2016-08-15T13:36:24-05:00 2015-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-01-01 363311936 Stevens Community Medical Center STEV 3205891313 PO Box 660 Morris MN 56267 Jason Breuer President/CEO 3205891313 2016-08-15 1 Kim Hunwardsen CPA P00484560 6122536500 2016-08-15 2015 2016-12-15 16:53:06Z Jason Breuer PO Box 660 Morris MN 56267 39749150 0 X www.scmcinc.org X 1984 MN Promotion of health 13 9 361 160 158 0 273387 99912 39143705 38851847 147806 296103 53532 54007 39618430 39301869 31113 37720 0 0 20578655 20349633 0 0 0 14657070 14452330 35266838 34839683 4351592 4462186 46482638 51075343 5055624 5185914 41427014 45889429 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 28872981 37720 38851689 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. 28872981 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 91 0 1 361 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 198946 0 39592 Kim Tatsumi MD Director / Physician 40.00 X 148045 0 22122 Greg Abler MD Director (thru July)/Physician 40.00 X 77711 0 24119 Joan Lunzer MD Director/Physician 40.00 X 245034 0 26891 John Rau President / CEO 40.00 X X 333136 0 44366 Kerrie Erickson Vice President of Finance 40.00 X 157079 0 22435 Jason Breuer Vice President of Operations 40.00 X 90479 0 9911 Andrea Giambi DO Radiologist 40.00 X 494772 0 21816 Michael Holte MD Orthopedic Surgeon 40.00 X 729865 0 39343 Randell Lussenden CRNA 40.00 X 468419 0 28826 Brent Barnstuble MD Family Practice Physician 40.00 X 357540 0 37703 Robert Bosl MD Family Practice Physician 40.00 X 333560 0 21816 3634586 0 338940 29 0 1 0 JE Dunn North Central Inc 800 Washington Ave N Ste 600 Minneapolis MN 55401 Construction services 5302302 North Star Physicians Services 2680 28th Ave SW Cambridge MN 55008 ER and urgent care MD services 821250 NovaCare Rehabilitation 4714 Gettysburg Rd Mechanicsburg PA 17055 Therapy services 576811 Cerner Health Serv IncSiemens 51 Valley Stream Parkway Malvern PA 19355 IS support 532225 BMJ Enterprises Inc 151 20th St SW Benson MN 56215 CRNA services 401535 15 99912 99912 Patient service revenue 622110 38756684 38756684 Supporting revenue 900099 95005 95005 Non Patient Sales 900099 158 158 38851847 125552 125552 51896 0 51896 51896 51896 611661 441110 170551 170551 170551 8282 6171 2111 2111 39301869 38851689 158 350110 X 37720 37720 1419182 775878 643304 15471920 12834065 2637855 836349 694342 142007 1555944 1058883 497061 1066238 835165 231073 44181 44181 57787 57787 4205454 3856569 348885 99479 3582 95897 1758472 1323283 435189 421149 421149 415919 28504 387415 92486 78115 14371 66608 56080 10528 2146836 2146836 353833 353833 Medical supplies 3340107 3340107 Bad debts expense 608400 608400 MN Care tax 596530 596530 DHS Medicare Surcharge 245089 245089 34839683 28872981 5966702 0 221807 478608 11896003 10712061 6117966 7087738 1172537 1271478 405101 309911 44390477 23002248 15800034 21388229 10710882 9632530 158308 194788 46482638 51075343 4704624 5185914 262500 88500 0 5055624 5185914 X 41056935 45668971 370079 220458 41427014 45889429 46482638 51075343 X 4462186 229 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 25267 8283 8511 25039 0 262917 262917 27047451 11010554 16036897 16514876 11721877 4792999 565233 269817 295416 21388229 X 38843319 -354237 -354237 39197556 104313 104313 39301869 34231283 0 34231283 608400 608400 34839683 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. 1 1 X 1 X 1 X 190.000000000000 1 1 0 1 1 196957 196957 0.00580 3608961 3121051 487910 0.01430 2715939 1884154 831785 0.02430 6521857 5005205 1516652 0.04440 129033 129033 0.00380 141981 141981 0.00410 4442 4442 0.00010 275456 275456 0.00800 6797313 5005205 1792108 0.05240 35909 35909 0.00100 59840 59840 0.00170 95749 95749 0.00270 0 608400 148385 11426935 11489969 -63034 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 13 1 0 1 1 X http://www.scmcinc.org/news/community-health X 1 13 1 http://www.scmcinc.org/news/community-health-needs 0 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 1 X 0 X X X X 1 X 0 0 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. 2 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 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 1 Part I, Line 2: 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. X X X X 0 0 0 1 0 0 0 0 0 Patrick Burke MD Director / Physician 148204 0 27062 0 23680 0 15802 0 26142 0 240890 0 0 0 Kim Tatsumi MD Director / Physician 146636 0 152 0 1257 0 11784 0 12642 0 172471 0 0 0 Joan Lunzer MD Director/Physician 213187 0 30154 0 1693 0 19103 0 10164 0 274301 0 0 0 John Rau President / CEO 278369 0 0 0 54767 0 20538 0 25038 0 378712 0 0 0 Kerrie Erickson Vice President of Finance 149173 0 2152 0 5754 0 12437 0 11039 0 180555 0 0 0 Andrea Giambi DO Radiologist 145999 0 327209 0 21564 0 20538 0 3966 0 519276 0 0 0 Michael Holte MD Orthopedic Surgeon 666176 0 34279 0 29410 0 19213 0 22818 0 771896 0 0 0 Randell Lussenden CRNA 126425 0 338318 0 3676 0 20538 0 9476 0 498433 0 0 0 Brent Barnstuble MD Family Practice Physician 183659 0 151478 0 22403 0 13913 0 26250 0 397703 0 0 0 Robert Bosl MD Family Practice Physician 188958 0 118712 0 25890 0 20538 0 3630 0 357728 0 0 0 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 CRNA also receives quarterly bonuses contingent on the services he provides 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 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.