2016-10-26T16:34:41-05:00 2015-12-31 460403496 CASEY PETERSON & ASSOCIATES LTD 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2015-01-01 432040599 BENNETT COUNTY HOSPITAL AND NURSING HOME BENN 6056856622 PO BOX 70 D MARTIN SD 57551 Andrew Riggin CEO 6056856622 2016-10-26 1 DEIDRE BUDAHL CPA P01273830 6053481930 2016-10-26 2015 2017-02-10 21:41:12Z Andrew Riggin PO BOX 70 D MARTIN SD 57551 8964678 0 X www.bennettcountyhospital.com X 2004 SD Provide healthcare and nursing home services 5 5 155 5 0 0 44391 30373 7231212 8882062 -3178 -56091 50195 29935 7322620 8886279 0 0 0 0 3796508 3813851 0 0 0 3457198 4100701 7253706 7914552 68914 971727 5915417 6209713 2794071 2116642 3121346 4093071 Caring people working together, as a team, to provide quality healthcare and education for a healthier community. 0 0 7140374 8817800 BENNETT COUNTY HOSPITAL AND NURSING HOME IS A CRITICAL ACCESS HOSPITAL LOCATED IN MARTIN, SD. THE ORGANIZATION IS THE ONLY HOSPITAL IN THE COUNTY SERVING APPROXIMATELY 3,600 RESIDENTS. BENNETT COUNTY IS LOCATED BETWEEN INDIAN RESERVATIONS IN A VERY RURAL AREA. BENNETT COUNTY HOSPITAL AND NURSING HOME HAS 20 HOSPITAL BEDS, 43 NURSING BEDS, AND 2 ASSISTED LIVING BEDS. DURING 2015, THE HOSPITAL WING HAD 305 PATIENT BED DAYS AND 423 SWING BED DAYS. THE NURSING HOME HAD 14,109 RESIDENT DAYS. 7140374 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 155 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X the organization 6056856622 102 MAJOR ALLEN P O BOX 70D MARTIN SD 57551 DAVID JONES CHAIRMAN 0.50 X X 0 0 0 Dale McDonnell SECRETARY/TREASURER 0.50 X X 0 0 0 Doug O'Bryan Vice-Chair 0.50 X X 0 0 0 Brad Otte BOARD MEMBER 0.50 X 0 0 0 Jason Fanning BOARD MEMBER 0.50 X 0 0 0 Ethel Frein CEO 40.00 X 114371 0 5997 Judy Soderlin CFO 40.00 X 46920 0 5997 ROSE HOITEN PHYSICIAN 40.00 X 189134 0 5997 350425 0 17991 2 0 1 0 DELTA HEALTHCARE PROVIDERS PO BOX 202940 DALLAS TX 75320 CONTRACT PHYSICAL THERAPY 131434 MEDPRO HEALTHCARE STAFFING 1580 SAWGRASS CORPORATE PKWY SUITE SUNRISE FL 33323 CONTRACT MEDICAL STAFF 108692 MEDICAL SOLUTIONS 1010 N 102ND ST OMAHA NE 68114 CONTRACT MEDICAL ASSISTANCE 102225 LUX TRAVEL NURSE INC 13126 COOL BREEZE ROAD HOT SPRINGS SD 57747 CONTRACT MEDICAL STAFF 100042 4 30373 30373 PATIENT SERVICE REVENU 621400 8864657 8864657 OTHER REVENUE 621400 6400 6400 CAFETERIA 621400 6340 6340 HEALTH FAIR REVENUE 621400 4665 4665 8882062 3167 3167 46240 17641 28599 28599 28599 1500 60758 -59258 -59258 -59258 Miscellaneous 900099 1336 1336 1336 8886279 8817800 0 38106 X 161291 161291 3073933 2907646 166287 417990 387707 30283 160637 134871 25766 80470 80470 1134715 1053981 80734 45052 42985 2067 431091 406494 24597 164909 164909 126747 103717 23030 42161 38353 3808 21971 11978 9993 7575 7575 623986 623986 47378 47378 BAD DEBTS 873226 873226 MEdical Supplies 330061 330061 Equipment Maintenance 170416 170416 MISCELLANEOUS 943 943 7914552 7140374 774178 0 757878 798683 1195916 1185092 1424152 2034176 156445 160477 35315 51816 4004360 2024891 2345711 1979469 5915417 6209713 472547 489446 2040105 1167825 37725 30918 243694 428453 2794071 2116642 X 2830567 3743622 290779 349449 3121346 4093071 5915417 6209713 X 971727 -2 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1218961 379788 839173 2785399 1645103 1140296 1979469 X 8030694 -873226 -873226 8903920 -17641 -17641 8886279 7058969 17643 17643 7041326 873226 873226 7914552 Part IV, Line 2b: The liability account reflects amounts held by the Hospital for nursing home residents to use for personal expenses. Part X, Line 2: As of December 31, 2015, the Organization had no uncertain tax positions that qualify for either recognition or disclosure in the financial statements. The Organization's income tax filings are subject to audit by various taxing authorities. Management continually evaluates expiring statutes of limitation, audits, proposed settlements, changes in tax law and new authoritative rulings. The Organization believes their estimates are appropriate based on current facts and circumstances. Interest and penalties assessed by income taxing authorities, if any, are included in interest expense. Part XI, Line 2d - Other Adjustments: Provision for bad debts -873,226. Part XI, Line 4b - Other Adjustments: Rental Expenses netted against revenue on 990 -17,641. rounding Part XII, Line 2d - Other Adjustments: Rental expenses netted against revenue on 990 17,641. rounding 2. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts 873,226. 1 1 1 X 1 X 0 0 0 17121 17121 0.00240 3279087 3118679 160408 0.02280 3296208 3118679 177529 0.02520 3296208 3118679 177529 0.02520 1 873226 560611 2294409 2208743 85666 X 1 1 1 1 Bennett County Hospital 102 Major Allen Martin SD 57551 www.bennettcountyhospital.com X X X BEnnett County Hospital 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.BENNETTCOUNTYHOSPITAL.COM X 1 15 1 WWW.BENNETTCOUNTYHOSPITAL.COM 1 0 1 X 100.000000000000 200.000000000000 X X X X X X 1 1 X X X 1 X WWW.BENNETTCOUNTYHOSPITAL.COM X X X X X 1 X X X 1 X X X X X X X 1 X 0 0 BEnnett County Hospital Part V, Section B, Line 5: THe Hospital is an active participant in nationwide quality improvement projects through South Dakota Foundation for Medical Care the QIO for Medicare and Medicaid programs in South Dakota. The Hospital also used information from the Centers for disease control and prevention and the national center for chronic disease prevention and health promotion. These sources were compared to goals established by the surgeon general in "healthy people 2010 (HP2010) and the target population of Bennett County Hospital. BEnnett County Hospital Part V, Section B, Line 11: SUSTAINABILITY OF BENNETT COUNTY HEALTH CARE (HOSPITAL AND NURSING HOME) WILL BE INFLUENCED BY THE FOLLOWING GOALS AND MEASURES IMPLEMENTED:1. TO KEEP THE ORGANIZATION MOVING BY CASH FLOWING TO ENSURE ACCESS TO EMERGENCY, ACUTE, SKILLED SWING BED, HOME HEALTH AND LONG TERM CARE FOR THE COUNTY AND RESERVATION AREAS.2. A CPA FIRM HAS BEEN INVOLVED TO ENSURE COST ACCOUNTING IS MAXIMIZED FOR ORGANIZATIONAL DIRECTION.3. A CONSULTANT TO ASSIST WITH LONG TERM CARE BUDGETING, AND OPERATIONAL ASSISTANCE CONTINUES TO BE ENGAGED TO IMPROVE OPERATIONAL SUCCESS.4. SUCCESSFUL OPENING AND OPERATION OF ON-SITE RURAL HEALTH CLINIC5. THE ORGANIZATION HAS IMPLEMENTED AN ELECTRONIC HEALTH RECORD SYSTEM AND MUST CONTINUE TO MEET THE REQUIREMENTS AND DEADLINES PROPOSED BY THE CENTER FOR MEDICARE SERVICES TO MAXIMIZE QUALITY CARE AND FINANCIAL REIMBURSEMENT.6. THE HOSPITAL IS ASSESSING THE NEED AND SUSTAINABILITY OF EMPLOYING A PHYSICIAN TO FUNCTION SPECIFICALLY ON THE BCHC TEAM.7. THE FACILITY CONTINUES TO FACE WORK FORCE CHALLENGES.8. THE HOSPITAL COMPLETED THE HEN PROJECT WITH THE QIO AND WILL PARTICIPATE IN THE NEW COLLABORATIVE HIIN.THE TRANSPORTATION ISSUE HAS BEEN DISCUSSED WITH PRAIRIE HILLS TRANSIT IN SPEARFISH, SD AND THE PINE RIDGE INDIAN TRIBE WITH NO SUCCESSFUL OUTCOMES FROM COMMUNITY MEETINGS THAT HAVE BEEN HELD. BEnnett County Hospital Part V, Section B, Line 18d: Bennett County Hospital and Nursing Home internal and external collection practices take into account the extent to which the patient qualifies for charity, a patient's good faith effort to apply for a government program or for charity from Bennett County Hospital and Nursing Home, and a patient's good faith effort to comply with his or her payment agreements with Bennett County Hospital and Nursing Home. For patients who qualify for charity and who are cooperating in good faith to resolve their hospital bills, Bennett County Hospital and Nursing Home may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. BEnnett County Hospital Part V, Section B, Line 20e: The policy is posted in emergency rooms, waiting rooms, and in the admission office in an effort to communicate with policy to patients at the time of service. BEnnett County Hospital Part V, Section B, Line 22d: Rates charged to FAP eligible individuals are based on the US Department of Health approved sliding fee scale that is also used by the federally qualified health center in Martin Part I, Line 7: Costing method is ratio of patient cost to charges as determined with worksheet 2 in the instructions for schedule H. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 873,226. Part II, Community Building Activities: THe Hospital currently does not engage in any community building activities. Part III, Line 4: Patient and resident receivables are uncollateralized patient, resident and third-party payor obligations. Payments of patient and resident receivables are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim.The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients, residents and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third-parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Part III, Line 8: Medicare allowable costs are determined directly from Medicare Cost report using methodologies prescribed by Medicare. Part III, Line 9b: THE FINANCIAL ASSISTANCE POLICY IS PROVIDED TO PATIENTS PRIOR TO COLLECTION PRACTICES BEING PERFORMED. Part VI, Line 2: AN OUTSIDE CONSULTANT CAME TO THE FACILITY AND PERFORMED AN ENVIRONMENTAL SCAN. THIS CONSISTED OF A MEETING WITH THE BENNETT COUNTY HOSPITAL EXECUTIVE TEAM AND MEMBERS OF OUR COMMUNITY. WE INVITED FIFTEEN BUSINESS OWNERS AND PROMINENT MEMBERS OF THE COMMUNITY TO A STRATEGIC PLANNING MEETING. THIS LISTENING OPPORTUNITY ASSISTED IN MAKING RECOMMENDATIONS TO OUR BOARD OF DIRECTORS IN THE CONTINUED PLANNING AND DIRECTION TO DEVELOP SHORT AND LONG TERM VISION OF HEALTHCARE FOR THE REGION. IN ADDITION SURVEYS WERE SENT OUT TO VARIOUS MEMBERS OF THE COMMUNITY WITH A 50% RETURN RATE. IN THE SUMMER OF 2013, THE HOSPITAL HIRED A CONSULTANT TO HELP WITH STRATEGIC PLANNING. DURING THIS PLANNING SESSION WITH THE BOARD AND KEY MANAGEMENT, CONSIDERATION WAS GIVEN TO COMMUNITY NEEDS. Part VI, Line 3: We have posted our charity care policy on our web site, www.bennettcountyhospital.com. Our billing staff in the facility informs patients of our financial assistance program when patients are having difficulties in paying for their healthcare. In addition, we have posted the policy in numerous locations within the facility. Part VI, Line 4: Martin is a community with a population of approximately 1,100, within Bennett County. The local economy is largely agriculturally based. Our facility is the sole hospital for Bennett County, which has a population of approximately 3,600. Bennett County is situated between the Pine Ridge and Rosebud Indian reservation. Because of this proximity, approximately 56% of the population is Native American. On average, approximately 88% of our facility patients are Native American. Although primarily served by the Indian Health Service (IHS), Native Americans within Martin utilize our facility. In many situations, our facility does not get reimbursed by IHS for the care provided to their beneficiaries. This is a tremendous financial burden imposed upon us, in addition to serving other community members who may require financial assistance. In addition, Bennett County and it's neighboring county (Todd) are the 25th and 5th, respectively, poorest counties in the United States. 33.8% of the Bennett County population has an income level below 100% of the federal poverty level. Part VI, Line 5: Our Board of Directors consists of community members who are accessible to community members for input into services provided. Each year, we provide a health fair for community members. Various health information topics are provided to the community. Part VI, Line 7, Reports Filed With States SD X X X 0 0 0 0 0 0 0 0 0 ROSE HOITEN PHYSICIAN 189134 0 0 0 0 0 0 0 5997 0 195131 0 0 0 Form 990, Part VI, Section B, line 11 THe form 990 is reviewed by management as prepared by a CPA. A copy of the filed 990 is provided to the board. Form 990, Part VI, Section B, line 12c The Organization requires officers and board members to disclose potential conflicts of interest annually and potential conflicts are monitored by the business office throughout the year and brought to the attention of the board as necessary. Form 990, Part VI, Section B, line 15 Compensation for the Administrator is determined by the board of directors. Data from the South Dakota Association of Healthcare Organizations is used to determine reasonable compensation for the Administrator. All other employee compensation is determined by the Administrator. Comparability data from the South Dakota Association of Healthcare Organizations is used. Form 990, Part VI, Section C, line 19 The hospital makes governing documents, the conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Other Professional Fees: Program service expenses 1,053,981. Management and general expenses 80,734. Fundraising expenses 0. Total expenses 1,134,715. Form 990, Part XI, line 9: ROUNDING -2. form 990 part XI line 2c The Organization has not changed the process for the selection of an independent auditor or oversight of the independent auditor by the board of directors.