2023-08-10T09:31:22-05:00 2022-09-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2021-10-01 460255944 MOBRIDGE REGIONAL HOSPITAL MOBR 6058453692 1401 10TH AVE W MOBRIDGE SD 57601 JOHN AYOUB CFO 6058453692 2023-08-02 1 JOHN AYOUB 999009999 LAURIE HANSON CPA P00851848 6053391999 2023-08-01 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JOHN AYOUB 1401 10TH AVE W MOBRIDGE SD 57601 26428139 0 X WWW.MOBRIDGEHOSPITAL.ORG X 1959 SD PROVIDING HEALTHCARE TO PEOPLE THROUGHOUT THE REGION. 12 10 236 175 0 0 6124715 1797352 23499741 24403604 291472 227183 0 0 29915928 26428139 0 0 0 0 15950092 16550783 0 0 0 8956121 9554510 24906213 26105293 5009715 322846 37250293 34651954 10115155 7292367 27135138 27359587 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 22076583 24403604 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, 2022, THE HOSPITAL PROVIDED CARE TO THE NORTH CENTRAL REGION OF SOUTH DAKOTA, AND THE SOUTH CENTRAL REGION OF NORTH DAKOTA. THE HOSPITAL HAD:1,669 PATIENT DAYS1,543 ACUTE CARE DAYS806 SWING BED CARE DAYS4,487 EMERGENCY ROOM VISITS19,292 RURAL HEALTH CLINIC VISITS7,236 ASSISTED LIVING DAYS (PRAIRIE SUNSET VILLAGE) 22076583 1 1 0 0 0 0 0 0 0 0 1 1 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 1 236 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 DONALD LUCEK SURGEON 40.00 0.00 X 368754 0 29146 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 40.00 0.00 X 351687 0 38986 DR MATT SCHAFFER PHYSICIAN 40.00 0.00 X 337269 0 36596 DR EMILY BODEN PHYSICIAN 40.00 0.00 X 322898 0 40418 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 40.00 0.00 X 314254 0 29514 DR JOSH HENDERSON INTERNAL MEDICINE 40.00 0.00 X 301054 0 36596 WAYNE JOHNSON CRNA 40.00 0.00 X 191499 0 8902 RENAE KARST CFO 40.00 0.00 X 114014 0 25679 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 0.30 X 0 0 0 JOHN AYOUB CEO 40.00 0.00 X 0 0 0 2301429 0 245837 29 0 1 0 KRAUS-ANDERSON CONSTRUCTION COMPANY 501 SOUTH 8TH STREET MINNEAPOLIS MN 55404 CONSTRUCTION SERVICES 2745462 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 IT SERVICES 801728 DAVIS PARTNERSHIP ARCHITECTS 2901 BLACKE STREET SUITE 100 DENVER CO 80205 ARCHITECT FEES 486859 ST ALEXIUS MEDICAL CENTER PO BOX 5510 BISMARCK ND 58506 PROFESSIONAL SERVICES 301581 NORTHLAND IMAGING SERVICE 2223 EAST ROSSER AVENUE BISMARCK ND 58501 MRI OUTREACH SERVICES 194364 10 1580029 217323 1797352 PATIENT SERVICE REVENUE 621400 22385120 22385120 PHARMACY REVENUE 621400 934412 934412 1084072 1084072 24403604 227183 227183 26428139 24403604 0 227183 897432 743007 154425 12226551 10890800 1335751 420986 392645 28341 2135506 2025718 109788 870308 793720 76588 288279 288279 1832 1832 92820 92820 1633106 1427787 205319 84828 8179 76649 185433 109036 76397 70501 3625 66876 417241 362266 54975 44507 37844 6663 47926 47926 125411 125411 1610207 1263128 347079 295470 23743 271727 MEDICAL SUPPLIES 3182044 3084447 97597 EQUIPMENT AND MAINTENAN 1220636 638224 582412 DUES AND SUBSCRIPTIONS 39100 13077 26023 215169 86000 129169 26105293 22076583 4028710 0 15829788 9469177 3789353 3637781 296449 445677 655026 542752 205536 248565 45079767 27579877 13793795 17499890 1857733 2093212 822613 714900 37250293 34651954 1545643 2089032 3617209 1557510 985698 -519680 3183992 3090505 782613 1075000 10115155 7292367 X 26079292 26402138 1055846 957449 27135138 27359587 37250293 34651954 X 322846 -98397 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 95575 95575 15907723 10804015 5103708 21130673 16053785 5076888 7945796 722077 7223719 17499890 INTEREST IN MOBRIDGE REGIONAL HEALTHCARE FOUNDATION 957449 F ASSETS LIMITED AS TO USE 1135763 F 2093212 DEFERRED COMPENSATION PLAN PAYABLE 714900 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 360100 1075000 X 26428139 0 26428139 0 26428139 26105293 0 26105293 0 26105293 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 168000 168000 0.00640 6092617 3552462 2540155 0.09730 6260617 3552462 2708155 0.10370 4844317 1652497 3191820 0.12230 4844317 1652497 3191820 0.12230 11104934 5204959 5899975 0.22600 1 696812 114277 6978233 6945805 32428 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 MOST RECENT CHNA CONDUCTED THE FOLLOWING CONCERNS WERE IDENTIFIED: ADULT SUBSTANCE ABUSE, POVERTY, AFTER SCHOOL CARE, CHILDCARE FOR CHILDREN TOO YOUNG FOR SCHOOL, SENIOR CARE, CRISIS INTERVENTION RESOURCES, BULLYING IN SCHOOLS, TRANSPORTATION, YOUTH TOBACCO USE, SEXUAL VIOLENCE, AND HEALTH INSURANCE EDUCATION. THE COMMITTEE REVIEWED THESE CONCERNS ALONG WITH OTHER HEALTH DATA AND IDENTIFIED THE FOLLOWING NEEDS TO FOCUS ON IN ITS IMPLEMENTATION STRATEGY: 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.IN THE CURRENT TAX YEAR MRH DID NOT HAVE TIME TO START ADDRESSING THE MAJORITY OF THE NEEDS IDENTIFIED IN THE NEW CHNA DUE TO TIMING, HOWEVER TELEHEALTH SERVICES FOR MENTAL AND BEHAVIORAL HEALTH AND ADDICTION COUNSELING HAVE BEEN INSTITUTED BY THE FACILITY THROUGH INTEGRATIVE HEALTH CENTERS (IHC). IHC PROVIDES LICENSED COUNSELORS AND A NURSE PRACTITIONER ON AN OUTREACH BASIS IN MOBRIDGE, SELBY, AND MCLAUGHLIN. IT IS IMPERATIVE THAT THE SERVICE BE IMPLEMENTED IN OUR TIMBER LAKE CLINIC WITHIN THE NEXT SIX MONTHS.DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, THE ORGANIZATION FOCUSED ON MEETING NEEDS OF THE COMMUNITY RELATED TO COVID-19. IDENTIFIED NEEDS FROM THE IMPLEMENTATION STRATEGY WERE NOT SPECIFICALLY ADDRESSED WITH THE FOLLOWING EXCEPTION:NEED FOR ADDITIONAL NURSING HOME BEDS/OPTIONSMOBRIDGE REGIONAL HOSPITAL CONTINUED TO PARTNER WITH WALWORTH COUNTY CARE CENTER TO ALLOW WALWORTH COUNTY CARE CENTER TO OBTAIN A NURSING HOME INNOVATION GRANT FROM THE STATE OF SOUTH DAKOTA. MRH FULFILLED ITS OBLIGATIONS OF THE PARTNERSHIP BY QUANTITATIVELY IDENTIFYING THE DEFINITIVE NEED, HELPING TO EXPAND EXISTING/NEW SERVICES TO MEET THAT NEED, AND LOOKING FOR OPPORTUNITIES TO REDUCE THE NEED BY FOCUSING ON BOLSTERING OR CREATING OTHER OFFERINGS WITHIN THE LONG-TERM CARE CONTINUUM FOR THE COMMUNITY. THE CFO SITS ON THE GOVERNING BOARD OF THE NURSING HOME WHICH ENHANCES COLLABORATION.CERTAIN ISSUES WERE IDENTIFIED AS IMPORTANT, BASED ON COMMUNITY INPUT AND DISCUSSIONS, BUT MRH HAS NOT ADDRESSED THEM IN THIS PLAN AS THESE NEEDS ARE BETTER ADDRESSED BY OTHER ORGANIZATIONS WITHIN OUR COMMUNITY. MRH HAS A WILLINGNESS TO WORK WITH OTHER ENTITIES WITHIN THE COMMUNITY TO LOOK AT PROVIDING APPROPRIATE PROGRAMS, BUT WILL NOT TAKE THE LEAD ON THE FOLLOWING ISSUES:DAYCARE AND OTHER CHILDCARE SERVICESINCREASE LOCAL INCOME/DECREASE POVERTY LEVEL - ECONOMIC DEVELOPMENTINCREASE STAFFING AND LOCAL WORKFORCE DEVELOPMENT 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 9/30/22. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDES NET LOSSES OF $3,116,060 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 16.4% 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 9/30/2022. 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 COLLECTION 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 V, SECTION B, LINE 7, COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIPTION OF FAILURETYPE OF FAILURE: 501(R)(3) - THE ORGANIZATION FAILED TO COMPLETE, APPROVE, AND POST ITS 2021 COMMUNITY HEALTH NEEDS ASSESSMENT TO THEIR WEBSITE ON OR BEFORE SEPTEMBER 30, 2022.CAUSE OF THE FAILURE: THE HOSPITAL WAS INCORRECTLY UNDER THE UNDERSTANDING THAT IT HAD UNTIL DECEMBER 31, 2022 TO COMPLETE, APPROVE, AND POST IT'S 2021 CHNA REPORT.FACILITY OR FACILITIES WHERE THE FAILURE OCCURRED: THE FAILURE OCCURRED AT MOBRIDGE REGIONAL HOSPITAL.THE DATE(S) OF THE FAILURE: SEPTEMBER 30, 2022THE DATE OF ITS DISCOVERY: DECEMBER 12, 2022DESCRIPTION OF THE CORRECTION OF THE FAILUREMETHOD OF CORRECTION: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED, BOARD APPROVED, AND POSTED TO THE ORGANIZATION'S WEBSITE.DATE OF CORRECTION: DECEMBER 14, 2022DESCRIPTION OF THE PRACTICES OR PROCEDURES PUT INTO PLACEMOBRIDGE REGIONAL HOSPITAL'S FAILURE TO MEET THE REQUIRED DEADLINE FOR COMPLETING, RECEIVING BOARD APPROVAL, AND POSTED ITS 2021 CHNA REPORT WAS NEITHER WILLFUL NOR EGREGIOUS.THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS POSTED ON THE WEBSITE AT: HTTPS://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT-990/ 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 5,265 PEOPLE RACIALLY COMPRISED OF MAINLY CAUCASIAN (80.08%) AND NATIVE AMERICANS/ALASKAN NATIVE (10.87%). 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 $51,746. APPROXIMATELY 16.4% OF THE POPULATION OF WALWORTH COUNTY IS BELOW THE FEDERAL POVERTY LEVEL. CORSON COUNTY HAS A POPULATION OF 3,800 AND IS THE SECOND LARGEST COUNTY IN OUR SERVICE AREA. THE FPL OF CORSON COUNTY IS 42%. 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 CONTINUE 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 0 0 0 0 0 0 1 0 DR DONALD LUCEK SURGEON 365754 0 3000 0 0 0 11600 0 17546 0 397900 0 0 0 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 311129 0 40558 0 0 0 11600 0 27386 0 390673 0 0 0 DR MATT SCHAFFER PHYSICIAN 295807 0 41462 0 0 0 11600 0 24996 0 373865 0 0 0 DR EMILY BODEN PHYSICIAN 283840 0 39058 0 0 0 10601 0 29817 0 363316 0 0 0 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 275196 0 39058 0 0 0 11600 0 17914 0 343768 0 0 0 DR JOSH HENDERSON INTERNAL MEDICINE 261996 0 39058 0 0 0 11600 0 24996 0 337650 0 0 0 WAYNE JOHNSON CRNA 188499 0 3000 0 0 0 7543 0 1359 0 200401 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 7 ALL EMPLOYEES RECEIVED BONUSES IN 2021 AS A RESULT OF COVID19; PHYSICIANS ALSO RECEIVE PRODUCTION BONUSES AS PART OF THEIR COMPENSATION PACKAGE. 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 594070 594070 40897930 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 $236,862 AND ESTIMATED BENEFITS OF $35,556 DURING CALENDAR YEAR 2021. 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 -98,397. 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