0 0 Part I, Line 4b Contributions to a 457(F) supplemental Non-qualified Retirement Plan: Dave Dobosenski - $40,617 Schedule J, Line 6a Annual employer contributions to the 457(f) plan are conditioned upon attaining certain pre-set goals and are contingent on approval by the board of directors. The award is based on two components - longevity and performance. Performance is based on meeting 3 goals - net revenue, net margin and net assets. 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 11131979 13000000 13000000 2008 0 0 1 1 B 2822079 3683432 3683432 2008 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 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 III, line 2 SCRMC contracted with Midwest Spine to offer enhanced spine surgical services during fiscal year 2017. Form 990, Part VI, Section A, line 6 St. Croix Regional Medical Center has two classes of members - sponsoring members and physician electors. Individuals and corporations may become sponsoring members through donations of a specified amount to the medical center. Individuals may become physician electors by providing services at St. Croix Regional Medical Center through specified employment conditions. Form 990, Part VI, Section A, line 7a Physician electors vote in the election of four physician trustees. Sponsoring members vote in the election of five community trustees. Form 990, Part VI, Section A, line 7b The members vote on the auditors employed to audit the books of the Medical Center and to prepare an annual report. An Ops council, consisting of five individuals appointed by River Valley Medical Center, a related organization, has signficant oversight of authority at the Medical Center. The Ops council's authority includes, but is not limited to, review and approval of all policies and procedures as they relate to medical operations and recommendation of the annual capital and operating budgest to the finance committee of the board of directors. 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, 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 15a CEO - annual performance and salary review is conducted by the board of directors using such outside information as deemend 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 June. 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 12,079,764. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,079,764. Purchased Services: Program service expenses 3,885,342. Management and general expenses 846,570. Fundraising expenses 0. Total expenses 4,731,912. Therapits & Other Phy Fees: Program service expenses 113,111. Management and general expenses 0. Fundraising expenses 0. Total expenses 113,111. Independent Contractors: Program service expenses 1,045,105. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,045,105. Consulting Services: Program service expenses 297,662. Management and general expenses 436,664. Fundraising expenses 0. Total expenses 734,326. 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 1367995 411583 SCV Pharmacies Frederic Pharmacy LLC 201 Oak Street West Frederic WI 54837 464469897 Pharmaceuticals WI 2567539 1137936 SCV Pharmacies St Croix Valley Pharmacy LLC 235 State Street St Croix Falls WI 54024 464463191 Pharmaceuticals WI 2 8418 St Croix Regional Medical Center St Croix Falls Pharmacy LLC 216 South Adams Street St Croix Falls WI 54024 464487348 Pharmaceuticals WI 2019044 405684 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 9 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