2019-09-11T10:56:45-05:00 2018-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-01-01 363311936 Stevens Community Medical Center STEV 3205891313 400 E 1st St Morris MN 56267 John Rau President/CEO 3205891313 2019-09-10 1 Deb Nelson CPA P01264758 6122536500 2019-09-05 199.116.169.122 2019-09-10 11:12:08 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2019-02-21 02:37:17Z John Rau 400 E 1st St Morris MN 56267 40112665 0 X www.scmcinc.org X 1984 MN Promotion of health 12 8 343 111 0 0 185450 276623 39970867 39524414 231798 247213 54415 56032 40442530 40104282 26840 26111 0 0 22439061 22760111 0 0 0 16471291 17286394 38937192 40072616 1505338 31666 54340001 54122623 5163688 4915455 49176313 49207168 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 34008885 26111 39524414 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 29,054 hospital outpatient visits, 31,679 clinic and urgent care visits, 2,410 inpatient days, 8,370 outpatient counseling visits, 97 deliveries, 438 surgeries, 2,502 emergency room visits, and 23,361 therapy treatments in 2018. SCMC also owns and operates the Courage Cottage, an adult foster care facility specializing in care for the terminally ill. In 2018, 10 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 $23,761,470 in 2018. The charges foregone for services supplied under SCMC's charity care policy (free and/or subsidized care) was $837,000 in 2018.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. 34008885 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 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 1 113 0 1 343 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 0 0 MN X Kerrie McEvilly 3205897627 400 E 1st St Morris MN 56267 David Paul Chair 1.00 X X 1190 0 0 Paul Groneberg Vice Chair (Jan-Jun) 1.00 X X 780 0 0 Bart Finzel - Director (Jan-Jul)/Vice Chair(Aug-Dec) 1.00 X X 680 0 0 Jan Hagen Treasurer 1.00 X X 1200 0 0 Ward Voorhees Secretary 1.00 X X 840 0 0 Pieranna Garavaso Director 1.00 X 350 0 0 Jodi DeCamp Director 1.00 X 650 0 0 Paul Martin Director 1.00 X 700 0 0 Darryl Larson Director 1.00 X 400 0 0 Patrick Burke MD Director (Jan-Apr)/Physician 30.00 X 124723 0 40402 Elizabeth Meichsner MD Director/Physician 40.00 X 270595 0 51157 Toby Christie-Perkins DO Director/Physician 40.00 X 357694 0 50569 Jason Huikko MD Director (May-Dec)/Physician 40.00 X 265170 0 11454 Jason Breuer President/CEO (Jan-May) 40.00 X X 243319 0 22117 John Rau President/CEO (May-Dec) 40.00 X X 172076 0 26175 Kerrie McEvilly Vice President of Finance 40.00 X 175918 0 24282 Michael Holte MD Orthopedic Surgeon (Jan-Mar) 40.00 X 642832 0 11110 Randell Lussenden CRNA 40.00 X 484378 0 42126 Andrea Giambi DO Radiologist 40.00 X 466420 0 42984 Somkiat Viratyosin MD General Surgeon 40.00 X 388106 0 55382 Brent Barnstuble MD Physician 40.00 X 360521 0 47919 3958542 0 425677 31 0 1 0 St Cloud Hospital 1406 6th Ave N St Cloud MN 56303 Software Implementation and Support 1652317 Novacare Rehabilitation 4714 Gettysburg Rd Mechanicsburg PA 17055 Therapy Services 856131 Freelance Physicians 3737 Moraga Ave San Diego CA 92117 ER & Urgent Care MD Services 744200 Gilbert Mechanical Contractors 5251 W 74th Street Edina MN 55439 Construction Services 404138 Cerner Health Services Inc 51 Valley Stream Parkway Malvern PA 19355 I.T. Support 394827 14 276623 276623 Patient service revenue 622110 39417670 39417670 Supporting revenue 900099 106744 106744 39524414 221595 221595 55221 0 55221 55221 55221 25618 0 25618 25618 25618 9194 8383 811 811 40104282 39524414 0 303245 X 26111 26111 1843866 1172357 671509 16361513 14097595 2263918 872690 742434 130256 2536700 2022533 514167 1145342 945245 200097 32828 32828 62430 62430 4556619 4202814 353805 114663 13912 100751 1816708 1565483 251225 2068362 1108501 959861 430185 360792 69393 92278 85843 6435 49146 37706 11440 2456415 2033128 423287 314612 302283 12329 Medical supplies 3188880 3188880 Bad debts expense 771825 771825 MN Care tax 586856 586856 Pharmacy 340B Program C 444783 444783 299804 299804 40072616 34008885 6063731 0 42916 28388 12013845 11166247 7507754 8852756 1243631 1275075 196634 154466 50059663 30147535 21013566 19912128 12182047 12522671 139608 210892 54340001 54122623 5003688 4778999 160000 136456 5163688 4915455 X 49087719 49136826 88594 70342 49176313 49207168 54340001 54122623 X 31666 -811 X 0 1 X 1 0 X 1 24308 9194 8383 25119 0 371723 371723 29657573 14358747 15298826 19408614 15391857 4016757 621753 396931 224822 19912128 Estimated third party payor settlements 136456 136456 X 39331646 -771825 -771825 40103471 811 811 40104282 39300791 0 39300791 771825 771825 40072616 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: Provision for bad debts in revenue for financial statements -771,825. Part XI, Line 4b - Other Adjustments: Auxiliary net income not included in financial statements 811. Part XII, Line 4b - Other Adjustments: Provision for bad debts in revenue for financial statements 771,825. 1 1 X 1 X 1 X 170.000000000000 1 1 1 0 1 1 502000 502000 0.01280 5095634 4020796 1074838 0.02730 2252771 1725277 527494 0.01340 7850405 5746073 2104332 0.05350 114949 114949 0.00290 95273 95273 0.00240 6826 6826 0.00020 217048 217048 0.00550 8067453 5746073 2321380 0.05900 26071 26071 0.00070 61792 61792 0.00160 87863 87863 0.00230 0 771825 31202 10914223 10974724 -60501 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 16 1 0 0 1 X See Section C X 1 16 1 See Section C 0 1 X 100.000000000000 170.000000000000 X X X X 1 1 X X X X 1 X See Section C X See Section C X See Section C X 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 received input from a wide representation of the community it serves when conducting the 2016 Community Health Needs Assessment. We hosted a community forum in November 2016 at the Morris Senior Center that was attended by 38 individuals (another 10 were invited but unable to attend). 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, university and high school students, and others. Multiple staff members from Horizon Public Health were active participants as well. 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. It was a very productive evening and there are plans for future collaboration to go into more depth on some of the issues discussed. SCMC then designed its 3-year implementation plan to outline how we might best be able to address some of the identified needs. Stevens Community Medical Center Part V, Section B, Line 11: The 2016 Community Health Needs Assessment conducted by the Stevens Community Medical Center (SCMC) identified a wide range of current issues in the county, as well as the residents and community leaders' concerns for the future. Included in those are the various needs of the aging population, adequate resources for addressing mental health issues, continuing access to healthcare providers in rural Minnesota, as well as obesity and lifestyle choices which negatively impact a person's health and wellbeing. 1. Mental Health - need for more services and resources Two of SCMC's mental health providers participated in the Day at Home event held in Alexandria, Minnesota in the fall of 2018. Several representatives from the Minnesota Legislature were present to hear the concerns/needs of both mental health professionals and consumers. SCMC was successful in obtaining the services of a Child and Adolescent Psychiatrist from the beginning of 2018 to October of 2018. We also participated in the 2018 Stevens County Health Fair, educating the public about the various services available at SCMC to address behavioral health concerns. 2. Access to Health Care Providers:SCMC has successfully added not one, but two orthopedic surgeons. The orthopedic team includes Dr. Paul Havel and Dr. Richard Bergstrom. Dr. Timothy Jay will be starting in the fall of 2020 after finishing his residency as an orthopedic surgeon. In addition to these orthopedic surgeons, efforts are underway for a contract with Dr. Michael Holte for an additional 1 day per week orthopedic coverage in clinic and surgical assistance in the coming months. SCMC hired Risa Dorweiler, dermatology Nurse Practitioner as a much needed addition to the need in dermatology care team. SCMC continues to search for an internal medicine physician. Emergency Care made a transition from a contract with an outside firm to having four ER physicians primarily devoted to SCMC's ER department. Dr. Jason Hughes took on the ER Medical Director role.3. Transportation:SCMC continues to bear the cost of transit for area residents to travel to SCMC for appointments using either the Morris Transit or Rainbow Rider services. Signage and a phone were added to the front entrance to help assist patients and guests to contact local transportation. 4. Health Impact for Poor Lifestyle choices:In 2018, SCMC again sponsored the annual Fall into Health free event where the primary goal was to communicate the importance of healthy choices to our community, with all ages welcome. We offered access to free lab tests, flu shots, a free community (healthy) meal, many information booths staffed by SCMC and community members and others where healthy choices were promoted. 170 people participated in the lab tests, 46 in the flu shots and 350 enjoyed the free meal. The SCMC provider panel and keynote speaker's message all encouraged the community's healthy choices and answered questions about the future of health, what SCMC has to offer and the importance of staying on top of it (physical, mental, and environmental).The Power of Produce was another health initiative SCMC provided during the summer months. P.O.P. participated with the local Farmers Market and each week Power of Produce created a new activity educating and attracting the younger generation by showing them the fun in eating healthy and making good food choices. This project is led and organized by the SCMC dietician with the help of summer interns and the marketing department at SCMC.In 2018, the SCMC Registered Dietitian (RD) led a comprehensive weight management program called Renew Weight Management Program, impacting 17 people. SCMC connected with the Regional Fitness Center in our community to offer the fitness component of the program. The registered dietitian also offered group nutrition classes to various community groups. This included Morris Area Elementary School ECFE where the RD discussed toddler and pre-K nutrition with 15 parents. She also led health-conscious grocery store tours with 11 total participants as part of the University of Minnesota-Morris employee wellness program.In 2018, SCMC Courage Cottage again sponsored the annual Turkey Trot. There were 93 participants. This was a fun, healthy, community activity that also served as a fundraiser for the Courage Cottage, SCMC's adult foster care home. 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 MNSure applications and assist patients in applying for programs where there is a need and possibility for basis of eligibility. We are also an HPE (Hospital Presumptive Eligibility) site and provide and screen for short term medical assistance approvals. Schedule H, Part V, Section B, line 7a: https://scmcinc.org/sites/default/files/Community%20Health%20Needs%20Assessment%202016_1.pdf Schedule H, Part V, Section B, line 10a: https://scmcinc.org/sites/default/files/Implementation%20Plan%202016%20CHNA_0.pdf Schedule H, Part V, Section B, line 16a: https://scmcinc.org/sites/default/files/Full Policy Financial Assistance_0.pdf Schedule H, Part V, Section B, line 16b: https://scmcinc.org/sites/default/files/Stevens Community Care Application.pdf Schedule H, Part V, Section B, line 16c: https://scmcinc.org/sites/default/files/Financial%20assistance%20policy_0.pdf 2 1 - Starbuck Clinic 501 Poler Street Starbuck MN 56381 Rural Health Care Clinic 2 - Courage Cottage 409 East 1st Street Morris MN 56267 Adult Foster Care Facility Part I, Line 3c: The following factors are used by the organization to help determine eligibility for Financial Assistance: -Proof of household income (such as social security award letters, pay stubs and tax returns).-Assessing the patient's ability to make reasonable monthly payments on balance owed (expense form reflecting household income and expenses).-When income and expense documentation doesn't reflect an accurate picture of a patient's ability to pay, additional considerations are made (e.g. wages have changed since the last filed tax return).-SCMC provides assistance in applying for healthcare programs where applicable. Status of insurance is reviewed at application. -SCMC does not consider assets in the determination of eligibility for Financial Assistance.Along with the above considerations, the Federal Poverty Guidelines (FPG) are reviewed and the most appropriate discount is offered. The organization provides a 23% self-pay discount; and 40 to 80% FinancialAssistance discount when income levels meet 170% down to 101% of the 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 expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. 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 $771,825. Part II, Community Building Activities: In 2018 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 close to $62,000 in local real estate taxes for our two 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: A review of all bad debt account notes from 2018 was performed. The amount reported in Part III, line 3 is comprised of accounts where the patient indicated interest in FAP, an application was sent, but was either not returned or returned with incomplete documentation. All accounts shown in this figure reflect several attempts to receive an application and supporting documentation. Therefore, a reasonable determination for Financial Assistance eligibility could not be made and it is reasonable to consider this amount as charity care. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses is located in Footnote 1 on page 6 and 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 Critical Access Hospital. There was a shortfall for 2018. 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: Patients that qualify for FAP are sent an approval letter with percentage of discount extended and effective dates of approval. For partial FAP eligibility the letter outlines any remaining balance due and lists several options including reasonable payments to satisfy the remainder of the balance. The collections cycle starts over for FAP qualifying applicants. There would need to be another 120 days before ECA's would be initiated but we try to avoid this wherever possible being flexible with payments that are reasonable. The 30-day notice is satisfied via the final notice letter provided in absence of payment for an account with no payments or contact at 90 days from billing cycle (plain language summary is sent at this time). The patient has 240 days from first billing cycle in which to apply for FAP. Our collection agency is aware of these regulations. If the patient is sent to collections after 120 days but within the 240-day application period window, our collection agency assists us with patient coordination if the patient shows interest in applying for financial assistance. 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. In addition we conducted a Community Health Needs Assessment in 2016. 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 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. The charity care guidelines, policy, plain language summary, application, instructions and contact information are posted on our website. 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 Financial Assistance, 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. Final notices for non-payment are sent at least 90 days after first statement delivery, the plain language summary is also mailed. Calls are also being placed throughout this timeframe to prevent accounts from going to bad debt by obtaining reasonable payment and educating on FAP availability. 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 64% of our inpatients are Medicare and/or Medicare HMO and another 11% 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.Stevens County is a federally designated Health Professional Shortage Area (HPSA) for both primary care and mental health. Pope County, where the Starbuck Clinic is located, is also a federally designated HPSA. Part VI, Line 5: As described earlier, SCMC has a community Board of Directors that represent specific portions of our service area. 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. SCMC 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.SCMC is the only hospital in Morris.MERC Program/Residency/Internships- SCMC has benefited from Medical Residency and FNP programs that participate in the MERC funding program. This assists SCMC with the costs associated with clinical rotations, such as extra hours and lodging expenditures. It allows SCMC to continue to support the growth of students in Rural Health Care programs. Courage Cottage donations are used to support end of life care, as SCMC identified that as a community need. SCMC's administration advocates with government contacts to encourage measures that will improve the overall health of the community we serve.SCMC is an advocate for the change to tobacco sales in Stevens County. Commissioners voted to ban the sale of tobacco products to those under the age of 21 effective August 1st. SCMC also plans to remove a smoking shed from their property. Part VI, Line 7, Reports Filed With States MN X X 1 0 0 1 0 0 0 0 0 Patrick Burke MD Director (Jan-Apr)/Physician 121463 0 3260 0 0 0 10260 0 30146 0 165129 0 0 0 Elizabeth Meichsner MD Director/Physician 265713 0 102 0 4780 0 14438 0 36898 0 321931 0 0 0 Toby Christie-Perkins DO Director/Physician 271105 0 86278 0 311 0 16500 0 34312 0 408506 0 0 0 Jason Huikko MD Director (May-Dec)/Physician 263194 0 1759 0 217 0 1136 0 10484 0 276790 0 0 0 Jason Breuer President/CEO (Jan-May) 125912 0 0 0 117407 0 8032 0 14127 0 265478 0 0 0 John Rau President/CEO (May-Dec) 170903 0 0 0 1173 0 13534 0 12743 0 198353 0 0 0 Kerrie McEvilly Vice President of Finance 165832 0 101 0 9985 0 13809 0 11161 0 200888 0 0 0 Michael Holte MD Orthopedic Surgeon (Jan-Mar) 267164 0 41183 0 334485 0 5692 0 5418 0 653942 0 0 0 Randell Lussenden CRNA 126088 0 354446 0 3844 0 21313 0 21031 0 526722 0 0 0 Andrea Giambi DO Radiologist 141753 0 321364 0 3303 0 21313 0 22007 0 509740 0 0 0 Somkiat Viratyosin MD General Surgeon 364222 0 3852 0 20032 0 21313 0 34353 0 443772 0 0 0 Brent Barnstuble MD Physician 246101 0 114019 0 401 0 16500 0 31696 0 408717 0 0 0 Part I, Line 4a Jason Breuer (President/CEO) received a separation payment of $117,300 in 2018. His employment ended on 5/14/18. 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 CRNAs also receive quarterly bonuses contingent on the services they provide 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 11b 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 The Board of Directors references the MN Hospital Association CEO Compensation Survey when reviewing the CEO's compensation on an annual basis. Besides participating in MHA compensation surveys, SCMC also references Medi-Sota and HHRAM compensation surveys that includes 49 hospitals in MN for various positions. 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 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 633,540. Management and general expenses 93. Fundraising expenses 0. Total expenses 633,633. Purchased services: Program service expenses 3,569,274. Management and general expenses 285,450. Fundraising expenses 0. Total expenses 3,854,724. Other Support Fees: Program service expenses 0. Management and general expenses 68,262. Fundraising expenses 0. Total expenses 68,262. Form 990, Part XI, line 9: Auxiliary Activity included for tax -811.