2013-08-15T13:29:21-05:00 2012-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2012-01-01 363311936 STEVENS COMMUNITY MEDICAL CENTER STEV 3205891313 PO BOX 660 MORRIS MN 56267 JOHN RAU 3205891313 2013-08-15 1 SARAH VOGT CPA P00978242 6122536500 2013-08-15 2012 2016-02-24 21:20:13Z JOHN RAU PO BOX 660 MORRIS MN 56267 38683477 0 X WWW.SCMCINC.ORG X 1984 MN PROMOTION OF HEALTH 13 9 360 141 379 0 156671 186187 37492772 38208841 284359 216409 54147 49786 37987949 38661223 20592 21015 0 0 21545797 21756739 0 0 0 14942991 15142680 36509380 36920434 1478569 1740789 43816556 42758014 11760896 8961734 32055660 33796280 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 31078759 21015 38208841 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. 31078759 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 135 0 1 360 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X KERRIE MCEVILLY 3205897627 400 E 1ST ST MORRIS MN 56267 DAVID PAUL 1.00 X X 350 0 0 PAUL GRONEBERG 1.00 X X 330 0 0 JAN HAGEN 1.00 X X 210 0 0 WARD VOORHEES 1.00 X X 300 0 0 PIERANNA GARAVASO 1.00 X 225 0 0 JODI DECAMP 1.00 X 200 0 0 BART FINZEL 1.00 X 200 0 0 PAUL MARTIN 1.00 X 250 0 0 DARRYL LARSON 1.00 X 200 0 0 OLYN WERNSING MD 40.00 X 158532 0 28426 KIM TATSUMI MD 40.00 X 187818 0 32376 GREG ABLER MD 40.00 X 330641 0 31670 JOAN LUNZER MD THRU JUNE 2012 40.00 X 214758 0 35369 JOHN RAU 40.00 X X 272739 0 41100 KERRIE MCEVILLY 40.00 X 134575 0 25379 ANDREA GIAMBI DO 40.00 X 573374 0 21253 MICHAEL HOLTE MD 40.00 X 646961 0 32170 RANDELL LUSSENDEN 40.00 X 480174 0 29571 JACK MUTNICK MD 40.00 X 713882 0 35195 JAMES GREEN MD 40.00 X 634806 0 20529 4350525 0 333038 27 0 1 0 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 21 186187 186187 PATIENT SERVICE REVENU 622110 38121146 38121146 SUPPORTING REVENUE 900099 87316 87316 NON PATIENT SALES 900099 379 379 38208841 230560 230560 48572 0 48572 48572 48572 14151 -14151 -14151 -14151 9317 8103 1214 1214 38661223 38208462 379 266195 21015 21015 1471827 1007612 464215 16380512 13586345 2794167 847293 707552 139741 2011120 1656692 354428 1045987 856466 189521 10097 10097 53169 53169 4249940 3934017 315923 85571 20306 65265 2271986 1607510 664476 397218 397218 418355 38607 379748 143059 135599 7460 47154 40907 6247 290102 290102 2124601 2124601 391134 391134 MEDICAL SUPPLIES 3615777 3615777 MN CARE TAX 621100 621100 BAD DEBTS EXPENSE 423417 423417 36920434 31078759 5841675 0 165691 396382 5443823 7666227 6716668 6348401 1160517 1218730 338974 288937 33821614 18695347 16463425 15126267 13286185 11510026 241273 203044 43816556 42758014 4442229 4551016 6006167 3448218 1312500 962500 11760896 8961734 X 31944268 33635145 111392 161135 32055660 33796280 43816556 42758014 X 1740789 -169 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 25173 9317 9148 25342 0 262917 262917 19842745 8873344 10969401 13421469 9604815 3816654 294483 217188 77295 15126267 X 38187894 -284983 -284983 38472877 188346 188346 38661223 36497017 0 36497017 423417 423417 36920434 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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: 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 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS RECORDED IN FUND BALANCE FOR FINANCIAL STATEMENTS 187,132. AUXILIARY INCOME NOT INCLUDED IN FINANCIAL STATEMENTS 1,214. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS IN REVENUE FOR FINANCIAL STATEMENTS 423,417. 1 1 X 1 X 1 X 190.000000000000 1 1 0 1 1 645092 645092 0.01770 3702464 2609969 1092495 0.02990 2957839 2303777 654062 0.01790 7305395 4913746 2391649 0.06550 120953 120953 0.00330 11691 11691 0.00030 9981 9981 0.00030 142625 142625 0.00390 7448020 4913746 2534274 0.06940 21015 21015 0.00060 75433 75433 0.00210 96448 96448 0.00270 0 423417 84683 10169965 10069273 100692 X 1 0 1 1 STEVENS COMMUNITY MEDICAL CENTER

400 EAST 1ST STREET MORRIS MN 56267

X X X X STEVENS COMMUNITY MEDICAL CENTER 1 0 1 1 100.000000000000 1 190.000000000000 1 X X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 4 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 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. STEVENS COMMUNITY MEDICAL CENTER 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 MN X X X X 0 0 0 1 0 0 0 0 0 OLYN WERNSING MD 138400 0 101 0 20031 0 12656 0 18698 0 189886 0 0 0 KIM TATSUMI MD 150824 0 14000 0 22994 0 15064 0 20348 0 223230 0 0 0 GREG ABLER MD 169796 0 151101 0 9744 0 15000 0 19850 0 365491 0 0 0 JOAN LUNZER MD THRU JUNE 2012 208517 0 101 0 6140 0 17199 0 21206 0 253163 0 0 0 JOHN RAU 244065 0 0 0 28674 0 19375 0 23140 0 315254 0 0 0 KERRIE MCEVILLY 134316 0 101 0 158 0 10712 0 15870 0 161157 0 0 0 ANDREA GIAMBI DO 145662 0 404158 0 23554 0 19375 0 5367 0 598116 0 0 0 MICHAEL HOLTE MD 594026 0 31901 0 21034 0 15000 0 20662 0 682623 0 0 0 RANDELL LUSSENDEN 123599 0 353645 0 2930 0 19375 0 11828 0 511377 0 0 0 JACK MUTNICK MD 158628 0 525078 0 30176 0 13125 0 25358 0 752365 0 0 0 JAMES GREEN MD 572358 0 29989 0 32459 0 13125 0 10608 0 658539 0 0 0 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 CRNA ALSO RECEIVES QUARTERLY BONUSES CONTINGENT ON THE SERVICES HE PROVIDES TO PATIENTS OF SCMC. A CITY OF MORRIS STEVENS COUNTY MINNESOTA 416005393 2006-08-29 7000000 FINANCE APPROX 23000 SQ FT ADDN, REFINANCE NOTE SERIES 1998-ISSUED 12/10/98 0 0 0 A 3551782 7000000 1327349 107268 5565383 2007 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: AUXILIARY ACTIVITY INCLUDED FOR TAX -1,214. AUXILIARY CONTRIBUTION ELIMINATED FOR TAX 1,045.