2017-08-14T09:44:56-05:00 2016-09-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2015-10-01 460255944 MOBRIDGE REGIONAL HOSPITAL MOBR 6058453692 1401 10TH AVE W MOBRIDGE SD 57601 JOHN AYOUB CEO 6058453692 2017-08-11 1 LAURIE HANSON P00851848 6053391999 2017-08-10 2015 2021-01-29 14:40:06Z JOHN AYOUB 1401 10TH AVE W MOBRIDGE SD 57601 22921733 0 X WWW.MOBRIDGEHOSPITAL.ORG X 1959 SD PROVIDING HEALTHCARE TO PEOPLE THROUGHOUT THE REGION. 12 10 205 200 0 0 380320 207513 20371363 22591596 28047 25335 98331 97289 20878061 22921733 0 0 0 0 10492297 11222837 0 0 0 8954141 9944825 19446438 21167662 1431623 1754071 23829256 24952161 9641938 9010772 14187318 15941389 THE MISSION OF MOBRIDGE REGIONAL HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES IN A COMPASSIONATE AND PROFESSIONAL MANNER FOR PEOPLE THROUGHOUT THE REGION. 0 0 19102232 22688885 MOBRIDGE REGIONAL HOSPITAL (MRH), A 25-BED CRITICAL ACCESS HOSPITAL, 16 BED ASSISTED LIVING CENTER, 8 BED SENIOR HOUSING CENTER, AND MEDICAL CLINICS, PROVIDES HEALTHCARE SERVICES TO PERSONS THROUGHOUT THE REGION. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016, THE HOSPITAL PROVIDED CARE TO THE NORTH CENTRAL REGION OF SOUTH DAKOTA, AND THE SOUTH CENTRAL REGION OF NORTH DAKOTA. THE HOSPITAL HAD: 1,569 PATIENT DAYS 1,489 ACUTE CARE DAYS 790 SWING BED CARE DAYS 3,777 EMERGENCY ROOM VISITS19,968 RURAL HEALTH CLINIC VISITS 6,060 ASSISTED LIVING DAYS (PRAIRIE SUNSET VILLAGE) 19102232 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 1 205 1 0 0 0 0 0 0 0 0 0 0 X 12 10 0 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X RENAE TISDALL 6058458164 PO BOX 580 MOBRIDGE SD 57601 BILL BACHMEIER CHAIRMAN 1.00 0.00 X X 0 0 0 DELPHINE STEUCK VICE CHAIR 1.00 0.00 X X 0 0 0 HEIDI ROSHAU TREASURER 1.00 0.00 X X 0 0 0 DR TOM SWANSON SECRETARY 1.00 0.00 X X 0 0 0 JAKE KRAFT DIRECTOR 1.00 0.00 X 0 0 0 WALLY SCHOTT DIRECTOR 1.00 0.00 X 0 0 0 DR LEONARD LINDE DIRECTOR 1.00 0.30 X 0 0 0 BARB GROSS DIRECTOR 1.00 0.00 X 0 0 0 LAURIE BAUER DIRECTOR 1.00 0.00 X 0 0 0 LORI HIEL DIRECTOR 1.00 0.00 X 0 0 0 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 40.00 0.00 X 323699 0 28808 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 40.00 0.00 X 341514 0 21607 ANGELIA SVIHOVEC CEO UNTIL 9.30.16 40.00 0.00 X 0 0 0 RENAE TISDALL CFO 40.00 0.00 X 86237 0 25908 DR BELA CSAKI SURGEON 40.00 0.00 X 345249 0 16154 DR JOSH HENDERSON INTERNAL MEDICINE 40.00 0.00 X 244333 0 26076 DEBBIE SMITH CRNA 40.00 0.00 X 215775 0 17228 DR COLETTE DUCHENEAUX FAMILY MEDICINE 40.00 0.00 X 369453 0 30004 JESSIE NORDER CNP 40.00 0.00 X 187438 0 24199 2113698 0 189984 11 0 1 0 CHI ST ALEXIUS HEALTH 900 EAST BROADWAY BISMARCK ND 58501 IT SERVICES, CEO SALARY, SUPPLIES, ETC 250538 NORTHERN PLAINS LAB PO BOX 2036 BISMARCK ND 58502 OUTSOURCE LABORATORY SERVICES 153392 MONDAK IMAGING SERVICES 11 SOUTH 7TH ST 241 MILES CITY MT 59301 DIAGNOSTIC IMAGING 140280 3 207513 207513 PATIENT SERVICE REVENUE 623110 21658626 21658626 ASSISTED LIVING REVENUE 623110 448860 448860 ELECTRONIC HEALTH RECORDS 900099 362425 362425 ANCILLARY CHARGES 900099 72661 72661 CHANGE IN FOUNDATION INTEREST 900099 49024 49024 22591596 23357 23357 97289 0 97289 97289 97289 1978 0 1978 1978 1978 22921733 22688885 0 25335 810987 696610 114377 8199397 7574189 625208 271057 248638 22419 1385636 1280173 105463 555760 505701 50059 320793 320793 15005 15005 58284 58284 940478 940478 99130 11707 87423 746562 626897 119665 91275 91275 324894 320404 4490 30504 30504 75743 67857 7886 311895 311895 1660104 1660104 167052 136171 30881 MEDICAL SUPPLIES 2241120 2241120 BAD DEBT 1677194 1677194 EQUIPMENT AND MAINTENAN 1029071 1006784 22287 DUES AND SUBSCRIPTIONS 70471 31943 38528 85250 45758 39492 21167662 19102232 2065430 0 6829729 7692655 2624891 2820957 143327 145657 381328 352984 64670 69664 30802377 19151054 12185056 11651323 6000 6000 1262209 1316180 332046 896741 23829256 24952161 1219302 1341261 798367 443537 3455000 3090000 3881864 3783076 287405 352898 9641938 9010772 X 13409128 15109563 778190 831826 14187318 15941389 23829256 24952161 1754071 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 95575 95575 15889926 8217910 7672016 14014721 10525652 3489069 802155 407492 394663 11651323 INTEREST IN FOUNDATION 680245 F UNDER INDENTURE AGREEMENTS 635935 F 1316180 PREMIUM ON BONDS PAYABLE 7518 DEFERRED COMPENSATION PLAN PAYABLE 390566 UNAMORTIZED DEBT ISSUANCE COST -56686 PSV DEPOSITS 11500 352898 X 21190903 -1569083 -1569083 22759986 161747 161747 22921733 19490468 0 19490468 1677194 1677194 21167662 PART X, LINE 2: THE ORGANIZATION IS 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 ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL 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 ORGANIZATION 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 ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT RECLASSIFIED AS EXPENSE -1,677,194. NET ASSETS RELEASED FROM RESTRICTION 108,111. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN FOUNDATION 49,024. RESTRICTED GRANTS AND CONTRIBUTIONS 112,723. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT RECLASSIFIED AS EXPENSE 1,677,194. 1 1 X 1 X 1 X 1 1 1 0 0 91000 91000 0.00470 3174087 2512968 661119 0.03390 3265087 2512968 752119 0.03860 3399504 1070306 2329198 0.11950 3399504 1070306 2329198 0.11950 6664591 3583274 3081317 0.15810 0 1677194 1257896 5637077 5668622 -31545 X 1 1 1 1 MOBRIDGE REGIONAL HOSPITAL 1401 10TH AVENUE W MOBRIDGE SD 57601 WWW.MOBRIDGEHOSPITAL.ORG 48404 X X X X MOBRIDGE REGIONAL HOSPITAL 1 0 0 1 X X X X X X X 15 1 0 0 1 X SEE 7D X X 1 15 1 SEE PART V, LINE 10A NARRATIVE. 0 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X 1 X SEE PART V, LINE 16I NARRATIVE X SEE PART V, LINE 16I NARRATIVE X X X X 1 X 0 X X X X X 1 X 1 1 MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 5: THE FACILITY OBTAINED DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH FOCUS GROUPS, SURVEYS AND PERSONAL INTERVIEWS INVOLVING COMMUNITY LEADERS, COMMUNITY HEALTHCARE PROVIDERS, COORDINATING AGENCIES, COMMUNITY MEMBERS AND THE UNDERSERVED POPULATION. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE AT HTTP://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT/MOBRIDGE REGIONAL HOSPITAL:PART V, SECTION B, LINE 10ATHE HOSPITAL'S IMPLEMENTATION STRATEGY IS POSTED ON THE WEBSITE AT HTTP://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT/. THE IMPLEMENTATION STRATEGY BEGINS ON PAGE 5 OF THE CHNA. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 11: PURSUANT TO THE IMPLEMENTATION STRATEGY ADOPTED BY MOBRIDGE REGIONAL HOSPITAL, THE FOLLOWING ACTIONS PLANS HAVE BEEN DEVELOPED. - MENTAL HEALTH CARE - THE HOSPITAL WILL IDENTIFY OPPORTUNITIES TO OFFER ADDITIONAL MENTAL HEALTH SERVICES, BOTH IN PERSON AND ELECTRONICALLY. MRH WILL ALSO CONTINUE TO DEVELOP RELATIONSHIPS WITH MENTAL HEALTH PROFESSIONALS IN THE AREA.- URGENT CARE - MRH WILL EVALUATE THE BENEFITS AND COSTS OF ADDITIONAL URGENT CARE OPTIONS. - CANCER TREATMENT CENTER - MRH WILL CONTINUE TO DEVELOP RELATIONSHIPS WITH ONCOLOGISTS IN ORDER TO ENHANCE CANCER CARE OPTIONS IN THE COMMUNITY.KIDNEY DIALYSIS AND PEDIATRICS WILL NOT BE ADDRESSED. FINANCIAL FEASIBILITY STUDIES WERE COMPLETED. WE FOUND THE COST TO ADD KIDNEY DIALYSIS WAS FAR TOO GREAT AND WE ARE THEREFORE UNABLE TO PROVIDE THIS PARTICULAR SERVICE. THE COST TO RECRUIT AND RETAIN A PEDIATRICIAN WAS ALSO TOO GREAT. PEDIATRIC NEEDS WERE REFERED TO BISMARCK, PIERRE, AND SIOUX FALLS. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 16I: PART V, LINE 16A, FAP WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16I: A FINANCIAL ASSISTANCE NOTICE IS MADE PART OF THE BILLING INVOICE. A FINANCIAL ASSISTANCE NOTICE IS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, AND ADMISSIONS OFFICE, AND THE FULL POLICY IS MADE AVAILABLE UPON REQUEST. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 20E: PROVIDED FINANCIAL ASSISTANCE INFORMATION WITH PATIENT DISCHARGE MATERIALS. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNT CHARGED TO A PATIENT UNDER THE FINANCIAL ASSISTANCE POLICY FOR EMERGENCY AND MEDICALLY NECESSARY CARE IS 50% OF GROSS CHARGES. THIS IS BASED ON THE LOWEST DISCOUNT UNDER THE CHARITY CARE POLICY OF 50%. THE DISCOUNT IS GREATER THAN THE DISCOUNT AS CALCULATED UTILIZING THE LOOKBACK METHOD. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 23: THE HOSPITAL PROVIDES A REDUCTION TO GROSS CHARGES UNDER THE FOLLOWING CONDITIONS: PATIENTS INDICATE THEY HAVE FAMILY INCOME OF NO MORE THAN 300% OF FPG, ARE UNINSURED OR UNDERINSURED, AND COMPLETE THE REQUIRED PAPERWORK TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE.THE HOSPITAL HAS NOT DETERMINED THE AMOUNT GENERALLY BILLED UNDER THE VARIOUS PROPOSED METHODS OF CALCULATION. THEREFORE, IT IS POSSIBLE A PATIENT UNDER THE FINANCIAL ASSISTANCE POLICY COULD HAVE PAID MORE THAN THE AMOUNT GENERALLY BILLED. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 24: THE FINANCIAL ASSISTANCE POLICY COVERS MEDICALLY NECESSARY SERVICES ONLY. THEREFORE, THE HOSPITAL MAY HAVE CHARGED FAP-ELIGIBLE INDIVIDUALS AN AMOUNT EQUAL TO GROSS CHARGES FOR NONMEDICALLY NECESSARY SERVICES. 4 1 - PRAIRIE SUNSET VILLAGE 1320 W GRAND XING MOBRIDGE SD 57601 ASSISTED LIVING & SENIOR HOUSING 2 - MOBRIDGE MEDICAL CLINIC 1309 10TH AVE W MOBRIDGE SD 57601 PROVIDER BASED RURAL HEALTH CLINIC 3 - WEST RIVER HEALTH CLINIC 103 1ST AVENUE E MCLAUGHLIN SD 57642 PROVIDER BASED RURAL HEALTH CLINIC 4 - WEST DAKOTA HEALTH CLINIC 906 MAIN TIMBER LAKE SD 57656 PROVIDER BASED RURAL HEALTH CLINIC PART I, LINE 3C: PLEASE REFER TO PART V, LINE 13, LINE 23 AND LINE 24 FOR OTHER FACTORS USED IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7B WAS DETERMINED USING THE MEDICAID PS&R REPORT AND THE GENERAL LEDGER ACCOUNTING SYSTEM. LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 9/30/16. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,677,194 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART III, LINE 2: BAD DEBT EXPENSE ON PART III LINES 2 AND 3 IS BASED ON CHARGES. WHEN A PAYMENT IS RECEIVED OR A DISCOUNT GIVEN ON A BAD DEBT ACCOUNT IT OFFSETS THE CURRENT FISCAL YEAR BAD DEBT EXPENSE THROUGH A RECOVERY OF BAD DEBT ACCOUNT. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO FINANCIAL ASSISTANCE IS ESTIMATED BASED ON INCOME LEVELS. A LARGE PORTION OF MRH CHARGES ARE GENERATED BY THOSE BELOW THE POVERTY LEVEL. STATISTICS PROVE THAT MOST OF THE MENTIONED PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE. AFTER REVIEW, MRH ESTIMATES APPROXIMATELY 75% OF BAD DEBT AT COST IS ATTRIBUTABLE TO PERSONS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: THE FOOTNOTE FOR BAD DEBT EXPENSE IS LOCATED ON PAGES 7 AND 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 9/30/16. THE ENTIRE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE SHORTFALL IS THE DIRECT RESULT OF SEQUESTRATION ENACTMENTS PUT IN PLACE BY THE FEDERAL GOVERNMENT. PART III, LINE 9B: THE PATIENT ACCOUNT SPECIALIST AT THE MOBRIDGE REGIONAL HOSPITAL KEEPS ON FILE ALL GUARANTORS WHO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE AND APPLIES THE FINANCIAL ASSISTANCE TO ALL ACCOUNTS WHEN THE GUARANTOR BALANCE BECOMES DUE. UPDATED FINANCIAL INFORMATION IS REQUESTED ANNUALLY FOR ANY CHANGES IN FINANCIAL ASSISTANCE THAT MAY APPLY. PART VI, LINE 2: MOBRIDGE REGIONAL HOSPITAL (MRH) IS COMMITTED TO PROVIDING HIGH QUALITY HEALTHCARE SERVICES TO ALL PEOPLE THROUGHOUT THE REGION. THE FACILITY PROVIDES FAMILY MEDICINE, INTERNAL MEDICINE, OB, ICU, ALS, AMBULANCE SERVICE, EMERGENCY CARE, AND SURGICAL SERVICES TO ALL PEOPLE WHO ARE IN NEED OF THOSE SERVICES. MRH CURRENTLY IS WORKING IN COLLABORATION WITH WALWORTH COUNTY AND THE STATE OF SOUTH DAKOTA TO PROVIDE COMMUNITY HEALTH SERVICES, INCLUDING FAMILY PLANNING SERVICES, ADULT HEALTH, AND CHILD IMMUNIZATIONS. MRH'S MANAGEMENT STRIVES TO LISTEN TO THE COMMUNITY NEEDS. IF NEW HEALTHCARE NEEDS ARISE, ADMINISTRATION WILL COMPLETE AN ANALYSIS OF COST/BENEFIT FOR THE NEW SERVICE TO BE OFFERED. MRH'S ADMINISTRATION BELIEVES IN BEING OUT IN THE PUBLIC AT EVENTS TO ANSWER QUESTIONS THAT MAY SURFACE ABOUT THE FACILITY. DURING THE YEAR ENDED 9/30/16 THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED. PLEASE SEE SCHEDULE H PART V FOR MORE INFORMATION. PART VI, LINE 3: MRH POSTS ITS FINANCIAL ASSISTANCE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN THE ADMISSIONS AREAS AND CLINIC AREAS IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FACILITY PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS WITH DISCHARGE MATERIALS. THE PATIENTS ACCOUNT MANAGER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE.MRH'S FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO BOTH NEW AND ESTABLISHED PATIENTS. THE FINANCIAL ASSISTANCE POLICY COVERS ALL MEDICALLY NECESSARY SERVICES PROVIDED BY THE INSTITUTION THAT ARE ORDERED BY PHYSICIANS.MRH'S FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO ALL PATIENTS WHO INDICATE AN INABILITY TO PAY AND MEET THE CRITERIA AS ESTABLISHED BY THE HOSPITAL FOR ALL OR A PORTION OF THEIR OUTSTANDING HOSPITAL BILL. PART VI, LINE 4: MRH IS LOCATED IN A SMALL RURAL COMMUNITY IN WALWORTH COUNTY, SOUTH DAKOTA, KNOWN AS MOBRIDGE. WALWORTH COUNTY HAS A POPULATION OF 5,443 PEOPLE RACIALLY COMPRISED OF MAINLY CAUCASIAN (82.4%) AND NATIVE AMERICANS/ALASKAN NATIVE (13.6%). THE COMMUNITY BORDERS THE STANDING ROCK RESERVATION AND THE CHEYENNE RIVER RESERVATION WHICH ACCOUNTS FOR THE LARGER NATIVE AMERICAN POPULATION AND RELATIONS WITH INDIAN HEALTH SERVICES. THE MEDIAN HOUSEHOLD INCOME OF MOBRIDGE IS $41,358, AND THE MEDIAN FAMILY INCOME IS $52,316. ROUGHLY 11.5% OF THE POPULATION IS BELOW THE POVERTY LINE. THE FACILITY OWNS AND OPERATES CLINICS IN MOBRIDGE, MCLAUGHLIN AND TIMBER LAKE. THE FACILITY SERVES PATIENTS FROM A SIX COUNTY AREA (WALWORTH, ZIEBACH, CORSON, DEWEY, CAMPBELL AND POTTER) AND IS APPROXIMATELY ONE HUNDRED MILES FROM ANOTHER HOSPITAL WITH A HIGHER LEVEL OF CARE OFFERED. ZIEBACH COUNTY IS THE 6TH POOREST COUNTY IN AMERICA, AND 46% OF PEOPLE LIVING IN THIS COUNTY ARE UNDER FEDERAL POVERTY GUIDELINES. PART VI, LINE 5: THE MOBRIDGE REGIONAL HOSPITAL IS COMMITTED TO THE PATIENTS WE SERVE, REGARDLESS OF RACE, COLOR, RELIGION, SEX, DISABILITY, OR ABILITY TO PAY. THE ORGANIZATION'S FINANCIAL ASSISTANCE ADJUSTMENTS HAVE CONTINUED TO TREND UP OVER THE PAST FEW YEARS, AND WE CONTINUE TO FOCUS BUDGET EFFORTS TO CONTINUE THIS TREND. MRH IS 100 MILES FROM ANOTHER HEALTHCARE FACILITY WITH A HIGHER LEVEL OF CARE AND PARTICIPATES IN THE NORTH DAKOTA AND SOUTH DAKOTA TRAUMA SYSTEMS WITH LEVEL III AND LEVEL IV CERTIFICATIONS, RESPECTIVELY. MRH CONTINUES A BROAD LEVEL OF BOARD INVOLVEMENT FOR CORSON, DEWEY, AND WALWORTH COUNTIES TO MONITOR COMMUNITY NEEDS IN THOSE AREAS. MRH CONTINUES TO BE A POPULAR PLACE FOR MEDICAL STUDENTS TO COMPLETE CLINICAL ROTATIONS, AND WE CONTINUE TO OFFER A WIDE VARIETY OF CERTIFICATION CLASSES TO NURSES AND THE MEMBERS OF THE COMMUNITY INCLUDING EMT-B, PALS, ACLS, TNCC, ALSO, NALS, EMT-I, AND CPR. MRH HAS DEVELOPED A WORKSITE WELLNESS PROGRAM WITHIN THE ORGANIZATION AND HAS GOALS TO WORK WITH OTHER BUSINESSES IN THE COMMUNITY TO PROMOTE OVERALL HEALTHY LIFESTYLES.MRH PROVIDES VARIOUS HEALTH SCREENINGS AVAILABLE TO THE COMMUNITY AND SURROUNDING COMMUNITIES THROUGHOUT THE YEAR. THE HEALTH SCREENINGS INCLUDE FREE CHOLESTEROL CHECKS, BMI, BLOOD PRESSURE AND WAIST/HIP RATIOS. THESE PREVENTATIVE HEALTH SCREENINGS PROMOTE THE GENERAL HEALTH OF THE COMMUNITY.THE HOSPITAL HAS A BOARD OF DIRECTORS COMPRISED OF VOLUNTEERS WHO RESIDE IN THE SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE AREA. ALL QUALIFIED PHYSICIANS WHO SHOW AN INTEREST MUST GO THROUGH A CREDENTIAL REVIEW AND BOARD APPROVAL. SURPLUS FUNDS, IF AVAILABLE, ARE REINVESTED IN THE FACILITIES TO IMPROVE PATIENT CARE. X X 0 0 0 0 0 0 0 1 0 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 282400 0 33173 0 8126 0 10600 0 18637 0 352936 0 0 0 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 267721 0 65988 0 7805 0 10600 0 11445 0 363559 0 0 0 DR BELA CSAKI SURGEON 336654 0 0 0 8595 0 10600 0 5794 0 361643 0 0 0 DR JOSH HENDERSON INTERNAL MEDICINE 202575 0 33173 0 8585 0 9554 0 16888 0 270775 0 0 0 DEBBIE SMITH CRNA 214922 0 0 0 853 0 8679 0 8954 0 233408 0 0 0 DR COLETTE DUCHENEAUX FAMILY MEDICINE 250288 0 110733 0 8432 0 10600 0 19787 0 399840 0 0 0 JESSIE NORDER CNP 115753 0 66418 0 5267 0 7296 0 17134 0 211868 0 0 0 PART I, LINE 7 THE PHYSICIANS ARE PAID BASED ON RELATIVE VALUE UNIT BASED PRODUCTION. A CITY OF MOBRIDGE SOUTH DAKOTA 466000320 607429BA4 2007-05-08 5773898 REFINANCE BONDS ISSUED 1997 USED FOR CONSTRUCTION; PURCHASE CT, CLINIC & EMR 0 0 0 A 2665000 5773898 265908 88005 1000000 4416499 2008 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MOBRIDGE, SOUTH DAKOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 07/13/2012 FORM 990, PART VI, SECTION A, LINE 3 MRH CURRENTLY HAS A MANAGEMENT AGREEMENT WITH ST. ALEXIUS MEDICAL CENTER IN BISMARCK, ND. THE AGREEMENT PROVIDES THE CEO, ANGELIA K. SVIHOVEC, AND INFORMATION TECHNOLOGY SUPPORT AT A COST TO MRH. THE ORIGINAL MANAGEMENT AGREEMENT DATE WAS JANUARY 1, 2000. ANGELIA SVIHOVEC, CEO, RECEIVED W-2 COMPENSATION OF $177,413 AND BENEFITS OF $16,614 DURING THE CALENDAR YEAR ENDED 12/31/15. THE CEO OVERSEES ALL DAILY OPERATIONAL ACTIVITIES AND REPORTS TO THE ORGANIZATION'S BOARD OF DIRECTORS. MS. SVIHOVEC WORKS VERY CLOSELY WITH ALL DEPARTMENT SUPERVISORS TO ENSURE THAT ALL AREAS OF THE HOSPITAL ARE RUNNING EFFICIENTLY AND SMOOTHLY. MS. SVIHOVEC IS RESPONSIBLE FOR PHYSICIAN CONTRACTING AND WORKS VERY CLOSELY WITH HUMAN RESOURCES FOR RECRUITMENT OF PROFESSIONAL MEDICAL STAFF. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBER; ALL MEMBERS HAVE ONE VOTE (SAME VOTING RIGHTS). EACH PERSON WHO DONATES $100 OR MORE IS A MEMBER ENTITLED TO ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7A THE NOMINATING COMMITTEE NOMINATES CANDIDATES FOR ELECTION. THE MEMBERS VOTE ON CANDIDATES AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE CEO, CFO, AND BOARD OF DIRECTORS WILL REVIEW THE FORM 990 VIA ELECTRONIC TRANSMISSION PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE ENTIRE BOARD OF DIRECTORS. IF A CONFLICT SHOULD ARISE, IT WOULD FIRST GO TO THE CEO FOR EVALUATION, THEN TO THE BOARD OF DIRECTORS FOR FINAL EVALUATION. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR MAKING THE FINAL DECISION IN DETERMINING IF A CONFLICT EXISTS. IF A CONFLICT IS FOUND, THE PERSON(S) INVOLVED WOULD BE REQUIRED TO ABSTAIN FROM DISCUSSIONS AND VOTING ON THE ITEM CAUSING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE FINANCE COMMITTEE DETERMINES AND APPROVES THE PHYSICIAN CONTRACTS, INCLUDING COMPENSATION. THE CEO'S SALARY IS DETERMINED USING A SALARY SURVEY AND DISCUSSIONS WITH THE MANAGEMENT COMPANY. THE FINANCE COMMITTEE APPROVES THE SALARY OF THE CEO ANNUALLY. THE BOARD OF DIRECTORS APPROVES THE FINANCE COMMITTEE MINUTES, WHICH INCLUDE DISCUSSIONS REGARDING THE CEO'S SALARY. SALARIES FOR OTHER OFFICERS OR MEMBERS OF MANAGEMENT ARE DETERMINED BY THE CEO THROUGH THE USE OF SALARY SURVEY INFORMATION FROM SDAHO AND EMPLOYEE SERVICE AND EXPERIENCE FILES. SALARY INCREASES WERE IMPLEMENTED ON SEPTEMBER 18TH, 2016. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. MOBRIDGE REGIONAL HEALTHCARE FOUNDATION PO BOX 580 MOBRIDGE SD 57601 460416693 OUTREACH FOR MOBRIDGE REGIONAL HOSPITAL SD 501(C)(3) LINE 11C, III-FI MOBRIDGE REGIONAL HOSPITAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0