2024-05-14T10:39:04-05:00 2023-06-30 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2022-07-01 810405434 ROSEBUD COMMUNITY HOSPITAL INC ROSE 4063462161 383 N 17TH AVENUE FORSYTH MT 59327 MINDY PRICE CEO 4063462161 2024-05-14 1 MINDY PRICE 999009999 0 SOLOMON MARDAKHAEV P01806552 6105653930 2024-05-14 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROSEBUD HEALTH CARE CENTER MINDY PRICE 383 N 17TH AVENUE FORSYTH MT 59327 11432053 0 X WWW.ROSEBUDHCC.ORG X 1980 MT THE FACILITY PROVIDES EMERGENCY ROOM, IN-PATIENT SKILLED CARE, LABORATORY SERVICES, RADIOLOGY (INCLUDING ULTRASOUND AND CT), RESPITE CARE, PHYSICAL THERAPY, LONG TERM CARE, AND OUT-PATIENT CLINIC SERVICES. 10 8 145 15 0 0 461999 984487 9825286 10438033 2735 9533 0 0 10290020 11432053 0 0 0 0 5661568 6175418 0 0 0 4416651 4804192 10078219 10979610 211801 452443 8776450 6836732 4290118 2705543 4486332 4131189 X EMPLOYEES OF RHCC ARE COMMITTED TO HIGH QUALITY, EFFICIENT AND PATIENT-CENTERED CARE FOR OUR FAMILY, FRIENDS AND COMMUNITY. IN FULFILLMENT OF THIS MISSION, ROSEBUD HEALTH CARE CENTER:-WILL PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY SERVICES IN ADDITION TO EXTENDED AND RESPITE CARE.-WILL PROMOTE THE OVERALL WELL BEING OF THE AREA RESIDENTS BY WORKING WITH AREA ORGANIZATIONS AND AGENCIES TO ENSURE THAT THE PUBLIC'S NEEDS ARE MET IN HEALTH RELATED SERVICES AND EDUCATION PROGRAMS.-RECOGNIZE EVERY INDIVIDUAL'S DIGNITY AND VALUE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, DISABILITY, CREED OR SOCIAL STATUS.-WILL SERVE ALL INDIVIDUALS THAT SEEK CARE REGARDLESS OF ABILITY TO PAY.-WILL MAINTAIN A DEDICATED, PROFESSIONAL STAFF THROUGH CONTINUING EDUCATION, IN-SERVICE TRAINING, COMPETITIVE WAGES AND OTHER MEANS OF RECOGNITION TO PROMOTE GROWTH AND SATISFACTION WITH THE STAFF. 0 0 7724311 0 10438033 ROSEBUD HEALTH CARE CENTER IS A COMBINED CRITICAL ACCESS HOSPITAL, LONG TERM CARE FACILITY, AND CLINIC PROVIDING QUALITY HEALTH CARE, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND EDUCATION. IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, THE FOLLOWING WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXISTS. FREE CARE AND/OR SUBSIDIZED CARE (CHARITY CARE) CHARGES OF $68,538 THROUGH JUNE 30, 2023; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, FREE HEALTH FAIRS, LOW COST LAB HEALTH FAIRS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. RHCC PROVIDED 6494 DAYS OF HOSPITAL SERVICES, 5470 DAYS OF NURSING HOME CARE, AND 5482 RURAL HEALTH CLINIC VISITS DURING THE YEAR ENDED JUNE 30, 2023. 7724311 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 145 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MINDY PRICE 4063462161 383 N 17TH AVENUE FORSYTH MT 59327 MINDY PRICE CEO 40.00 X X 147257 0 16493 DR GERALD KILLEN CHAIRPERSON 1.00 X X 0 0 0 GAYLE HOLLAND VICE CHAIRPERSON 1.00 X X 0 0 0 DR HUNTER CORSE MEDICAL DIRECTOR 2.00 X 16500 0 0 DR WILLIAM C ANDERSON MEDICAL DIRECTOR (THRU SEPT 2022) 2.00 X 25500 0 0 ROB JOHNSTONE DIRECTOR 1.00 X 0 0 0 BOB LEE DIRECTOR 1.00 X 0 0 0 NANCY NILE DIRECTOR 1.00 X 0 0 0 CLAY REDDING DIRECTOR 1.00 X 0 0 0 CELESTE ROHRICH DIRECTOR 1.00 X 0 0 0 CHERYL SCHWARZKOPH DIRECTOR 1.00 X 0 0 0 LORRAINE ACKERMAN NURSE PRACTITIONER 40.00 X 119464 0 719 SHELLEY RICKETT PHYSICIAN ASSISTANT 40.00 X 132419 0 28697 KRISTINA KLEINOW PHYSICIAN ASSISTANT 40.00 X 112619 0 12683 STEPHANIE KANNING NURSE PRACTITIONER 40.00 X 133672 0 1092 JEANNE MACIAG DIRECTOR OF NURSING 40.00 X 121385 0 19336 808816 0 79020 7 0 1 0 TW CLARK 1117 N EVERGREEN RD 1 SPOKANE WA 99216 COVID ER REMODEL 321502 TREASURE STATE TRAVEL 1118 MINUTEMAN STREET BILLINGS MT 59105 TRAVEL STAFF - NURSES AND CNAS 302885 FISHER COMMERICAL FLOORING 802 FOURTH AVE N BILLINGS MT 59101 FLOORING AND FLOORING INSTALL 230000 SLATE HEALTHCARE 2100 WEST LOOP SOUTH SUITE 900 HOUSTON TX 77027 TRAVEL STAFF - NURSES AND CNAS 176627 TRUBRIDGE PO BOX 11407 BIRMINGHAM AL 352466448 EHR 115981 5 983987 500 984487 NET PATIENT SERVICE REVENUE 621400 9751432 9751432 OTHER OPERATING REVENUE 621400 686601 686601 10438033 9533 9533 11432053 10438033 0 9533 X 194531 141751 52780 5042794 3677930 1364864 938093 668858 269235 2273115 1774813 498302 3110 146 2964 208714 33314 175400 93590 67451 26139 58201 54957 3244 631073 631073 216357 151450 64907 MEDICAL SUPPLIES 1016933 336667 680266 TAXES AND LICENSES 142482 131931 10551 REPAIRS 34330 6414 27916 DUES AND SUBSCRIPTIONS 27108 2709 24399 99179 44847 54332 10979610 7724311 3255299 0 -232033 3543057 1199753 1631361 1859635 179110 197966 9139243 6038099 3222931 3101144 432024 478234 8776450 6836732 872084 875498 1538025 0 1655849 1588309 23932 7924 200228 233812 4290118 2705543 X 4466976 4081833 19356 49356 4486332 4131189 8776450 6836732 X 452443 -807586 X 0 1 X 0 1 1 X 6040868 3405488 2635380 3098375 2632611 465764 3101144 OTHER ASSETS 442001 RIGHT OF USE ASSETS 36233 478234 BILLINGS CLINIC LIABILITY 200228 RIGHT OF USE LIABILITY 33584 233812 11432053 0 11432053 0 11432053 10979610 0 10979610 0 10979610 1 1 X 1 X 1 X 1 1 1 0 1 1 80577 80577 0.00730 919036 405803 513233 0.04670 999613 405803 593810 0.05400 467443 261882 205561 0.01870 10500 10500 0.00100 3365292 3173885 191407 0.01740 3843235 3435767 407468 0.03710 4842848 3841570 1001278 0.09110 0 216169 43234 3587181 3652774 -65593 X 1 1 1 1 ROSEBUD COMMUNITY HOSPITAL 383 N 17TH AVENUE FORSYTH MT 59327 WWW.ROSEBUDHCC.ORG 13096 X X X X ROSEBUD COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X HTTPS://WWW.ROSEBUDHCC.ORG/WP-CONTENT/UPLOADS/2023/06/FORSYTH_2023_FINAL-CH X 1 19 1 ROSEBUDHCC.ORG/COMMUNITY-HEALTH-SURVEY/ 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X SEE PART V, PAGE 8, 16J X SEE PART V, PAGE 8, 16J X SEE PART V, PAGE 8, 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 ROSEBUD COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: ROSEBUD HEALTH CARE CENTER PROVIDED A LIST OF OUTPATIENT AND INPATIENT ADMISSIONS. THOSE ZIP CODES WITH THE GREATEST NUMBER OF ADMISSIONS WERE SELECTED TO BE INCLUDED IN THE SURVEY. A RANDOM LIST OF 800 RESIDENTS WAS THEN SELECTED WITH THE ASSISTANCE OF THE MSU HELPS LAB. RESIDENCE WAS STRATIFIED IN THE INITIAL SAMPLE SELECTION SO THAT EACH AREA WOULD BE REPRESENTED IN PROPORTION TO THE OVERALL SERVED POPULATION AND THE PROPORTION OF PAST ADMISSIONS. TEN KEY INFORMANT INTERVIEW WERE CONDUCTED TO IDENTIFY IMPORTANT LOCAL HEALTHCARE ISSUES, HOW TO IMPROVE THE HEALTH OF THE COMMUNITY AND GAPS IN HEALTH SERVICES. IT WAS INTENDED THAT THIS RESEARCH WOULD HELP DETERMINE THE AWARENESS OF LOCAL PROGRAMS AND SERVICES, AS WELL AS THE LEVEL OF SATISFACTION WITH LOCAL SERVICES, PROVIDERS, AND FACILITIES. ROSEBUD COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: THE 2023 CHNA WAS CONDUCTED WITH ROSEBUD COUNTY PUBLIC HEALTH DEPARTMENT ROSEBUD COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: CANCER TREATMENT - PROVIDING SERVICES FOR CANCER TREATMENT IS CURRENTLY BEYOND THE AVAILABLE RESOURCES OF ROSEBUD HEALTH CARE CENTER. ALCOHOL/SUBSTANCE ABUSE - A FOCUS ON ALCOHOL AND SUBSTANCE ABUSE IS CURRENTLY BEYOND THE CAPACITY OF THE HOSPITAL AND OTHER COMMUNITY RESOURCES ARE BETTER SUITED TO ADDRESS THESE ISSUES AT THIS TIME. CARDIAC STRESS TESTS/CARDIAC REHABILITATION SERVICES - IT IS NOT FEASIBLE FOR ROSEBUD HEALTH CARE CENTER TO PROVIDE CARDIAC REHABILITATION BECAUSE THE CURRENT DEMAND WOULD NOT SUPPORT THE SERVICE AND IT WOULD NOT BE SUSTAINABLE. UPDATED. RHCC HAS RECEIVED A GRANT TO PURCHASE A 32 SLICE CT SCANNER THAT WILL INCREASE THE CAPIBILITY TO PROVIDE CARDIAC PROCEDURES. ADDITIONALLY, WORKING ON A PROJECT THROUGH MHN TO IMPROVE AWARENESS ON MENTAL HEALTH SERVICES AND EXPLORING THE OPPORTUNITY OF INTEGRATED BEHAVIORAL HEALTH. ROSEBUD COMMUNITY HOSPITAL PART V, SECTION B, LINE 16J: FAP URL: HTTPS://WWW.ROSEBUDHCC.ORG/WP-CONTENT/UPLOADS/2017/02/FINANCIAL-ASSISTANCE-BO-201-3-UPDATED-1-16-19.PDFFAP APPLICATION URL: HTTPS://WWW.ROSEBUDHCC.ORG/WP-CONTENT/UPLOADS/2017/02/FINANCIAL-ASSISTANCE-APP-JAN-2019.PDFFAP PLAIN LANGUAGE SUMMARY URL: HTTPS://WWW.ROSEBUDHCC.ORG/WP-CONTENT/UPLOADS/2019/04/FINANCIAL-ASSISTANCE-BROCHURE-2019-REV-2.PDF 2 1 - ROSEBUD COMMUNITY HOSPITAL 383 N 17TH AVENUE FORSYTH MT 59327 SKILLED NURSING FACILITY 2 - ROSEBUD COMMUNITY HOSPITAL 383 N 17TH AVENUE FORSYTH MT 59327 RURAL HEALTH CLINIC PART I, LINE 7: THE COST-TO-CHARGE RATIO USED WAS DERIVED BASED ON THE RATIO OF PATIENT CARE COST-TO-CHARGES WORKSHEET. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE PHYSICIAN CLINIC COSTS. THE PHYSICIAN CLINIC TOTAL COMMUNITY BENEFIT EXPENSE IS $1,260,093, THE DIRECT OFFSETTING REVENUE IS $837,785 AND THE NET COMMUNITY BENEFIT EXPENSE IS $422,308. PART II, COMMUNITY BUILDING ACTIVITIES: ROSEBUD COMMUNITY HOSPITAL HAS A HEALTH FAIR PROMOTION THAT PROVIDES LAB TESTS AT REDUCED RATES TO PEOPLE; THEY PARTICIPATE IN THE RESOURCE FAIR OFFERED WITHIN THE COMMUNITY, PROVIDING HEALTH AND MEDICAL INFORMATION; THEY PARTICIPATE IN THE MONTANA BREAST AND CERVICAL HEALTH PROGRAM, OFFERING FREE MAMMOGRAMS AND PAP TESTS FOR UNINSURED PATIENTS; THEY CONTINUE TO OFFER A CONCUSSION PROGRAM, PROVIDING SCREENING FOR YOUNG ATHLETES IN OUR COMMUNITY; THEY PROVIDE A COLON SCREENING PROGRAM; THEY PARTICIPATE IN AND PROMOTE HEALTHY MONTANA KIDS, A PROGRAM OFFERING HEALTH CARE "INSURANCE" TO UNINSURED, LOW INCOME CHILDREN; THEY OFFER A HEALTHY LIFESTYLES PROGRAM TO COMMUNITY MEMBERS, A PROGRAM FOCUSING ON EXERCISE AND GOOD NUTRITION AND WEIGHT LOSS; THEY ARE HELPING FUND WAGES FOR THE STARTUP OF A DAYCARE THAT IS NEEDED IN THE COMMUNITY.DUE TO THE DIFFICULTY IN TRACKING COSTS TO THESE SPECIFIC COMMUNITY BUILDING ACTIVITIES, THE FACILITY DOES NOT CURRENTLY TRACK THESE COSTS. HOWEVER, THE FACILITY DOES INCUR COSTS FOR THESE COMMUNITY BUILDING ACTIVITIES AND PLANS TO TRACK THE COSTS IN FUTURE YEARS TO BE REPORTED ON SCHEDULE H, PART II. PART III, LINE 2: THE COSTING METHODOLOGY USED TO DETERMINE THE COST OF BAD DEBT IS BASED ON THE FACILITY'S CALCULATED COST-TO-CHARGE RATIO. PART III, LINE 3: THE FACILITY TOOK A SAMPLE OF PATIENT ACCOUNTS TO DETERMINE WHAT PERCENTAGE OF THE BAD DEBT REPORTED AT COST WAS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. THE CALCULATED PERCENTAGE WAS APPLIED TO THE BAD DEBT AT COST TO DETERMINE THE COST ATTRIBUTABLE TO ELIGIBLE PATIENTS. PART III, LINE 4: WHILE THE FACILITY'S MOST RECENT AUDITED FINANCIAL STATEMENTS DO NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE, THE AMOUNT OF BAD DEBT EXPENSE WAS REPORTED AT $216,169 FOR THE YEAR ENDED JUNE 30, 2023. PART III, LINE 8: THE FACILITY'S JUNE 30, 2023 MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNT OF MEDICARE SHORTFALL REPORTED. ROSEBUD COMMUNITY HOSPITAL IS A DESIGNATED CRITICAL ACCESS HOSPITAL AND THEREFORE REIMBURSED FROM MEDICARE ON A COST BASIS. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. THE MEDICARE ALLOWABLE COSTS WE DEFINED BY MEDICARE AND DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. PART III, LINE 9B: PATIENTS UNABLE TO MEET PAYMENT PLAN REQUIREMENTS WILL BE ASKED TO COMPLETE A FINANCIAL WORK SHEET TO DETERMINE ALTERNATE PAYMENT OPTIONS. PATIENTS MAY BE ASKED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND/OR OTHER RELATED FORMS IN ORDER TO QUALIFY FOR ASSISTANCE UNDER THIS POLICY. THE PATIENT OR AUTHORIZED REPRESENTATIVE MAY BE REQUESTED TO APPLY FOR MEDICAID OR OTHER PUBLIC ASSISTANCE PROGRAMS AND TAKE REASONABLE ACTIONS NECESSARY TO OBTAIN SUCH ASSISTANCE. IF PATIENTS ARE FOUND TO BE ELIGIBLE FOR BENEFITS FROM MEDICAID OR OTHER GOVERNMENT SPONSORED FUNDING, ALL EFFORTS TO COLLECT FROM THAT PATIENT WILL CEASE AT THE TIME DETERMINATION IS MADE. FINANCIAL ASSISTANCE OUTLINED IN THIS POLICY SHALL NOT APPLY. PART VI, LINE 2: ROSEBUD HEALTH CARE CENTER IS OPEN TO HEARING THE NEEDS OF THE COMMUNITY THROUGH VARIOUS WAYS OTHER THAN WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT. AS THE COMMUNITY UTILIZES THE FACILITY FOR SHORT TERM RECOVERY OR LONGER TERM CARE, THEY USUALLY GIVE SUGGESTIONS AS TO WHAT SERVICES COULD BE ADDED OR WHAT SERVICES NEED TO BE ADDRESSED. RHCC ALSO SENDS OUT CONTINUAL SURVEYS TO PATIENTS BEING DISCHARGED FROM EITHER THE HOSPITAL OR OUTPATIENT SERVICES INCLUDING CLINIC AND OUTPATIENT VISITS. THESE FOLLOW UP SURVEYS ALSO PROVIDE GUIDANCE IN THE DIRECTION AND NEEDED SERVICES THE COMMUNITY IS SUGGESTING. PART VI, LINE 3: THE FACILITY HAS ONE FULL TIME BUSINESS OFFICE REPRESENTATIVE ASSIGNED TO SELF-PAY ACCOUNTS AND HAS ESTABLISHED A PROCEDURE FOR IMMEDIATE CONTACT WITH ALL SELF-PAY PATIENTS. FOLDERS HAVE BEEN PUT TOGETHER THAT INCLUDE OUR POLICIES AND INFORMATION ON FINANCIAL ASSISTANCE, HELP LOANS, PAYMENT PLANS AND CHARITY CARE. THESE FOLDERS ARE AT THE REGISTRATION DESK IN THE CLINIC AND AT THE NURSES STATION IN THE HOSPITAL TO BE DISCUSSED WITH AND DISTRIBUTED TO ANY SELF PAY PATIENTS THAT COME IN FOR TREATMENT. ADDITIONALLY, THE BUSINESS OFFICE REPRESENTATIVE FOLLOWS UP WITH EACH PATIENT THAT RECEIVED THE INFORMATION VIA TELEPHONE AND A LETTER. STATEMENTS ARE SENT OUT MONTHLY WITH A LETTER FOR THOSE SELF-PAY ACCOUNTS THAT CONTACT HAS NOT BEEN MADE PERSONALLY BY THE BUSINESS OFFICE REPRESENTATIVE ADVISING OF THE OPTIONS WE HAVE AVAILABLE TO ASSIST WITH FINANCIAL NEEDS. FOLLOW UP CALLS ARE ALSO MADE ON A REGULAR BASIS. WE WORK CLOSELY WITH THE SOCIAL SERVICES DIRECTOR IN ASSISTING PATIENTS COMPLETE PAPERWORK TO DETERMINE IF THEY QUALIFY FOR ANY FEDERAL, STATE OR LOCAL GOVERNMENT POLICIES. THE SOCIAL SERVICES DIRECTOR ASSISTS WITH THE NURSING HOME AND/OR POTENTIAL NURSING HOME RESIDENTS AND THE BUSINESS OFFICE REPRESENTATIVE ASSISTS WITH THE NON- NURSING HOME PATIENTS. PART VI, LINE 4: ROSEBUD HEALTH CARE CENTER PROVIDES SERVICES FOR RESIDENTS IN BOTH ROSEBUD COUNTY AS WELL AS TREASURE COUNTY. THESE COUNTIES INCLUDE THE TOWNS OF FORSYTH, COLSTRIP, LAME DEER, ROSEBUD, ASHLAND, INGOMAR, ANGELA AND HYSHAM. TOTAL INDIVIDUALS SERVED: 9,383ROSEBUD HEALTH CARE CENTER, IS THE ONLY HOSPITAL AND NURSING HOME IN ROSEBUD AND TREASURE COUNTY. RHCC HAS BEEN SERVING THE MEDICAL NEEDS OF ROSEBUD AND TREASURE COUNTIES DATING BACK TO THE EARLY 1920S, UTILIZING THE THREE FACILITIES THAT PROVIDE HOSPITAL CARE, EXTENDED CARE, AND CLINICAL OUTPATIENT CARE. THROUGHOUT THESE 95 YEARS, THERE HAS BEEN GROWTH, CHANGES, DEVELOPMENTS AND DISCOVERIES WITHIN MEDICAL SERVICES IN RHCC AS WELL AS IN THE UNITED STATES.ROSEBUD HEALTH CARE CENTER IS A PRIMARY CARE MEDICAL FACILITY THAT IS OPERATED AND MANAGED BY THE PEOPLE IT SERVES WITHIN ROSEBUD AND TREASURE COUNTIES. FORSYTH IS THE COUNTY SEAT AND IS HOME TO SEVERAL COAL MINERS, RAILROAD EMPLOYEES, WORKERS (COLSTRIP POWER PLANTS), CONSTRUCTION WORKERS, SMALL BUSINESS OWNERS, EDUCATORS, AND A GROWING NUMBER OF RETIRED RESIDENTS. PART VI, LINE 5: ROSEBUD HEALTH CARE CENTER'S BOARD OF DIRECTORS IS COMPRISED OF AN 11 PERSON SELF-APPOINTED BOARD. 8 MEMBERS ARE FROM THE COMMUNITY RHCC SERVES AND 3 ARE HOSPITAL EMPLOYEES, CEO, DON AND MEDICAL DIRECTOR. EXCEPT FOR THE CEO AND MEDICAL DIRECTOR, EACH PERSON IS ON A 3 YEAR ROTATION WITH THE OPTION TO BE REAPPOINTED OR STEP DOWN AFTER THE END OF THE 3 YEARS.RHCC AND ROSEBUD PUBLIC HEALTH HAVE A VERY GOOD WORKING RELATIONSHIP. PUBLIC HEALTH OCCUPIES A BUILDING THAT IS CONNECTED TO RHCC. THIS RELATIONSHIP HAS PROVIDED FOR OUR PROVIDERS TO SEE PATIENTS AT NO COST IN THE PUBLIC HEALTH SETTING WHICH PROVIDES FOR HEALTHCARE AT NO COST TO THE PATIENT. OUR PROVIDERS ARE PARTNERS WITH THE PUBLIC HEALTH TO PROVIDE SERVICES TO OUR FEMALE POPULATION UNDER TITLE X.ANOTHER BENEFIT RHCC PROVIDES TO OUR COMMUNITY IS TO THE ELDERLY WHO NEED NURSING HOME CARE BUT CANNOT AFFORD THE SERVICES. RHCC IS A MEDICAID PROVIDER FOR NURSING HOME SERVICES. MEDICAID'S REIMBURSEMENT FOR THESE SERVICES IS ABOUT 80% OF THE ACTUAL COST TO CARE FOR A PERSON IN THE NURSING HOME. PART VI, LINE 6: ROSEBUD HEALTH CARE CENTER IS NOT AN AFFILIATE OF ANY OTHER HEALTH CARE SYSTEM. X X X 0 0 0 0 0 0 0 0 0 MINDY PRICE CEO 143585 0 3672 0 0 0 2921 0 13572 0 163750 0 0 0 SHELLEY RICKETT PHYSICIAN ASSISTANT 129584 0 2835 0 0 0 2769 0 25928 0 161116 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 IS PROVIDED TO THE CEO FOR REVIEW PRIOR TO FILING AND THE DRAFT COPY WAS GIVEN TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE FACILITY HAS A YEARLY READING AND SIGNATURE OF COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. WE ALSO MONITOR VOTING MEMBERS WHERE ANY CONFLICT COULD EXIST. THE CONFLICT OF INTEREST POLICY APPLIES TO ALL OFFICERS, BOARD MEMBERS, AND EMPLOYEES. IF A CONFLICT EXISTS, THE FOLLOWING WILL OCCUR: THE CONFLICTING INTEREST IS FULLY DISCLOSED; THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTIONS; A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS; AND THE BOARD OR DULY CONSTITUTED COMMITTEE THEREOF WILL DETERMINE IF THE TRANSACTION IS IN THE BEST INTERESTS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT CONSULTING FIRM WITHOUT CONFLICT WAS CONTRACTED TO PERFORM COMPENSATION ANALYSIS OF COMPARABLE REGIONS AND FACILITIES. UPON PRESENTATION OF RESULTS, THE BOARD OF DIRECTORS VOTED ON ACCEPTANCE/REJECTION OF THE PROPOSED COMPENSATION PROGRAM, WHICH WAS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,605,206. MANAGEMENT AND GENERAL EXPENSES 185,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,790,406. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 169,607. MANAGEMENT AND GENERAL EXPENSES 313,102. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 482,709. FORM 990, PART XI, LINE 9: REIMBURSABLE COST AUDIT ADJUSTMENT -807,586.