2024-08-14T15:45:10-05:00 2023-09-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2022-10-01 460255944 MOBRIDGE REGIONAL HOSPITAL MOBR 6058453692 1401 10TH AVE W MOBRIDGE SD 57601 JOHN AYOUB CEO 6058453692 2024-08-14 1 1 LAURIE HANSON CPA P00851848 6053391999 2024-08-07 2022 2024-08-08 14:25:15Z JOHN AYOUB 1401 10TH AVE W MOBRIDGE SD 57601 27167311 0 X WWW.MOBRIDGEHOSPITAL.ORG X 1959 SD PROVIDING HEALTHCARE TO PEOPLE THROUGHOUT THE REGION. 12 10 255 75 0 0 1797352 490204 24403604 26498946 227183 178161 0 0 26428139 27167311 0 0 0 0 16550783 18156140 0 0 0 9554510 10028602 26105293 28184742 322846 -1017431 34651954 47667918 7292367 20957382 27359587 26710536 THE MISSION OF MOBRIDGE REGIONAL HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES IN A COMPASSIONATE AND PROFESSIONAL MANNER FOR PEOPLE THROUGHOUT THE REGION. 0 0 24507149 26498946 MOBRIDGE REGIONAL HOSPITAL (MRH), A 25-BED CRITICAL ACCESS HOSPITAL, 16 BED ASSISTED LIVING CENTER, 8 BED SENIOR HOUSING CENTER, MEDICAL CLINICS, AND AMBULANCE SERVICE, PROVIDES HEALTHCARE SERVICES TO PERSONS THROUGHOUT THE REGION. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2023, THE HOSPITAL PROVIDED CARE TO THE NORTH CENTRAL REGION OF SOUTH DAKOTA, AND THE SOUTH CENTRAL REGION OF NORTH DAKOTA. THE HOSPITAL HAD:1,526 PATIENT DAYS1,418 ACUTE CARE DAYS482 SWING BED CARE DAYS4,505 EMERGENCY ROOM VISITS19,299 RURAL HEALTH CLINIC VISITS7,987 ASSISTED LIVING DAYS (PRAIRIE SUNSET VILLAGE) 24507149 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 0 0 0 1 0 0 1 255 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 X X RENAE KARST 6058458164 PO BOX 580 MOBRIDGE SD 57601 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 40.00 0.00 X 386670 0 58580 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 40.00 0.00 X 322234 0 32502 BILL BACHMEIER CHAIRMAN 1.00 0.00 X X 0 0 0 LORI HEIL VICE CHAIR 1.00 0.00 X X 0 0 0 PATTI SCHMEICHEL SECRETARY 1.00 0.00 X X 0 0 0 HEIDI ROSHAU TREASURER 1.00 0.00 X X 0 0 0 ADAM HAYES DIRECTOR 1.00 0.00 X 0 0 0 CHRISTOPHER BOHLANDER DIRECTOR 1.00 0.00 X 0 0 0 JAKE KRAFT DIRECTOR 1.00 0.00 X 0 0 0 RICHARD GROSS DIRECTOR 1.00 0.00 X 0 0 0 LAURIE BAUER DIRECTOR 1.00 0.00 X 0 0 0 JOSH WUDEL DIRECTOR 1.00 1.00 X 0 0 0 RENAE KARST CFO 40.00 0.00 X 130505 0 36566 JOHN AYOUB CEO 40.00 0.25 X 0 0 0 DR DONALD LUCEK SURGEON 40.00 0.00 X 288382 0 51940 DR MATT SCHAFFER PHYSICIAN 40.00 0.00 X 363157 0 40706 DR EMILY BODEN PHYSICIAN 40.00 0.00 X 345121 0 45898 DR JOSH HENDERSON INTERNAL MEDICINE 40.00 0.00 X 343963 0 40706 DR ALAN LAWRENCE SURGEON 40.00 0.00 X 381058 0 26818 2561090 0 333716 29 0 1 0 KRAUS-ANDERSON CONSTRUCTION COMPANY 501 SOUTH 8TH STREET MINNEAPOLIS MN 55404 CONSTRUCTION SERVICES 6067655 DAVIS PARTNERSHIP ARCHITECTS 2901 BLACKE STREET SUITE 100 DENVER CO 80205 ARCHITECT FEES 490681 ST ALEXIUS MEDICAL CENTER PO BOX 5510 BISMARCK ND 58506 PROFESSIONAL SERVICES 294248 NATIONAL MEDICAL RESOURCES 2792 E BROADWAY AVE BISMARCK ND 58501 PROFESSIONAL SERVICES 260001 AVEL ECARE 4500 N LEWIS AVE SIOUX FALLS SD 57104 PROFESSIONAL SERVICES 190446 10 50000 417504 22700 490204 PATIENT SERVICE REVENUE 621400 24099622 24099622 PHARMACY REVENUE 621400 1881191 1881191 518133 518133 26498946 178161 178161 27167311 26498946 0 178161 967765 792418 175347 13301377 12026372 1275005 436623 410962 25661 2492308 2386756 105552 958067 871734 86333 274493 274493 251 251 88641 88641 1604966 1252671 352295 89760 6957 82803 200211 101402 98809 62259 62259 449161 395969 53192 39156 31402 7754 57999 57999 104390 104390 1805179 1563531 241648 333433 314949 18484 MEDICAL SUPPLIES 3398010 3307974 90036 EQUIPMENT AND MAINTENAN 1326868 757871 568997 DUES AND SUBSCRIPTIONS 52528 24843 27685 141297 98949 42348 28184742 24507149 3677593 0 9469177 5254983 3637781 3764544 542752 566794 248565 242598 62566692 29385056 17499890 33181636 2093212 2359550 445677 357898 714900 1939915 34651954 47667918 2089032 4842286 1557510 -519680 12253366 3090505 2993815 1075000 867915 7292367 20957382 X 26402138 25384707 957449 1325829 27359587 26710536 34651954 47667918 X -1017431 368380 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104552 104552 15907723 11189752 4717971 22237571 17426511 4811060 24316846 768793 23548053 33181636 DEFERRED COMPENSATION PLAN PAYABLE 867915 867915 X 27167311 0 27167311 0 27167311 28184742 0 28184742 0 28184742 PART X, LINE 2: THE HOSPITAL 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 HOSPITAL 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. 1 1 X 1 X 1 X 1 1 1 0 0 130000 130000 0.00460 4728888 3393305 1335583 0.04740 4858888 3393305 1465583 0.05200 6869179 2012638 4856541 0.17230 6869179 2012638 4856541 0.17230 11728067 5405943 6322124 0.22430 1 1306469 171147 6791366 6821785 -30419 X 1 1 1 1 MOBRIDGE REGIONAL HOSPITAL 1401 10TH AVENUE W MOBRIDGE SD 57601 WWW.MOBRIDGEHOSPITAL.ORG 48404 X X X X 4 PROVIDER BASED CLINICS MOBRIDGE REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE 7D X X 1 21 1 SEE PART V, LINE 10A NARRATIVE. 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X SEE NARRATIVE X SEE NARRATIVE X SEE NARRATIVE X X X X X X 1 X 0 X X X X 1 X 0 0 MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 5: THE MOBRIDGE REGIONAL HOSPITAL CONDUCTED AN ELECTRONIC COMMUNITY SURVEY TO UNDERSTAND IN GREAT DEPTH THE CURRENT PERCEPTION OF COMMUNITY HEALTH AND THE UNDERSTANDING OF HEALTH AND WELLNESS SERVICES AVAILABLE IN OUR AREA. THE SURVEY OF FORTY-FOUR QUESTIONS RECEIVED SEVENTY-NINE SUBMISSIONS AND ADDRESSED NINETEEN DIFFERENT TOPICS AND WHETHER EACH TOPIC WAS AN ISSUE WITHIN OUR COMMUNITY.A FOCUS GROUP OF COMMUNITY LEADERS, COMMUNITY HEALTHCARE PROVIDERS, COORDINATING AGENCIES, AND COMMUNITY MEMBERS REPRESENTING UNDERSERVED POPULATIONS ANALYZED THE DATA. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE AT HTTP://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT-990/MOBRIDGE REGIONAL HOSPITAL:PART V, SECTION B, LINE 10ATHE HOSPITAL'S IMPLEMENTATION STRATEGY IS POSTED ON THE WEBSITE AT HTTP://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT-990/THE IMPLEMENTATION STRATEGY BEGINS ON PAGE 8 OF THE CHNA. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 11: IN THE CHNA AND IMPLEMENTATION STRATEGY COMPLETED DURING FY22, THE FOLLOWING PRIORITY ITEMS WERE IDENTIFIED: MENTAL AND BEHAVIORAL HEALTH AND ADDICTION COUNSELING, EDUCATION ABOUT EXISTING SERVICES, IMPROVING COMMUNITY PERCEPTION OF CONFIDENTIALITY, REVISITING THE NURSING HOME STUDY, IMPROVING YOUTH BEHAVIORS, PARTNERING WITH WEST RIVER SCHOOLS, AND INVESTIGATING OPPORTUNITIES TO INCREASE DAYCARE ACCESSIBILITY AND AFFORDABILITY. MRH WILL ADDRESS ALL OF THE IDENTIFIED PRIORITY NEEDS.DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2023, THE ORGANIZATION MADE PROGRESS TOWARD MEETING THE IDENTIFIED NEEDS FROM THE FY22 CHNA AS FOLLOWS:MENTAL AND BEHAVIORAL HEALTH AND ADDICTION COUNSELING:MRH PARTNERED WITH IHC (INTEGRATED HEALTH CENTERS) TO PROVIDE BEHAVIORAL HEALTH SERVICES TO THE COMMUNITY. SERVICES ARE AVAILABLE IN ALL FOUR RURAL HEALTH CLINICS AND INCLUDE PROVIDING A CERTIFIED NURSE PARACTITIONER IN PSYCHIATRY FOR DIAGNOSIS AND MEDICATION MANAGEMENT AS WELL AS TWO LICENSED CLINICAL SOCIAL WORKERS FOR COUNSELING AND FOLLOW UP. MRH CONTINUES TO FOCUS ON PROVIDER EDUCATION ALONG WITH DIRECT-TO-CONSUMER EDUCATION FOR ADDITIONAL REFERRALS AND SELF-REFERRALS TO THE SERVICE. THERE CONTINUES TO BE WORK DONE TO ADD ADDITIONAL STAFF, SHOULD WE FIND THE DEMAND OUTPACES OUR CURRENT CAPACITY.EDUCATION ABOUT EXISTING SERVICES:MRH DISTRIBUTES A COMMUNITY NEWSLETTER THAT COMES OUT FOUR TIMES PER YEAR TO SHARE WITH MEMBERS OF OUR COMMUNITY AND SURROUNDING COMMUNITIES TO PROMOTE OUR CURRENT AND NEW SERVICE OFFERINGS AND TO EDUCATE THEM. MRH HAS ALSO INCREASED THE PRODUCTION OF FACEBOOK POSTS, WEBSITE UPDATES, AND VIDEOS TO EDUCATE ABOUT CURRENT AND NEW SERVICE OFFERINGS. THERE HAVE BEEN A NUMBER OF EDUCATIONAL PIECES PRODUCED IN CONJUNCTION WITH OUR BUILDING PROJECT AND HEALTH FUTURES CAPITAL CAMPAIGN TO HIGHLIGHT NEW AND EXISTING SERVICES. MRH HAS MADE A VERY CONCERTED EFFORT TO SHARE MORE INFORMATION ABOUT OUR SERVICES AND MISSION-DRIVEN WORK WITH THE PUBLIC. WE HAVE WORKED WITH THE MOBRIDGE TRIBUNE TO CREATE A RELATIONSHIP WHERE WE SHARE ARTICLES ABOUT NEW AND EXISTING SERVICES, LOCAL PHILANTHROPY, ETC. AS A GUEST COLUMNIST. WE ALSO HAVE STARTED BUILDING AN EMAIL LIST THROUGH THE MRHC FOUNDATION TO SEND OUT A PERIODIC NEWSLETTER, 'THE HEARTBEAT'. THIS NEWSLETTER IS MEANT TO EDUCATE THE PUBLIC ABOUT DIFFERENT SERVICES WE PROVIDE. IMPROVING COMMUNITY PERCEPTION OF CONFIDENTIALITY:MRH FOCUSES ON EMPLOYEE EDUCATION STRESSING THE IMPORTANCE OF CONFIDENTIALITY. THIS INCLUDES AUDITS OF THE EMR (ELECTRONIC MEDICAL RECORD) BEHAVIORS THAT IMPACT PATIENT CONFIDENTIALITY. THESE UPDATES AND METHODOLOGY OF AUDITS ARE BEING COMMUNICATED AT ALL-EMPLOYEE FORUMS. ALSO, WITH REGARDS TO THOSE AUDITS, WE FEEL IT IS IMPORTANT FOR US TO KNOW THAT WE ARE KEEPING PATIENTS' INFORMATION CONFIDENTIAL AS WE RAISE AWARENESS OF EFFORTS TO DO SO. REVISITING THE NURSING HOME STUDY:THE MRH CEO MET WITH THE BOARD OF DIRECTORS OF THE WCCC (WALWORTH COUNTY CARE CENTER) ON AUGUST 2, 2023 TO REAFFIRM SUPPORT AND DISCUSS MANY THINGS. AMONG THE TOPICS DISCUSSED WAS THE DESIRE TO REFRESH, WITH ADDITIONAL INFORMATION AND INCREASED SERVICE AREA, THE NURSING HOME STUDY THAT WAS ORIGINALLY PERFORMED IN 2020. WCCC AND MRH BOTH PLEDGED SUPPORT TO THE IDEA. THE COLLABORATION ALSO AGREED TO PURSUE GRANT FUNDING TO PAY FOR IT, WHICH HAS NOT BEEN SECURED TO DATE.IMPROVING YOUTH BEHAVIORS:THE IHC PARTNERSHIP INCLUDES ACCESS TO CHILD (LESS THAN 5 YEARS OLD) AND ADOLESCENT COUNSELING. MRH HAS ALSO PROVIDED ADDITIONAL FINANCIAL SUPPORT TO THE MYO (MOBRIDGE YOUTH ORGANIZATION). MRH CONTINUES TO PROVIDE FREE SPORTS PHYSICALS TO ENSURE AS MANY STUDENTS AS POSSIBLE HAVE ACCESS TO SCHOOL SPORTS. THE MRH DIRECTOR OF DIAGNOSTIC IMAGING TEACHES THE HEALTHCARE CAREERS CLASSES AT THE MOBRIDGE POLLOCK HIGH SCHOOL TO ENGAGE STUDENTS IN HEALTH AWARENESS, EDUCATION, AND POTENTIAL INTEREST IN HEALTHCARE CAREERS; WE ALSO PROVIDE SCRUBS CAMP TO ENGAGE HIGH SCHOOL STUDENTS IN THE SURROUNDING COMMUNITIES. MRH ALSO COORDINATES THE MISYA WALK TO RAISE AWARENESS OF SUICIDE. MRH ALSO SPONSORS THE ANNUAL THINK & DRIVE EVENT TO ENCOURAGE HEALTHY YOUTH BEHAVIORS IN HIGH SCHOOL STUDENTS IN THE SURROUNDING COMMUNITIES.PARTNERING WITH WEST RIVER SCHOOLS:THIS WAS NOT ADDRESSED AS OF FY23.INVESTIGATING OPPORTUNITIES TO INCREASE DAYCARE ACCESSIBILITY AND AFFORDABILITY:MRH WORKED DIRECTLY WITH THE MOBRIDGE ECONOMIC DEVELOPMENT CORPORATION TO PARTNER WITH AND/OR SUPPORT TIGER KIDS AND RIVER'S EDGE LEARNING CENTER TO EXPAND CAPACITY. ULTIMATELY, THE COMMUNITY WORKED TO TRANSITION THE TWO ENTITIES INTO THE LAKE OAHE LEARNING ACADEMY (LOLA), A NOT-FOR-PROFIT, 501(C)(3) COMMUNITY CORPORATION THAT HAS EXPANDED CAPACITY WITH ADDITIONAL POTENTIAL FOR CAPACITY GAINS INTO THE FUTURE. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 13H: THE ORGANIZATION QUALIFIES FREE VERSUS DISCOUNTED CARE BASED ON PROFESSIONAL FEES VERSUS TECHNICAL FEES. WE OFFER 100% OF FREE CARE FOR PROFESSIONAL FEES AND UP TO AN 95% DISCOUNT FOR TECHNICAL FEES. BOTH ARE CALCULATED BASED ON FEDERAL POVERTY GUIDELINES IN THE FAP.PRESUMPTIVE ELIGIBILITY MAY BE USED AS A LAST RESORT. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 16J: PART V, LINE 16A, FAP WEBSITE:HTTPS://MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/PART V, LINE 16C, PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/PART V, LINE 16J: A FINANCIAL ASSISTANCE NOTICE IS MADE PART OF THE BILLING INVOICE. A FINANCIAL ASSISTANCE NOTICE IS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, AND ADMISSIONS OFFICE, AND THE FULL POLICY IS MADE AVAILABLE UPON REQUEST AND ON THE WEBSITE. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. 1 3 - PRAIRIE SUNSET VILLAGE 1320 W GRAND XING MOBRIDGE SD 57601 ASSISTED LIVING & SENIOR HOUSING PART I, LINE 3C: THE ORGANIZATION QUALIFIES FREE VERSUS DISCOUNTED CARE BASED ON PROFESSIONAL FEES VERSUS TECHNICAL FEES. WE OFFER 100% OF FREE CARE FOR PROFESSIONAL FEES AND UP TO AN 95% DISCOUNT FOR TECHNICAL FEES. BOTH ARE CALCULATED BASED ON FEDERAL POVERTY GUIDELINES IN THE FAP.IN ADDITION TO FPG, THE HOSPITAL USES AN ASSET TEST, REVIEWS MEDICAL INDIGENCY, AND CONSIDERS INSURANCE STATUS IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. PRESUMPTIVE ELIGIBILITY MAY BE USED AS A LAST RESORT. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7B WAS DETERMINED USING THE MEDICAID PS&R REPORT AND THE GENERAL LEDGER ACCOUNTING SYSTEM. LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 9/30/23. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDES NET LOSSES OF $5,805,731 ATTRIBUTABLE TO PHYSICIAN CLINICS. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PATIENTS AND RESIDENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL. THE 13.1% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: FOOTNOTE FROM FINANCIAL STATEMENTS: PLEASE SEE NOTE 1, FINANCIAL STATEMENT, PATIENT AND RESIDENT SERVICE REVENUE ON PAGES 14-15. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2023. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: THE PATIENT ACCOUNT SPECIALIST AT THE MOBRIDGE REGIONAL HOSPITAL KEEPS ON FILE ALL GUARANTORS WHO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE AND APPLIES THE FINANCIAL ASSISTANCE TO ALL ACCOUNTS WHEN THE GUARANTOR BALANCE BECOMES DUE. UPDATED FINANCIAL INFORMATION IS REQUESTED ANNUALLY FOR ANY CHANGES IN FINANCIAL ASSISTANCE THAT MAY APPLY. IF AN ACCOUNT GOES TO COLLECTIONS AND OUR COLLECTION AGENCY IDENTIFIES THAT A PATIENT IS MEETING FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA, THE PATIENT'S ACCOUNT MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE. COLLECTION ACTIVITY WILL BE SUSPENDED ON ACCOUNTS, AND THE FINANCIAL ASSISTANCE APPLICATION WILL BE REVIEWED. IF THE ENTIRE ACCOUNT BALANCE IS ADJUSTED, THE ACCOUNT WILL BE RETURNED. IF A PARTIAL ADJUSTMENT OCCURS, THE PATIENT FAILS TO COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS, OR IF THE PATIENT IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY WILL RESUME. PART VI, LINE 2: MOBRIDGE REGIONAL HOSPITAL (MRH) IS COMMITTED TO PROVIDING HIGH QUALITY HEALTHCARE SERVICES TO ALL PEOPLE THROUGHOUT THE REGION. THE FACILITY PROVIDES FAMILY MEDICINE, INTERNAL MEDICINE, OB, ICU, ALS, AMBULANCE SERVICE, EMERGENCY CARE, AND SURGICAL SERVICES TO ALL PEOPLE WHO ARE IN NEED OF THOSE SERVICES. MRH CURRENTLY IS WORKING IN COLLABORATION WITH WALWORTH COUNTY AND THE STATE OF SOUTH DAKOTA TO PROVIDE COMMUNITY HEALTH SERVICES, INCLUDING FAMILY PLANNING SERVICES, ADULT HEALTH, AND CHILD IMMUNIZATIONS. MRH'S MANAGEMENT STRIVES TO LISTEN TO THE COMMUNITY NEEDS. IF NEW HEALTHCARE NEEDS ARISE, ADMINISTRATION WILL COMPLETE AN ANALYSIS OF COST/BENEFIT FOR THE NEW SERVICE TO BE OFFERED. MRH'S ADMINISTRATION BELIEVES IN BEING OUT IN THE PUBLIC AT EVENTS TO ANSWER QUESTIONS THAT MAY SURFACE ABOUT THE FACILITY. PART VI, LINE 3: MRH POSTS ITS FINANCIAL ASSISTANCE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN THE ADMISSIONS AREAS AND CLINIC AREAS IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FACILITY PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS WITH DISCHARGE MATERIALS. THE PATIENTS ACCOUNT MANAGER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. PART VI, LINE 4: MRH IS LOCATED IN A SMALL RURAL COMMUNITY IN WALWORTH COUNTY, SOUTH DAKOTA, KNOWN AS MOBRIDGE. WALWORTH COUNTY HAS A POPULATION OF 5,315 PEOPLE RACIALLY COMPRISED OF MAINLY CAUCASIAN (77.9%) AND NATIVE AMERICANS/ALASKAN NATIVE (15.2%). THE COMMUNITY BORDERS THE STANDING ROCK RESERVATION AND THE CHEYENNE RIVER RESERVATION WHICH ACCOUNTS FOR THE LARGER NATIVE AMERICAN POPULATION AND RELATIONS WITH INDIAN HEALTH SERVICES.WALWORTH COUNTY'S MEDIAN FAMILY INCOME IS $57,967. APPROXIMATELY 13.2% OF THE POPULATION OF WALWORTH COUNTY IS BELOW THE FEDERAL POVERTY LEVEL WITH APPROXIMATELY 11.7% OF THE POPULATION WITHOUT HEALTHCARE COVERAGE. CORSON COUNTY HAS A POPULATION OF 3,902 AND IS THE SECOND LARGEST COUNTY IN OUR SERVICE AREA. THE FPL OF CORSON COUNTY IS 43.4% WITH APPROXIMATELY 20.4% OF THE POPULATION WITHOUT HEALTHCARE COVERAGE. THE FACILITY OWNS AND OPERATES CLINICS IN MOBRIDGE, MCLAUGHLIN, TIMBER LAKE AND SELBY. THESE FACILITIES SERVE PATIENTS FROM A SIX-COUNTY AREA (WALWORTH, ZIEBACH, CORSON, DEWEY, CAMPBELL AND POTTER). MOBRIDGE REGIONAL HOSPITAL PROVIDES OBSTETRICS, FAMILY AND INTERNAL MEDICINE, AND SURGICAL SERVICES. IT IS APPROXIMATELY ONE HUNDRED MILES FROM ANOTHER HOSPITAL WITH A HIGHER LEVEL OF CARE OFFERED. PART VI, LINE 5: THE MOBRIDGE REGIONAL HOSPITAL IS COMMITTED TO THE PATIENTS WE SERVE, REGARDLESS OF RACE, COLOR, RELIGION, SEX, DISABILITY, OR ABILITY TO PAY. THE ORGANIZATION'S FINANCIAL ASSISTANCE ADJUSTMENTS HAVE CONTINUED TO TREND UP OVER THE PAST FEW YEARS, AND WE CONTINUE TO FOCUS BUDGET EFFORTS TO ADAPT TO THIS TREND. MRH IS 100 MILES FROM ANOTHER HEALTHCARE FACILITY WITH A HIGHER LEVEL OF CARE AND PARTICIPATES IN THE NORTH DAKOTA AND SOUTH DAKOTA TRAUMA SYSTEMS WITH LEVEL IV CERTIFICATION. MRH CONTINUES A BROAD LEVEL OF BOARD INVOLVEMENT FOR CORSON, DEWEY, AND WALWORTH COUNTIES TO MONITOR COMMUNITY NEEDS IN THOSE AREAS. MRH CONTINUES TO BE A POPULAR PLACE FOR MEDICAL STUDENTS TO COMPLETE CLINICAL ROTATIONS, AND WE CONTINUE TO OFFER A WIDE VARIETY OF CERTIFICATION CLASSES TO NURSES AND THE MEMBERS OF THE COMMUNITY INCLUDING EMT-B, PALS, ACLS, TNCC, ALSO, NALS, EMT-I, AND CPR. MRH HAS DEVELOPED A WORKSITE WELLNESS PROGRAM WITHIN THE ORGANIZATION AND HAS GOALS TO WORK WITH OTHER BUSINESSES IN THE COMMUNITY TO PROMOTE OVERALL HEALTHY LIFESTYLES.THE HOSPITAL HAS A BOARD OF DIRECTORS COMPRISED OF VOLUNTEERS WHO RESIDE IN THE SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE AREA. ALL QUALIFIED PHYSICIANS WHO SHOW AN INTEREST MUST GO THROUGH A CREDENTIAL REVIEW AND BOARD APPROVAL. SURPLUS FUNDS, IF AVAILABLE, ARE REINVESTED IN THE FACILITIES TO IMPROVE PATIENT CARE. 0 1 0 0 0 0 0 0 0 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 386670 0 0 0 0 0 27696 0 30884 0 445250 0 0 0 DR ALAN LAWRENCE SURGEON 381058 0 0 0 0 0 6516 0 20302 0 407876 0 0 0 DR MATT SCHAFFER PHYSICIAN 363157 0 0 0 0 0 12200 0 28506 0 403863 0 0 0 DR EMILY BODEN PHYSICIAN 345121 0 0 0 0 0 12200 0 33698 0 391019 0 0 0 DR JOSH HENDERSON INTERNAL MEDICINE 343963 0 0 0 0 0 12200 0 28506 0 384669 0 0 0 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 322234 0 0 0 0 0 12200 0 20302 0 354736 0 0 0 DR DONALD LUCEK SURGEON 288382 0 0 0 0 0 31639 0 20302 0 340323 0 0 0 RENAE KARST CFO 130505 0 0 0 0 0 5572 0 30993 0 167070 0 0 0 PART I, LINE 3 THE CEO IS COMPENSATED THROUGH A MANAGEMENT AGREEMENT WITH CHI ST. ALEXIUS MEDICAL CENTER IN BISMARCK, ND. THE EXECUTIVE COMMITTEE OF MOBRIDGE REGIONAL HOSPITAL REVIEWS THE MANAGEMENT AGREEMENT AND MAKES A DETERMINATION AS TO WHETHER THE COMPENSATION FOR THE CEO'S SERVICES IS REASONABLE. PART I, LINE 4B DEFERRALS WERE MADE TO THE 457(B) PLAN (NOT SUBSTANTIALLY VESTED) BY THE FOLLOWING PARTICIPANTS: DR. TRAVIS HENDERSON - $15,496 AND DR. DON LUCEK - $20,500. A CITY OF MOBRIDGE SOUTH DAKOTA 466000320 2021-12-27 41492000 CONSTRUCT A NEW INPATIENT WING, REMODEL SURGERY, RADIOLOGY, PHARMACY, & ER 0 0 0 A 13048901 13048901 28443099 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 0 A 1 FORM 990 SCHEDULE K, PART II, LINE 3 THE TAX-EXEMPT BOND FINANCING IS BASED ON A DRAW DOWN METHOD FOR INTERIM FINANCING WITH THE LENDER AFTER ALLOWABLE EXPENSES ARE PAID AND APPROVED. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN OF THE BOARD, WHO SHALL ACT AS CHAIRMAN OF SAID COMMITTEE, THE SECRETARY, VICE-CHAIRMAN, AND TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES OF THE EXPRESSED WISHES OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 MRH CURRENTLY HAS A MANAGEMENT AGREEMENT WITH CHI ST. ALEXIUS MEDICAL CENTER IN BISMARCK, ND. THE MANAGEMENT AGREEMENT PROVIDES THAT CHI ST. ALEXIUS HEALTH WILL PROVIDE MANAGEMENT AND ADMINISTRATIVE SERVICES. THE AGREEMENT REMAINS IN EFFECT IN PERPETUITY BUT MAY BE CANCELLED BY THE HOSPITAL FOLLOWING A 90-DAY NOTICE. JOHN AYOUB, CEO, RECEIVED COMPENSATION OF $251,221 AND ESTIMATED BENEFITS OF $37,325 DURING CALENDAR YEAR 2022. THE CEO OVERSEES ALL DAILY OPERATIONAL ACTIVITIES AND REPORTS TO THE ORGANIZATION'S BOARD OF DIRECTORS. THE CEO WORKS VERY CLOSELY WITH ALL DEPARTMENT SUPERVISORS TO ENSURE THAT ALL AREAS OF THE HOSPITAL ARE RUNNING EFFICIENTLY AND SMOOTHLY. THE CEO IS RESPONSIBLE FOR PHYSICIAN CONTRACTING AND WORKS VERY CLOSELY WITH HUMAN RESOURCES FOR RECRUITMENT OF PROFESSIONAL MEDICAL STAFF. THE CEO'S SALARY IS DETERMINED USING A SALARY SURVEY AND DISCUSSIONS WITH THE MANAGEMENT COMPANY. THE EXECUTIVE COMMITTEE APPROVES THE SALARY OF THE CEO ANNUALLY. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBER; ALL MEMBERS HAVE ONE VOTE (SAME VOTING RIGHTS). EACH PERSON WHO DONATES $100 OR MORE IS A MEMBER ENTITLED TO ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7A THE NOMINATING COMMITTEE NOMINATES CANDIDATES FOR ELECTION. THE MEMBERS VOTE ON CANDIDATES AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE CEO, CFO, AND BOARD OF DIRECTORS WILL REVIEW THE FORM 990 VIA ELECTRONIC TRANSMISSION PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE ENTIRE BOARD OF DIRECTORS. IF A CONFLICT SHOULD ARISE, IT WOULD FIRST GO TO THE CEO FOR EVALUATION, THEN TO THE BOARD OF DIRECTORS FOR FINAL EVALUATION. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR MAKING THE FINAL DECISION IN DETERMINING IF A CONFLICT EXISTS. IF A CONFLICT IS FOUND, THE PERSON(S) INVOLVED WOULD BE REQUIRED TO ABSTAIN FROM DISCUSSIONS AND VOTING ON THE ITEM CAUSING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15B THE FINANCE COMMITTEE DETERMINES AND APPROVES THE PHYSICIAN CONTRACTS, INCLUDING COMPENSATION. SALARIES FOR OTHER OFFICERS OR MEMBERS OF MANAGEMENT ARE DETERMINED BY THE CEO THROUGH THE USE OF SALARY SURVEY INFORMATION FROM SDAHO AND EMPLOYEE SERVICE AND EXPERIENCE FILES. THIS PROCESS IS UNDERTAKEN ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FOUNDATION INTEREST 368,380. MOBRIDGE REGIONAL HEALTHCARE FOUNDATION PO BOX 580 MOBRIDGE SD 57601 460416693 OUTREACH FOR MOBRIDGE REGIONAL HOSPITAL SD 501(C)(3) LINE 12C, III-FI MOBRIDGE REGIONAL HOSPITAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0