2020-08-17T08:17:08-05:00 2019-09-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2018-10-01 460255944 MOBRIDGE REGIONAL HOSPITAL MOBR 6058453692 1401 10TH AVE W MOBRIDGE SD 57601 JOHN AYOUB CEO 6058453692 2020-08-14 1 LAURIE HANSON P00851848 6053391999 2020-08-14 96.2.77.247 2020-08-14 10:13:52 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 87C603189A7DF35062A6A77CB1DDE10F911D97AB 2018 2020-11-06 18:47:13Z JOHN AYOUB 1401 10TH AVE W MOBRIDGE SD 57601 24158710 0 X WWW.MOBRIDGEHOSPITAL.ORG X 1959 SD PROVIDING HEALTHCARE TO PEOPLE THROUGHOUT THE REGION. 12 10 222 175 0 0 78345 516966 23442190 23436123 131365 204349 79447 1272 23731347 24158710 0 0 0 0 12957400 13610025 0 0 0 9647298 9157273 22604698 22767298 1126649 1391412 27184101 28197894 7632575 7225036 19551526 20972858 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 20125186 23437395 MOBRIDGE REGIONAL HOSPITAL (MRH), A 25-BED CRITICAL ACCESS HOSPITAL, 16 BED ASSISTED LIVING CENTER, 8 BED SENIOR HOUSING CENTER, AND MEDICAL CLINICS, PROVIDES HEALTHCARE SERVICES TO PERSONS THROUGHOUT THE REGION. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, THE HOSPITAL PROVIDED CARE TO THE NORTH CENTRAL REGION OF SOUTH DAKOTA, AND THE SOUTH CENTRAL REGION OF NORTH DAKOTA. THE HOSPITAL HAD:1,246 PATIENT DAYS1,103 ACUTE CARE DAYS1,177 SWING BED CARE DAYS4,012 EMERGENCY ROOM VISITS19,947 RURAL HEALTH CLINIC VISITS8,001 ASSISTED LIVING DAYS (PRAIRIE SUNSET VILLAGE) 20125186 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 7 0 1 222 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X RENAE TISDALL 6058458164 PO BOX 580 MOBRIDGE SD 57601 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 40.00 0.00 X 354170 0 27222 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 40.00 0.00 X 333798 0 35960 DR MATT SCHAFFER PHYSICIAN 40.00 0.00 X 335654 0 33419 DR JOSH HENDERSON INTERNAL MEDICINE 40.00 0.00 X 286058 0 33579 DR AHMED ALI SURGEON UNTIL MARCH 40.00 0.00 X 280223 0 6222 HOLLY LASHMET CRNA 40.00 0.00 X 261956 0 11086 DR DONALD LUCEK SURGEON FROM MAY 40.00 0.00 X 251388 0 11463 RENAE TISDALL CFO 40.00 0.00 X 100432 0 24717 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 HEIDI ROSHAU TREASURER 1.00 0.00 X X 0 0 0 DR TOM SWANSON SECRETARY 1.00 0.00 X X 0 0 0 CHRISTOPHER BOHLANDER DIRECTOR 1.00 0.00 X 0 0 0 DR LEONARD LINDE DIRECTOR 1.00 0.00 X 0 0 0 BARB GROSS DIRECTOR 1.00 0.00 X 0 0 0 JAKE KRAFT DIRECTOR 1.00 0.00 X 0 0 0 PATTI SCHMEICHEL DIRECTOR 1.00 0.00 X 0 0 0 PAT FUHRMAN DIRECTOR 1.00 0.30 X 0 0 0 JOHN AYOUB CEO 40.00 0.00 X 0 0 0 2203679 0 183668 20 0 1 0 CERNER PO BOX 959156 ST LOUIS MO 63195 MAINTENANCE & SOFTWARE ENHANCEMENTS 431229 CHI ST ALEXIUS HEALTH 900 EAST BROADWAY BISMARCK ND 58501 MANAGEMENT AND ADMIN SERVICES 272926 AVERA HEALTH 3900 W AVERA DR SIOUX FALLS SD 57108 ECARE SERVICES 221412 NORTHERN PLAINS LAB PO BOX 2036 BISMARCK ND 58502 LAB PROCESSING SERVICES 147150 NORTHLAND IMAGING SERVICE 2223 E ROSSER BISMARCK ND 58501 MRI SERVICES 136016 6 17000 121152 378814 516966 PATIENT SERVICE REVENUE 621400 23094050 23094050 342073 342073 23436123 204349 204349 1272 0 1272 1272 1272 24158710 23437395 0 204349 895101 763749 131352 9840489 8826478 1014011 342903 308300 34603 1857972 1669528 188444 673560 632179 41381 239528 239528 4333 4333 67482 67482 1179614 1079718 99896 77087 6421 70666 185201 96078 89123 60462 60462 248646 244483 4163 96370 79026 17344 56035 56035 223227 223227 1340927 1060590 280337 255702 255702 MEDICAL SUPPLIES 2994097 2959452 34645 EQUIPMENT AND MAINTENAN 1096769 872251 224518 BAD DEBT 920741 920741 DUES AND SUBSCRIPTIONS 47234 26634 20600 63818 44594 19224 22767298 20125186 2642112 0 8340158 9437035 3484114 3891799 450847 370218 429895 484959 185858 207980 33536126 23584736 10608477 9951390 1268500 1268500 1790111 1852316 626141 733697 27184101 28197894 1376903 1445815 2276779 1864752 3446268 3361772 532625 552697 7632575 7225036 X 18680614 20065196 870912 907662 19551526 20972858 27184101 28197894 X 1391412 29920 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 95575 95575 15900908 9595523 6305385 16403909 13426326 2977583 1135734 562887 572847 9951390 INTEREST IN MOBRIDGE REGIONAL HEALTHCARE FOUNDATION 907662 F ASSETS LIMITED AS TO USE 944654 F 1852316 DEFERRED COMPENSATION PLAN PAYABLE 542697 PSV DEPOSITS 10000 552697 X 23231139 -920741 -920741 24151880 6830 6830 24158710 21846557 0 21846557 920741 920741 22767298 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT RECLASSIFIED AS EXPENSE -920,741. PART XI, LINE 4B - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS -10,170. CHANGE IN INTEREST IN FOUNDATION 17,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT RECLASSIFIED AS EXPENSE 920,741. 1 1 X 1 X 1 X 1 1 1 0 0 172000 172000 0.00790 4364800 2879794 1485006 0.06800 4536800 2879794 1657006 0.07590 4818604 1527634 3290970 0.15060 4818604 1527634 3290970 0.15060 9355404 4407428 4947976 0.22650 0 920741 126142 6158491 6189986 -31495 X 1 1 1 1 MOBRIDGE REGIONAL HOSPITAL 1401 10TH AVENUE W MOBRIDGE SD 57601 WWW.MOBRIDGEHOSPITAL.ORG 48404 X X X X MOBRIDGE REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE 7D X X 1 18 1 SEE PART V, LINE 10A NARRATIVE. 0 1 X 100.000000000000 300.000000000000 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 X 1 X 0 0 MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 5: THE FACILITY OBTAINED DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH SURVEYS AND PERSONAL INTERVIEWS INVOLVING COMMUNITY LEADERS, COMMUNITY HEALTHCARE PROVIDERS, COORDINATING AGENCIES, COMMUNITY MEMBERS AND THE UNDERSERVED POPULATION. ELECTRONIC SURVEYS WERE OBTAINED ALONG WITH PAPER SURVEYS BEING PROVIDED FOR INDIVIDUALS WHO PREFERRED NON-ELECTRONIC MEANS. 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 7 OF THE CHNA. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE TAX YEAR AND AS SUCH THE HOSPITAL HAS NOT TAKEN SPECIFIC ACTIONS WITH RESPECT TO THE CURRENT IMPLEMENTATION STRATEGY. THE FOLLOWING COMMUNITY HEALTH PRIORITY AREAS WERE IDENTIFIED AND THE FOLLOWING ACTIONS WILL BE TAKEN BY THE HOSPITAL DURING FUTURE YEARS. SOME OF THE PRIORITIES MAY BE CONTINUATIONS OF NEEDS ADDRESSED IN THE PRIOR IMPLEMENTATION STRATEGY.PURSUANT TO THE IMPLEMENTATION STRATEGY ADOPTED BY MOBRIDGE REGIONAL HOSPITAL, THE FOLLOWING ACTIONS PLANS HAVE BEEN DEVELOPED. EDUCATION REGARDING THE DANGERS ASSOCIATED WITH DRUG & ALCOHOL ABUSEMOBRIDGE REGIONAL HOSPITAL HAS INTERNAL RESOURCES AVAILABLE FOR EDUCATION AND TREATMENT REFERRAL OPTIONS WITH REGARDS TO DRUG AND ALCOHOL ABUSE; MORE WORK WILL BE DONE TO MAKE COMMUNITY MEMBERS AWARE OF THE CURRENT OFFERINGS. IN ADDITION, MRH WILL WORK WITH COMMUNITY PARTNERS TO IDENTIFY, STRENGTHEN, AND/OR CREATE ADDITIONAL RESOURCES. MRH WILL FOCUS EFFORTS ON AN EXTERNAL COMMUNITY CAMPAIGN TO PROVIDE NEEDED EDUCATION REGARDING THE DANGERS ASSOCIATED WITH DRUG AND ALCOHOL ABUSE AND WILL LOOK FOR ADDITIONAL RESOURCES AND OPPORTUNITIES TO FACILITATE TREATMENT OPTIONS AND BEHAVIORAL CHANGES TO PROMOTE HEALTH AND WELLNESS IN THIS AREA.NEED FOR ADDITIONAL NURSING HOME BEDS/OPTIONSMOBRIDGE REGIONAL HOSPITAL HAS SUCCESSFULLY PARTNERED WITH THE WALWORTH COUNTY CARE CENTER TO OBTAIN A NURSING HOME INNOVATION GRANT FROM THE STATE OF SOUTH DAKOTA. MRH WILL FULFILL THE OBLIGATIONS OF THE GRANT TO QUANTITATIVELY IDENTIFY THE DEFINITIVE NEED, HELP TO EXPAND EXISTING/NEW SERVICES TO MEET THAT NEED, AND LOOK FOR OPPORTUNITIES TO REDUCE THE NEED BY FOCUSING ON BOLSTERING OR CREATING OTHER OFFERINGS WITHIN THE LONG-TERM CARE CONTINUUM FOR THE COMMUNITY.NEED FOR ADDITIONAL MENTAL & BEHAVIORAL HEALTH SERVICESMOBRIDGE REGIONAL HOSPITAL HAS DONE A LOT OF WORK IN THIS AREA AND HAS MADE SIGNIFICANT STRIDES SINCE THE LAST COMMUNITY HEALTH NEEDS ASSESSMENT, BUT SIGNIFICANT OPPORTUNITIES STILL REMAIN. IN ADDITION TO THE PSYCHIATRY SERVICES ESTABLISHED AND THE TELEMEDICINE LINKAGES AVAILABLE, MRH WILL WORK TO IDENTIFY OPPORTUNITIES TO OFFER ADDITIONAL MENTAL AND BEHAVIORAL HEALTH SERVICES WITHIN THE COMMUNITIES, BOTH PHYSICALLY AND ELECTRONICALLY. EFFORTS TO INCREASE AWARENESS OF CURRENT OFFERINGS WILL TAKE PLACE TO ENSURE THOSE WHO NEED SERVICES KNOW WHAT IS ALREADY AVAILABLE. IN ADDITION, MRH WILL WORK WITH EXISTING MENTAL AND BEHAVIORAL HEALTH PROFESSIONALS TO ENSURE WE CONTINUE TO FUNCTION COLLABORATIVELY AND EXPLORE THE PROVISION OF ADDITIONAL SERVICES TO MEET THE GREAT NEEDS IDENTIFIED.COMMUNITY TRANSPORTATIONMOBRIDGE REGIONAL HOSPITAL WILL WORK TO IDENTIFY AND ENGAGE COMMUNITY MEMBERS AND STAKEHOLDERS WHO ARE WILLING TO COME TOGETHER TO CREATE AND IMPLEMENT A LONG-TERM PLAN TO ADDRESS THIS NEED. THIS WILL BEGIN WITH THE IDENTIFICATION OF ALL CURRENT OPTIONS, OFFERINGS, AND SERVICE PROVIDING ORGANIZATIONS. ADDITIONAL LOCAL, REGIONAL, AND STATE RESOURCES WILL BE IDENTIFIED AND A GAP ANALYSIS WILL BE CONDUCTED TO DETERMINE AN APPROPRIATE AND REALISTIC STATE TO TRY TO ACHIEVE AND A TIMELINE IN WHICH TO ACHIEVE IT.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 SERVICES INCREASE LOCAL INCOME/DECREASE POVERTY LEVEL - ECONOMIC DEVELOPMENT INCREASE STAFFING AND LOCAL WORKFORCE DEVELOPMENT MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE USED AS A LAST RESORT. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 16J: PART V, LINE 16A, FAP WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16C, PLAIN LANGUAGE SUMMARY WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/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 20E: PROVIDED FINANCIAL ASSISTANCE INFORMATION WITH PATIENT DISCHARGE MATERIALS. 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. 4 1 - MOBRIDGE MEDICAL CLINIC 1309 10TH AVE W MOBRIDGE SD 57601 PROVIDER BASED RURAL HEALTH CLINIC 2 - WEST RIVER HEALTH CLINIC 103 1ST AVENUE E MCLAUGHLIN SD 57642 PROVIDER BASED RURAL HEALTH CLINIC 3 - WEST DAKOTA HEALTH CLINIC 906 MAIN TIMBER LAKE SD 57656 PROVIDER BASED RURAL HEALTH CLINIC 4 - PRAIRIE SUNSET VILLAGE 1320 W GRAND XING MOBRIDGE SD 57601 ASSISTED LIVING & SENIOR HOUSING PART I, LINE 3C: 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 9/30/19. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDES NET COSTS OF $2,958,774 ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $920,741 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART III, LINE 2: THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PATIENTS AND RESIDENTS. THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND RESIDENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE 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 13.7% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE FOR BAD DEBT EXPENSE IS LOCATED ON PAGES 8 AND 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2019. 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 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 5,443 PEOPLE RACIALLY COMPRISED OF MAINLY CAUCASIAN (82.4%) AND NATIVE AMERICANS/ALASKAN NATIVE (13.6%). 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. THE MEDIAN HOUSEHOLD INCOME OF MOBRIDGE IS $41,358, AND THE MEDIAN FAMILY INCOME IS $52,316. ROUGHLY 11.5% OF THE POPULATION IS BELOW THE POVERTY LINE. THE FACILITY OWNS AND OPERATES CLINICS IN MOBRIDGE, MCLAUGHLIN AND TIMBER LAKE. THE FACILITY SERVES PATIENTS FROM A SIX COUNTY AREA (WALWORTH, ZIEBACH, CORSON, DEWEY, CAMPBELL AND POTTER) AND IS APPROXIMATELY ONE HUNDRED MILES FROM ANOTHER HOSPITAL WITH A HIGHER LEVEL OF CARE OFFERED. ZIEBACH COUNTY IS THE 6TH POOREST COUNTY IN AMERICA, AND 46% OF PEOPLE LIVING IN THIS COUNTY ARE UNDER FEDERAL POVERTY GUIDELINES. 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 III AND LEVEL IV CERTIFICATIONS, RESPECTIVELY. 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.MRH PROVIDES VARIOUS HEALTH SCREENINGS AVAILABLE TO THE COMMUNITY AND SURROUNDING COMMUNITIES THROUGHOUT THE YEAR. THE HEALTH SCREENINGS INCLUDE FREE CHOLESTEROL CHECKS, BMI, BLOOD PRESSURE AND WAIST/HIP RATIOS. THESE PREVENTATIVE HEALTH SCREENINGS PROMOTE THE GENERAL HEALTH OF THE COMMUNITY.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. X X X 0 0 0 0 0 0 0 1 0 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 335027 0 19143 0 0 0 11000 0 16692 0 381862 0 0 0 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 333798 0 0 0 0 0 11000 0 25450 0 370248 0 0 0 DR MATT SCHAFFER PHYSICIAN 299542 0 36112 0 0 0 11000 0 22835 0 369489 0 0 0 DR JOSH HENDERSON INTERNAL MEDICINE 286058 0 0 0 0 0 11000 0 23021 0 320079 0 0 0 DR AHMED ALI SURGEON UNTIL MARCH 201829 0 78394 0 0 0 0 0 6222 0 286445 0 0 0 HOLLY LASHMET CRNA 251956 0 10000 0 0 0 1014 0 10073 0 273043 0 0 0 DR DONALD LUCEK SURGEON FROM MAY 240479 0 10909 0 0 0 0 0 11463 0 262851 0 0 0 PART I, LINE 3 THE CEO IS COMPENSATED THROUGH A MANAGEMENT AGREEMENT WITH ST. ALEXIUS MEDICAL CENTER IN BISMARCK, ND. THE BOARD OF DIRECTORS 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 THE PHYSICIANS ARE PAID BASED ON RELATIVE VALUE UNIT BASED PRODUCTION. A CITY OF MOBRIDGE SOUTH DAKOTA 466000320 607429BA4 2007-05-08 5773898 REFINANCE BONDS ISSUED 1997 USED FOR CONSTRUCTION; PURCHASE CT, CLINIC & EMR 0 0 0 A 3865000 5773898 265908 88005 1000000 4416499 2008 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MOBRIDGE, SOUTH DAKOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 08/15/2017 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 $205,451 AND ESTIMATED BENEFITS OF $34,077. 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. 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 A, LINE 8B THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. 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 15 THE FINANCE COMMITTEE DETERMINES AND APPROVES THE PHYSICIAN CONTRACTS, INCLUDING COMPENSATION. THE CEO'S SALARY IS DETERMINED USING A SALARY SURVEY AND DISCUSSIONS WITH THE MANAGEMENT COMPANY. THE FINANCE COMMITTEE APPROVES THE SALARY OF THE CEO ANNUALLY. THE BOARD OF DIRECTORS APPROVES THE FINANCE COMMITTEE MINUTES, WHICH INCLUDE DISCUSSIONS REGARDING THE CEO'S SALARY. 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 29,920. 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 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0