2026-04-17T14:23:38-05:00 2025-06-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2024-07-01 460239781 PLATTE COMMUNITY MEMORIAL HOSPITAL INC PLAT 6053373364 601 E 7TH STREET PLATTE SD 57369 MARK BURKET CEO 6053373364 2026-04-09 1 1 LAURIE HANSON CPA P00851848 6053391999 2026-04-09 2024 2025-03-06 01:10:19Z PLATTE HEALTH CENTER-AVERA MARK BURKET 601 E 7TH STREET PLATTE SD 57369 22678204 0 X WWW.PHCAVERA.ORG X 1947 SD PROVIDE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. 9 7 193 30 0 0 268134 73214 19390028 21587146 1493020 951670 69837 66174 21221019 22678204 23883 9865 0 0 11352803 11398103 0 0 0 5893043 6615524 17269729 18023492 3951290 4654712 35260796 40036195 7211910 6648868 28048886 33387327 X PLATTE COMMUNITY MEMORIAL HOSPITAL, INC. IS A HEALTH MINISTRY ROOTED IN THE GOSPEL. OUR MISSION IS TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES BY PROVIDING QUALITY SERVICES GUIDED BY CHRISTIAN VALUES. 0 0 15444426 9865 21587146 THE PURPOSE OF THE PLATTE COMMUNITY MEMORIAL HOSPITAL, INC. IS TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY OF PLATTE AND THE SURROUNDING AREAS. THE FACILITY CONSISTS OF A 17-BED CRITICAL ACCESS HOSPITAL, A 39-BED LONG-TERM CARE FACILITY, AND THREE RURAL HEALTH CLINICS IN PLATTE, GEDDES, AND WHITE LAKE, SOUTH DAKOTA. SERVICES OFFERED INCLUDE PRIMARY CARE, EMERGENCY, SAME-DAY SURGERY, CARDIAC REHAB, PHARMACY, LABORATORY, IMAGING, PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, TELEMEDICINE, SLEEP LAB, PSYCHIATRY, AND NUMEROUS SPECIALTIES VIA OUTREACH PROVIDERS. INPATIENT AND OUTPATIENT STATISTICAL DATA FOR THE YEAR WERE AS FOLLOWS: 485 INPATIENT DAYS; 312 SWING BED DAYS; 12,540 LONG-TERM CARE DAYS; 7,557 OUTPATIENT VISITS; AND 10,498 CLINIC VISITS.TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE PLATTE HEALTH CENTER AVERA PROVIDES CHARITY CARE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE. CONSISTENT WITH ITS MISSION TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES BY PROVIDING QUALITY SERVICES GUIDED BY CHRISTIAN VALUES, PHCA STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE.PHCA ATTESTED TO THE PROGRAM YEAR 2024 OF MEANINGFUL USE. THIS ATTESTATION TO CMS STATES PHCA HAS MET AND WILL COMPLY WITH THE REQUIREMENTS FOR MEANINGFUL USE. WITH THIS, PHCA HAS ENHANCED PATIENT CARE BY IMPLEMENTING AN ELECTRONIC HEALTH RECORD SYSTEM AS WELL AS THE MANY PATIENT SAFETY MEASURES THAT COMES WITH IT. 15444426 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 30 0 1 193 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X VICKI JENSEN 6053373364 601 E 7TH STREET PLATTE SD 57369 HAU TRAN PHYSICIAN 40.00 X 373200 0 60705 DR NELSON BATOON PHYSICIAN 40.00 X 370495 0 60705 MARK BURKET CEO 40.00 X 247204 0 81038 JEFFREY KONSTANZ PHYSICIAN ASSISTANT 40.00 X 217629 0 65562 APRIL VEURINK CNP 40.00 X 181880 0 9472 DR JEROME BENTZ PHYSICIAN 25.00 X 165560 0 9114 VICKI JENSEN CFO 40.00 X 109047 0 50506 DENNIS VANDERWERFF PRESIDENT UNTIL 11/2024 4.00 X X 0 0 0 KAREN TURNIS DIRECTOR/PRESIDENT FROM 11/2024 4.00 X X 0 0 0 JESSE BLOCK VICE PRESIDENT 1.00 X X 0 0 0 JILL GUSTAD SECRETARY 1.00 X X 0 0 0 BRANDI DELANGE TREASURER 1.00 X X 0 0 0 JORDEN GILLEN DIRECTOR FROM 11/2024 1.00 X 0 0 0 ROBERT GRAVES DIRECTOR 1.00 X 0 0 0 ANN JOHNSON DIRECTOR 1.00 X 0 0 0 DENNIS SEVERSON DIRECTOR 1.00 X 0 0 0 TRAVIS TEGETHOFF DIRECTOR FROM 11/2024 1.00 X 0 0 0 1665015 0 337102 15 0 1 0 SF CONSTRUCTIONJOURNEY PO BOX 2728 SIOUX FALLS SD 571012728 CONSTRUCTION 1796124 PRIME TIME HEALTHCARE LLC PO BOX 3544 OMAHA NE 681033544 TEMP/CONTRACT CNAS AND RNS 563244 AVERA QUEEN OF PEACE 525 N FOSTER MITCHELL SD 57301 MGMT AGREEMENT/SERVICES 480782 AVERA HEALTH 3900 W AVERA DRIVE SIOUX FALLS SD 57104 PURCHASED SERVICES 456327 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 571175045 PURCHASED SERVICES 280811 8 56214 17000 73214 NET PATIENT SERVICE REVENUE 621110 19943938 19943938 PHARMACY REVENUE 623990 1272274 1272274 370934 370934 21587146 354970 354970 66174 0 66174 66174 66174 596700 0 596700 596700 596700 22678204 21587146 0 1017844 5710 5710 4155 4155 474273 474273 57965 57965 8384079 7829769 554310 256273 187669 68604 1635299 1571962 63337 590214 547939 42275 506 134 372 110010 11629 98381 451 451 71206 71206 1583616 1281601 302015 28565 6643 21922 210360 146462 63898 487284 53104 434180 437778 413349 24429 40559 34390 6169 54798 42082 12716 142223 109230 32993 1178074 1079950 98124 131205 24370 106835 MEDICAL SUPPLIES 1621375 1610514 10861 REPAIRS AND MAINTENANCE 392855 390593 2262 EQUIPMENT LEASE/RENTAL 26740 23009 3731 97919 12197 85722 18023492 15444426 2579066 0 2720413 2263453 1908145 5445505 200302 334231 133306 169874 28651338 15302277 12136211 13349061 3340558 9686477 10736981 7379431 271262 196294 3813618 1211869 35260796 40036195 1928458 1697409 425 465 4772891 4339267 510136 611727 7211910 6648868 X 24712605 29786697 3336281 3600630 28048886 33387327 35260796 40036195 X 4654712 346639 337090 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 451 0 0 0 451 0 PART II-B, LINE 1F THE AMOUNT FOR GRANTS PAID TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES REPRESENTS THE PORTION OF DUES PAID TO SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATION (SDAHO) THAT ARE ATTRIBUTABLE TO LOBBYING. 0 1 X 3071801 115 236251 3308167 2786086 1473 284242 3071801 2611416 1390 173280 2786086 2936661 962 -326207 2611416 2502516 1168 432977 2936661 0.00000 0.56490 0.43510 1 0 242952 242952 21990684 10685224 11305460 5987295 4238504 1748791 430407 378549 51858 13349061 INTEREST IN AVERA HEALTH FOUNDATION 884183 F UNDER LOAN AGREEMENT 255940 F ASSETS LIMITED AS TO USE - FUNDED DEPRECIATION 6239308 F 7379431 DEFERRED COMPENSATION PAYABLE 611727 611727 X 23290727 346639 265884 612523 22678204 0 22678204 17952286 0 17952286 71206 71206 18023492 PART IV, LINE 2B: THE NURSING HOME RESIDENTS ARE ALLOWED TO HAVE FUNDS IN THE RESIDENT TRUST ACCOUNT. THE MONEY CAN BE USED FOR ANY PERSONAL ITEMS THEY DESIRE: SNACKS, LUNCH, HAIRCUTS, ETC. THE RESIDENTS ARE NOT CHARGED ANY FEES FOR UTILIZING THE ACCOUNT. THE ACCOUNT IS RECONCILED MONTHLY BY THE BUSINESS OFFICE STAFF. INTEREST IS PAID TO ANY INDIVIDUAL RESIDENT WHO HAS OVER $50 IN THEIR ACCOUNT. PART V, LINE 4: THE INCOME WILL BE USED TOWARD EXPENDITURES FOR HEALTHCARE SERVICES. PART X, LINE 2: THE HEALTH 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 HEALTH 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: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 337,090. INVESTMENT EXPENSES -71,206. 1 1 X 1 X 1 X 1 1 1 0 0 1 22 76000 76000 0.00420 1 22 76000 76000 0.00420 4 187 23551 16860 6691 0.00040 2212397 1944244 268153 0.01490 4 10710 10710 0.00060 8 187 2246658 1961104 285554 0.01590 9 209 2322658 1961104 361554 0.02010 1 208697 47583 5980973 6029353 -48380 X 1 1 1 1 PLATTE HEALTH CENTER-AVERA 601 E 7TH STREET PLATTE SD 57369 WWW.PHCAVERA.ORG 10557 X X X X X 3 PROVIDER-BASED CLINICS PLATTE HEALTH CENTER-AVERA 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X SEE PART V SECTION C X 1 24 1 SEE PART V SECTION C 0 1 X 150.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V SECTION C X SEE PART V SECTION C X SEE PART V SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 PLATTE HEALTH CENTER-AVERA PART V, SECTION B, LINE 5: THE CHNA COORDINATOR COLLECTED QUALITATIVE OR PRIMARY REVIEW DATA THROUGH THE USE OF A COMMUNITY-WIDE SURVEY, FOCUS GROUPS, KEY INFORMANT INTERVIEWS. DATA WAS ALSO COLLECTED FROM THE U.S. DEPARTMENT OF EDUCATION, CENTERS FOR DISEASE CONTROL AND PREVENTION, BUREAU OF LABOR STATISTICS, U.S. CENSUS BUREAU, COUNTY HEALTH RANKINGS, SOUTH DAKOTA DEPARTMENT OF HEALTH, ROBERT WOOD JOHNSON FOUNDATION, HEALTHCARE CONNECTION, AND THE SOUTH DAKOTA DEPARTMENT OF LABOR.THE GREATEST PORTION OF THE ORGANIZATION'S PATIENTS AND CUSTOMERS RESIDE IN THE COUNTY OF CHARLES MIX AND THE TOWNS OR PLATTE, GEDDES, AND WHITE LAKE. THE PUBLIC WAS SURVEYED THROUGH SOCIAL MEDIA, USING THE FACILITY'S FACEBOOK PAGE, AVERA'S WEBPAGE, A POSTER WITH A QR CODE, A LINK SENT TO AREA SCHOOLS AND CHAMBERS OF COMMERCE AND VIA EMAIL TO ALL EMPLOYEES. PAPER COPIES OF THE SURVEY WERE AVAILABLE UPON REQUEST FREE OF CHARGE. THE SURVEY WAS OPENED ON NOVEMBER 14, 2024, AND CLOSED ON JANUARY 13, 2025. A TOTAL OF 197 SURVEYS WERE COLLECTED WITH 147 SURVEYS FULLY COMPLETED.FOCUS GROUPS CONSISTED OF DEPARTMENT DIRECTORS WITHIN THE HOSPITAL AND BOARD MEMBERS FROM WITHIN THE COMMUNITY. INTERVIEWS WERE CONDUCTED WITH THE FOLLOWING KEY COMMUNITY MEMBERS: CHARLES MIX COUNTY COMMUNITY HEALTH NURSE, THE PLATTE-GEDDES SCHOOL COUNSELOR, THE OLDER ADULT RESOURCE NETWORK CONSULTANT FOR LUTHERAN SOCIAL SERVICES, AND THE MINISTERIAL ASSOCIATION. PLATTE HEALTH CENTER-AVERA PART V, SECTION B, LINE 11: IN ITS FY25 CHNA, THE PLATTE HEALTH CENTER IDENTIFIED THE TOP THREE COMMUNITY HEALTH NEEDS AS FOLLOWS:1. MENTAL HEALTH SERVICES: ENHANCE ACCESS TO CURRENT SERVICES; RESEARCH DEVELOPMENT OF A COMMUNITY MENTAL HEALTH COALITION AND UTILIZE MARKETING STRATEGIES TO INCREASE AWARENESS OF SERVICES AND THE STIGMA ASSOCIATED WITH MENTAL HEALTH. 2. AGING ISSUES/ELDER CARE SERVICES/NETWORKS: ENHANCE SERVICES TO KEEP PEOPLE IN THEIR OWN HOME LONGER. 3. PROMOTE HEALTH MANAGEMENT STRATEGIES: MANAGEMENT OF CHRONIC HEALTH CONDITIONS (CHF, COPD, HTN, CANCERS, OBESITY): CONTINUED ACCESS TO PREVENTION/SCREENING PROGRAMS, CHRONIC DISEASE MANAGEMENT PROGRAMS AND ACCESS TO PROPER DIET (FRESH FRUITS/VEGETABLES) AND NUTRITION. OTHER HEALTH NEEDS WERE IDENTIFIED DURING THE CHNA PROCESS. HOWEVER, DUE TO LIMITED FINANCIAL RESOURCES, THE PLATTE HEALTH CENTER CANNOT ADDRESS ALL THE IDENTIFIED NEEDS. MEDICAL SERVICES FOR OBSTETRICS, PEDIATRICS ORTHODONTIA: THESE SERVICES ARE OUTSIDE THE FACILITY'S SCOPE TO ADDRESS. PATIENTS HAVE ESTABLISHED SELF-REFERRALS TO THESE SERVICES OUTSIDE OF THE COMMUNITY. PLATTE HEALTH CENTER IS COMMITTED TO ONGOING STAFF TRAINING AND SUPPORT TO ENHANCE EMERGENCY ROOM PREPAREDNESS. ADDICTION AND SUBSTANCE ABUSE: THE PROGRAMS ARE OUTSIDE OF THE FACILITY'S SCOPE OF PRACTICE TO ADDRESS. INFORMATION GATHERED THROUGH THE CHNA WILL BE SHARED WITH THE LOCAL MENTAL HEALTH SERVICES AND COUNSELORS. CHILDCARE/AFTER SCHOOL PROGRAMS: THIS NEED WAS BEING ADDRESSED THROUGH THE PLATTE DEVELOPMENT CORPORATION WITH GRANT DOLLARS OBTAINED AFTER CONDUCTING/PROVIDING THE GREATER PLATTE COMMUNITY CHILD CARE LANDSCAPE STUDY. AFFORDABLE HOUSING: THIS WAS ALSO A PRIORITY ON THE FACILITY'S 2022 CHNA. SINCE THAT TIME, THE FACILITY HAS PROVIDED TWO GOVERNOR HOMES IN PLATTE. ONE OF THE HOMES HAS BEEN SOLD, AND THE OTHER IS AVAILABLE FOR SALE. THE FACILITY BELIEVES THE IMMEDIATE NEED FOR HOUSING HAS MUCH IMPROVED OVER THE PAST THREE YEARS. HEALTHY FAMILY/RECREATIONAL/FITNESS ACTIVITIES: THIS NEED IS OUTSIDE OF THE FACILITY'S SCOPE OF SERVICES TO ADDRESS. THE FACILITY IS AN ADVOCATE FOR THE PROPOSED WALKING TRAIL AND HAS PLEDGED $25,000 IN FINANCIAL SUPPORT TO ITS DEVELOPMENT. THE CITY AND PRIVATE SECTOR ARE PROVIDING OPTIONS FOR EXERCISE/WELLNESS PROGRAMS.PLATTE HEALTH CENTER COMPLETED A NEW CHNA IN 2025 BUT FOCUSED ON NEEDS FROM THE PRIOR CHNA DUE TO TIMING.THE FOLLOWING ACTIONS WERE TAKEN DURING THE YEAR TO ACHIEVE THE GOALS OF THE 2021 CHNA: HEALTH SCREENINGS/PREVENTION: PLATTE HEALTH CENTER CONTINUED TO PROMOTE AND MARKET THE PLANET HEART SCREENINGS, IN COLLABORATION WITH THE AVERA HEART HOSPITAL. THIS CARDIOVASCULAR AND VASCULAR SCREENING IS MADE AVAILABLE TO PATIENTS FOR A LOW COST OF $125. THE FACILITY CONTINUES TO PROMOTE AND MARKET ANNUAL MAMMOGRAMS. PATIENT DATA IS MONITORED AND WOMEN WHO ARE OVERDUE FOR THEM MAMMO SCREENING ARE CONTACTED VIA LETTER AND PHONE/TEXT NOTIFICATIONS. CHRONIC CARE MANAGEMENT SERVICES WERE OFFERED TO MEDICARE PATIENTS WITH TWO OR MORE CHRONIC CONDITIONS. SOCIAL MEDIA CAMPAIGNS ARE ONGOING TO BRING AWARENESS TO LOCAL AVAILABILITY. SOME OF THOSE INCLUDE DIABETES, FALL RISK PREVENTION, BREAST CANCER AWARENESS, HEART HEALTH, IMMUNIZATION SAFETY, CERVICAL CANCER AWARENESS, BENEFITS OF PHYSICAL ACTIVITY, SLEEP HEALTH, ALCOHOL AWARENESS, SUMMER SAFETY, TEEN DRIVING, FIREWORKS SAFETY, AND STROKE SIGNS AND SYMPTOMS. MENTAL HEALTH SERVICES: A CURRENT YEAR EVALUATION OF THE PSYCHIATRY SPECIALTY REVEALED A VERY SUCCESSFUL SERVICE LINE. THE PROVIDER GIVES PATIENTS ACROSS A LARGE EXTENDED DEMOGRAPHIC ACCESS TO A MUCH-NEEDED RESOURCE. HOUSING/DAYCARE: TO ADDRESS AFFORDABLE HOUSING IN THE COMMUNITY, THE FACILITY PURCHASED TWO GOVERNOR HOMES. UPON DELIVERY OF THE HOMES, GARAGES AND BASEMENTS WERE COMPLETED IN MARCH 2025. THESE AFFORDABLE HOMES WERE MADE AVAILABLE FOR SALE TO THE PUBLIC. A PURCHASE AGREEMENT WAS IN PLACE FOR ONE OF THE HOMES AS OF JUNE 30, 2025. PLATTE HEALTH CENTER-AVERA PART V, SECTION B, LINE 13H: PRESUMPTIVE CHARITY CARE IS A TOOL OF LAST RESORT AND APPLIES ONLY AFTER ALL OTHER AVENUES HAVE BEEN EXHAUSTED. THERE ARE OCCASIONS WHEN A PATIENT MAY APPEAR ELIGIBLE FOR A CHARITY CARE DISCOUNT, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE BECAUSE DOCUMENTATION WAS LACKING THAT WOULD SUPPORT THE PROVISION OF FINANCIAL AID. SUCH INSTANCES HAVE RESULTED IN A PATIENT'S BILL BEING ASSIGNED TO A COLLECTION AGENCY AND ULTIMATELY RECOGNIZED IN THE ACCOUNTING RECORDS AS A BAD DEBT EXPENSE, DUE TO A LACK OF PAYMENT. THIS APPROACH, HOWEVER, RESULTS NEITHER IN A FAIR SOLUTION FOR THE PATIENT NOR IN AN APPROPRIATE ACCOUNTING OF THE TRANSACTION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES, WHICH COULD PROVIDE PHC WITH SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH A CHARITY CARE DISCOUNT, WITHOUT NEEDING TO DETERMINE ELIGIBILITY FOR MEDICAL INDIGENCE. THIS PRESUMPTIVE ELIGIBILITY, WHEN PROPERLY DOCUMENTED INTERNALLY BY PHC STAFF, IS SUFFICIENT TO PROVIDE A CHARITY CARE DISCOUNT TO PATIENTS WHO QUALIFY. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF THE PRESUMPTIVE CIRCUMSTANCES, THE ONLY DISCOUNT THAT CAN BE GRANTED TO THE PATIENT BY PHC IS A 100% WRITE-OFF OF THE ACCOUNT BALANCE. PLATTE HEALTH CENTER-AVERA PART V, SECTION B, LINE 24: THE POLICY DOES NOT COVER ELECTIVE PROCEDURES AND THE FACILITY HAS CONFIRMED NO FAP PATIENTS HAD ELECTIVE PROCEDURES. PART V SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ PART V SECTION B, LINE 7A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ PART V SECTION B, LINE 16A-C THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT:HTTPS://WWW.AVERA.ORG/APP/FILES/PUBLIC/F10AF35D-8C2D-477E-9F1A-31BC7C509C8D/PLATTE-FINANCIAL-ASSISTANCE-BILLING-PRACTICES-2025.PDFTHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.AVERA.ORG/APP/FILES/PUBLIC/0A291553-92BC-48CA-B0C6-BC3C3CA75652/PLATTE-SUMMARY-FINANCIAL-ASSISTANCE-2025.PDFTHE APPLICATION IS AVAILABLE AT:HTTPS://WWW.AVERA.ORG/APP/FILES/PUBLIC/856D3C94-C52B-4E50-BF9B-F3FE6A06C5A1/PLATTE-FINANCIAL-ASSISTANCE-APPLICATION-2025.PDF 1 1 - PLATTE CARE CENTER 601 E 7TH STREET PLATTE SD 57369 NURSING HOME PART I, LINE 3C: IN ADDITION TO FPG, PLATTE HEALTH CENTER AVERA (PHC) UTILIZES FACTORS AS MARKED IN PART V, LINE 13: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND PRESUMPTIVE CARE. 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 7E AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM.LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HEALTH CENTER 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 ($47,583) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN CHARLES MIX COUNTY FOR 2023. THEREFORE, 22.8 PERCENT OF IMPLICIT PRICE CONCESSIONS CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGES 14-15 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/25. 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: IF A PATIENT QUALIFIES FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME, UNINSURED, OR UNDER-INSURED PATIENTS AND IS COOPERATING WITH THE ORGANIZATION WITH REGARD TO EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. WHEN THE ORGANIZATION SENDS THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY SHALL REFLECT THE REDUCED-PAYMENT LEVEL FOR WHICH THE PATIENT WAS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS. IF AN UNCOLLECTED ACCOUNT IS IN COLLECTION AND IT'S DETERMINED THE ACCOUNT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THEN ALL COLLECTION ACTIVITY IS STOPPED. PHC DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES PHC UTILIZES MAY REPORT TO THE CREDIT AGENCIES. PART VI, LINE 2: THE PLATTE HEALTH CENTER IS CONSTANTLY EVALUATING THE NEEDS OF OUR PATIENTS AND THE COMMUNITIES WE SERVE. PATIENT SURVEYS ARE INSTRUMENTAL IN BOTH SHORT AND LONG-TERM STRATEGIC PLANNING. THE PLATTE, GEDDES, AND WHITE LAKE MEDICAL CLINICS PERFORM AN ANNUAL PATIENT SATISFACTION SURVEY. THE NURSING HOME ALSO PERFORMS ANNUAL SURVEYS. THE HOSPITAL SURVEYS ARE ONGOING. EMERGENCY AND INPATIENT SURVEYS ARE PERFORMED BY AN INDEPENDENT THIRD PARTY UPON DISCHARGE, WITH QUARTERLY SCORES BEING PROVIDED TO ADMINISTRATION. ALL OF THE SURVEY RESULTS ARE REVIEWED BY ADMINISTRATION AND THEN DISCUSSED AT THE BOARD LEVEL. THE BOARD AGENDA HAS A STANDING STRATEGIC PLANNING ITEM THAT DISCUSSES FACILITY GOALS AND COMMUNITY NEEDS; AND HOW EACH CAN BE ACHIEVED. MONTHLY PROVIDER MEETINGS ARE ALSO INSTRUMENTAL TO MEETING THE NEEDS OF OUR PATIENTS. ADMINISTRATION, PHYSICIANS, AND ADVANCED PRACTICE PROVIDERS MEET REGULARLY TO DISCUSS THE NEED FOR NEW SERVICES, EVALUATING CURRENT SERVICES, AND ESTABLISHING BEST PRACTICES TO ENSURE WE OFFER A TOP NOTCH PATIENT EXPERIENCE. PART VI, LINE 3: THE PATIENT ASSISTANCE POLICY IS POSTED ON OUR FACILITY'S WEBSITE AT WWW.PHCAVERA.ORG. SIGNAGE IS ALSO POSTED THROUGHOUT OUR FACILITY THAT EXPLAINS WHAT PATIENTS SHOULD DO IF THEY HAVE CONCERNS ABOUT PAYING THEIR BILL. DISCHARGE PACKETS INCLUDE THE SUMMARY FOR FINANCIAL ASSISTANCE DOCUMENT.UPON OUTPATIENT SERVICE REGISTRATIONS AND/OR ADMISSION, THE BUSINESS OFFICE STAFF WORKS TO EDUCATE ALL SELF-PAY PATIENTS ON OUR PATIENT ASSISTANCE POLICY. THE SUMMARY OF FINANCIAL ASSISTANCE DOCUMENT AND THE PATIENT ASSISTANCE FORM ARE SENT OUT WITH THE INITIAL SELF-PAY BILL TO ALL SELF-PAY PATIENTS WITHIN 7-10 DAYS OF THE DATE OF SERVICE. SELF-PAY BALANCES THAT GO UNPAID FOR 60 DAYS WILL RECEIVE A SERIES OF TWO LETTERS WITH THEIR MONTHLY STATEMENT. THE LETTERS EXPLAIN THE FACILITY'S COLLECTION PROCESS, AND INCLUDE THE PLAIN LANGUAGE DOCUMENT, THE PATIENT ASSISTANCE FORM, AND POLICY FOR THE GUARANTOR TO COMPLETE. THE FORM IS REQUIRED TO BE COMPLETED AND RETURNED IN A TIMELY MANNER. UPON RECEIPT OF THE PATIENT ASSISTANCE FORM, THE FORM IS REVIEWED TO DETERMINE THE AMOUNT OF DISCOUNT THE PATIENT QUALIFIES FOR UNDER THE POLICY. A FOLLOW-UP LETTER IS MAILED TO THE PATIENT EXPLAINING THE AMOUNT OF DISCOUNT AND PAYMENT PLAN FOR THE REMAINING BALANCE. FAILURE TO RETURN THE COMPLETED PATIENT ASSISTANCE FORM OR CONTACTING THE FACILITY FOR PAYMENT ARRANGEMENTS WILL RESULT IN THE PATIENT ACCOUNT GOING TO THE FACILITY'S COLLECTION AGENCY PROVIDED AT LEAST 120 DAYS HAVE PASSED SINCE THE FIRST POST DISCHARGE BILLING STATEMENT WAS SENT TO THE PATIENT. IF THE PATIENT RETURNS THE COMPLETED ASSISTANCE FORM WITHIN 240 DAYS FROM THE FIRST POST DISCHARGE BILLING STATEMENT, PHC WILL HALT COLLECTION ACTIVITY UNTIL A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY CAN BE MADE. IF PHC APPROVES THE PATIENT FOR FINANCIAL ASSISTANCE, COLLECTION ACTIONS WILL CEASE. PART VI, LINE 4: PLATTE HEALTH CENTER AVERA IS A CRITICAL ACCESS HOSPITAL IN PLATTE, SD. PLATTE IS A RURAL COMMUNITY WITH ALMOST 1,400 RESIDENTS LOCATED IN SOUTH CENTRAL SOUTH DAKOTA. THE FACILITY SERVES AN AREA OF ABOUT 5,000 PEOPLE IN CHARLES MIX, DOUGLAS, GREGORY, AURORA, AND BRULE COUNTIES. THE DOMINANT INDUSTRIES INCLUDE SMALL FAMILY BUSINESSES AND FAMILY FARMS. THE AREA IS VERY WELL KNOWN FOR RECREATIONAL HUNTING AND FISHING. WITH MORE THAN 1,950 PERMANENT CAMPSITES IN THE COUNTY, THE POPULATION RAPIDLY INCREASES BETWEEN MAY AND OCTOBER.THE PHCA ALSO PROVIDES CARE FOR THREE DIFFERENT HUTTERITE COLONIES IN ITS GEOGRAPHIC SERVICE AREA: THE PLATTE COLONY, CEDAR GROVE COLONY, AND GRASS RANCH COLONY. THESE COLONIES MAKE UP A LARGE PORTION OF OUR POPULATION AND COMPRISE SOME UNIQUE CULTURAL DIFFERENCES. THE PLATTE HEALTH CENTER AVERA MAKES EXTRA EFFORT TO ENSURE WE ARE MEETING THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. HUTTERITE COLONIES ARE NOT A PART OF THE REFERENCED CENSUS DATA.THE MAJORITY OF PEOPLE SERVED BY PHC ARE LIVING IN NORTHERN CHARLES MIX COUNTY. THE COUNTY IS AN ESTIMATED 1100 SQUARE MILES AND HAS A POPULATION OF 9,343. CONSISTENTLY 80 PERCENT OF PLATTE HEALTH CENTER AVERA'S HOSPITAL DISCHARGES COME FROM CHARLES MIX COUNTY, AND ABOUT 74 PERCENT OF ALL SERVICES. ACCORDING TO THE U.S. CENSUS BUREAU QUICK FACTS DATA, CHARLES MIX COUNTY IS COMPRISED OF ABOUT 64 PERCENT CAUCASIAN PEOPLE, 31 PERCENT NATIVE AMERICAN, AND 5 PERCENT OTHER. PHC PREDOMINANTLY SERVES A CAUCASIAN POPULATION. THE ANNUAL MEDIAN HOUSEHOLD INCOME FOR CHARLES MIX COUNTY IN 2024 IS $64,850; HOWEVER, ALMOST 21.4 PERCENT OF THE POPULATION LIVES BELOW THE POVERTY LEVEL ($31,200/YEAR FOR A FAMILY OF FOUR). THERE ARE AN ESTIMATED 2,459 (OR 26%) PEOPLE ELIGIBLE FOR SOUTH DAKOTA MEDICAID; 1,071 ADULTS AND 1,388 CHILDREN, WHICH IS A STATISTIC THAT CONTINUES TO RISE EVERY YEAR. ABOUT 13.4 PERCENT OF THE COUNTY'S POPULATION REMAINS UNINSURED, WHICH IS ABOUT FIVE PERCENT MORE THAN THE STATE AVERAGE. THE LOCAL PLATTE-GEDDES SCHOOL DISTRICT HAS APPROXIMATELY 12.4% OF THE STUDENTS ON FREE/REDUCED MEAL PLANS. PART VI, LINE 5: THE PLATTE HEALTH CENTER BOARD OF DIRECTORS CONSISTS OF NINE VOLUNTEER MEMBERS WHO REPRESENT ALL OF OUR SERVICE AREAS, INCLUDING PLATTE, GEDDES, WHITE LAKE, ACADEMY, NEW HOLLAND, AND HARRISON, SD. THE BOARD MEMBERS SHOW A SINCERE INTEREST IN UNDERSTANDING THE OPERATIONS OF THE FACILITY, ITS CONTINUED VIABILITY, AS WELL AS THE NEEDS OF THE COMMUNITY IT SERVES. THE BOARD HAS A STANDING ITEM FOR STRATEGIC PLANNING ON THEIR MONTHLY AGENDA. THIS IS FOR DISCUSSION ON THE NEED FOR NEW OR EXPANDED SERVICES, BUILDING PROJECTS, PROVIDERS, OUTREACH SERVICES, AND OTHER PATIENT RELATED TOPICS. AS A STANDING ITEM, THESE ITEMS BECOME GOALS AND STRATEGY FOR THE FACILITY'S FUTURE. THE BOARD HAS COMMITTED TO CONTRIBUTING FUNDS ANNUALLY TO THE AVERA POOLED INVESTMENTS. THESE FUNDS ARE INTENDED TO SUPPORT EQUIPMENT UPGRADES AND FUTURE BUILDING PROJECTS.MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PROVIDERS IN THE AREA. IN TOTAL WITH AVERA ESERVICES THE FACILITY HAS ABOUT 250 CREDENTIALLED PROVIDERS. THIS NUMBER INCLUDES THE THREE FULL-TIME EMPLOYED FAMILY PRACTICE PHYSICIANS, TWO CERTIFIED NURSE PRACTITIONERS, TWO PHYSICIAN ASSISTANTS, AND A CERTIFIED REGISTERED NURSE ANESTHETIST. PHC HAS NUMEROUS SPECIALTY PHYSICIANS VIA OUTREACH CLINICS AND ESERVICES.PHC IS THE ONLY HOSPITAL IN THE PLATTE COMMUNITY. THE NEXT CLOSEST CRITICAL ACCESS HOSPITAL IS 35 MILES TO THE EAST; AND THE CLOSEST REGIONAL HOSPITAL IS 66 MILES NORTHEAST. PHC WORKS VERY HARD TO PROVIDE QUALITY HEALTHCARE IN A RURAL SETTING. PHC PROVIDES INNOVATIVE TECHNOLOGY APPLICATIONS LEVERAGED BY HIGHLY TRAINED STAFF WITH ECARE SERVICES, WHICH INCLUDE EEMERGENCY, EICU, EPHARMACY, AND ECONSULT. THROUGH A GROWING TELECOMMUNICATIONS NETWORK, WE OFFER VIDEO TELECONFERENCING FOR EDUCATIONAL AND MEDICAL SERVICES. WE EXTEND OUR MISSION IN THE REGION THROUGH MOBILE OUTREACH PROGRAMS AND PROVIDE LOCAL HEALTH CARE SPECIALIST VISITS RIGHT HERE IN PLATTE SAVING OUR PATIENTS TIME AND TRAVEL EXPENSES. THE FACILITY IS CERTIFIED AS A TRAUMA RECEIVING FACILITY WITH FULLY INTEGRATED EEMERGENCY AND ESTROKE SERVICES IN BOTH EMERGENCY ROOM (ER) BAYS. EMERGENCY ROOM SERVICES ARE A SUBSIDIZED SERVICE FOR THE ORGANIZATION. THIS SERVICE IS NOT ONLY PROVIDED TO COMPLY WITH REGULATORY REQUIREMENTS BUT HAS ALSO BEEN IDENTIFIED AS A CRITICAL SERVICE FOR THE COMMUNITY AND ORGANIZATION AS IT ENSURES ACCESS TO EMERGENCY SERVICES FOR OUR CUSTOMERS.PLATTE HEALTH CENTER IS A FARM (FRONTIER AND RURAL MEDICINE) SITE. THE FARM PROGRAM IS THE UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE'S RURAL TRACK MEDICAL STUDENT PROGRAM. THIS IS A UNIQUE OPPORTUNITY FOR A SELECT GROUP OF MEDICAL STUDENTS TO OBTAIN NINE MONTHS OF THEIR CLINICAL TRAINING IN RURAL COMMUNITIES. THE PROGRAM EDUCATES MEDICAL STUDENTS ON THE NEED FOR PHYSICIANS IN RURAL FAMILY MEDICINE; AND THE FACILITY BUILDS ON RELATIONSHIPS THAT COULD RESULT IN THE RECRUITMENT OF FUTURE PHYSICIANS. THIS IS A COMPETITIVE PROGRAM IN WHICH BOTH THE HOSPITAL AND MEDICAL STUDENT MUST APPLY FOR THROUGH AN APPLICATION PROCESS.PLATTE HEALTH CENTER IS A HEALING MINISTRY FOR THE SICK, THE ELDERLY, AND THE OPPRESSED, AND PROVIDES HEALTHCARE SERVICES TO ALL PERSONS IN NEED, WITHOUT REGARD TO AGE, RACE, SEX, CREED, NATIONAL ORIGIN, OR ABILITY TO PAY.IN CONJUNCTION WITH THE FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT, THE FACILITY MAKES OTHER CONTRIBUTIONS TO THE COMMUNITY IT SERVES. THE PLATTE HEALTH CENTER ENCOURAGES VOLUNTEERING AT ALL LEVELS OF THE FACILITY. FACILITY EMPLOYEES ROUTINELY DONATE TIME AND MONEY TO SOME VERY WORTHY CAUSES. THE FACILITY PARTICIPATED IN THE FOLLOWING VOLUNTEER PROJECTS DURING THE YEAR: PLATTE HEALTH CENTER STAFF VOLUNTEERS TO OPERATE THE PUBLIC MOVIE THEATER THE SECOND SATURDAY OF EVERY MONTH. STAFF CONDUCTED A FOOD DRIVE FOR THE HELPING HANDS FOOD PANTRY LOCATED IN PLATTE, SD. THE MEDICAL CLINICS HOSTED A COMMUNITY BAKE SALE. THE PROCEEDS WERE USED TO COVER THE EXPENSE OF MEDICAL LICENSES FOR TWO PHYSICIANS WHO ARE FULFILLING A MEDICAL MISSION IN NORTH AFRICA. OUR RADIOLOGY DEPARTMENT CONDUCTED GO PINK EVENTS IN OCTOBER FOR BREAST CANCER AWARENESS. FUNDS WERE RAISED TO SUPPORT THE LOCAL BREAST CANCER SURVIVOR SUPPORT GROUP; AND TO PROVIDE SCREENING MAMMOGRAMS FOR UNINSURED/UNDERINSURED WOMEN. SURPLUS MEDICAL SUPPLIES ARE SENT TO FOREIGN COUNTRIES IN NEED. BAKE SALES COVER THE COST OF MAILING THESE ITEMS. FACILITY PROVIDES MEDICAL, NURSING, AND OTHER HEALTHCARE PROFESSION STUDENTS THE OPPORTUNITY TO JOB SHADOW AND GAIN HANDS-ON LEARNING AT THE FACILITY. EMPLOYEES PARTICIPATED AND HELPED ORGANIZE NUMEROUS FUND RAISING ACTIVITIES FOR LOCAL RESIDENTS DEALING WITH SERIOUS HEALTH CONDITIONS. PART VI, LINE 6: THE PLATTE HEALTH CENTER IS AFFILIATED WITH THE AVERA HEALTH SYSTEM AND IS A MANAGED FACILITY OF AVERA QUEEN OF PEACE. AVERA QUEEN OF PEACE AND THE PHC WORK COOPERATIVELY TO ENHANCE HEALTHCARE. THEIR DEDICATED RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, AND VARIOUS OTHER ACTIVITIES.THROUGH THIS AFFILIATION, THE PLATTE HEALTH CENTER HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCE ASSISTANCE, PHYSICIAN RECRUITING, AND MANY OTHER SERVICES. AVERA HEALTH CAN PROVIDE THESE SERVICES TO THE HOSPITAL AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE ON ITS OWN. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. X 0 0 0 0 0 0 0 0 0 HAU TRAN PHYSICIAN 307474 0 0 0 65726 0 17250 0 43932 0 434382 0 0 0 DR NELSON BATOON PHYSICIAN 370495 0 0 0 0 0 17250 0 43932 0 431677 0 0 0 MARK BURKET CEO 246342 0 0 0 862 0 35833 0 45556 0 328593 0 0 0 JEFFREY KONSTANZ PHYSICIAN ASSISTANT 190016 0 27613 0 0 0 22771 0 43067 0 283467 0 0 0 APRIL VEURINK CNP 165657 0 7000 0 9223 0 9112 0 510 0 191502 0 0 0 DR JEROME BENTZ PHYSICIAN 158180 0 0 0 7380 0 8318 0 796 0 174674 0 0 0 VICKI JENSEN CFO 109047 0 0 0 0 0 6380 0 44358 0 159785 0 0 0 SCHEDULE J, PART I PHYSICIANS AND ADVANCED PRACTICE PROVIDERS CAN ACHIEVE INCENTIVE PAY AS OUTLINED IN THEIR RESPECTIVE EMPLOYMENT CONTRACTS. FOR THE YEAR END 06/30/25, THE FACILITY HAD TWO ADVANCED PRACTIVE PROVIDERS ACHIEVE THEIR INCENTIVE GOALS. ONE WAS A PHYSICIAN ASSISTANT WHO EARNED AN INCENTIVE BASED ON PRODUCTIVITY STANDARDS. THE OTHER WAS A CERTIFIED NURSE PRACTITIONER WHO ACHIEVED INCENTIVE BY MEETING THE FOLLOWING CRITERIA: PARTICIPATION/ATTENDANCE AT PROVIDER AND MEDICAL STAFF MEETINGS; ED RESPONSE TIME REQUIREMENTS; STAFF EDUCATION REQUIREMENTS; AND ANNUAL WELLNESS VISITS FOR NURSING HOME RESIDENTS. JEANETTE PHEIFER MOTHER OF BRANDI DELANGE, BOARD MEMBER 15151 PAYROLL/WAGES 0 JULIE GUSTAD MOTHER-IN-LAW OF JILL GUSTAD, BOARD MEMBER 42814 PAYROLL/WAGES 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL HAVE THE BOARD PRESIDENT AS ITS CHAIRMAN AND RESPONSIBLE PERSON. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE FACILITY DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF DIRECTORS AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF DIRECTORS. ALL OTHER COMMITTEES ARE ADVISORY TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B IF AND WHEN THE EXECUTIVE COMMITTEE MEETS, IT DOES NOT PREPARE MINUTES FOR THEIR MEETINGS. INSTEAD, IT REPORTS TO THE BOARD AND DISCUSSION OF EXECUTIVE COMMITTEE MEETINGS IS INCLUDED IN THE BOARD MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE FORM 990. AFTER THEIR REVIEW, A COPY OF THE COMPLETED FORM 990 IS GIVEN TO ALL BOARD MEMBERS FOR THEIR FEEDBACK. THE CFO FILES THE TAX RETURN WITH THE IRS AFTER VERIFYING WITH THE BOARD THAT IT IS OKAY TO PROCEED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD IS REQUIRED ANNUALLY TO SIGN-OFF ON THE CONFLICT OF INTEREST POLICY. PER POLICY, BOARD MEMBERS ARE EXPECTED TO DISCLOSE CONFLICTS AS THEY ARISE. THE FULL BOARD REVIEWS THE POTENTIAL CONFLICTS OF INTEREST AND DETERMINES WHETHER A CONFLICT EXISTS. IF A CONFLICT EXISTS, THE AFFECTED PERSON IS REQUIRED TO ABSTAIN FROM VOTING ON THE ITEM THAT GIVES RISE TO THE CONFLICT. ALL EMPLOYEES ARE REQUIRED TO FOLLOW THE CONFLICT OF INTEREST POLICY. ADMINISTRATION REVIEWS AND RESOLVES ANY CONFLICTS AS THEY ARISE. IN MATTERS OF PATIENT CARE, ADMINISTRATION WOULD CONVENE AN ETHICS COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 PER THE CEO'S CONTRACT, THE CEO ANNUAL COMPENSATION SHALL BE AGREED UPON AT AN ANNUAL REVIEW OF THE CEO'S COMPENSATION AND PERFORMANCE BY THE BOARD. IF NO OTHER AMOUNT IS SET AT THE ANNUAL REVIEW, THE SALARY SHALL REMAIN THE SAME FOR THE NEXT CALENDAR YEAR, SUBJECT TO ANNUAL INFLATIONARY INCREASE. THIS ANNUAL REVIEW SHALL OCCUR THREE MONTHS PRIOR TO THE END OF EACH YEAR OF THE CONTRACT. THE COMPENSATION PACKAGE FOR THE CFO IS BASED ON A REVIEW OF THE SDAHO ANNUAL COMPENSATION SURVEY AND APPROVED BY THE CEO. THE ANNUAL SDAHO SURVEY IS BASED ON MARKET BY FACILITY SIZE AND LOCATION. ANY MARKET INCREASES ARE AWARDED ON JULY 1ST ANNUALLY. ANNUAL MERIT INCREASES (NOT TO EXCEED 2.5 PERCENT) ARE GIVEN BASED ON A PERFORMANCE REVIEW ON THE CFO'S ANNIVERSARY DATE OF EMPLOYMENT. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 337,090.