STEVENS COMMUNITY MEDICAL CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- STEVENS COMMUNITY MEDICAL CENTER INC (EIN 36-3311936)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-08-15
- IRS object ID
- 201642289349303784
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T13:36:24-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363311936 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stevens Community Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STEV | BusinessNameControlTxt |
| Phone | 3205891313 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 660 | AddressLine1Txt |
| City | Morris | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56267 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jason Breuer | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 3205891313 | PhoneNum |
| Signature | 2016-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2016-08-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jason Breuer | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 660 | AddressLine1Txt |
| City | Morris | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56267 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $39,749,150 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.scmcinc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | Promotion of health | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 361 | TotalEmployeeCnt |
| Total Volunteers | 160 | TotalVolunteersCnt |
| Total Gross UBI | $158 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $273,387 | PYContributionsGrantsAmt |
| CY Contributions Grants | $99,912 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,143,705 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $38,851,847 | CYProgramServiceRevenueAmt |
| PY Investment Income | $147,806 | PYInvestmentIncomeAmt |
| CY Investment Income | $296,103 | CYInvestmentIncomeAmt |
| PY Other Revenue | $53,532 | PYOtherRevenueAmt |
| CY Other Revenue | $54,007 | CYOtherRevenueAmt |
| PY Total Revenue | $39,618,430 | PYTotalRevenueAmt |
| CY Total Revenue | $39,301,869 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $31,113 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $37,720 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,578,655 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,349,633 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,657,070 | PYOtherExpensesAmt |
| CY Other Expenses | $14,452,330 | CYOtherExpensesAmt |
| PY Total Expenses | $35,266,838 | PYTotalExpensesAmt |
| CY Total Expenses | $34,839,683 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,351,592 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,462,186 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $46,482,638 | TotalAssetsBOYAmt |
| Total Assets EOY | $51,075,343 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,055,624 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,185,914 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $41,427,014 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $45,889,429 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $28,872,981 | ExpenseAmt |
| Grant | $37,720 | GrantAmt |
| Revenue | $38,851,689 | RevenueAmt |
| Desc | 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 31,945 hospital outpatient visits, 28,849 clinic and urgent care visits, 3,049 inpatient days, 8,498 outpatient counseling visits, 85 deliveries, 564 surgeries, 2,666 emergency room visits, and 21,728 therapy treatments in 2015. SCMC also owns and operates the Courage Cottage, an adult foster care facility specializing in care for the terminally ill. In 2015, 16 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 $24,063,791 in 2015. The charges foregone for services supplied under SCMC's charity care policy (free and/or subsidized care) was $377,000 in 2015.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. | Desc |
| Total Program Service Expenses | $28,872,981 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 91 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 361 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kerrie Erickson | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3205897627 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 E 1st St | AddressLine1Txt |
| City | Morris | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56267 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| David Paul | |||||||
| Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Paul Groneberg | |||||||
| Vice Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jan Hagen | |||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ward Voorhees | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Pieranna Garavaso | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jodi DeCamp | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Bart Finzel | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Paul Martin | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Darryl Larson | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Patrick Burke MD | |||||||
| Director / Physician | 40.00 | Yes (X) | $198,946 | $0 | $39,592 | ||
| Kim Tatsumi MD | |||||||
| Director / Physician | 40.00 | Yes (X) | $148,045 | $0 | $22,122 | ||
| Greg Abler MD | |||||||
| Director (thru July)/Physician | 40.00 | Yes (X) | $77,711 | $0 | $24,119 | ||
| Joan Lunzer MD | |||||||
| Director/Physician | 40.00 | Yes (X) | $245,034 | $0 | $26,891 | ||
| John Rau | |||||||
| President / CEO | 40.00 | Yes (X) | Yes (X) | $333,136 | $0 | $44,366 | |
| Kerrie Erickson | |||||||
| Vice President of Finance | 40.00 | Yes (X) | $157,079 | $0 | $22,435 | ||
| Jason Breuer | |||||||
| Vice President of Operations | 40.00 | Yes (X) | $90,479 | $0 | $9,911 | ||
| Andrea Giambi DO | |||||||
| Radiologist | 40.00 | $494,772 | $0 | $21,816 | Yes (X) | ||
| Michael Holte MD | |||||||
| Orthopedic Surgeon | 40.00 | $729,865 | $0 | $39,343 | Yes (X) | ||
| Randell Lussenden | |||||||
| CRNA | 40.00 | $468,419 | $0 | $28,826 | Yes (X) | ||
| Brent Barnstuble MD | |||||||
| Family Practice Physician | 40.00 | $357,540 | $0 | $37,703 | Yes (X) | ||
| Robert Bosl MD | |||||||
| Family Practice Physician | 40.00 | $333,560 | $0 | $21,816 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,634,586 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $338,940 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 29 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| JE Dunn North Central Inc | |||||
| 800 Washington Ave N Ste 600 | Minneapolis | MN | 55401 | Construction services | $5,302,302 |
| North Star Physicians Services | |||||
| 2680 28th Ave SW | Cambridge | MN | 55008 | ER and urgent care MD services | $821,250 |
| NovaCare Rehabilitation | |||||
| 4714 Gettysburg Rd | Mechanicsburg | PA | 17055 | Therapy services | $576,811 |
| Cerner Health Serv IncSiemens | |||||
| 51 Valley Stream Parkway | Malvern | PA | 19355 | IS support | $532,225 |
| BMJ Enterprises Inc | |||||
| 151 20th St SW | Benson | MN | 56215 | CRNA services | $401,535 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $99,912 | AllOtherContributionsAmt |
| Total Contributions | $99,912 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient service revenue | 622110 | $38,756,684 | $38,756,684 | |
| Supporting revenue | 900099 | $95,005 | $95,005 | |
| Non Patient Sales | 900099 | $158 | $158 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $38,851,847 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $125,552 | TotalRevenueColumnAmt |
| Exclusion | $125,552 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $51,896 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $51,896 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,896 | TotalRevenueColumnAmt |
| Exclusion | $51,896 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $611,661 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $441,110 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $170,551 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,551 | TotalRevenueColumnAmt |
| Exclusion | $170,551 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $8,282 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $6,171 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,111 | TotalRevenueColumnAmt |
| Exclusion | $2,111 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,301,869 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,851,689 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $158 | UnrelatedBusinessRevenueAmt |
| Exclusion | $350,110 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,720 | TotalAmt |
| Program Services | $37,720 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,419,182 | TotalAmt |
| Program Services | $775,878 | ProgramServicesAmt |
| Management And General | $643,304 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,471,920 | TotalAmt |
| Program Services | $12,834,065 | ProgramServicesAmt |
| Management And General | $2,637,855 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $836,349 | TotalAmt |
| Program Services | $694,342 | ProgramServicesAmt |
| Management And General | $142,007 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,555,944 | TotalAmt |
| Program Services | $1,058,883 | ProgramServicesAmt |
| Management And General | $497,061 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,066,238 | TotalAmt |
| Program Services | $835,165 | ProgramServicesAmt |
| Management And General | $231,073 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,181 | TotalAmt |
| Management And General | $44,181 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,787 | TotalAmt |
| Management And General | $57,787 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,205,454 | TotalAmt |
| Program Services | $3,856,569 | ProgramServicesAmt |
| Management And General | $348,885 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,479 | TotalAmt |
| Program Services | $3,582 | ProgramServicesAmt |
| Management And General | $95,897 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,758,472 | TotalAmt |
| Program Services | $1,323,283 | ProgramServicesAmt |
| Management And General | $435,189 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $421,149 | TotalAmt |
| Management And General | $421,149 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,919 | TotalAmt |
| Program Services | $28,504 | ProgramServicesAmt |
| Management And General | $387,415 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,486 | TotalAmt |
| Program Services | $78,115 | ProgramServicesAmt |
| Management And General | $14,371 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,608 | TotalAmt |
| Program Services | $56,080 | ProgramServicesAmt |
| Management And General | $10,528 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,146,836 | TotalAmt |
| Program Services | $2,146,836 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $353,833 | TotalAmt |
| Program Services | $353,833 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical supplies | $3,340,107 | $3,340,107 |
| Bad debts expense | $608,400 | $608,400 |
| MN Care tax | $596,530 | $596,530 |
| DHS Medicare Surcharge | $245,089 | $245,089 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,839,683 | TotalAmt |
| Program Services | $28,872,981 | ProgramServicesAmt |
| Management And General | $5,966,702 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,807 | BOYAmt |
| EOY | $478,608 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,896,003 | BOYAmt |
| EOY | $10,712,061 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,117,966 | BOYAmt |
| EOY | $7,087,738 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,172,537 | BOYAmt |
| EOY | $1,271,478 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $405,101 | BOYAmt |
| EOY | $309,911 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $44,390,477 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $23,002,248 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,800,034 | BOYAmt |
| EOY | $21,388,229 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,710,882 | BOYAmt |
| EOY | $9,632,530 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,308 | BOYAmt |
| EOY | $194,788 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,482,638 | BOYAmt |
| EOY | $51,075,343 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,704,624 | BOYAmt |
| EOY | $5,185,914 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $262,500 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,500 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,055,624 | BOYAmt |
| EOY | $5,185,914 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,056,935 | BOYAmt |
| EOY | $45,668,971 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,079 | BOYAmt |
| EOY | $220,458 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,427,014 | BOYAmt |
| EOY | $45,889,429 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,482,638 | BOYAmt |
| EOY | $51,075,343 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,462,186 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $229 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $25,267 | BeginningBalanceAmt |
| Additions During Year | $8,283 | AdditionsDuringYearAmt |
| Distributions During Year | $8,511 | DistributionsDuringYearAmt |
| Ending Balance | $25,039 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $262,917 | OtherCostOrOtherBasisAmt |
| Book Value | $262,917 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,047,451 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,010,554 | DepreciationAmt |
| Book Value | $16,036,897 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,514,876 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,721,877 | DepreciationAmt |
| Book Value | $4,792,999 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $565,233 | OtherCostOrOtherBasisAmt |
| Depreciation | $269,817 | DepreciationAmt |
| Book Value | $295,416 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,388,229 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $38,843,319 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$354,237 | OtherRevenueAmt |
| Revenue Not Reported | -$354,237 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,197,556 | RevenueSubtotalAmt |
| Other Revenues Not Included | $104,313 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $104,313 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $39,301,869 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $34,231,283 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $34,231,283 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $608,400 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $608,400 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $34,839,683 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 251,823. Provision for bad debts in revenue for financial statements -608,400. Auxiliary contribution eliminated for tax 2,340. |
| Part XI, Line 4b - Other Adjustments: | Contributions recorded in fund balance for financial statements 102,202. Auxiliary net income not included in financial statements 2,111. |
| Part XII, Line 4b - Other Adjustments: | Provision for bad debts in revenue for financial statements 608,400. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 190.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $196,957 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $196,957 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,608,961 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,121,051 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $487,910 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01430 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,715,939 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,884,154 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $831,785 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02430 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,521,857 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,005,205 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,516,652 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04440 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $129,033 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $129,033 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $141,981 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $141,981 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,442 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $275,456 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $275,456 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,797,313 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,005,205 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,792,108 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05240 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,909 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,909 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $59,840 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $59,840 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $95,749 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $95,749 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $608,400 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $148,385 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,426,935 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,489,969 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$63,034 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stevens Community Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 East 1st Street | AddressLine1Txt |
| City | Morris | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56267 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.scmcinc.org | WebsiteAddressTxt |
| State License | 00653 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | one provider based clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stevens Community Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.scmcinc.org/news/community-health | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.scmcinc.org/news/community-health-needs | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 190.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Stevens Community Medical Center | Part V, Section B, Line 5: Stevens Community Medical Center worked closely with Stevens Traverse Grant County Public Health, as well as a representative from the University of Minnesota Extension Center for Community Vitality, in conducting our 2013 Needs Assessment. We began with a large amount of data mining to define and identify the community served, its demographics, health issues, and other community needs. In addition, we held a community forum in June 2013 attended by 30 individuals. 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, the university and others. 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. Additional interviews were held with law enforcement, public health, and school administration employees to gather further input. From there, SCMC determined how we might best be able to address some of the identified needs over the next 3 years. |
| Stevens Community Medical Center | Part V, Section B, Line 6b: University of Minnesota Extension Services and Stevens Traverse Grant County Public Health were the primary organizations SCMC worked with in carrying out our 2013 Community Health Needs Assessment. There were many other county organizations that provided input throughout the process. |
| Stevens Community Medical Center | Part V, Section B, Line 11: 2015 Efforts in Addressing the Significant Needs Identified in CHNA1. Mental Health - SCMC began quarterly 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 is also in the early planning stages of developing a program for local high school students and their families to better prepare for the transition into their college career. The goal is to coach students and parents with tools to manage this new time in their lives, ultimately resulting in less stress and mental health concerns.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. SCMC Behavioral Health providers have completed stress management education with UMM staff. Plan in 2016 will be to integrate a behavioral health component into the "Renew" program. The "Renew" program was originally designed to be a weight management program only but a behavioral health component was identified as a need to help assist with promoting overall health. SCMC providers have developed the program and will begin this in 2016. 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. 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. 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. 2. Aging Demographics - SCMC's Courage Cottage house continues to serve a great community need. In 2015, we completed our building expansion and achieved the goal of having the capacity to serve 5 patients at all times. SCMC hosted the second annual "Fall into Health" community event, which had 500 attendees, including a very good representation of the local senior population. We provided over 170 free lab draws (glucose, cholesterol and hemoglobin) as part of that event. We provided a free healthy meal, had informational booths represented by SCMC staff and community partners in health care, and had a panel of 5 healthcare providers answer questions from the community. In addition, the event included keynote speaker Morris Morrison, motivational speaker and author of "Overnight Success". This event was a very successful partnership with other community organizations and businesses.In 2015, SCMC partnered with the University of Minnesota Nursing School on the P.A.D. (Peripheral Artery Disease) Prairie Initiative. 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.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 - Our registered dietician had speaking engagements at community businesses or organizations roughly 4 times in 2015, discussing healthy eating choices. She worked with the dietician from the Morris Health Eating Initiative to plan the healthy meal for the "Fall into Health" community event, ensuring that it met nutritional guidelines. At that event, SCMC provided education and brochures around the theme "Farm to Table". Our registered dietician developed the "Renew" weight loss program and brought it to the University of Minnesota-Morris staff and other community members. She now teaches this class once a year at the university and also once a year at SCMC. The SCMC class is open to the general public. The Power of Produce is a SCMC sponsored booth at the weekly Farmer's Market held in Morris throughout the summer. The SCMC dietician promotes healthy eating by offering activities for children that engage them in learning about fruits and vegetables and making smart food choices. Each participant receives a $2.00 token to use at a vendor's booth. In 2015, about 30 children participated in the Power of Produce on average each week.SCMC helps support healthy eating in the community by promoting access to healthy meals with two separate programs. SCMC supports the "BackPack Program" at the local school. This program is designed to send food home with children for the weekend to help supplement intake between school days. The second program that SCMC support is the "Food Drop" during the summer months. Financial and volunteer resources are provided by SCMC to help with the program. Food is purchased and distributed to families 3 times during the summer. The "Food Drop" is a volunteer activity that is open to all members of the public. Food is distributed to about 200 family units with each event. The idea is to provide access to food for families. b) Lack of physical activity - SCMC has continued our successful "bike during your break" program, which continues to be very popular with our employees. We also continue to have good participation in our lunchtime yoga classes offered in the facility. In addition, an SCMC R.N. 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. In addition, SCMC loans out a "Zumba for Seniors" DVD to interested patients at no charge to encourage physical activity in older adults.Continued further 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. |
| Schedule H, Part V, Section B, line 11 continuation: | c) Use of drugs and tobacco - Patients are routinely asked if they would like to visit with someone or receive an informational 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Starbuck Clinic | ||||
| 501 Poler Street | Starbuck | MN | 56381 | Family practice clinic |
| 3 - Courage Cottage | ||||
| 409 East 1st Street | Morris | MN | 56267 | Adult foster care facility |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 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 $608,400. |
| Part II, Community Building Activities: | In 2015, 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 $59,000 in local real estate taxes for our three 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 24% 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 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 2015 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. A Community Needs Assessment was completed in 2013. |
| 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 thereafter 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 68% of our inpatients are Medicare and/or Medicare HMO and another 8% 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. 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. The community health service activities are designed to complement the identified health needs in our area. Some of the specific reported services, such as men's and women's health nights, have educated the public on preventative health initiatives and have also identified previously undetected health risk factors for participants. SCMC also 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. |
| Part VI, Line 7, Reports Filed With States | MN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Organization makes donations to other organizations exempt under 501(c)(3) and government entities to ensure the funds will be used for charitable purposes. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patrick Burke MD | ||||||||||||||
| Director / Physician | $148,204 | $0 | $27,062 | $0 | $23,680 | $0 | $15,802 | $0 | $26,142 | $0 | $240,890 | $0 | $0 | $0 |
| Kim Tatsumi MD | ||||||||||||||
| Director / Physician | $146,636 | $0 | $152 | $0 | $1,257 | $0 | $11,784 | $0 | $12,642 | $0 | $172,471 | $0 | $0 | $0 |
| Joan Lunzer MD | ||||||||||||||
| Director/Physician | $213,187 | $0 | $30,154 | $0 | $1,693 | $0 | $19,103 | $0 | $10,164 | $0 | $274,301 | $0 | $0 | $0 |
| John Rau | ||||||||||||||
| President / CEO | $278,369 | $0 | $0 | $0 | $54,767 | $0 | $20,538 | $0 | $25,038 | $0 | $378,712 | $0 | $0 | $0 |
| Kerrie Erickson | ||||||||||||||
| Vice President of Finance | $149,173 | $0 | $2,152 | $0 | $5,754 | $0 | $12,437 | $0 | $11,039 | $0 | $180,555 | $0 | $0 | $0 |
| Andrea Giambi DO | ||||||||||||||
| Radiologist | $145,999 | $0 | $327,209 | $0 | $21,564 | $0 | $20,538 | $0 | $3,966 | $0 | $519,276 | $0 | $0 | $0 |
| Michael Holte MD | ||||||||||||||
| Orthopedic Surgeon | $666,176 | $0 | $34,279 | $0 | $29,410 | $0 | $19,213 | $0 | $22,818 | $0 | $771,896 | $0 | $0 | $0 |
| Randell Lussenden | ||||||||||||||
| CRNA | $126,425 | $0 | $338,318 | $0 | $3,676 | $0 | $20,538 | $0 | $9,476 | $0 | $498,433 | $0 | $0 | $0 |
| Brent Barnstuble MD | ||||||||||||||
| Family Practice Physician | $183,659 | $0 | $151,478 | $0 | $22,403 | $0 | $13,913 | $0 | $26,250 | $0 | $397,703 | $0 | $0 | $0 |
| Robert Bosl MD | ||||||||||||||
| Family Practice Physician | $188,958 | $0 | $118,712 | $0 | $25,890 | $0 | $20,538 | $0 | $3,630 | $0 | $357,728 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 5 | FormAndLineReferenceDesc |
| Explanation | 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 CRNA also receives quarterly bonuses contingent on the services he provides to patients of SCMC. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11 | 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 | SCMC participates in the MN Hospital Association compensation survey as well as refers to a compensation review that includes 49 hospitals in MN. In addition, SCMC has hired a compensation consultant to review the CEO salary on occasion. The board entered into a 5-year compensation contract with the CEO at the beginning of 2010, which fixed his salary for that length of time, based on market analysis. 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 (Minnesota Hospital Association) 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 449,106. Management and general expenses 45,394. Fundraising expenses 0. Total expenses 494,500. Purchased services: Program service expenses 3,407,463. Management and general expenses 303,491. Fundraising expenses 0. Total expenses 3,710,954. |
| Form 990, Part XI, line 9: | Auxiliary Activity included for tax -2,111. Auxiliary contribution eliminated for tax 2,340. |
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