2017-10-31T13:47:45-05:00 2016-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2016-01-01 363311936 Stevens Community Medical Center STEV 3205891313 400 E 1st St Morris MN 56267 Jason Breuer President/CEO 3205891313 2017-10-31 1 Kim Hunwardsen CPA P00484560 6122536500 2017-10-30 198.135.124.203 2017-10-31 08:32:50 CD P 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 F6CCFCC9BA9C612BF295D4DB650AF8F15E682770 2016 2021-01-29 14:40:06Z X Jason Breuer 400 E 1st St Morris MN 56267 39423450 0 X www.scmcinc.org X 1984 MN Promotion of health 13 9 373 153 111 0 99912 160346 38851847 39066666 296103 125654 54007 56003 39301869 39408669 37720 27408 0 0 20349633 21771219 0 0 0 14452330 15829227 34839683 37627854 4462186 1780815 51075343 52655412 5185914 4985777 45889429 47669635 X Stevens Community Medical Center's mission is to strive for excellence in the delivery of inpatient and outpatient care through cooperation with qualified health care providers; through the provision of appropriate facilities and technology; and through active promotion of health education among the public.Our pledge to the recipients of this Medical Center's health care is to address their needs in as expert, efficient, compassionate, and convenient manner as possible. 0 0 31010237 27408 39066555 Stevens Community Medical Center is a not-for-profit integrated health care system. The mission of the Medical Center is to make available high quality health care. The Medical Center serves the population of West Central Minnesota and is becoming a regional health care center."CARING IS OUR REASON FOR BEING"SCMC provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of SCMC, it is recognized that not all individuals possess the ability to purchase essential medical services. To further that, our mission is to serve the community with respect to providing health care services and health care education. For example, the Medical Center is committed to providing medical services to all members of its community, provide free care and/or subsidized care, promote health activities and programs to support the community, and provide care to persons covered by governmental programs at below cost. Therefore, financial assistance will be considered where the need and/or an individual's inability to pay exists. SCMC had 31,408 hospital outpatient visits, 29,649 clinic and urgent care visits, 2,641 inpatient days, 7,404 outpatient counseling visits, 89 deliveries, 509 surgeries, 2,767 emergency room visits, and 24,129 therapy treatments in 2016. SCMC also owns and operates the Courage Cottage, an adult foster care facility specializing in care for the terminally ill. In 2016, 13 residents were served, and the cost to provide their care was subsidized by community donations.Recognizing its mission to the community, SCMC provides services to Medicare, Medicaid, and other patients covered by governmental programs, sometimes at a reimbursement below cost. The total discounts accepted for providing care to patients was $24,989,147 in 2016. The charges foregone for services supplied under SCMC's charity care policy (free and/or subsidized care) was $872,000 in 2016.Charity care is also provided through many reduced price services and free SCMC programs and information offered throughout the year based on activities and services which SCMC believes will serve a bona fide community need. These include: various brochures to educate patients; staff speaking for a variety of community events including SCMC sponsored "health nights," elderly and adult education; sponsoring a smoking cessation program and a variety of other "wellness" type programs at subsidized cost; providing meeting facilities for various community groups; offering support groups; and providing assistance to educators through our work with student nurses. 31010237 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 105 0 1 373 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 0 0 MN X Kerrie Erickson 3205897627 400 E 1st St Morris MN 56267 David Paul Chair 1.00 X X 0 0 0 Paul Groneberg Vice Chair 1.00 X X 0 0 0 Jan Hagen Treasurer 1.00 X X 0 0 0 Ward Voorhees Secretary 1.00 X X 0 0 0 Pieranna Garavaso Director 1.00 X 0 0 0 Jodi DeCamp Director 1.00 X 0 0 0 Bart Finzel Director 1.00 X 0 0 0 Paul Martin Director 1.00 X 0 0 0 Darryl Larson Director 1.00 X 0 0 0 Patrick Burke MD Director / Physician 40.00 X 185202 0 41637 Kim Tatsumi MDDirector thru Aug 2016)/Physician 40.00 X 146639 0 25275 Joan Lunzer MDDirector thru Oct 2016)/Physician 40.00 X 212848 0 24884 Elizabeth Meichsner MD Director(began Sept 2016)/Physician 40.00 X 366311 0 43591 Toby Christie-Perkins DO Director(began Nov 2016)/Physician 40.00 X 352077 0 38591 Jason Breuer President / CEO 40.00 X X 222296 0 27228 Kerrie Erickson Vice President of Finance 40.00 X 161855 0 13023 Andrea Giambi DO Radiologist 40.00 X 480474 0 37807 Michael Holte MD Orthopedic Surgeon 40.00 X 733917 0 39821 Randell Lussenden CRNA 40.00 X 475394 0 29496 Brent Barnstuble MD Physician 40.00 X 346968 0 41820 Somkiat Viratyosin MD General Surgeon 40.00 X 348509 0 48931 John Rau Former President/CEO 0.00 X 367686 0 0 4400176 0 412104 30 1 1 0 JE Dunn North Central Inc 800 Washington Ave N Ste 600 Minneapolis MN 55401 Construction services 1430784 Freelance Physician 3737 Moraga Ave San Diego CA 92117 ER and urgent care MD 1028321 GE Healthcare PO Box 96483 Chicago IL 60693 Maintenance 887200 NovaCare Rehabilitation 4714 Gettysburg Rd Mechanicsburg PA 17055 Therapy services 603130 Cerner Health Serv IncSiemens 51 Valley Stream Parkway Malvern PA 19355 IS support 377693 15 160346 160346 Patient service revenue 622110 38979357 38979357 Supporting revenue 900099 87198 87198 Non Patient Sales 900099 111 111 39066666 130789 130789 54292 0 54292 54292 54292 3367 8502 -5135 -5135 -5135 2148 0 2148 2148 5842 6279 -437 -437 39408669 39066555 111 181657 X 27408 27408 1840567 1422334 418233 367686 367686 15179838 12575982 2603856 785091 619615 165476 2460248 1700022 760226 1137789 876611 261178 43223 43223 59248 59248 4451589 3829359 622230 94995 2888 92107 1745736 1361917 383819 386777 386777 426110 28124 397986 126968 81225 45743 94579 84750 9829 2518712 2518712 356562 356562 Medical supplies 3724631 3724631 MN Care tax 619586 619586 Bad debts expense 579384 579384 Pharmacy 340B Program C 309064 309064 292063 292063 37627854 31010237 6617617 0 478608 156207 10712061 10918136 7087738 7314062 1271478 1235387 309911 325153 46976987 25252552 21388229 21724435 9632530 10669009 194788 313023 51075343 52655412 5185914 4985777 5185914 4985777 X 45668971 47482415 220458 187220 45889429 47669635 51075343 52655412 X 1780815 -609 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 25039 7990 7381 25648 0 371723 371723 28055038 12149728 15905310 17334324 12788938 4545386 1215902 313886 902016 21724435 X 38867049 -445938 -445938 39312987 95682 95682 39408669 37053605 5135 5135 37048470 579384 579384 37627854 Part IV, Line 1b: The organization holds the assets for the Stevens Community Medical Center Ladies' Auxiliary/Gift Shop. The assets are not included on the books of the Medical Center. The revenue and expense have been recorded on the applicable lines of the Form 990. Part X, Line 2: The Medical Center is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Medical Center has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Net assets released from restrictions for operations 132,344. Provision for bad debts in revenue for financial statements -579,384. Auxiliary contribution eliminated for tax 1,102. Part XI, Line 4b - Other Adjustments: Contributions recorded in fund balance for financial statements 99,106. Auxiliary net income not included in financial statements 1,711. Loss on sale of assets in expenses for financial statements -5,135. Part XII, Line 2d - Other Adjustments: Loss on sale of assets in expenses for financial statements 5,135. Part XII, Line 4b - Other Adjustments: Provision for bad debts in revenue for financial statements 579,384. 1 1 X 1 X 1 X 190.000000000000 1 1 1 0 1 1 486000 486000 0.01310 4545639 3787910 757729 0.02050 2417345 1044223 1373122 0.03710 7448984 4832133 2616851 0.07070 109015 109015 0.00290 101407 101407 0.00270 5081 5081 0.00010 215503 215503 0.00570 7664487 4832133 2832354 0.07640 26673 26673 0.00070 77522 77522 0.00210 104195 104195 0.00280 0 579384 69039 10076595 10127182 -50587 X 1 1 1 1 Stevens Community Medical Center 400 East 1st Street Morris MN 56267 www.scmcinc.org 00653 X X X X one provider based clinic Stevens Community Medical Center 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Section C X 1 16 1 See Section C 0 1 X 100.000000000000 190.000000000000 X X X X X X 1 1 X X X X 1 X X X X X X 1 X 0 X X X X 1 X 1 0 Stevens Community Medical Center Part V, Section B, Line 5: Stevens Community Medical Center received input from a wide representation of the community it serves when conducting the 2016 Community Health Needs Assessment. We hosted a community forum in November 2016 at the Morris Senior Center that was attended by 38 individuals (another 10 were invited but unable to attend). Participants included wide representation from the community including the areas of child care, elder care, agriculture, minority populations, human services, local business managers, physicians, mental health providers, university and high school students, and others. Multiple staff members from Horizon Public Health were active participants as well. We utilized a "World Cafe" format for engaging in discussion to identify the most significant community health needs as well as the community's current strengths and weaknesses in meeting those needs. It was a very productive evening and there are plans for future collaboration to go into more depth on some of the issues discussed. SCMC then designed its 3-year implementation plan to outline how we might best be able to address some of the identified needs. Stevens Community Medical Center Part V, Section B, Line 11: Needs from the most recently conducted CHNA in 2016 were not addressed due to timing of when the CHNA was completed, however during 2016 we continued to address the needs from the 2013 CHNA as follows:1. Mental Health - In 2016, SCMC continued to participate in semi-annual meetings with the Counseling Services staff at the University of Minnesota-Morris. The goal is to keep communications open and have strategies in place to deal with mental health issues for this at-risk age group. SCMC's Behavioral Medicine providers, as well as our social worker, attend these meetings. We are very interested in participating in the betterment of mental health for all youth and young adults in this community.SCMC works with the University of Minnesota, Morris on placing student interns with the Career Ready Internship program. One of those students, along with the director of Behavioral Medicine, planned the program "Transitioning into Early Adulthood: A Guide for Teens & Parents". Multiple planning sessions were well attended with area school counselors to discuss the specific need for this presentation. The presentation date was set for March of 2017 at the Morris Area School Auditorium.Internally, SCMC's licensed psychologist and psychiatric/mental health nurse hosted a Stress Management class open to all employees. Also, another licensed psychologist twice provided Violence Prevention and De-escalation training to SCMC staff. We collaborate with Stevens County Human Services with quarterly meetings to discuss mental health needs in the community and how to work towards providing those services. The "Stressless" program was implemented by SCMC's Amanda Storey and Angelina Lee for faculty and staff at UMM to participate in. This program allowed a guided tour into management of daily stresses. We continue our efforts to hire a psychiatrist or psychiatric nurse practitioner. In addition, efforts are being made by SCMC's Behavioral Medicine providers to communicate more frequently with physicians and to provide consults regarding symptoms, medications and ways to better manage care for mental health issues. Physicians are frequently requesting consults in the hospital, as well as Rule 25 assessments, in addition to providing referrals to the mental health providers. SCMC has had a provider in house complete the training in order to provide Rule 25 assessments. Administration decided access to this assessment capability would provide more timely information to physicians in order to create the best plan of care for patients. Behavioral Medicine staff visit the Emergency Room frequently to assess crisis situations in addition to providing needed mental health support in certain situations. SCMC physicians are increasingly using the PHQ9 screening tool (which is a part of Minnesota Community Measures) for anxiety and depression screening. They use it in a variety of situations including well-child visits and as a follow up tool to see how medications are working for a patient.Lack of inpatient mental health beds continues to be an issue in Minnesota. We end up sending patients to North Dakota quite often. There are times that mental health beds are not available and we have to admit someone as an inpatient on a 72-hour hold while we continue to search for an open bed. SCMC's Behavioral Medicine director regularly attends Region 4 South Mental Health Consortium meetings, where legislation is frequently discussed and updates provided. Behavioral Medicine gave two presentations in 2016 to education members of the consortium on topics of mental health. The annual "Day at Home" (formerly "Day at the Hill") is also a great opportunity for legislators, social service agencies, and mental health providers to interact with one another and discuss mental health issues and needs in the state of Minnesota. In 2016, SCMC Behavioral Medicine hosted a booth with information available to the attendees on Mental Health. SCMC continues to actively assess the need for behavioral health providers in the community and within the organization. Administration and the Behavioral Health Director actively work to replace open positions and assess the need for more providers within the organization. SCMC has been continuously working with the College of St. Scholastica to develop a program to allow Psychiatric Nurse Practitioner students the opportunity to complete their requirements at SCMC with the hope of permanent employment. 2. Aging Demographics - SCMC's Courage Cottage house continues to serve a great community need for end of life care. We have the capacity to serve 5 patients and are consistently operating with a waiting list. SCMC hosted the third annual "Fall into Health" community event, which again drew over 550 attendees. Consistent with last year's lab draws, we served over 170 who had their glucose, cholesterol and hemoglobin checked. The provider panel, consisting of 5 SCMC providers, was well attended. Ben Utecht, former NFL Super Bowl star, was the keynote speaker talking on concussions and sports. This has been a very successful partnership with other community organizations and businesses.In 2016, SCMC continued to be a part of the P.A.D. (Peripheral Artery Disease) Prairie Initiative with the University of Minnesota Nursing School. This program has a goal of improving the health and mobility of older adults with PAD. Community screenings will be held for anyone having symptoms of the disease. Lake Region Healthcare and Otter Tail County Public Health in Fergus Falls, Minnesota, are also involved in this collaborative effort. We have completed training of SCMC nursing staff to perform initial ABI's for prescreening. Identified patients were set up in the exercise treatment portion of the program, which is monitored by SCMC cardiac rehab nursing staff and a physical therapist. 3. Health impact of poor lifestyle choices - SCMC actively supports and sponsors the annual "Fall into Health" event. The event is open to the community. All local health care providers are invited to present information to the public on a variety of health issues which include disease processes, services available in the community and general health education information. The event also includes education about healthy eating and a healthy meal that is free to the public. SCMC also supports a variety of health events in the communities served by the organization. Some events include 5K walk/runs, children's athletic activities and events, and school based education with staff presenting to students. a) Poor eating habits - SCMC's Registered Dietitian reached out to multiple community businesses and organizations to promote healthy eating. She spoke with high school students at a Family and Consumer Science class about preparing to eat healthfully in college. She had a booth at the spring expo addressing healthy grains for people of all ages. She also presented about building a healthy plate when SCMC hosted a meeting for area health care volunteers. The SCMC Renew Weight Management Program was organized and led by the dietitian. Renew is a 3-month program for healthy eating and weight loss. January through March there was a community session held at SCMC with 14 participants. Membership fees were reimbursed for any SCMC employees who completed the program. Eleven participants took place in Renew offered at the University of Minnesota Morris as part of the UMM staff health insurance benefit from February to April 2016.The 2016 Fall into Health event featured the SCMC dietitian demonstrating how to make homemade salad dressings. The dietitian was also heavily involved in assuring the meal which served 500 people at the event was nutritionally balanced. SCMC's Power of Produce program, which was held for 8 weeks at the Farmer's Market in Morris over the summer, continues to grow its participants. In 2016, attendees grew to over 50 children each week from 30 the previous year. This program offers free activities for children to engage in while learning about fruits and vegetables. Tokens worth $2 each are provided for children to purchase something at the Farmer's Market. This has proven to benefit the local vendors at the Farmer's Market greatly, bringing in around $700 total. SCMC continues to help support the "Food Drop" both financially and with volunteers and the day of the distribution. This program is available 3 times during the summer and there are no requirements to participate.b) Lack of physical activity - SCMC continues to provide the "bike during your break" program with great participation. We continue to work with the (SHIP) State Health Improvement Program to tap into opportunities to develop new programs.Continued below... Stevens Community Medical Center Part V, Section B, Line 13h: Federal guidelines and Minnesota Attorney General agreement percentage discounts were used to determine eligibility for discounts. Stevens Community Medical Center Part V, Section B, Line 15e: We send applications for MNSure and assist patients in applying for programs where there is a need and possibility for basis of eligibility. We are also HPE (Hospital Presumptive Eligibility) providers and can screen and submit short term MA approvals. Stevens Community Medical Center Part V, Section B, Line 23: See explanation in Part VI of Schedule H. Schedule H, Part V, Section B, line 7a: http://www.scmcinc.org/sites/default/files/Community%20Health%20Needs%20Assessment%202016_1.pdf Schedule H, Part V, Section B, line 10a: http://www.scmcinc.org/sites/default/files/Implementation%20Plan%202016%20CHNA_0.pdf Schedule H, Part V, Section B, line 11 continuation: An SCMC Registered Nurse provides diabetes education to patients with no charge for those services. This education is provided as a community benefit in order to eliminate financial barriers for patients and stresses the importance of exercise and goal setting to achieve exercise goals. c) Use of drugs and tobacco - Patients are routinely asked if they would like to visit with someone or receive an information packet about smoking cessation. If they want to visit with someone, typically the Behavioral Medicine or Respiratory Therapy director meets with them. This consultation is a service SCMC is providing free of charge. At the "Fall into Health" community event, the Respiratory Therapy director again had a booth. In addition, Horizon Public Health sponsored a booth at the event focusing on local community stories about smoking cessation. SCMC continues to work with Horizon Public Health on sponsored programs to work with both staff and patients on the use of drugs and tobacco. Schedule H, Part V, Section B, Line 16a, 16b, and 16c: See explanation in Part VI of Schedule H 2 1 - Starbuck Clinic 501 Poler Street Starbuck MN 56381 Family practice clinic 2 - Courage Cottage 409 East 1st Street Morris MN 56267 Adult foster care facility Part I, Line 3c: The Organization provides a 20% to 80% discount when income levels meet 190% down to 101% of the Federal Poverty Guidelines (FPG). For example, an 80% discount is given for income ranges from 101% to 120% of the FPG. Part I, Line 6a: The community benefit report is available to the public upon request. Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Medicaid and Other Mean's Tested was converted to cost using the cost-charge-ratio derived from Worksheet 2. Community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. Part I, Line 7g: N/A Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $579,384. Part II, Community Building Activities: In 2016, SCMC supported several significant health related community initiatives such as the Regional Fitness Center, Habitat for Humanity, and the local chapter of the American Cancer Society to name just a few. We also paid over $77,000 in local real estate taxes for our two medical clinics, which would certainly have a positive impact on the health of the communities we serve. Part III, Line 2: Bad debt expense is reported at charges as recorded by the Organization. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is 12% because that is the amount of applications that were denied due to lack of information or no response to Charity Care application process. The full amount of this is not reflected in Part I, line 7 and is considered community benefit. Had the appropriate information been provided and applications completed, this amount would have been considered charity care.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses is located in Footnote 1 on page 6 and page 7 of the attached financial statements. Part III, Line 8: Medicare allowable cost is based on the Medicare Cost Report. The Medicare Cost report is completed based on the rules & regulations set forth by Centers for Medicaid and Medicare Services.Stevens Community Medical Center is an acute care hospital. There was a shortfall for 2016 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: We follow the "MN Attorney General Agreement" guidelines regarding debt collection. The "MN Attorney General Agreement" outlines billing and collections practices we have agreed to follow for our patients. Some of those practices include: We do not attempt to collect a debt unless it is determined insurance has been billed and there is a reasonable basis to believe the patient owes the bill, that we have offered reasonable payment plans and will not refer to a collections agency if patients are meeting these payment terms, we have given patients the opportunity to apply for financial assistance, we allow for negotiation directly with us on complaints from patients after they have been sent to collections and that we agree to charge uninsured patients no more than what we would be reimbursed by our largest insurer. Part VI, Line 2: Many of our department heads are members of other boards or organizations throughout the community. These include the Chamber of Commerce, the Morris Area Community Development Committee, and Morris Area Child Care Center in addition to others. The information obtained from participating in these committees is utilized to continually assess the appropriateness of existing services and the need for potential new areas of health related opportunities. Conference committee meetings are also used to get input from all employees, who are also consumers of our services, regarding areas of potential growth. In addition we conducted a Community Health Needs Assessment in 2016. Part VI, Line 3: Stevens Community Medical Center provides a copy of our charity guidelines and financial assistance contact information to interested patients as part of our intake/screening process; self-pay patients (particularly inpatients) are asked if they have financial concerns and are referred to a financial counselor if a need is discovered. A variety of tools are used to determine potential needs through the registration, prior authorization, and billing processes - social worker's referral, identification of uninsured or underinsured status, and/or a previous history of inability to pay. We also post financial assistance contact information for persons interested in applying for Charity Care and/or Medicaid in patient common areas such as registration, waiting areas, physician rooms and the Cashier's office.In addition, if payments are not being made after 2-3 statements have been sent, a Financial Counselor will call to inform the patient of their options. At that time, we would send out an application for Charity Care, discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable. Part VI, Line 4: Stevens Community Medical Center serves the County of Stevens including the towns of Morris, Donnelly, Hancock, Chokio and Alberta. We also serve areas of Pope, Swift, Traverse, Grant, and Big Stone. We anticipate the total primary service area to be approximately 15,000, with a secondary market of an additional 20,000.The service area is primarily rural, with a strong agricultural base. We are also fortunate to have a university presence with the University of Minnesota, Morris. Approximately 64% of our inpatients are Medicare and/or Medicare HMO and another 11% are Medicaid and/or MN Care.There are three hospitals in the area that are larger than SCMC located in towns 50 miles from Morris in different directions. There are also hospitals in Benson, Wheaton, Graceville, Glenwood, Elbow Lake and Appleton, all of which are within a 30 mile radius of Morris.We are considered a federally designated medically underserved area for mental health services. Part VI, Line 5: As described earlier, SCMC has a community Board of Directors that represent specific portions of our service area. Medical staff privileges are extended to all qualified physicians in the community. We also own and operate an adult foster care facility which specializes in the terminally ill. This is currently subsidized by community donations. The Emergency Room is open 24 hours a day 7 days a week and is open to all patients regardless of ability to pay. All our employed physicians attend several educational opportunities, as do the balance of our licensed and professional staff. SCMC works to provide education to staff or opportunities for education on the latest most up to date care techniques and strategies as well as education related to compliance, billing, fraud, abuse and other regulatory rules. SCMC also works with a variety of higher education schools to provide onsite internships, residency experience, and fieldwork. Every dollar generated in excess of expenses at SCMC is reinvested in the organization to improve the services offered to the communities we serve. This includes effectively funding the depreciation of our building and equipment, investment in facilities and equipment, expansion of services to meet community need, and investment in education of staff to provide high quality effective care to our community members. Infrastructure investment has included updates to the facility to improve standard of care in OR and lab as well as Electronic Health Record.The community health service activities are designed to complement the identified health needs in our area. SCMC promotes community health with partnerships with other community groups such as the Farmer's Market, local food drop, local elementary/high school education programs, providing an athletic trainer to the local high school, and a community health group that coordinates activities such as the Fall Into Health. SCMC's dietician and diabetic educator provide diabetes presentations to local service groups. Much of the emphasis associated with these events is toward prevention and early detection.We are also acutely aware of the fact that a large percentage of the population we serve are senior citizens and value the benefit of the free transit services we provide for clinic appointments.Charity care is also provided through many reduced price services and free SCMC programs and information offered throughout the year based on activities and services which SCMC believes will serve a bona fide community need. These include: various brochures to educate patients; staff speaking for a variety of community events including SCMC sponsored "health nights", elderly and adult education; sponsoring a smoking cessation program and a variety of other "wellness" type programs at subsidized cost; providing meeting facilities for various community groups; offering support groups; and providing assistance to educators through our work with student nurses.SCMC provides many opportunities for community involvement through volunteering. Approximately 150 people volunteer for a variety of activities at SCMC. Volunteers are from a wide range of ages including youth from the local schools.SCMC is the only hospital in Morris.MERC Program/Residency/Internships- SCMC has benefited from Medical Residency and FNP programs that participate in the MERC funding program. This assists SCMC with the costs associated with clinical rotations, such as extra hours and lodging expenditures. It allows SCMC to continue to support the growth of students in Rural Health Care programs. Courage Cottage donations are used to support end of life care, as SCMC identified that as a community need. SCMC's administration advocates with government contacts to encourage measures that will improve the overall health of the community we serve. Part VI, Line 7, Reports Filed With States MN Schedule H, Part V, Section B, Line 16a, 16b, and 16c: SCMC identified in August 2017 that it did not have our Financial Assistance Application, Policy or Plain Language Summary posted on our website. The cause of the failure was a mistake and oversight and has since been corrected, with all documents now available on the website. We do not believe that any individuals were impacted by this oversight because SCMC takes extraordinary action to assure that all our patients have knowledge of our financial assistance program and have an opportunity to apply. SCMC is a MNSure Certified Application Assistor site, so we accept and submit applications for MNSure. We are also a Hospital Presumptive Eligibility site with the ability to screen and enroll patients in temporary Medical Assistance. These programs allow our uninsured patients, when eligible, to secure coverage quickly. Patients are referred to a Financial Counselor when they check in as an uninsured patient (a part of our screening process). The Financial Counselor routinely follows up with them in person, over the phone or by mail. Financial Assistance applications and instructions are mailed to patients routinely who may benefit from it, particularly prior to taking collections actions. All registration areas, exam rooms, and waiting areas have signage informing and directing patients where to apply for SCMC's Financial Assistance program or other assistance. All hospital patients are asked if they have concerns with their financial situation, and Financial Counselors visit with them if they answer in the affirmative. To assure that the applications and policies remain on the website, both the Business Office Director and Marketing Director have been in communication and understand the importance of this requirement moving forward. Schedule H, Part V, Section B, line 23: In August 2017, the organization utilized the lookback method and calculated our 2016 AGB to be 37%. We identified that 20 total accounts in 2016 had been provided a 20% charity care discount based on our poverty scale guidelines. Of these 20 accounts, only 5 of them were determined to be overpaid by the patient based on the difference between discounts applied and the 37% AGB calculation. The total collective overpayment on all accounts was $135. All refunds on those accounts will be mailed out no later than 9/13/2017 to the three patients affected, along with a letter explaining the error in calculating their financial assistance percentage.For 2017, the 20% charity care category has now been discontinued and the lowest rate used for charity care will be 40%. There have been no accounts impacted in 2017 that need to be corrected. Each year we will calculate our AGB and assure that the poverty scales we use for determining write off percentages are no lower than the AGB. X X X 1 0 0 1 0 0 0 0 0 Patrick Burke MD Director / Physician 154411 0 20758 0 10033 0 14903 0 29015 0 229120 0 0 0 Kim Tatsumi MDDirector thru Aug 2016)/Physician 145038 0 101 0 1500 0 11889 0 15618 0 174146 0 0 0 Joan Lunzer MDDirector thru Oct 2016)/Physician 211861 0 151 0 836 0 16623 0 10554 0 240025 0 0 0 Elizabeth Meichsner MD Director(began Sept 2016)/Physician 198590 0 166002 0 1719 0 13913 0 30060 0 410284 0 0 0 Toby Christie-Perkins DO Director(began Nov 2016)/Physician 224780 0 126552 0 745 0 13913 0 27324 0 393314 0 0 0 Jason Breuer President / CEO 222116 0 0 0 180 0 0 0 28176 0 250472 0 0 0 Kerrie Erickson Vice President of Finance 161453 0 101 0 301 0 12578 0 1357 0 175790 0 0 0 Andrea Giambi DO Radiologist 142441 0 316643 0 21390 0 20538 0 19825 0 520837 0 0 0 Michael Holte MD Orthopedic Surgeon 666252 0 39852 0 27813 0 19213 0 23176 0 776306 0 0 0 Randell Lussenden CRNA 129174 0 342346 0 3874 0 20538 0 10002 0 505934 0 0 0 Brent Barnstuble MD Physician 211403 0 117181 0 18384 0 15900 0 28368 0 391236 0 0 0 Somkiat Viratyosin MD General Surgeon 207977 0 115158 0 25374 0 20538 0 30830 0 399877 0 0 0 John Rau Former President/CEO 7939 0 0 0 359747 0 0 0 0 0 367686 0 0 0 Part I, Line 4a John Rau (President/CEO) retired on 12/31/15. Per the terms of his contract, in 2016 he received a severance payment of $343,985.76 ($18,000 of which he elected to defer into the 457b Deferred Compensation Plan). Part I, Line 5 The physicians are eligible to receive quarterly incentive compensation based on their personal gross revenue production for non-ancillary services, according to the terms of their contracts. The CRNAs also receive quarterly bonuses contingent on the services they provide to patients of SCMC. Form 990, Part VI, Section A, line 8b The organization does not have any committees with authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b Prior to filing, the 990 is reviewed in detail by the Vice President of Finance and President/CEO. The Board of Directors is given the opportunity to review a copy prior to filing. A copy of the Form 990 is attached to the state filing. The state filing requires a Board Resolution approving the filing. During that time the board is briefed on information contained within the Form 990. Form 990, Part VI, Section B, line 12c The organization has two conflict of interest policies - one that covers officers and directors and one that covers other management staff (including other key employees, if applicable). Potential conflicts identified by officers and directors are reviewed by the remaining board members; those identified by management are reviewed by the President/CEO. Officers and directors are to abstain from voting on any such matter where they have a potential conflict of interest. The President/CEO evaluates each potential conflict identified by management on an individual basis in order to determine the appropriate restrictions to put in place. Form 990, Part VI, Section B, line 15a The Board of Directors references the MN Hospital Association CEO Compensation Survey when reviewing the CEO's compensation on an annual basis. Besides participating in MHA compensation surveys, SCMC also references Medi-Sota and HHRAM compensation surveys that includes 49 hospitals in MN for various positions. The President/CEO reviews salary ranges for officers and key employees of the organization on an annual basis. SCMC receives an annual assessment from Merritt-Hawkins (a recruiting firm) regarding compensation ranges for primary care and specialty physicians. This information is specific to different geographic regions, as well as for groups versus private practices. The President/CEO also reviews the AMGA (American Medical Group Association) compensation survey for physician compensation and the MHA compensation survey for the Vice President of Finance compensation annually. Form 990, Part VI, Section C, line 19 The audited financial statements, governing documents and conflict of interest policy are made available to the general public upon request. The audited financial statements are also attached to the Form 990. Form 990, Part IX, line 11g Repairs and maintenance: Program service expenses 390,977. Management and general expenses 76,106. Fundraising expenses 0. Total expenses 467,083. Purchased services: Program service expenses 3,438,382. Management and general expenses 546,124. Fundraising expenses 0. Total expenses 3,984,506. Form 990, Part XI, line 9: Auxiliary Activity included for tax -1,711. Auxiliary contribution eliminated for tax 1,102.