2018-04-30T10:37:06-05:00 2017-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2016-07-01 460239781 PLATTE COMMUNITY MEMORIAL HOSPITAL INC PLAT 6053373364 601 E 7TH STREET PLATTE SD 57369 MARK BURKET CEO 6053373364 2018-04-27 1 LAURIE HANSON P00851848 6053391999 2018-04-27 199.116.173.75 2018-04-27 10:30:57 CD P 974248CA41D94A414E643A61057C2CD568A63DD6 B16095FA32523CD326D583884BA37C70A3019BC0 2016 2021-01-29 14:40:06Z PLATTE HEALTH CENTER AVERA MARK BURKET 601 E 7TH STREET PLATTE SD 57369 14195611 0 X WWW.PHCAVERA.ORG X 1947 SD PROVIDE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. 9 9 201 50 0 0 127826 64017 13358918 13726480 56147 351459 55095 53655 13597986 14195611 6632 1850 0 0 8067710 9122733 0 0 0 4614424 4535553 12688766 13660136 909220 535475 16574120 17692470 8850434 9087566 7723686 8604904 X 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. 1 1 12143219 1850 13781287 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. 12143219 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 32 0 1 201 1 0 0 0 0 0 0 0 0 0 0 X 9 9 1 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X VICKI JENSEN 6053373364 601 E 7TH STREET PLATTE SD 57369 ROB REISER PRESIDENT 1.00 X X 0 0 0 RON ERICKSON VICE-PRESIDENT 1.00 X X 0 0 0 SHARON HOFTSEE TREASURER 1.00 X X 0 0 0 SANDY GANT SECRETARY 1.00 X X 0 0 0 MARK MOUNT DIRECTOR 1.00 X 0 0 0 RON MILLAR DIRECTOR 1.00 X 0 0 0 MICHELLE HOLZBAUER DIRECTOR 1.00 X 0 0 0 DENNIS VANDERWERFF DIRECTOR 1.00 X 0 0 0 KENNETH KUIPERS DIRECTOR FROM 12/2016 1.00 X 0 0 0 MARK BURKET CEO 40.00 X 0 0 0 VICKI JENSEN CFO 40.00 X 67032 0 25873 JEROME W BENTZ PHYSICIAN FAMILY MEDICINE 40.00 X 289540 0 24147 LISA MOFLE PHYSICIAN FAMILY MEDICINE 40.00 X 250312 0 24960 ROBERT HUBLEY PHYSICIAN FAMILY MEDICINE 40.00 X 258271 0 31448 KASEY HANSON PHYSICIAN ASSISTANT 40.00 X 135071 0 1321 JEFF KONSTANZ CNP 40.00 X 137363 0 25551 1137589 0 133300 6 0 1 0 AVERA QUEEN OF PEACE 525 N FOSTER MITCHELL SD 57301 ADMIN, IT, OTHER SERVICES 1016581 PRIME TIME HEALTHCARE 14811 SHEPARD ST OMAHA NE 68138 NURSING STAFF SERVICES 188629 AVERA ECARE 4500 N LEWIS AVE SIOUX FALLS SD 57104 ECARE SERVICES 133697 AVERA HEALTH 3900 W AVERA DR SIOUX FALLS SD 57104 ONTRACT SERVICES, ELECTRONIC MED FEES 126624 AVERA MCKENNAN 800 E21ST SIOUX FALLS SD 57105 PURCHASED SERVICES:MRI,NUCLEAR MED. 112180 5 64017 64017 NET PATIENT SERVICE REVENUE 322110 8980372 8980372 NURSING HOME REVENUE 323110 2946041 2946041 CLINIC REVENUE 621498 1631396 1631396 OTHER REVENUE 900099 168671 168671 13726480 16153 16153 53655 0 53655 53655 53655 318896 16410 0 0 318896 16410 335306 335306 14195611 13726480 0 405114 1850 1850 205300 205300 7087474 6719254 368220 193197 188508 4689 1196786 1126977 69809 439976 407139 32837 282723 282723 1126 1126 62162 62162 222470 209387 13083 38639 10190 28449 383880 346785 37095 347336 52366 294970 371094 342304 28790 52501 49002 3499 38738 36260 2478 341986 341986 859653 859653 87096 75096 12000 BAD DEBT 49629 49629 SUPPLIES 1012028 1012028 EQUIPMENT AND REPAIRS 244347 243230 1117 ALL OTHER EXPENSES 84770 47762 37008 55375 23813 31562 13660136 12143219 1516917 0 1357387 1583514 2133617 1768303 60030 186099 176243 106865 109323 16423538 9620650 7131483 6802888 5658669 7149019 14446 0 28704 16574120 17692470 942620 1395681 7907814 7572579 0 119306 8850434 9087566 X 5440700 6097102 463422 675517 1819564 1832285 7723686 8604904 16574120 17692470 X 535475 66120 279623 X 0 1 X 1 0 X 1 3681 3782 6447 1016 0 2161101 194787 2355888 2211336 -50235 2161101 2209820 1516 2211336 1990303 219517 2209820 1754823 235480 1990303 0.00000 0.77780 0.22220 1 0 43000 222952 265952 11922788 6543501 5379287 390544 333432 57112 3837174 2743717 1093457 7080 7080 6802888 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENT 4054857 C INTEREST IN AVERA HEALTH FOUNDATION 2906861 C UNDER LOAN AGREEMENT 187301 C 7149019 ESTIMATED THIRD PARTY-PAYOR SETTLEMENTS 90602 DEFERRED COMPENSATION PAYABLE 28704 119306 X 14266909 66120 5178 71298 14195611 0 14195611 13610507 0 13610507 49629 49629 13660136 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. 1 1 X 1 X 1 X 1 1 0 1 1 1 27 67000 67000 0.00490 1 329 232489 214165 18324 0.00130 2 356 299489 214165 85324 0.00620 5 208 18420 10200 8220 0.00060 37839 32500 5339 0.00040 7334459 5176254 2158205 0.15860 5 208 7390718 5218954 2171764 0.15960 7 564 7690207 5433119 2257088 0.16580 0 49629 27784 4132301 4155702 -23401 X 1 1 1 1 PLATTE HEALTH CENTER AVERA 601 E 7TH STREET PLATTE SD 57369 WWW.PHCAVERA.ORG 10557 X X X X X PLATTE HEALTH CENTER AVERA 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X SEE PART V SECTION C X 1 15 1 SEE PART V SECTION C 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.AVERA.ORG/APP/FILES/PUBLIC/55374/PLATTE-FINANCIAL-ASSISTANCE.PDF X SEE 16J X SEE 16J X X X X X X 1 X 0 X X X X 1 X 0 0 PLATTE HEALTH CENTER AVERA PART V, SECTION B, LINE 5: THE 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 4 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 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. X X X 0 0 0 0 0 0 0 0 0 JEROME W BENTZ PHYSICIAN FAMILY MEDICINE 284889 0 0 0 4651 0 0 0 24147 0 313687 0 0 0 LISA MOFLE PHYSICIAN FAMILY MEDICINE 250312 0 0 0 0 0 604 0 24356 0 275272 0 0 0 ROBERT HUBLEY PHYSICIAN FAMILY MEDICINE 252627 0 0 0 5644 0 7863 0 23586 0 289720 0 0 0 JEFF KONSTANZ CNP 128140 0 0 0 9223 0 2465 0 23086 0 162914 0 0 0 LISA MOFLE PHYSICIAN EDUCATION/RECRUITMENT X 50000 34178 0 0 1 JEFF KONSTANZ ADVANCE PRACTICE PROVIDER EDUCATION/RECRUITMENT X 25000 8763 0 0 1 KASEY HANSON ADVANCE PRACTICE PROVIDER EDUCATION/RECRUITMENT X 25000 17089 0 0 1 60030 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.