2023-10-18T08:43:01-05:00 2022-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-01-01 363311936 Stevens Community Medical Center STEV 3205891313 400 E 1st St Morris MN 56267 Kerrie McEvilly President/CEO 3205891313 2023-10-17 1 Kerrie McEvilly 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2023-10-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Kerrie McEvilly 400 E 1st St Morris MN 56267 50384763 0 X www.scmcinc.org X 1984 MN Promotion of health 12 8 363 11 0 0 6715124 953067 45441915 48806462 309633 504522 35671 40971 52502343 50305022 25860 20389 0 0 26651280 24841215 0 0 0 17932949 19920399 44610089 44782003 7892254 5523019 69174057 73500191 10337963 9117559 58836094 64382632 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 39059303 20389 48806462 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 provide 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 39,202 hospital outpatient visits, 38,890 clinic and urgent care visits, 1,284 inpatient days, 6,828 outpatient counseling visits, 83 deliveries, 605 surgeries, 2,562 emergency room visits, and 22,887 therapy treatments in 2022. SCMC also owns and operates the Courage Cottage, an assisted living facility specializing in care for the terminally ill. In 2022, 8 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 $38,030,580 in 2022. The charges foregone for services supplied under SCMC's charity care policy (free and/or subsidized care) was $1,691,030 in 2022.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. 39059303 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 104 0 1 363 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 Sarah Tahtinen 3205897627 400 E 1st St Morris MN 56267 David Paul Chair 1.00 X X 560 0 0 Bart Finzel Vice Chair 1.00 X X 720 0 0 Ward Vorhees Secretary 1.00 X X 660 0 0 Jan Hagen Treasurer 1.00 X X 900 0 0 Jodi DeCamp Director 1.00 X 450 0 0 Paul Martin Director 1.00 X 600 0 0 Darryl Larson Director 1.00 X 400 0 0 Rachel Johnson Director 1.00 X 350 0 0 Toby Christie-Perkins DO Director/Physician 40.00 X 323615 0 51527 Jason Huikko MD Director/Physician 40.00 X 348010 0 26344 Elizabeth Meichsner MD Director/Physician 40.00 X 376461 0 62992 Kerrie McEvilly President/CEO 40.00 X X 363373 0 55515 Jeffery Lewis Director of Finance 40.00 X 171769 0 22945 Timothy Jay MD Orthopedic Surgeon 40.00 X 709407 0 31877 Andrea Giambi DO Radiologist (Jan-April) 40.00 X 349396 0 7778 Brent Barnstuble MD Physician 40.00 X 371823 0 52185 Somkiat Viratyosin MD Surgeon 40.00 X 394569 0 51841 Eric Larson CRNA 40.00 X 430062 0 53585 3843125 0 416589 48 0 1 0 Novacare Rehabilitation 2965 Patridge Road Roseville MN 55113 Therapy Services 867480 Italians For Hire LLC 18198 US Hwy 81 Castlewood SD 57223 Radiology services 410714 Converdia 301 Sheyenne St West Fargo ND 58078 Locums Services 342246 Kevin T Marble 1224 Trumpet Dr Fort Worth TX 76131 Locums Services 331224 Upper Midwest Medical Inc 26998 State Hwy 104 Glenwood MN 56334 Medical professional services 322665 12 786351 166716 953067 Patient Service Revenue 621110 48671705 48671705 Supporting Revenue 900099 134757 134757 48806462 574564 574564 34987 0 34987 34987 34987 6150 76192 -70042 -70042 -70042 9533 3549 5984 5984 50305022 48806462 0 545493 X 20389 20389 1818155 1196292 621863 18391160 16126680 2264480 992010 865833 126177 2364767 1870227 494540 1275123 1095913 179210 16097 16097 110344 110344 5832453 5296157 536296 169463 22182 147281 2651551 2315812 335739 378801 378801 528266 391721 136545 76659 75348 1311 55725 48558 7167 2062838 1707372 355466 410061 398678 11383 Medical Supplies 5120227 5120227 Pharmacy 340B Program c 1556975 1556975 MN Care Tax 719242 719242 DHS Medicare Surcharge 231697 231697 44782003 39059303 5722700 0 1666 1666 12969446 10875382 10051539 8676926 1731944 1988853 86454 177433 53930110 36529666 18445269 17400444 25503958 33993529 383781 385958 69174057 73500191 6883812 5556906 523573 130205 2930578 3430448 10337963 9117559 X 58611929 64098223 224165 284409 58836094 64382632 69174057 73500191 X 5523019 29503 -5984 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 16307 9533 3549 22291 0 371723 371723 31859673 18716485 13143188 20934521 17233797 3700724 764193 579384 184809 17400444 Deferred compensation obligation 1881448 Estimated third party payor settlements 1549000 3430448 X 50398583 29503 29503 50369080 -64058 -64058 50305022 44852045 70042 70042 44782003 0 44782003 Part IV, Line 1b: The organization holds the assets for the Stevens Community Medical Center 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 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 4b - Other Adjustments: Auxiliary net income not included in financial statements 5,984. Loss on Sale of Asset -70,042. 1 1 X 1 X 1 X 170.000000000000 1 1 1 0 0 836336 836336 0.01870 6259333 4422123 1837210 0.04100 7095669 4422123 2673546 0.05970 108976 108976 0.00240 74043 74043 0.00170 1830 1830 0.00000 184849 184849 0.00410 7280518 4422123 2858395 0.06380 20129 20129 0.00040 66640 66640 0.00150 86769 86769 0.00190 1 1109806 0 7485367 7411254 74113 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 rural health clinic Stevens Community Medical Center 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X See Section C 1 22 1 See Section C 0 1 X 100.000000000000 170.000000000000 X X X X X 1 1 X X X X 1 X https://www.scmcinc.org/patient_resources/financial-forms/ X https://www.scmcinc.org/patient_resources/financial-forms/ X https://www.scmcinc.org/patient_resources/financial-forms/ 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: SCMC provided names, demographics, and contact information for 91 potential attendees. RHI reached out to all 91 to invite them to participate. Attendees could choose the focus group they preferred to attend based on their availability. Each focus group included a mix of attendees representing their community. All four focus groups were scheduled to be in-person at the Stevens Community Medical Center Multi-Purpose Room in Morris, Minnesota. Attendees included seniors, representatives from businesses, health care consumers, active health care providers, parents, school representatives, and lifelong residents. Twenty-three (23) of the 91 individuals signed up to attend and 21 attended. Secondary data was presented to attendees at the beginning of the focus groups and included information about community population by race and ethnicity, age range, percentage of unemployed, and percentage living in poverty. Data regarding quality-of-life variables such as rates of diabetes, obesity, adults currently smoking, and suicide were shared. Ratios of population to primary care providers, dentists, and mental health providers were also presented. Each focus group was asked the same questions. Focus group comments reflect the perceptions of the group. Thirty-one potential stakeholders were identified by the hospital and RHI reached out to all 31 to invite them to participate. Eight stakeholder interviews were scheduled and seven virtual meeting sessions were held; each approximately 60 minutes. As with the focus groups, secondary data was presented and RHI staff facilitated discussion of questions identified by SCMC. No identifiable information was disclosed to maintain confidentiality. Stevens Community Medical Center Part V, Section B, Line 11: A new CHNA was completed in 2022. Needs identified in the 2022 CHNA were: Improving access to care, making healthy lifestyle accessible to the community as a whole and collaborating to provide health education to our community. These needs were not addressed in 2022 due to the timing of when the CHNA was completed. During 2022 however, the organization still worked on addressing the needs from the previous CHNA from 2019.Community Health Needs Assessment 2022 Efforts in Addressing the Significant Needs Identified in 2019 CHNA:The 2019 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 issues are increased transportation options for the population. This includes transportation options that can serve patients outside of the Morris city limits and patients that require non-ambulatory transport after regular weekday business hours, the lack of child care options available, and the lack of an online central community communication hub for events and updates.1. TransportationSCMC continues to cover 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. We added a transportation service called Julia's Place that will provide transport from the city of Hancock to Morris and outside of the Stevens County line into Swift County. Julia's Place can bill MA which allows for more payment flexibility in patient transport. The SCMC marketing department has added links directly on the SCMC website to assist patients with transportation options and to provide access to transportation resources.2. Child CareIn June of 2021 a representative of SCMC attended the meeting hosted by the Stevens County Board of Commissioners. State funds had recently been awarded to Stevens County by the federal American Rescue Act 2021 for the Commissioners to allocate to community programs. SCMC commented during the meeting that they support the effort for increasing child care capacity and would like to see funds allocated to this area of need. Specifically, Kerrie McEvilly, CEO of SCMC, issued a letter to the commissioners with the request for them to fund the Hancock community child care center building plans, allow for grant request proposals to be submitted by current care providers for their needs, and for the commissioners to provide funding for a local provider recruitment program. Ongoing county daycare subcommittee meetings continue and focus on the remaining funds being used for a new construction build that will increase daycare capacity in Stevens County. In addition, extra money was allocated for the Morris Area Child Care Center to add more spots, with a total of six-pod structure that opened September 1st, 2023. The project has been well received by the community. Infant daycare and affordable daycare for lower paid staff is still a challenge but the situation is much less dire at present time than it had been in the past couple of years.3. Community Communications.SCMC collaborated with the Morris Area Chamber of Commerce and the Stevens County Building Resilience committee to apply for a community resilience initiative micro grant. The grant was received and a student was hired to perform the necessary work for building out a communication tool. The project resulted in a community calendar for all individuals in Stevens County to post meetings and events as well as a community resource page on the Morris Area Chamber of Commerce website. This tool is active and is being used by SCMC to promote its classes, activities, and current events. Since it's been active, other community initiatives and businesses have also utilized it as a means of getting their word out to public too. The promotional magnet that was designed and purchased with the remaining grant funds to communicate out the resource to community members has been available for free at community social events, the Morris Chamber, and Horizon Public Health buildings. The website that SCMC launched in April of 2021 has provided another great means of communication with the ability to add 'pop-ups' to the home page for alerts, and also hosts a facility calendar which is continually updated to include all community impacting events. Since 2019 a strategic effort has been made to utilize the SCMC Facebook and Instagram page to promote all COVID communications, facility updates, job postings, and community sponsored events and a variety of medical education, ie. Mental Health tips and resource shares, recipes from dietitian, and even sandal recommendations from our Podiatrists. The social media presence on Instagram and Facebook has provided a means for increased awareness and education. The information is also being brought directly to the business community by having a SCMC representativeparticipate in different community initiatives and meetings such as The Chamber Connection group hosted by the Morris Area Chamber and Morris Community Building Resilience championed by Stevens County Public Health. This outlet gives SCMC the opportunity to speak directly to the business leaders of our community and provide updates on the community health needs implementation plan and responses from our facility. This includes updates on providers, equipment, services, and employment opportunities. SCMC works with all local and county media outlets to get communications across depending what the topic or genre, ie. Radio, web, billboard, newspaper, etc. SCMC also brought back Fall into Health after a 3 year hiatus due to COVID-19. The event focuses on community health resources and showcases SCMC services and education but also drives in many demographics with a free healthy resourced meal, Free labs conducted by SCMC lab dept., health-related booths that include educations and communications from many SCMC services AND also many community health initiatives. The event brought in over 300 people. Stevens Community Medical Center Part V, Section B, Line 13b: The organization considers the patient's ability to make reasonable monthly payments on a balance owed. When income and expense documentation (such as pay stubs and tax returns) doesn't reflect an accurate picture of a patient's ability to pay, additional considerations are made. 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://www.scmcinc.org/about/community-health-needs-assessment/ Schedule H, Part V, Section B, line 10a: https://www.scmcinc.org/about/community-health-needs-assessment/ Schedule H, Part V, Section B, line 15d: The organization does not refer to an outside agency to assist with the application process as the Organization will assist individuals internally. 2 1 - Starbuck Clinic 501 Poler Street Starbuck MN 56381 Rural Health Care Clinic 2 - Courage Cottage 409 East 1st Street Morris MN 56267 Assisted Living 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).*Medical Indigency is also considered.* 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 40% discount to 80% 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. Outside of the FPG and FAP application process we standardly apply the 25% self-pay discount which is based off our Amounts Generally Billed (AGB) for all self-pay patients with qualifying services (i.e. medical necessary services which are not cosmetic or elective). 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 II, Community Building Activities: In 2022 SCMC supported several significant health related community initiatives such as supporting and participating in community health initiatives events, providing student shadowing opportunities and supporting the local school and university. We also paid over $66,640 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: The amount reported on line 2 represents implicit price concessions. The Medical Center determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The Hospital does not have a way to reasonably estimate the amount of implicit price concessions that are attributable to patients who would qualify for financial assistance. Part III, Line 4: The footnote to the organization's financial statements addressing implicit price concessions may be found on page 9 and 10 of the attached audited 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. 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 collections agency is aware of these regulations and assists us with patient coordination if they show interest in applying should they be sent to collections after 120 days but within the 240-day application period window. 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. Various departmental 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 2022. Part VI, Line 3: Stevens Community Medical Center provides a copy of our charity care 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. At the time 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 51% of our inpatients are Medicare and/or Medicare HMO and another 16% 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 assisted living 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 11 people volunteer for a variety of activities at SCMC. Volunteers are from a wide range of ages including youth from the local schools. SCMC staff volunteer their time to serve at the community food drop program.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 a tobacco-free facility. Part VI, Line 7, Reports Filed With States MN 1 Stevens County Food Shelf 701 Atlantic Ave Morris MN 56267 411829830 501(c)(3) 10000 0 Food Assistance 1 0 Part I, Line 2: The President/CEO reviews requests for all grants/projects. For Projects under $5000, we do not require reports back after funds have been given out. For projects over $5,000, we review the results with the organization's representative. X X X 0 0 0 1 0 0 0 0 0 Timothy Jay MD Orthopedic Surgeon 615712 0 89514 0 4181 0 0 0 35561 0 744968 0 0 0 Eric Larson CRNA 249200 0 180422 0 440 0 18300 0 37703 0 486065 0 0 0 Somkiat Viratyosin MD Surgeon 367884 0 6756 0 19929 0 21700 0 33711 0 449980 0 0 0 Elizabeth Meichsner MD Director/Physician 351320 0 23093 0 2048 0 25615 0 37703 0 439779 0 0 0 Brent Barnstuble MD Physician 316484 0 54739 0 600 0 16800 0 38957 0 427580 0 0 0 Kerrie McEvilly President/CEO 356574 0 5256 0 1543 0 23638 0 35416 0 422427 0 0 0 Toby Christie-Perkins DO Director/Physician 302181 0 21120 0 314 0 16800 0 38231 0 378646 0 0 0 Jason Huikko MD Director/Physician 346946 0 576 0 488 0 14700 0 15156 0 377866 0 0 0 Andrea Giambi DO Radiologist (Jan-April) 316499 0 31500 0 1397 0 0 0 8950 0 358346 0 0 0 Jeffery Lewis Director of Finance 159294 0 2754 0 9721 0 9313 0 13715 0 194797 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 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 CFO 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 as well as other hospitals' Form 990s when reviewing the CEO's compensation on an annual basis. Besides participating in MHA compensation surveys, SCMC also references the Medi-Sota compensation survey that includes approximately 50 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 the Faegre Drinker Midwest Rural Hospital Compensation Survey regarding compensation ranges for primary care and specialty physicians. The President/CEO also reviews the MGMA (Medical Group Management Association) compensation survey for physician compensation and the MHA 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 IX, line 11g Repairs and Maintenance: Program service expenses 708,237. Management and general expenses 0. Fundraising expenses 0. Total expenses 708,237. Purchased Services: Program service expenses 4,442,477. Management and general expenses 421,548. Fundraising expenses 0. Total expenses 4,864,025. Equipment Rent: Program service expenses 145,443. Management and general expenses 18,227. Fundraising expenses 0. Total expenses 163,670. Physician Recruitment: Program service expenses 0. Management and general expenses 96,521. Fundraising expenses 0. Total expenses 96,521. Form 990, Part XI, line 9: Auxiliary Net Income/Loss -5,984.