PLATTE COMMUNITY MEMORIAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: PLATTE COMMUNITY MEMORIAL HOSPITAL INC (EIN 46-0239781)
Tax period: 2016-07-01 to 2017-06-30
Filed: 2018-04-30
IRS object ID: 201841209349300339
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule D
Schedule H
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-04-30T10:37:06-05:00	ReturnTs
Tax Period End	2017-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	450250958	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	EIDE BAILLY LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	200 EAST 10TH ST PO BOX 5125	AddressLine1Txt
City	SIOUX FALLS	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	571175125	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460239781	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PLATTE COMMUNITY MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	PLAT	BusinessNameControlTxt
Phone	6053373364	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	601 E 7TH STREET	AddressLine1Txt
City	PLATTE	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57369	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MARK BURKET	PersonNm
Person Title	CEO	PersonTitleTxt
Phone	6053373364	PhoneNum
Signature	2018-04-27	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	LAURIE HANSON	PreparerPersonNm
PTIN	P00851848	PTIN
Phone	6053391999	PhoneNum
Preparation	2018-04-27	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	199.116.173.75	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2018-04-27	IPDt
IP Tm	10:30:57	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	974248CA41D94A414E643A61057C2CD568A63DD6	AtSubmissionCreationDeviceId
At Submission Filing Device Id	B16095FA32523CD326D583884BA37C70A3019BC0	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	PLATTE HEALTH CENTER AVERA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	MARK BURKET	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	601 E 7TH STREET	AddressLine1Txt
City	PLATTE	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57369	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$14,195,611	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.PHCAVERA.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1947	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	PROVIDE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES.	ActivityOrMissionDesc
Voting Members Governing Body	9	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	201	TotalEmployeeCnt
Total Volunteers	50	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$127,826	PYContributionsGrantsAmt
CY Contributions Grants	$64,017	CYContributionsGrantsAmt
PY Program Service Revenue	$13,358,918	PYProgramServiceRevenueAmt
CY Program Service Revenue	$13,726,480	CYProgramServiceRevenueAmt
PY Investment Income	$56,147	PYInvestmentIncomeAmt
CY Investment Income	$351,459	CYInvestmentIncomeAmt
PY Other Revenue	$55,095	PYOtherRevenueAmt
CY Other Revenue	$53,655	CYOtherRevenueAmt
PY Total Revenue	$13,597,986	PYTotalRevenueAmt
CY Total Revenue	$14,195,611	CYTotalRevenueAmt
PY Grants And Similar Paid	$6,632	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$1,850	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$8,067,710	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$9,122,733	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$4,614,424	PYOtherExpensesAmt
CY Other Expenses	$4,535,553	CYOtherExpensesAmt
PY Total Expenses	$12,688,766	PYTotalExpensesAmt
CY Total Expenses	$13,660,136	CYTotalExpensesAmt
PY Revenues Less Expenses	$909,220	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$535,475	CYRevenuesLessExpensesAmt
Total Assets BOY	$16,574,120	TotalAssetsBOYAmt
Total Assets EOY	$17,692,470	TotalAssetsEOYAmt
Total Liabilities BOY	$8,850,434	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$9,087,566	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$7,723,686	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$8,604,904	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	PLATTE HEALTH CENTER AVERA 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.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	Yes (1)	SignificantChangeInd
Expense	$12,143,219	ExpenseAmt
Grant	$1,850	GrantAmt
Revenue	$13,781,287	RevenueAmt
Desc	PROVISION OF INPATIENT AND OUTPATIENT HEALTHCARE SERVICES IN PLATTE, SD, AND THE SURROUNDING AREA. TOTAL PATIENT DAYS WERE 421; TOTAL NURSING HOME DAYS WERE 16,611. CLINIC VISITS TOTALED 10,874. TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS PATIENT ASSISTANCE POLICY WITHOUT CHARGE OR AMOUNTS LESS THAN ITS ESTABLISHED RATES. THIS AMOUNT EXCLUDES EXPENSES ASSOCIATED WITH A NUMBER OF ADDITIONAL COMMUNITY SERVICES PROVIDED BY THE HEALTH CENTER.PHC ATTESTED TO THE PROGRAM YEAR 2015 OF MEANINGFUL USE. THIS ATTESTATION TO CMS STATES PHC WILL MEET AND COMPLY WITH THE REQUIREMENTS FOR MEANINGFUL USE. WITH THIS, PHC HAS ENHANCED PATIENT CARE BY IMPLEMENTING AN ELECTRONIC HEALTH RECORD SYSTEM AS WELL AS THE MANY PATIENT SAFETY MEASURES THAT COMES WITH IT.	Desc
Total Program Service Expenses	$12,143,219	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	0	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	Yes (1)	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	32	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	201	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	9	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (1)	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	VICKI JENSEN	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6053373364	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	601 E 7TH STREET	AddressLine1Txt
City	PLATTE	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57369	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
ROB REISER
PRESIDENT	1.00	Yes (X)	Yes (X)	$0	$0	$0
RON ERICKSON
VICE-PRESIDENT	1.00	Yes (X)	Yes (X)	$0	$0	$0
SHARON HOFTSEE
TREASURER	1.00	Yes (X)	Yes (X)	$0	$0	$0
SANDY GANT
SECRETARY	1.00	Yes (X)	Yes (X)	$0	$0	$0
MARK MOUNT
DIRECTOR	1.00	Yes (X)		$0	$0	$0
RON MILLAR
DIRECTOR	1.00	Yes (X)		$0	$0	$0
MICHELLE HOLZBAUER
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DENNIS VANDERWERFF
DIRECTOR	1.00	Yes (X)		$0	$0	$0
KENNETH KUIPERS
DIRECTOR FROM 12/2016	1.00	Yes (X)		$0	$0	$0
MARK BURKET
CEO	40.00		Yes (X)	$0	$0	$0
VICKI JENSEN
CFO	40.00		Yes (X)	$67,032	$0	$25,873
JEROME W BENTZ
PHYSICIAN FAMILY MEDICINE	40.00			$289,540	$0	$24,147	Yes (X)
LISA MOFLE
PHYSICIAN FAMILY MEDICINE	40.00			$250,312	$0	$24,960	Yes (X)
ROBERT HUBLEY
PHYSICIAN FAMILY MEDICINE	40.00			$258,271	$0	$31,448	Yes (X)
KASEY HANSON
PHYSICIAN ASSISTANT	40.00			$135,071	$0	$1,321	Yes (X)
JEFF KONSTANZ
CNP	40.00			$137,363	$0	$25,551	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,137,589	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$133,300	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	6	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
AVERA QUEEN OF PEACE
525 N FOSTER	MITCHELL	SD	57301	ADMIN, IT, OTHER SERVICES	$1,016,581
PRIME TIME HEALTHCARE
14811 SHEPARD ST	OMAHA	NE	68138	NURSING STAFF SERVICES	$188,629
AVERA ECARE
4500 N LEWIS AVE	SIOUX FALLS	SD	57104	ECARE SERVICES	$133,697
AVERA HEALTH
3900 W AVERA DR	SIOUX FALLS	SD	57104	ONTRACT SERVICES, ELECTRONIC MED FEES	$126,624
AVERA MCKENNAN
800 E21ST	SIOUX FALLS	SD	57105	PURCHASED SERVICES:MRI,NUCLEAR MED.	$112,180

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Government Grants	$64,017	GovernmentGrantsAmt
Total Contributions	$64,017	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE	322110	$8,980,372	$8,980,372
NURSING HOME REVENUE	323110	$2,946,041	$2,946,041
CLINIC REVENUE	621498	$1,631,396	$1,631,396
OTHER REVENUE	900099	$168,671	$168,671

Field	Value	IRS element (for citing)
Total Program Service Revenue	$13,726,480	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$16,153	TotalRevenueColumnAmt
Exclusion	$16,153	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$53,655	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$53,655	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$53,655	TotalRevenueColumnAmt
Exclusion	$53,655	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$318,896	SecuritiesAmt
Other	$16,410	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$318,896	SecuritiesAmt
Other	$16,410	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$335,306	TotalRevenueColumnAmt
Exclusion	$335,306	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$14,195,611	TotalRevenueColumnAmt
Related Or Exempt Func Income	$13,726,480	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$405,114	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$1,850	TotalAmt
Program Services	$1,850	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$205,300	TotalAmt
Management And General	$205,300	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$7,087,474	TotalAmt
Program Services	$6,719,254	ProgramServicesAmt
Management And General	$368,220	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$193,197	TotalAmt
Program Services	$188,508	ProgramServicesAmt
Management And General	$4,689	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,196,786	TotalAmt
Program Services	$1,126,977	ProgramServicesAmt
Management And General	$69,809	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$439,976	TotalAmt
Program Services	$407,139	ProgramServicesAmt
Management And General	$32,837	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$282,723	TotalAmt
Management And General	$282,723	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$1,126	TotalAmt
Management And General	$1,126	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$62,162	TotalAmt
Management And General	$62,162	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$222,470	TotalAmt
Program Services	$209,387	ProgramServicesAmt
Management And General	$13,083	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$38,639	TotalAmt
Program Services	$10,190	ProgramServicesAmt
Management And General	$28,449	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$383,880	TotalAmt
Program Services	$346,785	ProgramServicesAmt
Management And General	$37,095	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$347,336	TotalAmt
Program Services	$52,366	ProgramServicesAmt
Management And General	$294,970	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$371,094	TotalAmt
Program Services	$342,304	ProgramServicesAmt
Management And General	$28,790	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$52,501	TotalAmt
Program Services	$49,002	ProgramServicesAmt
Management And General	$3,499	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$38,738	TotalAmt
Program Services	$36,260	ProgramServicesAmt
Management And General	$2,478	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$341,986	TotalAmt
Program Services	$341,986	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$859,653	TotalAmt
Program Services	$859,653	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$87,096	TotalAmt
Program Services	$75,096	ProgramServicesAmt
Management And General	$12,000	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
BAD DEBT	$49,629	$49,629
SUPPLIES	$1,012,028	$1,012,028
EQUIPMENT AND REPAIRS	$244,347	$243,230	$1,117
ALL OTHER EXPENSES	$84,770	$47,762	$37,008

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$55,375	TotalAmt
Program Services	$23,813	ProgramServicesAmt
Management And General	$31,562	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$13,660,136	TotalAmt
Program Services	$12,143,219	ProgramServicesAmt
Management And General	$1,516,917	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,357,387	BOYAmt
EOY	$1,583,514	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,133,617	BOYAmt
EOY	$1,768,303	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
EOY	$60,030	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$186,099	BOYAmt
EOY	$176,243	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$106,865	BOYAmt
EOY	$109,323	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$16,423,538	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$9,620,650	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$7,131,483	BOYAmt
EOY	$6,802,888	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$5,658,669	BOYAmt
EOY	$7,149,019	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
EOY	$14,446	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$28,704	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,574,120	BOYAmt
EOY	$17,692,470	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$942,620	BOYAmt
EOY	$1,395,681	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$7,907,814	BOYAmt
EOY	$7,572,579	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$119,306	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$8,850,434	BOYAmt
EOY	$9,087,566	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$5,440,700	BOYAmt
EOY	$6,097,102	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$463,422	BOYAmt
EOY	$675,517	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,819,564	BOYAmt
EOY	$1,832,285	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$7,723,686	BOYAmt
EOY	$8,604,904	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$16,574,120	BOYAmt
EOY	$17,692,470	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$535,475	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$66,120	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$279,623	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	Yes (1)	AgentTrusteeEtcInd
Beginning Balance	$3,681	BeginningBalanceAmt
Additions During Year	$3,782	AdditionsDuringYearAmt
Distributions During Year	$6,447	DistributionsDuringYearAmt
Ending Balance	$1,016	EndingBalanceAmt
Incl Escrow Custodial Acct Liab	0	InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,161,101	BeginningYearBalanceAmt
Investment Earnings Or Losses	$194,787	InvestmentEarningsOrLossesAmt
End Year Balance	$2,355,888	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,211,336	BeginningYearBalanceAmt
Investment Earnings Or Losses	-$50,235	InvestmentEarningsOrLossesAmt
End Year Balance	$2,161,101	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,209,820	BeginningYearBalanceAmt
Contributions	$1,516	ContributionsAmt
End Year Balance	$2,211,336	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,990,303	BeginningYearBalanceAmt
Contributions	$219,517	ContributionsAmt
End Year Balance	$2,209,820	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,754,823	BeginningYearBalanceAmt
Contributions	$235,480	ContributionsAmt
End Year Balance	$1,990,303	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.77780	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.22220	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	Yes (1)	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$43,000	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$222,952	OtherCostOrOtherBasisAmt
Book Value	$265,952	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$11,922,788	OtherCostOrOtherBasisAmt
Depreciation	$6,543,501	DepreciationAmt
Book Value	$5,379,287	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$390,544	OtherCostOrOtherBasisAmt
Depreciation	$333,432	DepreciationAmt
Book Value	$57,112	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,837,174	OtherCostOrOtherBasisAmt
Depreciation	$2,743,717	DepreciationAmt
Book Value	$1,093,457	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$7,080	OtherCostOrOtherBasisAmt
Book Value	$7,080	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$6,802,888	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENT	$4,054,857	C
INTEREST IN AVERA HEALTH FOUNDATION	$2,906,861	C
UNDER LOAN AGREEMENT	$187,301	C

Field	Value	IRS element (for citing)
Total Book Value Securities	$7,149,019	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
ESTIMATED THIRD PARTY-PAYOR SETTLEMENTS	$90,602
DEFERRED COMPENSATION PAYABLE	$28,704

Field	Value	IRS element (for citing)
Total Liability	$119,306	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$14,266,909	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$66,120	NetUnrealizedGainsInvstAmt
Other Revenue	$5,178	OtherRevenueAmt
Revenue Not Reported	$71,298	RevenueNotReportedAmt
Revenue Subtotal	$14,195,611	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$14,195,611	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$13,610,507	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$13,610,507	ExpensesSubtotalAmt
Other Expenses Not Included	$49,629	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$49,629	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$13,660,136	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART IV, LINE 1B:	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 IS ORGANIZED AS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HEALTH CENTER IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HEALTH CENTER IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. 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 54,807. BAD DEBT EXPENSE INCLUDED IN REVENUE ON F/S -49,629.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSES INCLUDED IN REVENUE ON F/S 49,629.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	27	PersonsServedCnt
Total Community Benefit Expns	$67,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$67,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00490	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	329	PersonsServedCnt
Total Community Benefit Expns	$232,489	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$214,165	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$18,324	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	356	PersonsServedCnt
Total Community Benefit Expns	$299,489	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$214,165	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$85,324	NetCommunityBenefitExpnsAmt
Total Expense	0.00620	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	5	ActivitiesOrProgramsCnt
Persons Served	208	PersonsServedCnt
Total Community Benefit Expns	$18,420	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,200	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,220	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$37,839	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,500	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,339	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,334,459	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,176,254	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,158,205	NetCommunityBenefitExpnsAmt
Total Expense	0.15860	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	5	ActivitiesOrProgramsCnt
Persons Served	208	PersonsServedCnt
Total Community Benefit Expns	$7,390,718	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,218,954	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,171,764	NetCommunityBenefitExpnsAmt
Total Expense	0.15960	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	7	ActivitiesOrProgramsCnt
Persons Served	564	PersonsServedCnt
Total Community Benefit Expns	$7,690,207	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,433,119	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,257,088	NetCommunityBenefitExpnsAmt
Total Expense	0.16580	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$49,629	BadDebtExpenseAmt
Bad Debt Expense Attributable	$27,784	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$4,132,301	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$4,155,702	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$23,401	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PLATTE HEALTH CENTER AVERA	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	601 E 7TH STREET	AddressLine1Txt
City	PLATTE	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57369	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.PHCAVERA.ORG	WebsiteAddressTxt
State License	10557	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Teaching Hospital	Yes (X)	TeachingHospitalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	PLATTE HEALTH CENTER AVERA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V SECTION C	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V SECTION C	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	150.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	HTTP://WWW.AVERA.ORG/APP/FILES/PUBLIC/55374/PLATTE-FINANCIAL-ASSISTANCE.PDF	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE 16J	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	SEE 16J	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PLATTE HEALTH CENTER AVERA	PART V, SECTION B, LINE 5: THE GREATEST PORTION OF THE ORGANIZATION'S PATIENTS AND CUSTOMERS RESIDE IN CHARLES MIX COUNTY AND THE COMMUNITIES OF PLATTE AND GEDDES. BOTH AN ONLINE AND PAPER SURVEY WERE UTILIZED TO SOLICIT BROADER INPUT FROM THE COMMUNITY REGARDING POTENTIAL COMMUNITY HEALTH NEEDS.INDIVIDUAL AND FOCUS GROUP INTERVIEWS WERE ALSO COMPLETED. THE FOCUS GROUP MEMBERS INCLUDED REPRESENTATION FROM THE MEDICAL COMMUNITY, HEALTHCARE CENTER STAFF, BUSINESS OWNERS, FARMERS, SCHOOL OFFICIALS, AND PUBLIC HEALTH. PLATTE HEALTH CENTER AVERA ALSO REACHED OUT TO THE LOCAL HUTTERITE BRETHREN COLONY MINISTERS, AS THEY REPRESENT A LARGE PORTION OF THE POPULATION.
PLATTE HEALTH CENTER AVERA	PART V, SECTION B, LINE 11: THE COMMUNITY OFTEN LOOKS TO THE ORGANIZATION TO IMPACT THE OVERALL HEALTH AND QUALITY OF LIFE IN THE SURROUNDING SERVICE AREA. THROUGH THE CHNA SURVEY, PARTICIPANTS HAD THE OPPORTUNITY TO PROVIDE FEEDBACK RELATED TO HOW THE ORGANIZATION COULD PROVIDE COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE OVERALL HEALTH AND QUALITY OF LIFE IN THE COMMUNITY. SURVEY PARTICIPANTS IDENTIFIED AFFORDABLE HOUSING, AFFORDABLE DAYCARE, AFTER SCHOOL ACTIVITIES, ACCESS TO INFORMATION ABOUT THE COMMUNITY, ALCOHOL CONSUMPTION, OVERWEIGHT/PHYSICAL INACTIVITY, SCREENING/PREVENTION, AND CHRONIC DISEASE MANAGEMENT AS AREAS OF CONCERN. DUE TO LIMITED FINANCIAL RESOURCES, THE HOSPITAL IS NOT ABLE TO ADDRESS ALL OF THE IDENTIFIED NEEDS. THE AFFORDABLE HOUSING, DAY CARE AND AFTERSCHOOL ACTIVITIES WILL BE SHARED WITH THE PLATTE CHAMBER OF COMMERCE AND DEVELOPMENT CORPORATION AND PLATTE-GEDDES SCHOOL DISTRICT AS THEY ARE BEYOND THE SCOPE OF THE HOSPITAL'S SERVICES. ALCOHOL CONSUMPTION AND STRATEGIES ARE CURRENTLY BEING FOCUSED ON BY PUBLIC SAFETY ORGANIZATIONS THROUGH PUBLIC HEALTH SERVICE ANNOUNCEMENTS AND INCREASED SATURATION PATROLS. THE MINISTERIAL ASSOCIATION AND SCHOOLS HAVE IMPLEMENTED STRATEGIES TO TARGET UNDERAGE CONSUMPTION RATES. UPON COMPLETION OF THE COMMUNITY HEALTH NEEDS PROCESS, PLATTE HEALTH CENTER AVERA IDENTIFIED THE FOLLOWING COMMUNITY HEALTH PRIORITIES TO BE ADDRESSED FOR THE 2016-2019 TIMEFRAME:PREVENTIVE/SCREENING PROGRAMSOBESITY/PHYSICAL INACTIVITYMAINTAIN AND IMPROVE ACCESS TO PREVENTION AND SCREENING ACTIVITIES: PLATTE HEALTH CENTER AVERA PARTNERS WITH THE AVERA HEART HOSPITAL TO PROVIDE PLANET HEART SCREENING SERVICES IN THE COMMUNITY AND SURROUNDING AREAS. ADDITIONALLY, THE FACILITY WORKS WITH VARIOUS GROUPS IN THE COMMUNITY TO PROVIDE THE STAFFING AND RESOURCES TO PROMOTE HEALTH SCREENINGS, MAMMOGRAPHY, COLO-RECTAL CANCER AND PROSTATE CANCER AND ENCOURAGE ANNUAL HEALTH CHECK-UPS. CURRENT YEAR EXAMPLES INCLUDE PLATTE HEALTH CENTER AVERA STAFF GOING ONSITE TO HUTTERITE COLONIES TO PROVIDE WOMEN'S HEALTH EDUCATION AND CHILDHOOD VACCINATIONS; TO THE LOCAL SCHOOLS TO PROVIDE HEALTH SCREENINGS TO STAFF; AND TO THE LOCAL PHARMACY TO PROVIDE BLOOD PRESSURE SCREENINGS.PROMOTE HEALTHY LIFESTYLE CHOICES AND HEALTH PROMOTION INITIATIVES TO PROMOTE PHYSICAL ACTIVITY AND PROMOTE WEIGHT MANAGEMENT: PLATTE HEALTH CENTER AVERA WILL CONTINUE TO PROVIDE THE STAFFING AND RESOURCES FOR THE COMMUNITY EXERCISE CLASSES AND DIABETIC EDUCATION PROGRAMS.
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 PHCA 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 PHCA 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 PHCA IS A 100% WRITE-OFF OF THE ACCOUNT BALANCE.
PLATTE HEALTH CENTER AVERA	PART V, SECTION B, LINE 16J: PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTP://WWW.AVERA.ORG/APP/FILES/PUBLIC/55375/PLATTE-FINANCIAL-ASSISTANCE-APPLICATION.PDFPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTP://WWW.AVERA.ORG/APP/FILES/PUBLIC/64345/PLATTE-SUMMARY-OF-FINANCIAL-ASSISTANCE.PDF
PLATTE HEALTH CENTER AVERA	PART V, SECTION B, LINE 24: THE HOSPITAL FACILITY MAY HAVE CHARGED FAP-ELIGIBLE INDIVIDUALS AN AMOUNT EQUAL TO GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY.
PART V. SECTION B, LINE 10A	THE IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND ATHTTP://WWW.AVERA.ORG/APP/FILES/PUBLIC/66931/2016-CHNA-IMPLEMENTATION-PLAN-PLATTE-HEALTH-CENTER.PDF
PART V. SECTION B, LINE 7A	THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ATHTTP://WWW.AVERA.ORG/APP/FILES/PUBLIC/64658/2016-CHNA-PLATTE.PDF

Field	Value	IRS element (for citing)
Facility	4	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - PLATTE HEALTH CENTER AVERA
601 E 7TH STREET	PLATTE	SD	57360	SKILLED NURSING
2 - PLATTE MEDICAL CLINIC
612 E 8TH STREET	PLATTE	SD	57369	MEDICAL CLINIC
3 - GEDDES MEDICAL CLINIC
PO BOX 167	GEDDES	SD	57342	MEDICAL CLINIC
4 - WHITE LAKE MEDICAL CLINIC
306 S JOHNSTON ST	WHITE LAKE	SD	57383	MEDICAL CLINIC

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	IN ADDITION TO FPG, PLATTE HEALTH CENTER AVERA (PHC) UTILIZES OTHER FACTORS INCLUDING MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PRESUMPTIVE CHARITY CARE MAY ALSO BE USED BASED ON INDIVIDUAL LIFE CIRCUMSTANCES (HOMELESSNESS, PATIENTS WITH NO INCOME, PATIENTS WHO HAVE QUALIFIED FOR OTHER FINANCIAL ASSISTANCE PROGRAMS SUCH AS FOOD STAMPS OR WIC).
PART I, LINE 6A:	PHC IS INCLUDED IN THE COMMUNITY BENEFIT REPORT THAT IS SUBMITTED TO AVERA HEALTH BY AVERA QUEEN OF PEACE. IT IS AVAILABLE THROUGH THE WEBSITE AND REQUESTED MAILING, AND IS FILED WITH THE CATHOLIC HEALTH ASSOCIATION. THE COMMUNITY BENEFIT REPORT CAN BE FOUND AT HTTP://WWW.AVERAANNUALREPORTS.ORG.
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. LINES 7B, 7E, AND 7F WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM.LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT.
PART I, LN 7 COL(F):	BAD DEBT EXPENSE OF $49,629 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE.
PART III, LINE 2:	BAD DEBT IS BASED ON CHARGES.
PART III, LINE 3:	THE AMOUNT ON LINE 3 OF $27,784 IS ABOUT 55 PERCENT OF BAD DEBT EXPENSE. THIS NUMBER IS BASED ON A DETAILED REVIEW OF THE CURRENT YEAR ACCOUNTS THAT WERE TRANSFERRED TO ACCOUNTS MANAGEMENT, INC. UPON REVIEWING EACH HOUSEHOLD ACCOUNT THAT WAS SENT TO AMI DURING THE YEAR, IT WAS FOUND THAT ABOUT 55 PERCENT OF THE OUTSTANDING BALANCES MAY HAVE BEEN ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. SINCE WE ARE IN A SMALL COMMUNITY, WE WERE ABLE TO IDENTIFY WHICH ACCOUNTS MAY HAVE QUALIFIED FOR CHARITY CARE BECAUSE OF LOW INCOME OR SOME KNOWN HARDSHIP TO THE HOUSEHOLD. ALSO FOR THIS REVIEW PROCESS, FAMILIES THAT HAVE ACCOUNTS AT AMI BUT HAVE RECENTLY APPLIED FOR CHARITY CARE WERE ALSO TAKEN INTO CONSIDERATION, AS THEY MOST LIKELY WOULD HAVE QUALIFIED ON THE PREVIOUS ACCOUNTS HAD THEY FILLED OUT THE APPLICATION.
PART III, LINE 4:	THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS ON PAGE 6 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 6/30/17. 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. AT SUCH TIME AS 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. PHC DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES PHC UTILIZES MAY REPORT TO THE CREDIT AGENCIES.A DETERMINATION THAT A PATIENT IS PRESUMED ELIGIBLE FOR CHARITY CARE IS MADE WHEN ADEQUATE INFORMATION IS PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES WHICH ALLOW PHCA TO DETERMINE THAT THE PATIENT QUALIFIES FOR CHARITY CARE.
PART VI, LINE 2:	THE PLATTE HEALTH CENTER AVERA 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 EACH MARCH. THE NURSING HOME ALSO PERFORMS ANNUAL SURVEYS IN MARCH. 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 SERVICES REGISTRATION AND/OR ADMISSION, THE BUSINESS OFFICE STAFF WORKS TO EDUCATE ALL SELF-PAY PATIENTS ON OUR PATIENT ASSISTANCE POLICY. SELF-PAY PATIENTS WHO MAY BE ELIGIBLE FOR MEDICAID OR OTHER STATE/FEDERAL BENEFITS ARE INFORMED OF A THIRD PARTY VENDOR WHOM THE FACILITY HAS ENLISTED TO ASSIST PATIENTS IN EXPLORING BENEFITS THAT MAY BE AVAILABLE. THE THIRD PARTY VENDOR IS A PUBLIC INTEREST LAW FIRM THAT PROVIDES FREE LEGAL SERVICES TO THOSE WHO QUALIFY. A REPRESENTATIVE FROM THAT VENDOR WILL CONTACT PATIENTS TO DETERMINE WHETHER IT IS APPROPRIATE FOR THEM TO ASSIST IN AN APPLICATION FOR BENEFITS. WHEN THE GROUP ACCEPTS A CASE, THEY FOLLOW IT UNTIL APPLICATIONS HAVE BEEN APPROVED OR DENIED. ALL OF THIS IS DONE AT NO CHARGE TO THE PATIENT.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 CEO/CFO WILL DETERMINE THE AMOUNT OF THE DISCOUNT THE PATIENT QUALIFIES FOR PER 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, PHCA WILL HALT COLLECTION ACTIVITY UNTIL A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY CAN BE MADE. IF PHCA APPROVES THE PATIENT FOR FINANCIAL ASSISTANCE, COLLECTION ACTIONS WILL CEASE.
PART VI, LINE 4:	PHC 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 FACILITY HAS THREE DIFFERENT HUTTERITE COLONIES IN ITS SERVICE AREA. THE DOMINANT INDUSTRIES INCLUDE SMALL FAMILY BUSINESSES AND FAMILY FARMS. THE AREA IS VERY WELL KNOWN FOR RECREATIONAL HUNTING AND FISHING, WHICH BOOSTS THE POPULATION BY ABOUT 20 PERCENT THROUGHOUT MAY-OCTOBER.THE MAJORITY OF PEOPLE SERVED BY PHC ARE LIVING IN NORTHERN CHARLES MIX COUNTY. THE COUNTY IS AN ESTIMATED 1150 SQUARE MILES AND HAS A POPULATION OF 9,396. CONSISTENTLY 80 PERCENT OF PLATTE HEALTH CENTER AVERA'S HOSPITAL DISCHARGES COME FROM CHARLES MIX COUNTY, AND 70 PERCENT OF ALL SERVICES. CHARLES MIX COUNTY IS COMPRISED OF ABOUT 64 PERCENT CAUCASIAN PEOPLE, 32 PERCENT NATIVE AMERICAN, AND 4 PERCENT OTHER. PHC PREDOMINANTLY SERVES A CAUCASIAN POPULATION. ACCORDING TO THE US CENSUS BUREAU, THE ANNUAL MEDIAN HOUSEHOLD INCOME FOR CHARLES MIX COUNTY IN 2016 IS $43,376; HOWEVER, 22 PERCENT OF THE POPULATION LIVES BELOW THE POVERTY LEVEL ($24,600/YEAR FOR A FAMILY OF FOUR). THERE ARE AN ESTIMATED 2,267 (OR 24%) PEOPLE ELIGIBLE FOR MEDICAL SERVICES; 690 ADULTS AND 1,577 CHILDREN. YET ALMOST 20 PERCENT OF THE POPULATION REMAINS UNINSURED. THE LOCAL PLATTE-GEDDES SCHOOL SYSTEM HAS APPROXIMATELY 31% OF THE STUDENTS ON FREE/REDUCED MEAL PLANS.
PART VI, LINE 5:	OUR BOARD CONSISTS OF 9 MEMBERS WHO REPRESENT ALL OF OUR SERVICE AREAS, INCLUDING PLATTE, GEDDES, ACADEMY, AND HARRISON, SD. THE BOARD WORKS TO SET ASIDE FUNDS EACH YEAR TO THE AVERA POOLED INVESTMENTS, WHICH ARE INTENDED TO ACCUMULATE TO SUPPORT EQUIPMENT UPGRADES AND FUTURE BUILDING PROJECTS.MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE AREA. IN TOTAL WITH AVERA ESERVICES, THE FACILITY HAS ABOUT 95 CREDENTIAL PHYSICIANS. THIS NUMBER INCLUDES THE THREE FULL-TIME EMPLOYED FAMILY PRACTICE PHYSICIANS, AND A HOST OF 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, ECONSULT AND EULTRASOUND. 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 SPECIALISTS 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 UNIVERISTY 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 A COMPETITIVE PROCESS.IN 2016, PLATTE HEALTH CENTER ACHIEVED THE FOLLOWING NATIONAL AWARDS THAT ONLY EXEMPLIFY THE FACILITY'S COMMITMENT TO STAFF, PATIENTS, AND COMMUNITY: TOP 20 BEST PRACTICES IN PATIENT SATISFACTION AWARD.U.S. NEWS & WORLD REPORT RECOGNIZED PLATTE CARE CENTER AS BEST NURSING HOMES FOR 2016-17.MEANINGFUL USE ATTESTATION ACHIEVED SLEEP LAB ACCREDITATIONCERTIFICATE OF ACHIEVEMENT - EXCELLENCE IN CARE SURGERYACR ACCREDITATION 3D MAMMOGRAPHYFIVE-STAR NURSING HOME FACILITYACHIEVED HIGH LEVEL OF FINANCIAL STEWARDSHIPDEFICIENCY FREE LTC STATE AND FEDERAL SURVEYHPV VACCINATION ORGANIZATION OF THE YEAREXCELLENCE IN OUTCOMES/EXCELLENCE IN PATIENT SATISFACTION (NATIONAL ORGANIZATION OF STATE OFFICE OF RURAL HEALTH) TOP PERFORMERPATIENT SATISFACTIONALL FACILITY SURVEYS PLATTE HEALTH CENTER AVERAGED IN THE NATIONAL 94TH PERCENTILE OF PATIENT SATISFACTIONPLATTE HEALTH CENTER - AVERA 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. ON MANY OCCASIONS, FACILITY EMPLOYEES DONATE TIME AND MONEY TO SOME VERY WORTHY CAUSES. SOME OF THE VOLUNTEER PROJECTS COMPLETED IN THE COMMUNITY THIS YEAR WERE AS FOLLOWS: PLATTE HEALTH CENTER STAFF RUNS THE PUBLIC MOVIE THEATER THE SECOND SATURDAY OF EVERY MONTH. STAFF DONATED AN ESTIMATED 500 POUNDS OF FOOD AND $160 CASH TO THE LOCAL HELPING HANDS FOOD PANTRY. THE MEDICAL CLINICS HOSTED TWO COMMUNITY BAKE SALES. THE PROCEEDS FROM THESE EVENTS GO TOWARD THE EXPENSE OF MEDICAL LICENSES FOR TWO PHYSICIANS WHO ARE FULFILLING A MEDICAL MISSION IN NORTH AFRICA. THE MEDICAL CLINICS ALSO PARTICIPATED IN THE COMMUNITY'S ANNUAL CANCER SOCIETY'S RELAY FOR LIFE EVENT. AN ESTIMATED $1,000 WAS RAISED FOR THAT ASSOCIATION. EDUCATION COORDINATORS VOLUNTEER TO PROVIDE A WEEKLY EXERCISE PROGRAM AT THE LOCAL SENIOR CITIZEN CENTER; AS WELL AS HOST HEALTHY EATING/COOKING CLASSES.EACH YEAR STAFF PROVIDES ITEMS FOR THE SHOEBOXES FOR GUATEMALA CAMPAIGN. THE FACILITY'S LAB DEPARTMENT PROVIDES EDUCATION SESSION WITH THE LOCAL HIGH SCHOOL. THE PURPOSE IS TO PARTNER WITH THE SCHOOL/STUDENTS TO EXPOSE THEM TO FUTURE CAREER OPPORTUNITIES. STUDENTS ARE ALSO ALLOWED TO JOB SHADOW IN AREAS OF INTEREST.OUR RADIOLOGY DEPARTMENT CONDUCTED GO PINK EVENTS IN OCTOBER FOR BREAST CANCER AWARENESS. FUNDS WERE RAISED FOR THE LOCAL BREAST CANCER SUPPORT GROUP ($4,900), SCARVES OF HOPE ($220), AND TO PAY FOR MAMMOGRAMS FOR UNDERINSURED/UNINSURED PATIENTS ($810). THE BUSINESS OFFICE STAFF CONDUCTED AN EMPLOYEE CHALLENGE IN SEPTEMBER TO RAISE MONEY FOR THE LOCAL SCHOOL DISTRICT'S DELINQUENT STUDENT LUNCH ACCOUNTS. THE $1,000 IN FUNDS WERE GIVEN TO THE SCHOOL'S ADMINISTRATORS TO DISTRIBUTE TO STUDENT ACCOUNTS WHERE THEY BELIEVED THE NEED WAS GREATEST.THE FACILITY'S DEPARTMENT HEADS SPEARHEADED AN EMPLOYEE GIVING CAMPAIGN TO ASSIST A STAFF MEMBER WHO HAD SIGNIFICANT HEALTH ISSUES. OVER $5,900 WERE RAISED TO DIRECTLY PAY OFF MEDICAL EXPENSES FOR THE FAMILY.
PART VI, LINE 6:	THE HOSPITAL IS A MANAGED FACILITY OF AVERA QUEEN OF PEACE. AVERA QUEEN OF PEACE AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. AS A MANAGED FACILITY, THE HOSPITAL IS ABLE TO PARTICIPATE IN AVERA E-CARE SERVICES. THESE SERVICES INCLUDE AVERA E-ICU, E-EMERGENCY, E-PHARMACY AND E-CONSULT. THESE SERVICES ALLOW RURAL PATIENTS TO BE CARED FOR AT THEIR LOCAL HOSPITALS, PROVIDE RURAL HOSPITALS ACCESS TO IMMEDIATE SPECIALTY CARE AND SUPPORT, AND HELP REDUCE HEALTH CARE COSTS AND TRAVEL.THE HOSPITAL ALSO 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 AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO THE HOSPITAL AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. AVERA QUEEN OF PEACE AND THE HOSPITAL DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO 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.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JEROME W BENTZ
PHYSICIAN FAMILY MEDICINE	$284,889	$0	$0	$0	$4,651	$0	$0	$0	$24,147	$0	$313,687	$0	$0	$0
LISA MOFLE
PHYSICIAN FAMILY MEDICINE	$250,312	$0	$0	$0	$0	$0	$604	$0	$24,356	$0	$275,272	$0	$0	$0
ROBERT HUBLEY
PHYSICIAN FAMILY MEDICINE	$252,627	$0	$0	$0	$5,644	$0	$7,863	$0	$23,586	$0	$289,720	$0	$0	$0
JEFF KONSTANZ
CNP	$128,140	$0	$0	$0	$9,223	$0	$2,465	$0	$23,086	$0	$162,914	$0	$0	$0

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (3 entries)

Relationship With OrgRelationshipWithOrgTxt	Loan PurposeLoanPurposeTxt	Loan From OrganizationLoanFromOrganizationInd	Original PrincipalOriginalPrincipalAmt	Balance DueBalanceDueAmt	DefaultDefaultInd	Board Or Committee ApprovalBoardOrCommitteeApprovalInd	Written AgreementWrittenAgreementInd
LISA MOFLE
PHYSICIAN	EDUCATION/RECRUITMENT	Yes (X)	$50,000	$34,178	0	0	Yes (1)
JEFF KONSTANZ
ADVANCE PRACTICE PROVIDER	EDUCATION/RECRUITMENT	Yes (X)	$25,000	$8,763	0	0	Yes (1)
KASEY HANSON
ADVANCE PRACTICE PROVIDER	EDUCATION/RECRUITMENT	Yes (X)	$25,000	$17,089	0	0	Yes (1)

Field	Value	IRS element (for citing)
Total Balance Due	$60,030	TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 2	PLATTE HEALTH CENTER AVERA PRIDES ITSELF ON PROVIDING OUTREACH CLINICS FOR PATIENTS' CONVENIENCE OF HAVING A WIDE VARIETY OF SERVICES CLOSE TO HOME. A UROLOGY OUTREACH CLINIC BEGAN IN PLATTE IN SEPTEMBER 2016. DR. PAPADOPOULOS IS ONSITE FOR A HALF DAY CLINIC ONE TIME A MONTH.
FORM 990, PART III, LINE 3	DR. CLAUSSEN, AN OPTHALMOLOGIST, CONTINUES TO COME TO PLATTE COMMUNITY FOR OUTREACH CLINICS ON A MONTHLY BASIS; HOWEVER, SHE NO LONGER PERFORMS CATARACT PROCEDURES AT THE FACILITY.
FORM 990, PART VI, SECTION A, LINE 1	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 2	DENNIS VANDERWERFF AND LISA MOFLE HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 3	AVERA QUEEN OF PEACE PROVIDES MANAGEMENT SERVICES TO THE HEALTH CENTER. MARK BURKET, CEO, WAS EMPLOYED BY AVERA QUEEN OF PEACE HOSPITAL, 525 NORTH FOSTER, MITCHELL, SD 57301 THROUGH DECEMBER 31, 2016. HIS 2016 ANNUAL COMPENSATION WAS $167,406 AND TOTAL PENSION AND OTHER BENEFITS WERE $37,064. MR. BURKET PRESIDES OVER THE DAY-TO-DAY OPERATIONS OF THE HEALTH CENTER. AS OF JANUARY 1, 2017 HE BECAME AN EMPLOYEE OF THE PLATTE HEALTH CENTER.
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	THE COMPENSATION PACKAGE FOR THE CEO WAS DETERMINED BY THE MANAGEMENT COMPANY, AVERA QUEEN OF PEACE THROUGH DECEMBER 31,2016. TOGETHER, THE PLATTE HEALTH CENTER BOARD OF DIRECTORS AND THE MANAGEMENT COMPANY PERFORMED AN ANNUAL EVALUATION OF THE CEO. AT THAT TIME, THE PLATTE HEALTH CENTER BOARD OF DIRECTORS REVIEWED AND DETERMINED WHETHER THE MANAGEMENT AGREEMENT WAS ACCEPTABLE IN TERMS AND CONDITIONS. EFFECTIVE JANUARY 1ST, 2017, THE CEO BECAME EMPLOYED BY THE PLATTE HEALTH CENTER. AT THAT TIME, A LAWYER WAS HIRED TO NEGOTIATE ON BEHALF OF THE PLATTE HEALTH CENTER BOARD OF DIRECTORS TO PREPARE A COMPENSATION PACKAGE FOR THE CEO. PER THE 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 ONLY TO THE ANNUAL ADJUSTMENT DESCRIBED BELOW. THIS ANNUAL REVIEW SHALL OCCUR THREE MONTHS PRIOR TO THE END OF EACH YEAR OF THE CONTRACT. THE SALARY SHALL BE PAYABLE IN EQUAL BIWEEKLY INSTALLMENTS THROUGHOUT THE CONTRACT YEAR, SUBJECT TO ALL APPLICABLE WITHHOLDING AND OTHER PAYROLL TAXES. IN ADDITION TO THE POSSIBLE INCREASE IN SALARY FOR EACH CALENDAR YEAR DESCRIBED ABOVE, THE CEO'S SALARY WILL BE ADJUSTED ANNUALLY ON EACH JULY 1ST FOR COST OF LIVING UTILIZING THE ANNUAL CONSUMER PRICE INDEX (CPI) FOR ALL URBAN CONSUMERS, BUT IN NO CASE SHALL ANY INCREASE BE MORE THAN FOUR PERCENT (4%) OR LESS THAN ONE PERCENT (1%). THE COMPENSATION PACKAGE FOR THE CFO IS BASED ON A REVIEW OF THE SDAHO ANNUAL COMPENSATION SURVEY AND APPROVED BY THE CEO. THE SDAHO SURVEY IS BASED ON MARKET BY FACILITY SIZE AND LOCATION. 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 268,875. NET ASSETS RELEASED FROM RESTRICTIONS-FOUNDATION -1,973. CHANGE IN INTEREST IN PERMANANT NET ASSETS OF FOUNDATION 12,721.