2019-11-01T07:10:39-05:00 2018-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-01-01 410726171 International Falls Memorial Hospital Association INTE 2182835401 1400 Highway 71 International Falls MN 56649 Melissa Marcotte CFO 2182835401 2019-10-28 1 Kim Hunwardsen CPA P00484560 6122536500 2019-10-28 216.147.181.49 2019-10-28 11:07:57 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2018 2020-01-14 16:20:31Z Rainy Lake Medical Center Robert Pastor II 1400 Highway 71 International Falls MN 56649 27507071 0 X www.rainylakemedical.com X 1945 MN To promote and provide health care and wellness services in our region that exceed expectations. 7 7 215 32 120 0 99973 245547 27053124 27139015 58460 53823 66399 65943 27277956 27504328 0 0 0 0 12716939 12577721 0 0 0 14488963 14109030 27205902 26686751 72054 817577 24442231 26399757 9329721 10382860 15112510 16016897 X Provide accessible quality healthcare to our communities using values of Respect, Integrity, Compassion and Excellence (RICE) in support of the vision comprised of the following elements: provider of choice for our communities, patient and family-centered care, expanding services, regional specialty relationships and preferred healthcare employer. 0 0 23116929 27138895 Provided health care services to the community of International Falls and surrounding area. In addition to providing direct patient care and in furtherance of its charitable purpose, Rainy Lake Medical Center (RLMC) provides a wide variety of benefits to the community including offering various community based service programs, cash contributions to non-profit agencies, the donation of space for use by community groups, and staff time of mentoring/job shadowing. Additionally, a number of health related education programs are provided for the benefit of the community, including health enhancements and wellness, classes on specific conditions, and programs designed to improve the general standards of the health of the community. RLMC also actively promotes its community care program, which provides free or reduced cost healthcare to patients who are unable to pay fully for services received. 23116929 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 1 0 0 0 1 72 0 1 215 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Melissa Marcotte 2182835431 1400 Highway 71 International Falls MN 56649 Susan Congrave Chair 4.00 0.00 X X 0 0 0 Jon Talsness MD Vice Chair 4.00 0.00 X X 0 0 0 Brian Briggs Secretary 4.00 2.00 X X 0 0 0 Don Billig Treasurer 4.00 0.00 X X 0 0 0 Robert Anderson Member 4.00 0.00 X 0 0 0 Richard Peterson Member 4.00 2.00 X 0 0 0 Steven Lindberg Member 4.00 0.00 X 0 0 0 Robert Pastor II CEO (as of Aug 2018) 40.00 1.00 X 123097 0 6300 Bonnie Erickson CEO (thru Aug 2018) 40.00 1.00 X 164520 0 0 Melissa Marcotte CFO 40.00 1.00 X 138638 0 3091 Jay Knaak Physician 40.00 0.00 X 280309 0 35440 Kimberly Versteeg Physician 40.00 0.00 X 242940 0 30055 Nancy Burmeister Nurse Practioner 40.00 0.00 X 145996 0 15534 Rio Silvernail Physician Assistant 40.00 0.00 X 135528 0 14539 Katie Chezick Pharmacy Director 40.00 0.00 X 131145 0 23641 1362173 0 128600 17 0 1 0 Acute Care Inc 1609 N Ankeny Blvd Suite 200 Ankeny IA 50023 Physician Fees 1725213 Kraus-Anderson Construction Co 206 Beltrami Ave NW Bemidji MN 56601 Construction Contractor 781493 Central MN Diagnostic Inc 525 10th St NE/PO Box 158 Milaca MN 56353 CT, Ultrasound, Mammography, MRI Lease 728108 RC Shefland Anesthesia LTD 27040 Cty Road 9 Bemidji MN 56601 Anesthesiologist Fees 485406 Aureus Radiology LLC CA Industries PO Box 3037 Omaha NE 68103 Contract Labor 323746 17 45158 184617 15772 245547 Patient Service Revenue 621990 26858826 26858826 Equity in Earnings of JV 621990 187727 187727 92462 92342 120 27139015 51609 51609 65943 0 65943 65943 65943 2757 2200 2743 0 14 2200 2214 2214 27504328 27138895 120 119766 X 437400 437400 10044793 9261683 783110 184808 165879 18929 1159312 1030186 129126 751408 664454 86954 23637 23637 32887 32887 5711827 4986343 725484 128228 128228 281375 124671 156704 386963 386963 26799 21264 5535 60948 37836 23112 267316 184448 82868 1490401 1028377 462024 109800 75762 34038 Medical Supplies 3371369 3371227 142 Bad Debts 828093 828093 Repairs and Maintenance 592917 295374 297543 MN Care Tax 224755 224755 571715 429614 142101 26686751 23116929 3569822 0 4376027 5126303 2897856 3779088 511421 566603 193830 158032 26565110 12363735 13970873 14201375 1902207 1925592 590017 642764 24442231 26399757 2464489 2495135 5623070 6757011 1242162 1130714 9329721 10382860 X 15041165 16002814 71345 14083 15112510 16016897 24442231 26399757 X 817577 -12673 99483 X 0 1 X 1 0 X 0 0 0 0 0 1 443 0 0 0 443 0 Part II-B, Line 1: The organization pays dues to various professional organizations. A portion of these dues are used towards lobbying expenses. The lobbying expenses go towards advocating for the organization's purpose and mission. 87371 87371 17001383 5111042 11890341 782191 349025 433166 8642305 6903668 1738637 51860 51860 14201375 Asset Retirement Obligation 18550 Estimated Third-Party Payor Settlements 1112164 1130714 X 26744844 -12673 -744611 -757284 27502128 2200 2200 27504328 25856458 -2200 -2200 25858658 828093 828093 26686751 Part X, Line 2: The 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 Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Center files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The 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 consolidated financial statements. The 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: Provision for Bad Debts included in revenue for financial statement -828,093. Change in unrecognized pension costs 99,483. Foundation net inc/(loss) recorded in temp. restricted contribution income -16,001. Part XI, Line 4b - Other Adjustments: Gain on disposal of Equipment reported in Expenses for Financial Statement 2,200. Part XII, Line 2d - Other Adjustments: Gain on disposal of Equipment reported in Expenses for Financial Statement -2,200. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts included in revenue for financial statement 828,093. 1 1 X 1 X 1 X 1 1 0 1 1 57487 57487 0.00220 57487 57487 0.00220 24195 2455 21740 0.00080 9111 9111 0.00040 14474587 10033052 4441535 0.17180 2800 2800 0.00010 14510693 10035507 4475186 0.17310 14568180 10035507 4532673 0.17530 5428 5428 0.00020 27860 27860 0.00110 20000 20000 0.00080 53288 53288 0.00210 1 828093 0 5722879 5832421 -109542 X 1 1 1 1 Rainy Lake Medical Center 1400 Highway 71 International Falls MN 56649 www.rainylakemedical.com 365894 X X X X 2 Rural Health Clinics/Specialty Provider-Based Clinic Rainy Lake Medical Center 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X https://www.rainylakemedical.com X 1 16 1 https://www.rainylakemedical.com 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X http://rainylakemedical.com/patient-resources/ X https://www.rainylakemedical.com/patient-resources/ X http://rainylakemedical.com/patient-resources/ X X X X X X 1 X 0 X X X X 1 X 0 0 Rainy Lake Medical Center Part V, Section B, Line 5: RLMC identified and surveyed 29 key community stakeholders representing a broad section of the community including local service providers, members of the religious community, business owners, and citizens from International Falls and the greater county. The agencies represented included those serving the medically underserved, low-income and minority populations of International Falls and Koochiching County. RLMC conducted two separate surveys: the first to obtain opinions regarding RLMC's success in implementing actions subsequent to its 2013 Community Needs Assessment, and the second survey asked for input on the current state of health in the community, what needs are unmet and which are of high priority. Rainy Lake Medical Center Part V, Section B, Line 6b: Quorum Health Resources assisted with the development of RLMC's Community Health Needs Assessment. Rainy Lake Medical Center Part V, Section B, Line 11: Actions taken during 2018 to address the identified needs for Accessibility and Affordability, Pre-existing conditions and improved Emergency Room Services include:-The expansion/improvement of the chemotherapy/infusion therapy department with a $1.5M renovation of their space.-The rollout of a Nurse Practitioner Hospitalist program which relieved the ER physicians from serving in a dual role and also improved RLMC's admit vs. transfer rate-Continued focus on enhancing the current EHR by installing the CPSI MUE bundle -Reaching agreement and establishing processes with Essentia Health to allow mutual access to viewing patient records through EpicCare Link.The following are community needs thatwere identified during the 2016 Community Health Needs Assessment but notaddressed by RLMC:1. Mental Health/Suicide (duplication of effort with local Essentia HealthClinic and other community Mental Health providers).2. Substance Abuse (outside of RLMC's mission)3. Alzheimer's (duplication of services with other community providers andoutside of RLMC's mission). Rainy Lake Medical Center Part V, Section B, Line 15e: The contact phone number is listed on the website and provided in all statements and letters mailed, and a business card is included in the application packet. Rainy Lake Medical Center Part V, Section B, Line 16j: Work closely with County services and community senior advocate. Part I, Line 6a: RLMC makes its community benefit data available to the public by including it in their audited financial statements and through the Minnesota Hospital Association Annual Report. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, line 7e, Health Professions Education, line 7f and Cash and in-kind contributions, line 7i, are reported based on actual expense amounts recorded in the general ledger. The cost for subsidized health services, line 7g, was determined using the Cost Report. Part I, Line 7g: Costs of the Specialty Clinic included are $1,341,462 for salaries, supplies and overhead allocations Part I, Ln 7 Col(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 $828,093. Part II, Community Building Activities: RLMC invests resources towards emergency preparedness, particularly a "decontamination team" that conducts drills throughout the year. The team is skilled in setting up a portable decontamination tent, dressing in an appropriate level of PPE and practicing decontaminating patients. RLMC also supports efforts to have the safe removal and treatment of garbage and waste products. RLMC also provides support to an educational institution in the area to help train health professionals. Part III, Line 2: For receivables associated with self-pay accounts, a provision for bad debts is recorded in the period of service based on past experience. Part III, Line 4: The footnote that describes bad debt expense is found on page 10 of the attached audit report. Part III, Line 8: RLMC is a critical access hospital. There was a shortfall for 2018due to sequestration. Even though Medicare was at a loss, the Hospitalprovides services to these patients because access to healthcare andindividual's health is important to the Hospital. Therefore, the Medicareshortfall is considered a community benefit.Medicare allowable costs were obtained from the 2018 Medicare cost report.The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: RLMC will not refer an account to a third party debt collection agency unless RLMC has given the patient reasonable opportunity to submit a community care application if the facts and circumstances suggest the patient may be eligible for community care, including for example, if the patient is uninsured or is on Minnesota Care, Medical Assistance, or other relief based on need. If a patient submits an application for community care after an account has been referred for collection activity, RLMC will suspend all collection activity until the patient's application has been processed and the patient has been notified of the decision. Part VI, Line 2: In addition to the Community Health Needs Assessment completed every 3 years, community health fairs are held where community members can provide feedback on their health care needs. A Patient & Family Advisory Council (PFAC) has also been formed which provides a link between the community and the organization. RLMC also has representation at the quarterly Community Mental Health meeting, which also includes social services, local mental health providers and law enforcement. The goal of the group is to share resources and address the local mental health needs. Part VI, Line 3: RLMC has staff that are Minnesota Community Application Agent (MNCAA) certified, which enables us to assist our patients with the Minnesota Care application process. RLMC communicates to patients our Community Care Program (Charity Care) in the following manner:1. Patients are given a Community Care brochure with a Minnesota Care insert at time of service.2. Statements and letters sent to patients offering Community Care.3. Phone calls are made to patients to discuss and offer Community Care and assistance with the Minnesota Care application process.4. All employees are educated annually about our Community Care program and three employees are educated to complete and submit Minnesota Care applications to the state for processing.5. Upon request, Community Care packets with applications for both our Community Care Program and the Minnesota Care Insurance are sent or given to patients.6. The RLMC website displays payment options where our Community Care Program is discussed. 7. One of the requirements for RLMC Community Care is a denial from the county in regards to financial assistance unless they are enrolled in the MN Senior Program. We offer to assist them with their Medical Assistance application.8. Signage communicating the Program to patients is displayed in many areas of the patient care area of the facility.9. Financial Counselors attend health fairs and other events in the community to promote the Program and answer any questions. Part VI, Line 4: RLMC's primary service area (PSA) is Koochiching County, Minnesota. The county is large and sparsely populated (less than 4.3 persons per square mile) with most of the population centered in International Falls. Other nearby communities includes Littlefork, Big Falls, Ranier, Birchdale and Loman. The PSA has an estimated population of less than 13,000 and population decline is projected to continue while the number of persons over 65 is expected to rise even more. Part VI, Line 5: Representation on the Board of Trustees is 100% local as all trustees are active and involved members of the local community. RLMC has in place an open medical staff model, and has specialists from several different health care systems providing care to patients. The organization has recently invested over $8 million in expansion and renovation of the current facility in order to provide better patient care and more local care, eliminating the need to travel 100+ miles to receive care. The organization also continues to expand the breadth of specialty services offered locally on an outreach basis.Emergency services are offered 24/7, 365 days a year to all needing care.Because of its remote location, if services of Chemotherapy and Labor/Delivery were not offered in the community, residents would have to travel 100+ miles to receive these critical services. The organization recently established a Patient & Family Advisory Council (PFAC) to allow for community input. Part VI, Line 7, Reports Filed With States MN X X 0 0 0 0 0 0 0 0 0 Bonnie Erickson CEO (thru Aug 2018) 142308 0 0 0 22212 0 0 0 0 0 164520 0 0 0 Jay Knaak Physician 273309 0 5000 0 2000 0 5400 0 31444 0 317153 0 0 0 Kimberly Versteeg Physician 242940 0 0 0 0 0 4856 0 26603 0 274399 0 0 0 Nancy Burmeister Nurse Practioner 126668 0 19328 0 0 0 2967 0 13971 0 162934 0 0 0 Rio Silvernail Physician Assistant 113438 0 22090 0 0 0 2742 0 13147 0 151417 0 0 0 Katie Chezick Pharmacy Director 125881 0 0 0 5264 0 2833 0 22211 0 156189 0 0 0 Form 990, Part VI, Section A, line 1 The Executive Committee will consist of the Chair, the Vice Chair, the Secretary and the Treasurer elected by the Board of Trustees at its first meeting after election. The Chair shall serve as chair of the Executive Committee. The Executive Committee will have the power to transact all regular business of the Medical Center, as authorized by the full Board, during the interim between meetings of the Board of Trustees, provided any action taken will not conflict with the policies and expressed wishes of the Board of Trustees, and that it will refer all matters of major importance to the Board of Trustees. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by the same accounting firm which prepares the audit and then it is reviewed by the CFO and CEO. In addition, a copy of the return is provided to the Board of Trustees for review before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The Organization's officers, directors, and key employees are reminded of the conflict of interest policy and must sign a conflict of interest statement annually. When a conflict of interest exists, the interested trustee may be present for discussion to answer questions, but may not advocate for the action to be taken and may be asked to leave the room while a vote is taken. Form 990, Part VI, Section B, line 15 The compensation for the CEO is set by the Board of Directors and is documented in the board minutes and CEO's written contract. To set the CEO's compensation, RLMC uses three external reports for determining and setting salary ranges. These include the Minnesota Hospital Association Salary Survey Report, the "HHRAM" (Healthcare Human Resources Association of Minnesota) Salary Survey Book, and the Medical Group Management Associate (MGMA) Physician Compensation Report Survey. The compensation for other officers and key employees is reviewed and approved by the CEO. HHRAM Salary Survey is used in determining these salaries as well as longevity and performance evaluations. These decisions are documented in the employee's personnel file. All reviews are performed as least annually. Form 990, Part VI, Section C, line 19 The governing documents, financial statements, and conflict of interest policy are not open to the public. Form 990, Part IX, line 11g Contracted Services: Program service expenses 885,543. Management and general expenses 3,240. Fundraising expenses 0. Total expenses 888,783. Purchased Services: Program service expenses 644,373. Management and general expenses 493,216. Fundraising expenses 0. Total expenses 1,137,589. Physician Fees: Program service expenses 2,389,724. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,389,724. Other Fees: Program service expenses 29,137. Management and general expenses 196,629. Fundraising expenses 0. Total expenses 225,766. Equipment Rent: Program service expenses 1,037,566. Management and general expenses 32,399. Fundraising expenses 0. Total expenses 1,069,965. Form 990, Part XI, line 9: Change in unrecognized pension costs 99,483. Falls Memorial Hospital Foundation Inc 1400 Highway 71 International Falls MN 56649 204585807 Support MN 501(c)(3) Line 12a, I Rainy Lake Medical Center 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0