STEVENS COMMUNITY MEDICAL CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- STEVENS COMMUNITY MEDICAL CENTER INC (EIN 36-3311936)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-15
- IRS object ID
- 201312279349302786
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-15T13:29:21-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 NICOLLET MALL STE 1300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363311936 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEVENS COMMUNITY MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STEV | NameControl |
| Phone | 3205891313 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 660 | AddressLine1 |
| City | MORRIS | City |
| State | MN | State |
| ZIP Code | 56267 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN RAU | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 3205891313 | Phone |
| Date Signed | 2013-08-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SARAH VOGT CPA | Name |
| PTIN | P00978242 | PTIN |
| Phone | 6122536500 | Phone |
| Date Prepared | 2013-08-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN RAU | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 660 | AddressLine1 |
| City | MORRIS | City |
| State | MN | State |
| ZIP Code | 56267 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 38683477 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SCMCINC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1984 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | PROMOTION OF HEALTH | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 360 | TotalNbrEmployees |
| Total Nbr Volunteers | 141 | TotalNbrVolunteers |
| Total Gross UBI | 379 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 156671 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 186187 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 37492772 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 38208841 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 284359 | InvestmentIncomePriorYear |
| Investment Income Current Year | 216409 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 54147 | OtherRevenuePriorYear |
| Other Revenue Current Year | 49786 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 37987949 | TotalRevenuePriorYear |
| Total Revenue Current Year | 38661223 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 20592 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 21015 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21545797 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21756739 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14942991 | OtherExpensePriorYear |
| Other Expenses Current Year | 15142680 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 36509380 | TotalExpensesPriorYear |
| Total Expenses Current Year | 36920434 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1478569 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1740789 | RevenuesLessExpensesCY |
| Total Assets BOY | 43816556 | TotalAssetsBOY |
| Total Assets EOY | 42758014 | TotalAssetsEOY |
| Total Liabilities BOY | 11760896 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8961734 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 32055660 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 33796280 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 31078759 | Expense |
| Grants | 21015 | Grants |
| Revenue | 38208841 | Revenue |
| Description | STEVENS COMMUNITY MEDICAL CENTER IS A NOT-FOR-PROFIT INTEGRATED HEALTH CARE SYSTEM. THE MISSION OF THE MEDICAL CENTER IS TO MAKE AVAILABLE HIGH QUALITY HEALTH CARE. THE MEDICAL CENTER SERVES THE POPULATION OF WEST CENTRAL MINNESOTA AND IS BECOMING A REGIONAL HEALTH CARE CENTER."CARING IS OUR REASON FOR BEING"SCMC PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF SCMC, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. TO FURTHER THAT, OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. FOR EXAMPLE, THE MEDICAL CENTER IS COMMITTED TO PROVIDING MEDICAL SERVICES TO ALL MEMBERS OF ITS COMMUNITY, PROVIDE FREE CARE AND/OR SUBSIDIZED CARE, PROMOTE HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY, AND PROVIDE CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THEREFORE, FINANCIAL ASSISTANCE WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY EXISTS. SCMC HAD 31,366 HOSPITAL OUTPATIENT VISITS, 30,332 CLINIC AND URGENT CARE VISITS, 3,438 INPATIENT DAYS, 7,893 OUTPATIENT COUNSELING VISITS, 91 DELIVERIES, 694 SURGERIES, 2,435 EMERGENCY ROOM VISITS, AND 18,708 THERAPY TREATMENTS IN 2012. SCMC ALSO OWNS AND OPERATES THE COURAGE COTTAGE, AN ADULT FOSTER CARE FACILITY SPECIALIZING IN CARE FOR THE TERMINALLY ILL. 20 RESIDENTS WERE SERVED IN 2012, 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 $23,109,004 IN 2012. THE CHARGES FOREGONE FOR SERVICES SUPPLIED UNDER SCMC'S CHARITY CARE POLICY (FREE AND/OR SUBSIDIZED CARE) WAS $1,133,516 IN 2012.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. | Description |
| Total Program Service Expense | 31078759 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 135 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 360 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERRIE MCEVILLY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3205897627 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 E 1ST ST | AddressLine1 |
| City | MORRIS | City |
| State | MN | State |
| ZIP Code | 56267 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DAVID PAUL | |||||||
| CHAIR | 1.00 | X | X | 350 | 0 | 0 | |
| PAUL GRONEBERG | |||||||
| VICE CHAIR | 1.00 | X | X | 330 | 0 | 0 | |
| JAN HAGEN | |||||||
| TREASURER | 1.00 | X | X | 210 | 0 | 0 | |
| WARD VOORHEES | |||||||
| SECRETARY | 1.00 | X | X | 300 | 0 | 0 | |
| PIERANNA GARAVASO | |||||||
| DIRECTOR | 1.00 | X | 225 | 0 | 0 | ||
| JODI DECAMP | |||||||
| DIRECTOR | 1.00 | X | 200 | 0 | 0 | ||
| BART FINZEL | |||||||
| DIRECTOR | 1.00 | X | 200 | 0 | 0 | ||
| PAUL MARTIN | |||||||
| DIRECTOR | 1.00 | X | 250 | 0 | 0 | ||
| DARRYL LARSON | |||||||
| DIRECTOR | 1.00 | X | 200 | 0 | 0 | ||
| OLYN WERNSING MD | |||||||
| DIRECTOR / PHYSICIAN | 40.00 | X | 158532 | 0 | 28426 | ||
| KIM TATSUMI MD | |||||||
| DIRECTOR / PHYSICIAN | 40.00 | X | 187818 | 0 | 32376 | ||
| GREG ABLER MD | |||||||
| DIRECTOR/PHYSICIAN | 40.00 | X | 330641 | 0 | 31670 | ||
| JOAN LUNZER MD THRU JUNE 2012 | |||||||
| DIRECTOR / INTERNIST | 40.00 | X | 214758 | 0 | 35369 | ||
| JOHN RAU | |||||||
| PRESIDENT / CEO | 40.00 | X | X | 272739 | 0 | 41100 | |
| KERRIE MCEVILLY | |||||||
| DIRECTOR OF FINANCE/IS | 40.00 | X | 134575 | 0 | 25379 | ||
| ANDREA GIAMBI DO | |||||||
| RADIOLOGIST | 40.00 | 573374 | 0 | 21253 | X | ||
| MICHAEL HOLTE MD | |||||||
| ORTHOPEDIC SURGEON | 40.00 | 646961 | 0 | 32170 | X | ||
| RANDELL LUSSENDEN | |||||||
| CRNA | 40.00 | 480174 | 0 | 29571 | X | ||
| JACK MUTNICK MD | |||||||
| ALLERGIST | 40.00 | 713882 | 0 | 35195 | X | ||
| JAMES GREEN MD | |||||||
| ORTHOPEDIC SURGEON | 40.00 | 634806 | 0 | 20529 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4350525 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 333038 | TotalOtherCompensation |
| Number Individuals GT100 K | 27 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NORTH STAR PHYSICIANS SERVICES | |||||
| 2680 28TH AVE SW | CAMBRIDGE | MN | 55008 | ER AND URGENT CARE MD SERVICES | 1007400 |
| NOVACARE REHABILITATION | |||||
| 4714 GETTYSBURG RD | MECHANICSBURG | PA | 17055 | THERAPY SERVICES | 497376 |
| SIEMENS MEDICAL SOLUTIONS USA | |||||
| 51 VALLEY STREAM PARKWAY | MALVERN | PA | 19355 | IS SUPPORT/IMPLEMENTATION | 433179 |
| ROBERT TILLMAN | |||||
| 1173 E LAKE GENEVA | ALEXANDRIA | MN | 56308 | CRNA SERVICES | 240015 |
| TECHNICAL LIFE CARE MEDICAL CO | |||||
| 4601 WESTON WOODS WAY | WHITE BEAR TOWNSHIP | MN | 55127 | EQUIPMENT SUPPORT | 146092 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 21 | NumberOfContractorsGT100K |
| All Other Contributions | 186187 | AllOtherContributions |
| Total Contributions | 186187 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 622110 | 38121146 | 38121146 | |
| SUPPORTING REVENUE | 900099 | 87316 | 87316 | |
| NON PATIENT SALES | 900099 | 379 | 379 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 38208841 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 230560 | TotalRevenueColumn |
| Exclusion | $230,560 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 48572 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 48572 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48572 | TotalRevenueColumn |
| Exclusion | $48,572 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 14151 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -14151 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -14151 | TotalRevenueColumn |
| Exclusion | -$14,151 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 9317 | GrossSalesOfInventory |
| Cost Of Goods Sold | 8103 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1214 | TotalRevenueColumn |
| Exclusion | $1,214 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 38661223 | TotalRevenueColumn |
| Related Or Exempt Function Income | 38208462 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 379 | UnrelatedBusinessRevenue |
| Exclusion | $266,195 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21015 | Total |
| Program Services | 21015 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1471827 | Total |
| Program Services | 1007612 | ProgramServices |
| Management And General | 464215 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16380512 | Total |
| Program Services | 13586345 | ProgramServices |
| Management And General | 2794167 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 847293 | Total |
| Program Services | 707552 | ProgramServices |
| Management And General | 139741 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2011120 | Total |
| Program Services | 1656692 | ProgramServices |
| Management And General | 354428 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1045987 | Total |
| Program Services | 856466 | ProgramServices |
| Management And General | 189521 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10097 | Total |
| Management And General | 10097 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53169 | Total |
| Management And General | 53169 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4249940 | Total |
| Program Services | 3934017 | ProgramServices |
| Management And General | 315923 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85571 | Total |
| Program Services | 20306 | ProgramServices |
| Management And General | 65265 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2271986 | Total |
| Program Services | 1607510 | ProgramServices |
| Management And General | 664476 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 397218 | Total |
| Management And General | 397218 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 418355 | Total |
| Program Services | 38607 | ProgramServices |
| Management And General | 379748 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 143059 | Total |
| Program Services | 135599 | ProgramServices |
| Management And General | 7460 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47154 | Total |
| Program Services | 40907 | ProgramServices |
| Management And General | 6247 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 290102 | Total |
| Program Services | 290102 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2124601 | Total |
| Program Services | 2124601 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 391134 | Total |
| Program Services | 391134 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MEDICAL SUPPLIES | 3615777 | 3615777 |
| MN CARE TAX | 621100 | 621100 |
| BAD DEBTS EXPENSE | 423417 | 423417 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36920434 | Total |
| Program Services | 31078759 | ProgramServices |
| Management And General | 5841675 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 165691 | BOY |
| EOY | 396382 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5443823 | BOY |
| EOY | 7666227 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6716668 | BOY |
| EOY | 6348401 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1160517 | BOY |
| EOY | 1218730 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 338974 | BOY |
| EOY | 288937 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 33821614 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 18695347 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16463425 | BOY |
| EOY | 15126267 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13286185 | BOY |
| EOY | 11510026 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 241273 | BOY |
| EOY | 203044 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43816556 | BOY |
| EOY | 42758014 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4442229 | BOY |
| EOY | 4551016 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6006167 | BOY |
| EOY | 3448218 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1312500 | BOY |
| EOY | 962500 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11760896 | BOY |
| EOY | 8961734 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31944268 | BOY |
| EOY | 33635145 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 111392 | BOY |
| EOY | 161135 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32055660 | BOY |
| EOY | 33796280 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43816556 | BOY |
| EOY | 42758014 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1740789 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -169 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 25173 | BeginningBalance |
| Additions During Year | 9317 | AdditionsDuringYear |
| Distributions During Year | 9148 | DistributionsDuringYear |
| Ending Balance | 25342 | EndingBalance |
| Included On FS | 0 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 262917 | OtherCostOrOtherBasis |
| Book Value | 262917 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19842745 | OtherCostOrOtherBasis |
| Depreciation | 8873344 | Depreciation |
| Book Value | 10969401 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13421469 | OtherCostOrOtherBasis |
| Depreciation | 9604815 | Depreciation |
| Book Value | 3816654 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 294483 | OtherCostOrOtherBasis |
| Depreciation | 217188 | Depreciation |
| Book Value | 77295 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 15126267 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 38187894 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -284983 | OtherRevenues |
| Revenue Not Rptd F990 | -284983 | RevenueNotRptdF990 |
| Revenue Subtotal | 38472877 | RevenueSubtotal |
| Other Revenues Not Included | 188346 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 188346 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 38661223 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 36497017 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 36497017 | ExpensesSubtotal |
| Other Expenses Not Included | 423417 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 423417 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 36920434 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
| NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 137,389. PROVISION FOR BAD DEBTS IN REVENUE FOR FINANCIAL STATEMENTS -423,417. AUXILIARY CONTRIBUTION ELIMINATED FOR TAX 1,045. | PART XI, LINE 2D - OTHER ADJUSTMENTS: | |
| CONTRIBUTIONS RECORDED IN FUND BALANCE FOR FINANCIAL STATEMENTS 187,132. AUXILIARY INCOME NOT INCLUDED IN FINANCIAL STATEMENTS 1,214. | PART XI, LINE 4B - OTHER ADJUSTMENTS: | |
| PROVISION FOR BAD DEBTS IN REVENUE FOR FINANCIAL STATEMENTS 423,417. | PART XII, LINE 4B - OTHER ADJUSTMENTS: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 190.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 645092 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 645092 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01770 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3702464 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2609969 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1092495 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02990 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2957839 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2303777 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 654062 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01790 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7305395 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4913746 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2391649 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06550 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 120953 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 120953 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00330 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11691 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11691 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9981 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9981 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 142625 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 142625 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7448020 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4913746 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2534274 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06940 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 21015 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 21015 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 75433 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 75433 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 96448 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 96448 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $423,417 | BadDebtExpenseAmount |
| Amount Attributable To | 84683 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10169965 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10069273 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 100692 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEVENS COMMUNITY MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 EAST 1ST STREET | AddressLine1 |
| City | MORRIS | City |
| State | MN | State |
| ZIP Code | 56267 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEVENS COMMUNITY MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 190.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| STEVENS COMMUNITY MEDICAL CENTER | ||||
| 400 EAST 1ST STREET | MORRIS | MN | 56267 | FAMILY PRACTICE CLINIC/SPECIALTY CLINIC |
| STARBUCK CLINIC | ||||
| 501 POLER STREET | STARBUCK | MN | 56381 | FAMILY PRACTICE CLINIC |
| SCMC SPECIALTY CLINIC | ||||
| 7900 CHAPIN DRIVE NE | NEW LONDON | MN | 56273 | SPECIALTY CLINIC |
| COURAGE COTTAGE | ||||
| 409 EAST 1ST STREET | MORRIS | MN | 56267 | ADULT FOSTER CARE FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: THE ORGANIZATION PROVIDES A 20% TO 80% DISCOUNT WHEN INCOME LEVELS MEET 190% DOWN TO 101% OF THE FEDERAL POVERTY GUIDELINES (FPG). FOR EXAMPLE, AN 80% DISCOUNT IS GIVEN FOR INCOME RANGES FROM 101% TO 120% OF THE FPG. | ||
| PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST. | ||
| PART I, LINE 7: CHARITY CARE, MEDICAID AND OTHER MEAN'S TESTED WAS CONVERTED TO COST USING THE COST-CHARGE-RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS ARE REPORTED BASED ON ACTUAL EXPENSES RECORDED TO THE GENERAL LEDGER. | ||
| PART I, LINE 7G: N/A | ||
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION WAS $423,417. | ||
| PART II: IN 2012, SCMC SUPPORTED SEVERAL SIGNIFICANT HEALTH RELATED COMMUNITY INITIATIVES SUCH AS THE REGIONAL FITNESS CENTER, HABITAT FOR HUMANITY, AND THE LOCAL CHAPTER OF THE AMERICAN CANCER SOCIETY TO NAME JUST A FEW. WE ALSO PAID OVER $75,000 IN LOCAL REAL ESTATE TAXES FOR OUR THREE MEDICAL CLINICS, WHICH WOULD CERTAINLY HAVE A POSITIVE IMPACT ON THE HEALTH OF THE COMMUNITIES WE SERVE. | ||
| PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS 20% BECAUSE THAT IS THE AMOUNT OF APPLICATIONS THAT WERE DENIED DUE TO LACK OF INFORMATION OR NO RESPONSE TO CHARITY CARE APPLICATION PROCESS. THE FULL AMOUNT OF THIS IS NOT REFLECTED IN PART I, LINE 7 AND IS CONSIDERED COMMUNITY BENEFIT. HAD THE APPROPRIATE INFORMATION BEEN PROVIDED AND APPLICATIONS COMPLETED, THIS AMOUNT WOULD HAVE BEEN CONSIDERED CHARITY CARE.BAD DEBT EXPENSE IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.FINANCIAL STATEMENT NOTE:THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE-OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. | ||
| 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 CMS. | ||
| PART III, LINE 9B: WE FOLLOW THE "MN ATTORNEY GENERAL AGREEMENT" GUIDELINES REGARDING DEBT COLLECTION. | ||
| PART V, SECTION B, LINE 12H: FEDERAL GUIDELINES AND MINNESOTA ATTORNEY GENERAL AGREEMENT PERCENTAGE DISCOUNTS. | STEVENS COMMUNITY MEDICAL CENTER | |
| PART V, SECTION B, LINE 14G: WE ALSO POST FINANCIAL ASSISTANT CONTACT INFORMATION FOR PERSONS INTERESTED IN APPLYING FOR CHARITY CARE AND/OR MEDICAID IN PATIENT COMMON AREAS LIKE REGISTRATION, WAITING AREAS, PHYSICIAN ROOMS AND BY THE BUSINESS OFFICE WINDOW. | STEVENS COMMUNITY MEDICAL CENTER | |
| PART V, SECTION B, LINE 20D: THE HOSPITAL USES THE MINNESOTA ATTORNEY GENERAL AGREEMENT DISCOUNT. | STEVENS COMMUNITY MEDICAL CENTER | |
| 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. | ||
| PART VI, LINE 3: STEVENS COMMUNITY MEDICAL CENTER PROVIDES A COPY OF OUR CHARITY GUIDELINES AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO INTERESTED PATIENTS AS PART OF OUR INTAKE/SCREENING PROCESS; SELF-PAY PATIENTS (PARTICULARLY INPATIENTS) ARE ASKED IF THEY HAVE FINANCIAL CONCERNS AND ARE REFERRED TO A FINANCIAL COUNSELOR THEREAFTER IF A NEED IS DISCOVERED. A VARIETY OF TOOLS ARE USED TO DETERMINE POTENTIAL NEEDS THROUGH THE REGISTRATION, PRIOR AUTHORIZATION, AND BILLING PROCESSES - SOCIAL WORKER'S REFERRAL, IDENTIFICATION OF UNINSURED OR UNDERINSURED STATUS, AND/OR A PREVIOUS HISTORY OF INABILITY TO PAY. WE ALSO POST FINANCIAL ASSISTANT CONTACT INFORMATION FOR PERSONS INTERESTED IN APPLYING FOR CHARITY CARE AND/OR MEDICAID IN PATIENT COMMON AREAS LIKE REGISTRATION, WAITING AREAS, PHYSICIAN ROOMS AND BY THE BUSINESS OFFICE WINDOW.IN ADDITION, IF PAYMENTS ARE NOT BEING MADE AFTER 2-3 STATEMENTS HAVE BEEN SENT, A FINANCIAL COUNSELOR WILL CALL TO INFORM THE PATIENT OF THEIR OPTIONS. AT THAT TIME, WE WOULD SEND OUT AN APPLICATION FOR CHARITY CARE, DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSIST THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. | ||
| PART VI, LINE 4: STEVENS COMMUNITY MEDICAL CENTER SERVES THE COUNTY OF STEVENS INCLUDING THE TOWNS OF MORRIS, DONNELLY, HANCOCK, CHOKIO AND ALBERTA. WE ALSO SERVE AREAS OF POPE, SWIFT, TRAVERSE, GRANT, BIG STONE AND, WITH OUR DERMATOLOGY, ALLERGY, AND THERAPY CLINIC IN NEW LONDON, KANDIYOHI COUNTY. 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 8% ARE MEDICAID AND/OR MN CARE.THERE ARE THREE HOSPITALS IN THE AREA THAT ARE LARGER THAN SCMC LOCATED IN TOWNS 50 MILES FROM MORRIS IN DIFFERENT DIRECTIONS. THERE ARE ALSO HOSPITALS IN BENSON, WHEATON, GRACEVILLE, GLENWOOD, ELBOW LAKE AND APPLETON, ALL OF WHICH ARE WITHIN A 30 MILES RADIUS OF MORRIS.WE ARE CONSIDERED A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA FOR MENTAL HEALTH SERVICES. | ||
| PART VI, LINE 5: AS DESCRIBED EARLIER, SCMC HAS A COMMUNITY BOARD OF DIRECTORS. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. WE ALSO OWN AND OPERATE AN ADULT FOSTER CARE FACILITY WHICH SPECIALIZES IN THE TERMINALLY ILL. THIS IS CURRENTLY SUBSIDIZED BY COMMUNITY DONATIONS.ALL OUR EMPLOYED PHYSICIANS ATTEND SEVERAL EDUCATIONAL OPPORTUNITIES, AS DO THE BALANCE OF OUR LICENSED AND PROFESSIONAL STAFF.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. THE COMMUNITY HEALTH SERVICE ACTIVITIES ARE DESIGNED TO COMPLEMENT THE IDENTIFIED HEALTH NEEDS IN OUR AREA. SOME OF THE SPECIFIC REPORTED SERVICES, SUCH AS MEN'S AND WOMEN'S HEALTH NIGHTS, HAVE EDUCATED THE PUBLIC ON PREVENTATIVE HEALTH INITIATIVES AND HAVE ALSO IDENTIFIED PREVIOUSLY UNDETECTED HEALTH RISK FACTORS FOR PARTICIPANTS.THIS IS ALSO TRUE OF THE DIABETES PRESENTATIONS TO LOCAL SERVICE GROUPS AND OUR ANNUAL DIABETES HEALTH AWARENESS NIGHT. 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. | ||
| MN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OLYN WERNSING MD | ||||||||||||||
| DIRECTOR / PHYSICIAN | 138400 | 0 | 101 | 0 | 20031 | 0 | 12656 | 0 | 18698 | 0 | 189886 | 0 | 0 | 0 |
| KIM TATSUMI MD | ||||||||||||||
| DIRECTOR / PHYSICIAN | 150824 | 0 | 14000 | 0 | 22994 | 0 | 15064 | 0 | 20348 | 0 | 223230 | 0 | 0 | 0 |
| GREG ABLER MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | 169796 | 0 | 151101 | 0 | 9744 | 0 | 15000 | 0 | 19850 | 0 | 365491 | 0 | 0 | 0 |
| JOAN LUNZER MD THRU JUNE 2012 | ||||||||||||||
| DIRECTOR / INTERNIST | 208517 | 0 | 101 | 0 | 6140 | 0 | 17199 | 0 | 21206 | 0 | 253163 | 0 | 0 | 0 |
| JOHN RAU | ||||||||||||||
| PRESIDENT / CEO | 244065 | 0 | 0 | 0 | 28674 | 0 | 19375 | 0 | 23140 | 0 | 315254 | 0 | 0 | 0 |
| KERRIE MCEVILLY | ||||||||||||||
| DIRECTOR OF FINANCE/IS | 134316 | 0 | 101 | 0 | 158 | 0 | 10712 | 0 | 15870 | 0 | 161157 | 0 | 0 | 0 |
| ANDREA GIAMBI DO | ||||||||||||||
| RADIOLOGIST | 145662 | 0 | 404158 | 0 | 23554 | 0 | 19375 | 0 | 5367 | 0 | 598116 | 0 | 0 | 0 |
| MICHAEL HOLTE MD | ||||||||||||||
| ORTHOPEDIC SURGEON | 594026 | 0 | 31901 | 0 | 21034 | 0 | 15000 | 0 | 20662 | 0 | 682623 | 0 | 0 | 0 |
| RANDELL LUSSENDEN | ||||||||||||||
| CRNA | 123599 | 0 | 353645 | 0 | 2930 | 0 | 19375 | 0 | 11828 | 0 | 511377 | 0 | 0 | 0 |
| JACK MUTNICK MD | ||||||||||||||
| ALLERGIST | 158628 | 0 | 525078 | 0 | 30176 | 0 | 13125 | 0 | 25358 | 0 | 752365 | 0 | 0 | 0 |
| JAMES GREEN MD | ||||||||||||||
| ORTHOPEDIC SURGEON | 572358 | 0 | 29989 | 0 | 32459 | 0 | 13125 | 0 | 10608 | 0 | 658539 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 5 | ReturnReference |
| Explanation | THE PHYSICIANS ARE ELIGIBLE TO RECEIVE QUARTERLY INCENTIVE COMPENSATION BASED ON THEIR PERSONAL GROSS REVENUE PRODUCTION FOR NON-ANCILLARY SERVICES, ACCORDING TO THE TERMS OF THEIR CONTRACTS. THE CRNA ALSO RECEIVES QUARTERLY BONUSES CONTINGENT ON THE SERVICES HE PROVIDES TO PATIENTS OF SCMC. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF MORRIS STEVENS COUNTY MINNESOTA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 416005393 | IssuerEIN |
| Date Issued | 2006-08-29 | DateIssued |
| Issue Price | 7000000 | IssuePrice |
| Description Of Purpose | FINANCE APPROX 23000 SQ FT ADDN, REFINANCE NOTE SERIES 1998-ISSUED 12/10/98 | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 3551782 | AmountRetired |
| Total Proceeds | 7000000 | TotalProceeds |
| Refunding Escrow | 1327349 | RefundingEscrow |
| Issuance Costs From Proceeds | 107268 | IssuanceCostsFromProceeds |
| Capital Expenditures | 5565383 | CapitalExpenditures |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 1 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 11 | PRIOR TO FILING, THE 990 IS REVIEWED IN DETAIL BY THE FINANCE DIRECTOR AND PRESIDENT/CEO. THE BOARD OF DIRECTORS IS GIVEN THE OPPORTUNITY TO REVIEW A COPY PRIOR TO FILING. A COPY OF THE FORM 990 IS ATTACHED TO THE STATE FILING. THE STATE FILING REQUIRES A BOARD RESOLUTION APPROVING THE FILING. DURING THAT TIME THE BOARD IS BRIEFED ON INFORMATION CONTAINED WITHIN THE FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS TWO CONFLICT OF INTEREST POLICIES - ONE THAT COVERS OFFICERS AND DIRECTORS AND ONE THAT COVERS OTHER MANAGEMENT STAFF (INCLUDING OTHER KEY EMPLOYEES, IF APPLICABLE). POTENTIAL CONFLICTS IDENTIFIED BY OFFICERS AND DIRECTORS ARE REVIEWED BY THE REMAINING BOARD MEMBERS; THOSE IDENTIFIED BY MANAGEMENT ARE REVIEWED BY THE PRESIDENT/CEO. OFFICERS AND DIRECTORS ARE TO ABSTAIN FROM VOTING ON ANY SUCH MATTER WHERE THEY HAVE A POTENTIAL CONFLICT OF INTEREST. THE PRESIDENT/CEO EVALUATES EACH POTENTIAL CONFLICT IDENTIFIED BY MANAGEMENT ON AN INDIVIDUAL BASIS IN ORDER TO DETERMINE THE APPROPRIATE RESTRICTIONS TO PUT IN PLACE. | |
| FORM 990, PART VI, SECTION B, LINE 15A | SCMC PARTICIPATES IN THE MN HOSPITAL ASSOCIATION COMPENSATION SURVEY AS WELL AS REFERS TO A COMPENSATION REVIEW THAT INCLUDES 49 HOSPITALS IN MN. IN ADDITION, SCMC HAS HIRED A COMPENSATION CONSULTANT TO REVIEW THE CEO SALARY ON OCCASION. THE BOARD ENTERED INTO A 5-YEAR COMPENSATION CONTRACT WITH THE CEO AT THE BEGINNING OF 2010, WHICH FIXED HIS SALARY FOR THAT LENGTH OF TIME, BASED ON MARKET ANALYSIS. THE PRESIDENT/CEO REVIEWS SALARY RANGES FOR OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ON AN ANNUAL BASIS. SCMC RECEIVES AN ANNUAL ASSESSMENT FROM MERRITT-HAWKINS (A RECRUITING FIRM) REGARDING COMPENSATION RANGES FOR PRIMARY CARE AND SPECIALTY PHYSICIANS. THIS INFORMATION IS SPECIFIC TO DIFFERENT GEOGRAPHIC REGIONS, AS WELL AS FOR GROUPS VERSUS PRIVATE PRACTICES. THE PRESIDENT/CEO ALSO REVIEWS THE AMGA (AMERICAN MEDICAL GROUP ASSOCIATION) COMPENSATION SURVEY FOR PHYSICIAN COMPENSATION AND THE MHA (MINNESOTA HOSPITAL ASSOCIATON) COMPENSATION SURVEY FOR THE DIRECTOR 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 XI, LINE 9: | AUXILIARY ACTIVITY INCLUDED FOR TAX -1,214. AUXILIARY CONTRIBUTION ELIMINATED FOR TAX 1,045. | CHANGES IN NET ASSETS OR FUND BALANCES: |