2013-02-01T15:29:39-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 390890676 ST CROIX REGIONAL MEDICAL CENTER STCR 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 JOHN TREMBLE 7154830556 2013-01-28 1 KOREY BOELTER P00775161 6123764500 2011 2016-02-25 16:41:14Z DAVE DOBOSENSKI 235 STATE STREET ST CROIX FALLS WI 54024 72054291 0 X WWW.SCRMC.ORG X 1954 WI TO PROVIDE QUALITY HEALTHCARE SERVICES TO ALL RESIDENTS OF THE SERVICE AREA. 9 5 555 139 143 0 96022 55060 60408797 65202932 57660 172182 267021 851058 60829500 66281232 24000 20000 0 0 23744186 24030427 0 0 0 35650284 39246411 59418470 63296838 1411030 2984394 42744679 48531694 25094130 27596751 17650549 20934943 X THE MISSION OF SCRMC IS TO PROVIDE THE HIGHEST QUALITY, ACCESSIBLE, INTEGRATED, COST EFFECTIVE CARE FOR INDIVIDUALS AND FAMILIES SERVED. 1 0 43387226 0 48775783 OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. PRIMARY AND SPECIALITY CARE FOR AMBULATORY PATIENTS AT FOUR SERVICE SITES. DURING FISCAL YEAR 2012, THERE WERE 98,837 OUTPATIENT VISITS, 7,428 EMERGENCY ROOM VISITS RECORDED, 1,689 OUTPATIENT SURGERIES, AND 212,992 LAB TESTS COMPLETED. 13386384 20000 15012061 INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2012, THERE WERE 268 BIRTHS, 1,623 INPATIENT ADMISSIONS, AND A TOTAL OF 4,535 INPATIENT DAYS FOR AN AVERAGE LENGTH OF STAY OF 2.79 DAYS. 1078197 0 1415088 CONTRACT PHARMACY - ST. CROIX REGIONAL MEDICAL CENTER BECAME ELIGIBLE TO PARTICIPATE IN THE 340B DRUG PRICING PROGRAM, WHICH IS MANAGED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OFFICE OF PHARMACY AFFAIRS (OPA), RESULTING IN THE REALIZATION OF A CONTRACT PHARMACY SERVICE. PARTICIPATION IN THE 340B DRUG PRICING PROGRAM RESULTS IN SIGNIFICANT SAVINGS, ESTIMATED TO BE 20-50%, ON THE COST OF PHARMACEUTICALS FOR USE BY OUTPATIENTS OF THE FACILITY. THROUGH THIS PROGRAM, ST. CROIX REGIONAL MEDICAL CENTER IS ABLE TO REACH MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICES. 57851807 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 43 0 555 1 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X X X JOHN TREMBLE CFO VP 7154830317 235 STATE STREET ST CROIX FALLS WI 54024 HARLEN HEGDAL 4.00 X X 550 0 0 MARSHA BEYER MD 2.00 X X 0 0 0 LARRY COLLINS 3.00 X X 650 0 0 CLYDE VAN OORT 2.00 X X 275 0 0 STEVE TESCH 2.00 X 250 0 0 JEFF HALL MD 2.00 X 0 0 0 JEANINE BRUNCLIK MD 2.00 X 0 0 0 WILLIAM SCHULTZ MD 2.00 X 0 0 0 CARLA GOETZ 2.00 X 175 0 0 JOHN TREMBLE 40.00 X 171397 0 14248 DAVE DOBOSENSKI 40.00 X 220106 0 16293 CLAUDIO NUNES 40.00 X 369360 0 31031 GURDESH BEDI 40.00 X 413486 0 22390 JOHN INGALLS 40.00 X 251431 0 14249 GEOFFERY GORES 40.00 X 231145 0 2165 THOMAS HINCK 40.00 X 230518 0 14764 LENNY LIBIS 0.00 X 101548 0 0 1990891 0 115140 8 1 1 0 RIVER VALLEY MEDICAL CENTER 208 SOUTH ADAMS STREET ST CROIX FALLS WI 54024 PHYSICIAN SERVICES 9008203 HEALTH PARTNERSREGIONS PO BOX 64059 ST PAUL MN 55164 PHYSICIAN SERVICES 1040847 ST CROIX VALLEY ANESTHESIA 2196 84TH AVENUE OSCEOLA WI 54020 CRNA SERVICES 988136 VOYAGEUR RADIOLOGY LLC 9975 DELLWOOD ROAD STILLWATER MN 55082 RADIOLOGIST SERVICES 980251 MARKET & JOHNSON INC 2350 GALLOWAY STREET EAU CLAIRE WI 54703 GENERAL CONSTRUCTION CONTRACTOR 507310 26 55060 55060 PATIENT SERVICES 624100 63567507 63567507 CONTRACT PHARMACY 624100 1415088 1415088 CAFETERIA MEAL SALES 722210 220337 220337 65202932 162897 162897 22178 7412 14766 14766 14766 5774932 5765647 9285 9285 9285 MISCELLANEOUS 900099 445120 445120 JOINT VENTURE REVENUE 900099 208448 208448 EHR PAYMENT 900099 128165 128165 54559 143 54416 836292 66281232 64982595 143 1243434 20000 20000 402075 402075 17591620 15147709 2443911 965731 849531 116200 3706019 3260099 445920 1364982 1200743 164239 201596 201596 57403 57403 19460426 18900455 559971 12100 4217 7883 8488736 8438555 50181 815152 741875 73277 1842045 1692253 149792 121381 105960 15421 111635 82986 28649 472436 432279 40157 3274944 2996574 278370 186630 185048 1582 BAD DEBTS 1943000 1943000 OTHER EXPENSES 1897700 1717521 180179 DUES AND FEES 125123 80703 44420 EQUIP RENTAL AND MAINT 124379 52299 72080 111725 111725 63296838 57851807 5445031 0 2594019 5803309 2077468 1698119 8674927 9164690 105000 174084 1108768 1140192 208356 221040 48725557 23370898 23653502 25354659 3116138 3001739 460072 1200815 746429 594881 0 178166 42744679 48531694 12344112 15803330 12084579 10807239 665439 986182 25094130 27596751 X 17650549 20934943 17650549 20934943 42744679 48531694 X 2984394 300000 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 9292 54011 43053 20250 0 900672 900672 25293626 10650988 14642638 779778 489561 290217 19126229 12230349 6895880 2625252 2625252 25354659 DEFERRED COMPENSATION PLAN 756782 ASSET RETIREMENT OBLIGATION 229400 986182 PART IV, LINE 1B: ST. CROIX REGIONAL MEDICAL CENTER IS AN AGENT FOR A CHECKING ACCOUNT THAT HOUSES FUNDS FOR THE WEST CENTER REGIONAL TRAUMA ADVISORY COUNCIL. THE MONIES ARE USED TO FUND TRAUMA TRAINING FOR THOSE PARTICIPATING HOSPITALS WITHIN THE COUNCIL. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER IS ALSO EXEMPT FROM STATE INCOME TAXES. THE MEDICAL CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE MEDICAL CENTER IS NOT AWARE OF ANY ADDITIONAL ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAN ARE CURRENTLY FILED IN THE TAX RETURN. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL AND STATE AUTHORITIES. THE MEDICAL CENTER HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE MEDICAL CENTER FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. 1 1 X 1 X 0 1 1 1 0 1 1 1086538 1086538 0.01770 8623321 5972306 2651015 0.04320 9709859 5972306 3737553 0.06090 54225 54225 0.00090 54225 54225 0.00090 9764084 5972306 3791778 0.06180 2 44 7512 7512 0.00010 14341 14341 0.00020 1 209462 209462 0.00340 47657 47657 0.00080 47 278972 278972 0.00450 1 1943000 1046645 16603432 16446689 156743 X 1 1 1 1 ST CROIX REGIONAL MEDICAL CENTER

235 STATE STREET ST CROIX FALLS WI 54024

X X X X ST CROIX REGIONAL MEDICAL CENTER 1 1 1 150.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X X X X 1 0 1 X 0 0 4 FREDERIC CLINIC

107 OAK STREET E FREDERIC WI 54837

PROVIDER BASED CLINIC INGALLS CLINIC

7456 MAIN STREET WEBSTER WI 54893

PROVIDER BASED CLINIC UNITY CLINIC

1482 190TH AVE BALSAM LAKE WI 54024

FREE STANDING CLINIC ST CROIX FALLS CLINIC

235 STATE STREET ST CROIX FALLS WI 54024

PROVIDER BASED CLINIC PART I, LINE 3C: ST CROIX REGIONAL MEDICAL CENTER, THROUGH ITS PATIENT ADVOCATES, EVALUATES EACH APPLICANT'S SITUATION IN ACCORDANCE WITH CRITERIA ESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE CRITERIA INCLUDES:1. INDIVIDUAL OR FAMILY INCOME2. FAMILY SIZE3. OTHER SOURCES OF PAYMENT FOR SERVICES4. INDIVIDUAL OR FAMILY ASSETSQUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE, FAMILY SIZE, AND INCOME LEVELS BASED ON 150% OF FEDERALPOVERTY GUIDELINES AS PUBLISHED ANNUALLY BY THE FEDERAL GOVERNMENT.GRANTING OF COMMUNITY CARE - AMOUNT:PATIENTS THAT QUALIFY FOR ST CROIX REGINAL MEDICAL CENTER'S CHARITY CARE PROGRAM WILL RECEIVE 100% OF THEIR ACCOUNT BALANCE APPLIED TO THE FUND.GRANTING OF COMMUNITY CARE - TERM:PATIENTS THAT QUALIFY FOR ST CROIX REGINAL MEDICAL CENTER'S CHARITY CARE PROGRAM WILL RECEIVE COMMUNITY CARE FOR A SPECIFIC HOSPITALIZATION OR FOR A SPECIFIED COURSE OF TREATMENT.ALL PATIENTS RECEIVEING CHARITY CARE MUST RE-APPLY IF THEIR STATUS CHANGES OR THE TREATMENT DURATION HAS ENDED. PART I, LINE 6A: ST. CROIX REGIONAL MEDICAL CENTER PARTICIPATES IN AN ANNUAL COMMUNITY BENEFIT REPORT PRODUCED BY THE WISCONSIN HOSPITAL ASSOCIATION. PART I, L7 COL(F): BAD DEBT EXPENSES OF $1,943,000 WERE SUBTRACTED FROM THE TOTAL EXPENSES OF $63,296,838 IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. PART II: THE ORGANIZATION PROVIDES DIRECT SUPPORT TO OVER 48 COMMUNITY ACTIVITIES, PROVIDES OVER 18,000 HOURS OF VOLUNTEER TIME IN INDIRECT PATIENT CARE ACTIVITIES, AND OVER 400 HOURS OF EDUCATION FOR HEALTHCARE PROFESSIONALS. PART III, LINE 4: FROM THE PATIENT ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS PARAGRAPH IN NOTE 1 TO THE AUDITED FINANCIAL STATEMENTS:"PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT OF INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTIBILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE MEDICAL CENTER. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME." PART III, LINE 8: THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. AMOUNTS REIMBURSED BY GOVERNMENT PAYORS ARE ESTIMATED TO BE LESS THAN THE COSTS TO PROVIDE THE SERVICES AS FOLLOWS:MEDICAID- WISCONSIN $2,482,800MEDICAID- MINNESOTA $225,800CHAMPUS AND VA $35,400MEDICARE - PHYSICIAN $3,846,200MEDICARE - HOSPITAL $33,300MEDICARE ADVANTAGE $435,200ALL GOVERNMENT PAYORS $7,058,700 TOTAL CHARITY CARE, UNCOMPENSATED CARE AND UNDER COMPENSATED CARE BY GOVERNMENT PAYORS WAS $7,512,00. THIS REPRESENTS 12.0% OF NET OPERATING REVENUES OF THE MEDICAL CENTER.ALL AMOUNTS IN LINE 6 WERE DERIVED FROM THE FILED 2012 MEDICARE COST REPORT. PART III, LINE 9B: THE MEDICAL CENTER HAS ESTABLISHED GUIDELINES FOR THE PROVISION OF HEALTH SERVICES AT REDUCED COSTS FOR INDIVIDUALS BASED UPON THEIR INCOME AND OTHER CIRCUMSTANCES. THE MEDICAL CENTER HAS A POLICY TO PROVIDE AN IMMEDIATE DISCOUNT TO ALL UNINSURED PATIENTS OF 10% OF CHARGES. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 17E: THE PATIENT WILL FIRST RECEIVE 2 BILLS FROM ST. CROIX REGIONAL MEDICAL CENTER. IF NO PAYMENT IS MADE AFTER 60 DAYS, THEN OUR PATIENT ADVOCATES CALL THE PATIENT LOOKING FOR PAYMENT. TWO PHONE CALLS ARE MADE BEFORE FURTHER COLLECTION EFFORTS ARE INITIATED. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: ST. CROIX REGIONAL MEDICAL CENTER USED THE AVERAGE PPO NEGOTIATED RATE AS THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. PART VI, LINE 2: OVERALL MARKETPLACE DEMOGRAPHICS AND COMPETITIVE ANALYSIS IS CONDUCTED ON A REGULAR BASIS. WHEN DEMAND FOR NEW SERVICE LINES IS INTENSIFIED, THEY ARE ADDED SLOWLY UNTIL DEMAND CAPACITY REACH CRITICAL LEVELS. PART VI, LINE 3: ALL PATIENTS HAVE ACCESS TO WRITTEN MATERIALS AND PAMPHLETS AT OR NEAR THE POINT OF REGISTRATION. IN ADDITION, PATENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURSES AVAILABLE. PART VI, LINE 4: THE ORGANIZATION SERVES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBERG IN WISCONSIN AND TAYLORS FALLS AND LINDSTROM IN EASTERN MINNESOTA. PART VI, LINE 6: THE CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 WI 1 SCHOLARSHIPS 20 20000 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION'S PROCEDURES INCLUDE SUBSTANTIATION OF EXPENSES, GRADES, TRANSCRIPTS AND RECEIPTS, AS WELL AS FOLLOW UP WITH COMMUNITY ORGANIZATIONS AND LEADERS. X X X X X 0 1 0 0 0 1 1 0 0 JOHN TREMBLE 151360 0 20037 0 0 0 9357 0 4891 0 185645 0 0 0 DAVE DOBOSENSKI 220106 0 0 0 0 0 13695 0 2598 0 236399 0 0 0 CLAUDIO NUNES 369360 0 0 0 0 0 16500 0 14531 0 400391 0 0 0 GURDESH BEDI 413486 0 0 0 0 0 16500 0 5890 0 435876 0 0 0 JOHN INGALLS 251431 0 0 0 0 0 13748 0 501 0 265680 0 0 0 GEOFFERY GORES 231145 0 0 0 0 0 0 0 2165 0 233310 0 0 0 THOMAS HINCK 230518 0 0 0 0 0 12816 0 1948 0 245282 0 0 0 LENNY LIBIS 0 0 0 0 101548 0 0 0 0 0 101548 0 0 0 PART I, LINE 4B CONTRIBUTIONS TO A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: JOHN TREMBLE $20,037 CINDY LUNDMARK $14,758 LAURA JENSEN $17,487 PART I, LINE 6 ANNUAL EMPLOYER CONTRIBUTIONS TO THE 457F PLAN ARE CONDITIONED UPON ATTAINING CERTAIN PRE-SET GOALS AND ARE CONTINGENT ON APPROVAL BY THE BOARD OF DIRECTORS. THE AWARD IS BASED ON TWO COMPONENTS - LONGEVITY AND PERFORMANCE. PERFORMANCE IS BASED ON MEETING 3 GOALS - NET REVENUE, NET MARGIN AND NET ASSETS. SUPPLEMENTAL INFORMATION PART III COMPENSATION REPORTED TO LENNY LEBIS IS THE RESULT OF THE PRIOR EMPLOYEE CHOOSING TO HAVE THE DISTRIBUTION FROM THEIR 457 SAVINGS PLAN BE DISTRIBUTED FROM THE AGENT HOLDING THEIR FUNDS TO SCRMC. SCRMC DEPOSITS THE DISTRIBUTION AND THEN PAYS THE PRIOR EMPLOYEE THROUGH THE PAYROLL PROCESS, WITHHOLDING FEDERAL AND STATE INCOME TAXES ON THE DISTRIBUTION. THESE TRANSACTION DO NOT RESULT IN SCRMC HAVING ANY ADDITIONAL EXPENSE. THIS DISTRIBUTION IS THE RESULT OF SAVINGS THE FORMER EMPLOYEE DID WHILE AN EMPLOYEE OF SCRMC. AT THE TIME SAVINGS WERE SET ASIDE, THEY WERE REPORTED ON THE 990 TAX RETURN. POLK COUNTY 396005730 2006-05-11 13000000 REFUND SERIES 2000 BONDS, FACILITY CONSTRUCTION AND EQUIPMENT PURCHASES 0 0 0 POLK COUNTY 396005730 2006-12-27 3683432 FACILITY CONSTRUCTION 0 0 0 5081575 13000000 13000000 2008 0 0 1 1 1154590 3683432 3683432 2008 0 0 1 1 1 1 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 RIVER VALLEY MEDICAL CENTER FOUR OWNER SERVE ON THE BOARD OF DIRECTORS OF SCRMC 9008203 PHYSICIAN SERVICES 0 FORM 990, PART IV FOUR OWNERS OF RVMC THE FOUR OWNERS OF RVMC INCLUDE MARSHA BEYER, JEFF HALL, JEANINE BRUNCLIK, WILLIAM SCHULTZ. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 ST. CROIX VALLEY EMERGENCY MEDICAL SERVICES, INC. (SCV EMS) WAS FORMED THROUGH A PARTNERSHIP WITH WESTERN WISCONSIN EMS AND LAKES REGION EMS IN AUGUST, 2011. SCV EMS PROVIDES EFFICIENT AMBULANCE SERVICE TO THE LOCAL COMMUNITIES WITHIN WESTERN WISCONSIN BETTER SERVING THE PATIENT POPULATION. FORM 990, PART VI, SECTION A, LINE 1 ST. CROIX REGIONAL MEDICAL CENTER HAS AN EXECUTIVE COMMITTEE WITH BROAD AUTHORITY TO ACT ON BEHALF OF ITS BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE INCLUDES THE CHAIR, VICE CHAIR, SECRETARY, TREASURER AND ONE OTHER DIRECTOR FROM THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PERIOD LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ST. CROIX REGIONAL MEDICAL CENTER HAS TWO CLASSES OF MEMBERS - SPONSORING MEMBERS, WHICH INCLUDES BOTH INDIVIDUALS AND CORPORATIONS, AND PROVIDER ELECTORS. INDIVIDUALS AND CORPORATIONS MAY BECOME SPONSORING MEMBERS THROUGH DONATIONS OF A SPECIFIED AMOUNT TO THE MEDICAL CENTER. INDIVIDUALS MAY BECOME PROVIDER ELECTORS BY PROVIDING SERVICES AT ST. CROIX REGIONAL MEDICAL CENTER THROUGH SPECIFIED EMPLOYMENT CONDITIONS. FORM 990, PART VI, SECTION A, LINE 7A PROVIDER ELECTORS VOTE IN THE ELECTION OF FOUR PROVIDER DIRECTORS. SPONSORING MEMBERS, INCLUDING INDIVIDUALS AND CORPORATIONS, VOTE IN THE ELECTION OF FIVE COMMUNITY DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS VOTE ON THE AUDITORS EMPLOYED TO AUDIT THE BOOKS OF THE MEDICAL CENTER AND TO PREPARE AN ANNUAL REPORT. AN OPS COUNCIL, CONSISTING OF FIVE INDIVIDUALS APPOINTED BY RIVER VALLEY MEDICAL CENTER, A RELATED ORGANIZATION, HAS SIGNIFICANT OVERSIGHT AUTHORITY AT THE MEDICAL CENTER. THE OPS COUNCIL'S AUTHORITY INCLUDES, BUT IS NOT LIMITED TO, REVIEW AND APPROVE OF ALL POLICIES AND PROCEDURES AS THEY RELATE TO MEDICAL OPERATIONS AND RECCOMMENDATION OF THE ANNUAL CAPITAL AND OPERATING BUDGETS TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: (A) A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO, (B) THE FORM 990 WAS PRESENTED FOR REVIEW AND APPROVAL TO THE ORGANIZATION'S FINANCE COMMITTEE IN NOVEMBER 2012, AND (C) THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWED AND APPROVED THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DERTERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THAT TOPIC. FORM 990, PART VI, SECTION B, LINE 15A CEO - ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED BY THE BOARD OF DIRECTORS USING SUCH OUTSIDE INFORMATION AS DEEMED NECESSARY. REVIEWS ARE CONDUCTED EACH JUNE. THE PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. OTHER OFFICERS - THE HUMAN RESOURCE DEPARTMENT CONDUCTS OUTSIDE RESEARCH TO DETERMINE REASONABLE COMPENSATION. THE CEO THEN DETERMINES THE COMPENSATION OF THESE INDIVIDUALS. REVIEWS ARE CONDUCTED EACH JUNE. THIS PROCESS LAST OCCURED IN FISCAL YEAR 2012. FORM 990, PART VI, SECTION C, LINE 19 THE MEDICAL CENTER'S GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNITY PHARMACY NET ASSETS 300,000. TOTAL TO FORM 990, PART XI, LINE 5: 300,000. REIMBURSEMENTS FOR PHYSICIAN SERVICES SCHEDULE L, PART IV AND SCHEDULE R, PART V, LINE 1O ST. CROIX REGIONAL MEDICAL CENTER REIMBURSES RIVER VALLEY MEDICAL CENTER (RVMC), FOR PHYSICIAN SERVICES PROVIDED BY EMPLOYEES OF RVMC. ALL PAYMENTS ARE "GROSS", MEANING THAT THEY INCLUDE UNIDENTIFIED AMOUNTS FOR BENEFITS AND MALPRACTICE INSURANCE, AS WELL AS W-2 COMPENSATION. UNITY PHARMACY LLC 1504 190TH AVENUE SUITE 100 BALSAM LAKE WI 54810 454471131 PHARMACEUTICALS WI 0 343425 ST CROIX REGIONAL MEDICAL CENTER ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC 235 EAST STATE STREET ST CROIX FALLS WI 54024 452872803 TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE. WI 501(C)(3) LINE 9 ST CROIX REGIONAL MEDICAL CENTER 1 CANCER CENTER OF WESTERN WISCONSIN 501 HOSPITAL ROAD NEW RICHMOND WI 54017 273238660 TO PROVIDE CARE TO CANCER PATIENTS. WI 501(C)(3) LINE 9 ST CROIX REGIONAL MEDICAL CENTER 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 ST CROIX VALLEY EMS INC Q 150200 MEMBERSHIP AGREEMENT