2021-04-07T14:56:30-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 390890676 ST CROIX REGIONAL MEDICAL CENTER STCR 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 SALLY BAJAK CFO 7154830556 2021-03-27 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-03-27 2019 2022-09-23 18:48:47Z DAVE DOBOSENSKI 235 STATE STREET ST CROIX FALLS WI 54024 122161632 0 X WWW.SCRMC.ORG X 1954 WI WE HELP PEOPLE TO LIVE HEALTHIER, HAPPIER AND LONGER LIVES. 9 6 898 150 4665966 0 145264 3890194 123997967 117452710 79439 221815 332333 293182 124555003 121857901 7970 280 0 0 56323072 56715790 0 0 0 63733953 59233662 120064995 115949732 4490008 5908169 83964969 103196260 15375684 28698806 68589285 74497454 X WE HELP PEOPLE TO LIVE HEALTHIER, HAPPIER AND LONGER LIVES. 0 0 77379155 280 84386659 OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. DURING FISCAL YEAR 2020, THERE WERE 9,496 EMERGENCY ROOM VISITS RECORDED, 1,103 OUTPATIENT SURGERIES, AND 109,686 CLINICAL VISITS.INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2020, THERE WERE 240 BIRTHS, 1,278 INPATIENT ADMISSIONS, AND A TOTAL OF 4,136 INPATIENT DAYS FOR AN AVERAGE LENGTH OF 3.24 DAYS. 11480121 0 14154470 ST. CROIX REGIONAL MEDICAL CENTER OPERATES FOUR PROVIDER BASED CLINICS AND ONE FREE STANDING CLINIC. TOGETHER, THE CLINICS STRIVE TO MEET THE HEALTHCARE NEEDS OF PATIENTS AND FAMILIES WHO LIVE AND WORK IN THE COMMUNITIES THEY SERVE. A TOTAL OF 109,686 CLINIC VISITS OCCURRED IN FISCAL YEAR 2020. 5774308 0 7119461 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. 5510199 6793825 ST. CROIX VALLEY PHARMACIES PROVIDE LOCAL PHARMACY CARE TO THE SERVICE AREA OF ST. CROIX REGIONAL MEDICAL CENTER. ST. CROIX VALLEY PHARMACIES IS THE SOLE MEMBER OF THE FOLLOWING COMMUNITY PHARMACIES: UNITY PHARMACY LOCATED IN THE UNITY CLINIC BUILDING NEAR BALSAM, WI, FREDERIC PHARMACY LOCATED IN THE FREDERIC CLINIC BUILDING IN FREDERIC, WI, AND, ST. CROIX FALLS PHARMACY LOCATED IN THE ST. CROIX FALLS CLINIC BUILDING IN ST. CROIX FALLS, WI. 5510199 6793825 100143783 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 90 0 898 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X SALLY BAJAK 7154830556 235 STATE STREET ST CROIX FALLS WI 54024 MARISA SPENCER PHYSICIAN 40.00 X 540242 0 7996 MUHAMMAD KHAN PHYSICIAN 40.00 X 475143 0 33712 VITTAL NAGAR PHYSICIAN 40.00 X 469356 0 32533 DANIELLE REDBURN PHYSICIAN 40.00 X 471145 0 40980 JAMES WALLACE PHYSICIAN 40.00 X 439160 0 43660 DAVE DOBOSENSKI CEO 40.00 X 389510 0 28847 SALLY BAJAK CFO 40.00 X 187886 0 29009 JOSEPH THIMM CHAIR 0.50 X X 0 0 0 PATRICK MCDONOUGH MD VICE CHAIR 40.00 X X 274060 0 39881 MICHAEL BUCHITE TREASURER 0.50 X X 0 0 0 GURDESH BEDI SECRETARY/PHYSICIAN OF SCRMC 40.00 X X 870386 0 46800 JOHN DRISCOLL TRUSTEE 0.50 X 0 0 0 CONNIE ERICKSON TRUSTEE 0.50 X 0 0 0 ANDREA JERRICK TRUSTEE (THRU AUG) 0.50 X 36393 0 1490 REBECCA LYMAN MD TRUSTEE 40.00 X 225760 0 37029 WILLIAM TIES TRUSTEE 0.50 X 0 0 0 JOSEPH WHITE TRUSTEE 0.50 X 0 0 0 4379041 0 341937 81 0 1 0 MIDWEST RADIOLOGY PA 2355 HWY 35 WEST SUITE 100 ROSEVILLE MN 55113 RADIOLOGY SERVICES 1805611 ST CROIX VALLEY ANESTHESIA LLC BOX 45 OSCEOLA WI 54020 CRNA SERVICES 1483432 TWIN CITIES ORTHOPEDICS PA 4200 DAHLBERG DR SUITE 300 GOLDEN VALLEY MN 55422 ORTHOPEDIC SURGICAL SERVICES 1291600 MIDWEST SPINE & BRAIN INSTITUTE 1950 NORTHWESTERN AVE SUITE 102 STILLWATER MN 55082 SPINAL SURGICAL SERVICES 953122 NORTH SUBURBAN EYE SPECIALISTS 3777 COON RAPIDS BLVD NW SUITE 100 COON RAPIDS MN 55433 OPTHALMOLOGY SERVICES 927534 10 3691748 198446 3890194 PATIENT SERVICES 624100 98541129 98541129 CONTRACT PHARMACY 624100 7119461 7119461 FREDERIC PHARMACY 624100 4514134 2393068 2121066 SCF PHARMACY 624100 3421896 2174188 1247708 UNITY PHARMACY 624100 2234610 1183745 1050865 1621480 1008824 246327 366329 117452710 254129 254129 17700 11564 6136 6136 6136 259853 292167 -32314 -32314 -32314 JOINT VENTURE REVENUE 900099 253046 253046 EHR INCENTIVE 900099 34000 34000 287046 121857901 112454415 4665966 847326 X 280 280 614291 614291 44893923 37219229 7674694 1987229 1607454 379775 6258854 4986681 1272173 2961493 2375643 585850 203441 9320 194121 49883 49883 16372753 14809584 1563169 204369 6631 197738 527425 306861 220564 2624162 1021717 1602445 2166333 1850292 316041 105166 61320 43846 247847 199755 48092 5328 4902 426 4042725 3708448 334277 324761 234312 90449 MEDICAL SUPPLIES 15162151 15162151 DRUGS AND MEDS 13532506 13310122 222384 PROVISION FOR BAD DEBTS 2092421 2092421 DUES AND PUBLICATIONS 946684 838690 107994 625707 337970 287737 115949732 100143783 15805949 0 761742 1068304 26481786 45204488 14089805 12524938 237911 345496 3303994 3175806 660819 954538 72825747 42634338 32512580 30191409 1455563 1504209 575000 517500 3885769 7709572 83964969 103196260 10109773 18731729 0 4547846 133000 95000 5132911 5324231 15375684 28698806 X 68589285 74497454 68589285 74497454 83964969 103196260 5908169 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12207 12207 0 PART II-B, LINE 1: ST CROIX REGIONAL MEDICAL CENTER (THE ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE ORGANIZATION IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO ENSURE THEIR MEMBERS' PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. THE ORGANIZATION IS ALSO A MEMBER OF THE NATIONAL RURAL HEALTH ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO SUPPORT RURAL HEALTH ISSUES THROUGH ADVOCACY, COMMUNICATIONS, EDUCATION AND RESEARCH. 1491495 1491495 44563914 24367819 20196095 50236 45466 4770 26720102 18221053 8499049 30191409 UNEMPLOYMENT RESERVE FUND 411890 DEFERRED COMPENSATION PLAN 4199027 AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 3098655 7709572 ASSET RETIREMENT OBLIGATION 217741 DEFERRED COMPENSATION PLAN 4639090 DEFERRED PAYROLL TAXES 467400 5324231 119765480 0 119765480 2092421 2092421 121857901 113857311 0 113857311 2092421 2092421 115949732 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,092,421. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,092,421. 1 1 X 1 X 1 X 1 1 1 0 0 367677 367677 0.00320 11971228 8101895 3869333 0.03400 12338905 8101895 4237010 0.03720 21400210 12569821 8830389 0.07760 21400210 12569821 8830389 0.07760 33739115 20671716 13067399 0.11480 0 1103898 551949 26871176 7553261 19317915 X 1 1 1 1 ST CROIX REGIONAL MEDICAL CENTER 235 STATE STREET ST CROIX FALLS WI 54024 WWW.SCRMC.ORG 1043240922 X X X X ST CROIX REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X WWW.HEALTHYPOLKCOUNTY.COM X 1 18 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X 1 X HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ X HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ X HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X X 1 X 0 0 ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: THE 2019 POLK COUNTY COMMUNITY HEALTH ASSESSMENT (CHA) IS THE RESULT OF A JOINT EFFORT BY EIGHT KEY PARTNERS WHO PROVIDED OVERSIGHT TO THE PROCESS, ASSURED COLLECTION AND COMPILATION OF SHARED DATA, AND ENGAGED RESIDENTS OF POLK COUNTY THROUGH A SERIES OF COMMUNITY MEETINGS AND SURVEYS. THESE EIGHT PARTNERS, REPRESENTING GOVERNMENTAL AGENCIES, LOCAL MEDICAL CENTERS AND HOSPITALS, UW-EXTENSION AND NONPROFIT ORGANIZATIONS, FORMED A CHA LEADERSHIP TEAM THAT WORKED TOGETHER TO ASSESS THE HEALTH OF POLK COUNTY RESIDENTS. THE PURPOSE OF A COMMUNITY HEALTH ASSESSMENT IS TO EVALUATE AND PRIORITIZE HEALTH CONCERNS IN ORDER TO EMPOWER THE COMMUNITY TO SOLVE HEALTH PROBLEMS AND IMPROVE HEALTH OUTCOMES. THE ULTIMATE GOAL IS FOR THE COMMUNITY TO COLLECTIVELY AND STRATEGICALLY TARGET EVIDENCE BASED INTERVENTIONS TO IMPROVE THE HEALTH OF THE POPULATION. THE CHA LEADERSHIP TEAM COLLECTED BOTH QUANTITATIVE AND QUALITATIVE DATA TO IDENTIFY THE TOP HEALTH PRIORITIES IN POLK COUNTY. METHODS USED INCLUDED A SURVEY, COMMUNITY FORUMS, A KEY PARTNER MEETING AND COMPREHENSIVE COLLECTION AND REVIEW OF SECONDARY HEALTH DATA. PARTNERS DISTRIBUTED THE COMMUNITY HEALTH SURVEY TO RESIDENTS THROUGHOUT POLK COUNTY FROM MID DECEMBER 2018 TO MID-FEBRUARY 2019. THE SURVEY WAS HOSTED BY THE SAME ONLINE DEVELOPMENT TOOL, SURVEY MONKEY, AS IN 2015 TO COMPARE SURVEY RESULTS. QUESTIONS WERE ADDED FOR THE 2019 VERSION TO ASSESS THE RESPONDENTS THOUGHTS ON THE SOCIAL DETERMINANTS OF HEALTH. THE LINK TO THE ONLINE SURVEY WAS WIDELY DISTRIBUTED THROUGH THE NETWORKS OF EACH OF THE PARTNER ORGANIZATIONS. THE SURVEY LAUNCH WAS ANNOUNCED BY A PRESS RELEASE AND WAS REPEATEDLY ADVERTISED IN LOCAL NEWSPAPERS, SOCIAL MEDIA, PARTNER WEBSITES AND FLYERS POSTED THROUGHOUT THE COUNTY. HARD COPIES OF THE SURVEY WERE AVAILABLE IN MEDICAL CENTER AND GOVERNMENT CENTER WAITING ROOMS WITH RECEPTION STAFF ENCOURAGING COMPLETION. SPECIAL EFFORT WAS MADE TO ENSURE THE SURVEY WAS AVAILABLE TO UNDERREPRESENTED GROUPS WHO CAN BE AT THE HIGHEST RISK OF SUFFERING FROM HEALTH DISPARITIES. THESE GROUPS INCLUDED WIC, PRENATAL CARE COORDINATION (PNCC), ECONOMIC SUPPORT AND BEHAVIORAL HEALTH PROGRAM PARTICIPANTS FROM POLK COUNTY, VETERANS SEEKING SERVICES FROM THE COUNTY VETERANS SERVICES OFFICE AND SENIORS ACCESSING SERVICES AT THE AGING AND DISABILITY RESOURCE CENTER (ADRC). FLYERS WERE LEFT IN LOCAL VILLAGE LAUNDROMATS, FOOD PANTRIES, AND GROCERY STORES WITH INFORMATION ON HOW TO ACCESS THE ONLINE SURVEY. SCHOOL SUPERINTENDENTS WERE SENT LINKS TO THE SURVEY AND ENCOURAGED TO FORWARD TO SCHOOL STAFF AND TO INCLUDE IN THEIR RESPECTIVE SCHOOL NEWSLETTERS. THE COUNTY LOCAL PASTOR GROUP WAS ALSO OUTREACHED AND PROVIDED LINKS TO THE ONLINE SURVEY. DATA FROM THE COMMUNITY SURVEY AND SECONDARY REVIEW WAS PRESENTED AND DISCUSSED AT BOTH THE COMMUNITY FORUMS AND KEY PARTNER MEETINGS WITH VOTING CONDUCTED FOR THE TOP HEALTH PRIORITIES. A TOTAL OF 907 POLK COUNTY RESIDENTS COMPLETED THE SURVEY. THIS WAS A 31% INCREASE IN THE RESPONSE RATE OVER THE 2016 COMMUNITY SURVEY. SURVEY RESPONDENTS REPRESENTED A WIDE RANGE OF COUNTY RESIDENTS, INCLUDING A VARIETY OF INCOME AND EDUCATIONAL LEVELS, AGE, AND HOUSEHOLD SIZE. OTHER THAN GENDER (A DISPROPORTIONATELY HIGH PERCENTAGE OF FEMALES COMPLETED THE SURVEY), THE DEMOGRAPHICS OF THE SURVEY RESPONDENTS OVERALL ALIGNED WITH THOSE OF POLK COUNTY AS A WHOLE. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: THE MEDICAL CENTER WORKED IN COLLABORATION WITH AMERY HOSPITAL AND CLINIC AND OSCEOLA MEDICAL CENTER WITH THE ULTIMATE GOAL TO IDENTIFY PRIORITY HEALTH ISSUES AND TO DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: IN ADDITION TO THE HOSPITAL FACILITIES MENTIONED ABOVE, THE MEDICAL CENTER WORKED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT, MENTAL HEALTH TASK FORCE OF POLK COUNTY, UNITED WAY OF ST. CROIX VALLEY AND UNIVERSITY OF WISCONSIN. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7D: HTTPS://WWW.SCRMC.ORG/DOCUMENTS/CHNA_CHA-FINAL-6_26_19.PDFSECTION B, LINE 10A:HTTPS://WWW.SCRMC.ORG/LEGAL-NOTICES/ ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE TOP HEALTH FOCUS AREAS. THE FINAL TOP HEALTH FOCUS AREAS SELECTED WERE:1. MENTAL HEALTH2. SUBSTANCE ABUSE3. NUTRITION AND PHYSICAL ACTIVITY4. ACCESS TO CAREAFTER REVIEWING THE DATA AND MAPPING EXISTING RESOURCES, SCRMC DEVELOPED AN IMPLEMENTATION STRATEGY. THE SCRMC GOVERNING BOARD APPROVED THE IMPLEMENTATION STRATEGY ON JUNE, 2020. THE ABOVE NEEDS WERE PRIORITIZED BASED ON SIZE, SEVERITY, AVAILABLE DATA, AND THE HOSPITAL'S ABILITY TO HAVE AN IMPACT. IN ORDER TO ADDRESS PRIORITY NEEDS, SCRMC WILL ENGAGE KEY COMMUNITY PARTNERS IN IMPLEMENTING STRATEGIES ACROSS THE SERVICE AREA. THESE STRATEGIES INCLUDE MODIFYING POLICIES, PROVIDING SUPPORT, ENHANCING ACCESS, CHANGING CONSEQUENCES AND INCENTIVES, PROVIDING INFORMATION, AND ENHANCING SKILLS. USING THE PRINCIPLES OF THE WISCONSIN WAY MODEL, WHICH HAS ITS ROOTS IN THE COUNTY HEALTH RANKINGS, THE COMMUNITY TOOL BOX, AND HEALTHIEST WISCONSIN 2020, THE CHNA LEADERSHIP TEAM WILL ACT ON THE RESULTS OF THE 2019 CHNA TO SPEARHEAD THE NEXT PHASE OF THE COMMUNITY HEALTH IMPROVEMENT PROCESS, ACTION PLANNING. ADDITIONAL PARTNERS AND COMMUNITY MEMBERS WILL BE MOBILIZED UNDER THE UMBRELLA OF POLK UNITED, A COMMUNITY COALITION DEDICATED TO HEALTH IMPROVEMENT ACTIVITIES. PARTNERS AND MEMBERS WILL SERVE ON HEALTH PRIORITY WORKGROUPS THAT WILL DEVELOP ACTION ORIENTED THREE YEAR PLANS TO ADDRESS THE FOUR HEALTH PRIORITY AREAS WITH THE GOAL OF REDUCING HEALTH DISPARITIES AND IMPROVING POPULATION HEALTH. SCRMC WORKS COLLABORATIVELY WITH AMERY HOSPITAL AND CLINIC, OSCEOLA MEDICAL CENTER, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY HEALTH DEPARTMENT, UNITED WAY OF ST. CROIX VALLEY, AND UW-EXTENSION TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC WOULD ALSO LIKE TO CONTRIBUTE EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. SCRMC IS ADDRESSING MENTAL HEALTH BY: - INTEGRATING STIGMA REDUCTION CAMPAIGNS SYSTEM-WIDE, ACROSS SECTORS, AND TO THE PUBLIC.- TRAINING STAFF IN MENTAL HEALTH FIRST AID.- STRATEGICALLY ALIGNING WITH COMMUNITY PARTNERS AND MENTAL HEALTH TASK FORCE TEAMS TO MAXIMIZE IMPACT AND REACH. SCRMC IS ADDRESSING SUBSTANCE ABUSE BY:- INTEGRATING STRATEGICALLY WITH PUBLIC HEALTH AND COMMUNITY PARTNERS.- SUPPORTING "DRUG FREE COMMUNITIES" THROUGH COALITION ENGAGEMENT AND GRANT FUNDING. SCRMC IS ADDRESSING NUTRITION AND PHYSICAL ACTIVITY BY:- SUPPORTING AND IMPLEMENTING REGION-WIDE ACTIVITIES WITH COMMUNITY PARTNERS (EXP. POWER OF PRODUCE). - CREATING AN INTERNAL IDENTIFICATION AND REFERRAL PROCESS THAT HELPS FAMILIES WITH NUTRITIONAL INADEQUACIES BE ROUTED TO THE APPROPRIATE COMMUNITY FOOD RESOURCES. - EDUCATING AREA YOUTH IN GARDENING AND HARVESTING. - CREATING A REGIONAL PHYSICAL ACTIVITY RESOURCE PLATFORM THAT IS USER FRIENDLY FOR PATIENTS, STAFF, AND COMMUNITY PARTNERS. SCRMC IS ADDRESSING ACCESS TO CARE BY: - OFFERING DENTAL SERVICES AS PART OF OUR CLINICAL SERVICES. - EXPANDING ACCESS TO AFFORDABLE INHALERS.- EXPANDING VACCINATION CAPABILITIES AT COMMUNITY PHARMACIES. SCRMC IS ADDRESSING SOCIAL DETERMINANTS OF HEALTH TO REDUCE HEALTH DISPARITIES THAT AFFECTS ALL HEALTH FOCUS AREAS, IS BY:- COLLABORATING WITH COMMUNITY PARTNERS TO ESTABLISH A PATHWAYS COMMUNITY HUB.- INTEGRATING A COMMUNITY HEALTH WORKER INTO THE SCRMC HEALTH SYSTEM. OTHER AREAS SCRMC IS ADDRESSING, NOT LISTED ABOVE OR IDENTIFIED AS A TOP FOCUS AREA, IS:- HEALTHY GROWTH AND DEVELOPMENT PROVIDERS WILL REVIEWING AND DISCUSS DEVELOPMENTAL MILESTONES AT WELL-CHILD VISITS. SCRMC IS, CURRENTLY, IN THE PROCESS OF APPLYING AND IMPLEMENTING THE "LITTLE MOMENTS COUNT" INITIATIVE BY INCORPORATING "REACH OUT AND READ" AT 6 MONTHS 5 YEARS OLD WELL-CHILD VISITS. - TOBACCO PREVENTION SCRMC IS COMMITTED TO PLAYING AN ACTIVE ROLE IN TOBACCO PREVENTION. STRATEGIES AND ACTIVITIES ARE AIMED AT PREVENTING, ELIMINATING, AND REDUCING SUBSTANCE USE. TOBACCO SCREENINGS, WHETHER FIRST HAND OR SECOND HAND SMOKE, IS AN ESSENTIAL QUESTION THAT IS ASKED AT EACH CLINIC AND HOSPITAL VISIT. PROVIDERS AND STAFF EDUCATE PATIENTS ON THE DETRIMENTS OF TOBACCO USE AND WILL SEND PATIENTS TO THE APPROPRIATE RESOURCES IF THEY ARE IN NEED OF ASSISTANCE. - INJURY AND VIOLENCE PREVENTION COMMUNITY INQUIRY HAS SURROUNDED A "TEXTING WHILE DRIVING" SCREENING QUESTION INTO THE ELECTRONIC HEALTH RECORD. FURTHER DISCUSSION MUST TAKE PLACE. WITH VIOLENCE PREVENTION, THERE IS STRONG SUPPORT FROM SCRMC IN TRAUMA-INFORMED CARE. SCRMC IS COLLABORATING EXTENSIVELY WITH COMMUNITY COMMITTEES SURROUNDING TRAUMA AND ADVERSE CHILDHOOD EXPERIENCES (ACE). THROUGH AWARENESS, EDUCATION, AND TREATMENT, SCRMC IS COMMITTED TO BEING A LEADER IN THIS AREA. - SEXUAL AND REPRODUCTIVE HEALTH SEXUAL AND REPRODUCTIVE HEALTH IS VERY IMPORTANT TO SCRMC. COUNSELING IS OFFERED FOR ANY ISSUE IN SEXUAL AND REPRODUCTIVE HEALTH. "TEEN HEALTH" INFORMATION IS INCLUDED IN ALL TEEN PRIMARY CARE VISITS IN THE AFTER VISIT SUMMARY (AVS). ALL PRIMARY CARE PROVIDERS SCREEN PATIENTS BETWEEN THE AGE OF 16-24 FOR CHLAMYDIA AND GONORRHEA IF THEY ARE DEEMED SEXUALLY ACTIVE. CERVICAL AND BREAST CANCER SCREENINGS ARE ADDRESSED AT EACH PRIMARY CARE VISIT. PATIENT EDUCATION MATERIALS ARE DISTRIBUTED THROUGH THE FACILITY IN A HEALTH LITERATE LANGUAGE. - ORAL HEALTH SCRMC KNOWS HOW IMPORTANT ORAL HEALTH IS TO A PERSON'S OVERALL WELL-BEING. PROVIDERS PROMOTE THE IMPORTANCE OF ORAL HEALTH TO PATIENTS AND WHERE THEY CAN SEEK SERVICES IN THE AREA. SCRMC NOW PROVIDES DENTAL SERVICES IN BURNETT COUNTY AT THE WEBSTER DENTAL CLINIC LOCATED IN THE WEBSTER HEALTH CENTER. - OCCUPATIONAL AND ENVIRONMENTAL HEALTH SCRMC PROVIDERS PROMOTE THE POSITIVE HEALTH BENEFITS OF GOOD OCCUPATIONAL AND ENVIRONMENTAL HEALTH AT PATIENT VISITS. SCRMC RUNS EMERGENCY PREPAREDNESS DRILLS TO ENSURE QUALITY COLLABORATION IF UNFORTUNATE EVENTS TAKE PLACE IN THE FUTURE. IN JULY 2019, SCRMC ENTERED INTO A PARTNERSHIP WITH HEALTHPARTNERS AND HARVARD UNIVERSITY TO IMPLEMENT A TOTAL WORKER HEALTH APPROACH WITHIN THE ORGANIZATION. SCRMC ACKNOWLEDGES THE WIDE RANGE OF SIGNIFICANT HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. SCRMC WILL BE ADDRESSING ALL HEALTH NEEDS RECOGNIZED IN THE CHNA. ST. CROIX REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13H: ST. CROIX REGIONAL MEDICAL CENTER MAY PRESUMPTIVELY DETERMINE ELIGIBILITY OF PATIENTS BASED ON EXTERNAL SOURCES AND DATABASES WITHOUT A FAP-APPLICATION. 5 1 - ST CROIX FALLS CLINIC 216 SOUTH ADAMS STREET ST CROIX FALLS WI 54024 RHC PROVIDER BASED CLINIC 2 - WEBSTER HEALTH CENTER 26425 LAKELAND AVE SOUTH WEBSTER WI 54893 RHC PROVIDER BASED CLINIC 3 - LINDSTROM CLINIC 12375 LINDSTROM LANE LINDSTROM MN 55045 FREE STANDING CLINIC 4 - FREDERIC CLINIC 205 OAK STREET WEST FREDERIC WI 54837 RHC PROVIDER BASED CLINIC 5 - UNITY CLINIC 1504 190TH AVENUE BALSAM LAKE WI 54810 RHC 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 INCOME{2) FAMILY SIZE{3) OTHER SOURCES OF PAYMENT FOR SERVICES.QUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE, FAMILY SIZE, AND INCOME LEVELS BASED ON 100% OF THE FEDERAL POVERTY GUIDELINES AS PUBLISHED ANNUALLY BY THE FEDERAL GOVERNMENT.IN ADDITION TO THE ABOVE LISTED ELIGIBILITY REQUIREMENTS DEPENDENT UPON INCOME, SCRMC MAY ALSO PRESUMPTIVELY DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PORTIONS OF OR THE ENTIRE FINANCIAL APPLICATION PROCESS MAY BE WAIVED FOR CERTAIN PATIENTS/GUARANTORS WHO PRESUMPTIVELY QUALIFY FOR FINANCIAL ASSISTANCE AND ARE SUBSEQUENTLY VERIFIED BASED ON SCRMC POLICIES AND PROCEDURES. EXAMPLES MAY INCLUDE PATIENTS/GUARANTORS WHO ARE HOMELESS, DECEASED WITHOUT AN ESTATE, BANKRUPTCY, FOOD STAMPS AND/OR PATIENTS/GUARANTORS WHO QUALIFY BY EXTERNAL AVAILABLE DATA SOURCES SUCH AS CREDIT AGENCIES OR SOCIAL ECONOMIC STATUS OF QUALIFYING FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FROM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: THE ORGANIZATION INCLUDED THE ACTIVITY OF FOUR RURAL HEALTH CLINICS FOR SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,092,421. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: SEE THE "PATIENT RECEIVABLES AND CREDIT POLICY" SECTION IN NOTE 1 TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBTS. PART III, LINE 8: THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE CALCULATION IS ALSO NOT INCLUDING THE ACTIVITY FROM FOUR RURAL HEALTH CLINICS AS THOSE AMOUNTS ARE BEING INCLUDED AS SUBSIDIZED SERVICES. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE FOLLOWING PROCEDURES ARE SECTION 8 IN SCRMC'S BILLING AND COLLECTION POLICY INCLUDED ON THEIR WEBSITE AND DESCRIBE THE POLICY AND PROCEDURES USED FOR PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. ST. CROIX REGIONAL MEDICAL CENTER WILL MAKE REASONABLE EFFORTS TO PATIENT/GUARANTORS THAT FINANCIAL ASSISTANCE IS AVAILABLE, WHERE TO GET THE INFORMATION, HOW TO APPLY, AND ASSISTANCE AVAILABLE WITH APPLYING. ST. CROIX REGIONAL MEDICAL CENTER WILL ALLOW AND PROCESS A FINANCIAL ASSISTANCE APPLICATION UP TO 240 DAYS AFTER THE PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. ST. CROIX REGIONAL MEDICAL CENTER WILL TAKE STEPS TO NOTIFY PATIENT/GUARANTOR ABOUT OUR FINANCIAL ASSISTANCE POLICY AND WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS BEFORE 120 DAYS FROM PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. IF A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, ST. CROIX REGINAL MEDICAL CENTER WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT, MAKE AN ELIGIBILITY DETERMINATION AS TO WHETHER THE PATIENT/GUARANTOR IS ELIGIBLE FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT/GUARANTOR IN WRITING. IF ELIGIBLE, THE FINAL NOTIFICATION PERIOD WILL BE RESET FOR ANOTHER 30 DAY PERIOD. IF A PATIENT/GUARANTOR DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY BY THE LAST DAY OF THE FINAL NOTIFICATION PERIOD, AND THE PATIENT/GUARANTOR HAS RECEIVED THE 30-DAY NOTICE DESCRIBED IN FINAL NOTIFICATION PERIOD, THEN ST. CROIX REGIONAL MEDICAL CENTER MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF A PATIENT/GUARANTOR HAS APPLIED FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY IN THE LAST SIX MONTHS, AND IT WAS DETERMINED THAT THE PATIENT/GUARANTOR IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY, THEN SCRMC MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION UNDER THE FINANCIAL ASSISTANCE POLICY IS RECEIVED PRIOR TO THE FINAL NOTICE, THEN EXTRAORDINARY COLLECTION ACTIONS WILL BE SUSPENDED AND PATIENT/GUARANTOR WILL BE PROVIDED A WRITTEN NOTICE THAT DESCRIBES ADDITIONAL INFORMATION REQUIRED UNDER THE FINANCIAL ASSISTANCE POLICY. IF ADDITIONAL INFORMATION REQUESTED IS NOT PROVIDED, THEN THE FINAL NOTIFICATION PERIOD WILL BE RESET. PART VI, LINE 2: OVERALL MARKETPLACE 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, PATIENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURCES AVAILABLE. PART VI, LINE 4: SCRMC SERVICES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST. CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBURG IN WISCONSIN AND TAYLOR FALLS AND LINDSTROM IN EASTERN MINNESOTA. PART VI, LINE 5: SCRMC WORKS COLLABORATIVELY WITH AMERY HOSPITAL AND CLINIC, OSCEOLA MEDICAL CENTER, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY HEALTH DEPARTMENT, UNITED WAY OF ST. CROIX VALLEY, AND UW-EXTENSION TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC CONTRIBUTES EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. X X X X 0 1 0 0 0 0 0 0 0 MARISA SPENCER PHYSICIAN 539756 0 0 0 486 0 7996 0 0 0 548238 0 0 0 MUHAMMAD KHAN PHYSICIAN 474657 0 0 0 486 0 16800 0 16912 0 508855 0 0 0 VITTAL NAGAR PHYSICIAN 468870 0 0 0 486 0 16800 0 15733 0 501889 0 0 0 DANIELLE REDBURN PHYSICIAN 470605 0 0 0 540 0 31800 0 9180 0 512125 0 0 0 JAMES WALLACE PHYSICIAN 437818 0 100 0 1242 0 31800 0 11860 0 482820 0 0 0 DAVE DOBOSENSKI CEO 387983 0 0 0 1527 0 16770 0 12077 0 418357 0 48911 0 SALLY BAJAK CFO 187472 0 0 0 414 0 12111 0 16898 0 216895 0 0 0 PATRICK MCDONOUGH MD VICE CHAIR 273250 0 0 0 810 0 29148 0 10733 0 313941 0 0 0 GURDESH BEDI SECRETARY/PHYSICIAN OF SCRMC 869900 0 0 0 486 0 46800 0 0 0 917186 0 0 0 REBECCA LYMAN MD TRUSTEE 224888 0 0 0 872 0 26878 0 10151 0 262789 0 0 0 PART I, LINE 4B DAVE DOBOSENSKI PARTICIPATES IN A 457(F) PLAN. IN FISCAL YEAR 2020, $35,825 WAS DEFERRED. NO CONTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2019 AS REPORTED IN SCHEDULE J, PART II. SALLY BAJAK PARTICIPATED IN A 457(F) PLAN. NO CONTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2019 AS REPORTED IN SCHEDULE J, PART II. DR. REBECCA LYMAN, DR. PATRICK MCDONOUGH, DR. GURDESH BEDI, DR. MUHAMMAD KHAN, DR. DANIELLE REDBURN, DR. CLAUDIO NUNES AND DR. JAMES WALLACE ARE ALL PARTICIPANTS IN A 457(F) PLAN. $15,000 TO EACH EMPLOYEE WAS CONTRIBUTED BY THE EMPLOYER DURING CALENDAR YEAR 2019 AS REPORTED IN SCHEDULE J, PART II. JILL TIES FAMILY MEMBER OF WILLIAM TIES (BOARD MEMBER) 406040 EMPLOYEE OF THE HOSPITAL, FAMILY MEMBER OF THE BOARD MEMBER - WILLIAM TIES. 0 FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONE CLASS OF MEMBERSHIP IN THE CORPORATION. MEMBERSHIP WILL EXPIRE ON SEPTEMBER 1 OF EACH YEAR, UNLESS PRIOR TO THAT DATE THE MEMBERSHIP IS RENEWED BY TURNING IN THE COMPLETED ANNUAL MEMBERSHIP RENEWAL FORM PRIOR TO THE SEPTEMBER 1 EXPIRATION DATE. AN ANNUAL $5.00 HANDLING FEE MAY BE DONATED ON AN OPTIONAL BASIS. MEMBERSHIP MAY NOT BE TRANSFERRED OR ASSIGNED DURING THE LIFE OF THE MEMBER. MEMBERSHIP SHALL NOT PASS BY INHERITANCE OR BEQUEST UPON THE DEATH OF THE MEMBER. A SINGLE MEMBERSHIP MAY BE HELD JOINTLY BY SPOUSES, BUT ONLY ONE SHALL BE ENTITLED TO VOTE AT ANY TIME. OTHERWISE, A MEMBERSHIP IS NOT DIVISIBLE INTEREST AND MAY NOT BE HELD BY MORE THAN ONE PERSON. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS HAVE THE ABILITY TO VOTE IN THE ELECTION OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF THE GOVERNING BOARD HAS DELEGATED OPERATIONAL LEADERSHIP AND OVERSIGHT TO THE EXECUTIVE COUNCIL, THE PRACTICE MANAGEMENT COUNCIL (PMC) AND THE MEDICAL EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COUNCIL IS COMPRISED OF THE SENIOR LEADERSHIP TEAM INCLUDING THE CEO, CMO, CFO, CNO, CAO|GC AND VP OF PRACTICE ADMINISTRATION. THIS TEAM IS STRATEGIC IN NATURE AND REQUIRES SHORT AND LONG TERM DECISION-MAKING THAT ALIGNS WITH THE ORGANIZATION'S VALUES, MISSION AND VISION. THE PMC COUNCIL IS COMPRISED OF THE CMO, THE VP OF PRACTICE ADMINISTRATION, SPECIALTY AND PRIMARY CARE DIRECTORS AND 4 PROVIDER LEADERS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE CLINICAL OPERATIONS OF THE ORGANIZATION. THE MEDICAL EXECUTIVE COMMITTEE IS COMPRISED OF THE CMO, CHIEF OF STAFF AND THE MEDICAL COMMITTEE CHAIRS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE HOSPITAL MEDICAL OPERATIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO. THE FORM 99O WAS PRESENTED TO THE FINANCE COMMITTEE IN MARCH, 2020 FOR REVIEW AND APPROVAL. UPON THE FINANCE COMMITTEE'S APPROVAL, THE FORM 990 WAS PRESENTED TO THE GOVERNING BOARD IN MARCH, 2020 FOR FINAL APPROVAL. UPON THE BOARD'S APPROVAL, THE FORM 990 WAS THEN FILED ELECTRONICALLY. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DETERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THE TOPIC. FORM 990, PART VI, SECTION B, LINE 15 CEO ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED THROUGH THE COMPENSATION COMMITTEE USING OUTSIDE CONSULTANTS AND VARIOUS COMPENSATION SURVEYS AS DEEMED NECESSARY. REVIEWS ARE TYPICALLY DONE IN JANUARY/FEBRUARY OF EACH CALENDAR YEAR. BASED UPON THE COMPENSATION COMMITTEE'S RECOMMENDATION, IT IS PRESENTED TO THE GOVERNING BOARD FOR FINAL REVIEW AND APPROVAL. OTHER OFFICERS THE HUMAN RESOURCE DIRECTOR CONDUCTS OUTSIDE RESEARCH USING COMPENSATION SURVEYS AND DATA TO DETERMINE REASONABLE COMPENSATION. THE CEO IN CONJUNCTION WITH THE HUMAN RESOURCE DIRECTOR'S RECOMMENDATION DETERMINES THE COMPENSATION OF THESE EMPLOYEES. REVIEWS ARE TYPICALLY DONE IN NOVEMBER/DECEMBER OF EACH CALENDAR YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE MEDICAL CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,445,605. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,445,605. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,391,162. MANAGEMENT AND GENERAL EXPENSES 1,036,504. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,427,666. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 1,695,679. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,695,679. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 45,164. MANAGEMENT AND GENERAL EXPENSES 526,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,829. OTHER SERVICES: PROGRAM SERVICE EXPENSES 231,974. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 231,974. 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