2016-11-10T14:35:37-06:00 2015-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2015-01-01 460232450 Freeman Regional Health Services FREE 6059254000 PO Box 370 Freeman SD 57029 Nicholas Brandner CEO 6059254000 2016-11-08 1 Laurie Hanson P00851848 6053391999 2016-11-08 2015 2017-02-10 21:41:12Z Nicholas Brandner PO Box 370 Freeman SD 57029 10862732 0 X www.freemanregional.com X 1944 SD Provide accessible, community based quality care that is competent, creative and compassionate. 9 9 200 87 0 0 266695 118983 10027158 10468126 115 49392 62273 55703 10356241 10692204 0 0 0 0 5043670 5345246 0 0 1546 4591097 4800146 9634767 10145392 721474 546812 12382200 12898579 3369179 3399129 9013021 9499450 The mission of Freeman Regional Health Services is to provide accessible, community-based quality care that is competent, creative and compassionate. 0 0 9140020 10468126 To operate on a non-profit and purely charitable basis, a hospital and nursing home for the care and treatment of those in need. FRHS is comprised of a 56 Bed Nursing Home and a 25 Bed Critical Access Hospital with a 24/7 Emergency Room. The Emergency Room has local providers on call and Telemedicine capabilities with a regional trauma center. Hospital acute patient days= 561, swing bed days= 348, nursing home resident days= 19,925. 9140020 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 31 0 1 200 1 0 0 0 0 0 1 1 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Mark Miller 6059254000 510 East 8th Street Freeman SD 57029 Lori Uecker President 2.00 X X 0 0 0 Dennis Wollman President (Until Nov 2015) 2.00 X X 0 0 0 Steve Fuhrmann Vice President 2.00 X X 0 0 0 Jason Aanenson Treasurer 2.00 X X 0 0 0 Cindy Mutchelknaus Secretary 2.00 X X 0 0 0 Cam Becker Trustee 2.00 X 0 0 0 Dan Crick Trustee (Beg Nov 2015) 2.00 X 0 0 0 Delmer Hofer Trustee 2.00 X 0 0 0 Jim Julson Trustee 2.00 X 0 0 0 Glenn Roth Trustee 2.00 X 0 0 0 Dan Gran CEO (until Jan 2015) 40.00 X 23730 0 238 Nicholas Brandner CEO (Beg Jan 2015) 40.00 X 126155 0 15010 Mark Miller CFO 40.00 X 90435 0 23984 240320 0 39232 1 0 0 0 Avera McKennan 800 E 21st St Sioux Falls SD 57105 Radiology/Lab/Physician Services 979068 Avera Sacred Heart Hospital 501 Summit St Yankton SD 57078 IT Support 412000 Cardinal Health 7000 Cardinal Place Dublin OH 43017 Pharmacy 162603 Wapiti Medical Group 107 Flynn Drive 600 Milbank SD 57252 Staffing 115216 Jay Allison MD 804 Walnut St Freeman SD 57029 Medical Services 112785 7 27387 29100 62496 118983 Patient Service Revenue 622110 10243353 10243353 Collaborative Arrangement 900099 185783 185783 Meals on wheels 624210 13983 13983 25007 25007 10468126 47692 47692 216201 158946 57255 57255 57255 1000 -700 1700 1700 1700 10730 27387 12282 -1552 -1552 10692204 10468126 0 105095 X 279552 279552 4096023 3802385 293638 77806 72125 5681 558567 495306 63261 333298 290596 42702 11058 11058 39425 39425 2241700 2084085 157615 44968 30924 12623 1421 347002 297658 49277 67 2215 2215 161453 161453 17275 14174 3101 14823 12257 2566 52483 52483 658453 658453 82509 82509 Medical Supplies 736754 736754 Provision for Bad Debts 202777 202777 Equipment Rental and Ma 117176 116760 416 Recruitment 3007 3007 67068 24099 42911 58 10145392 9140020 1003826 1546 3627192 4056068 1012723 1228428 173500 159049 175867 167443 14015419 7789602 6338277 6225817 992689 976952 51152 27811 19468 34141 14202 12382200 12898579 786507 680446 6305 27821 527721 493664 953173 948053 1006231 1143145 89242 106000 3369179 3399129 X 9013021 9499450 9013021 9499450 12382200 12898579 546812 -60383 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 299251 299251 8611609 4539948 4071661 4775131 3011681 1763450 329428 237973 91455 6225817 Estimated third-party payor settlements 106000 106000 X 10600272 -60383 -202777 -263160 10863432 -171228 -171228 10692204 10113843 171228 171228 9942615 202777 202777 10145392 Part IV, Line 2b: The organization maintains separate accounts for its patients and uses the funds for purchases as directed by patients. Part X, Line 2: The Facility 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 Facility is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Facility is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Facility 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 Facility 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 Facility 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 Expense -202,777. Part XI, Line 4b - Other Adjustments: Rental Expenses Reclassified -158,946. Direct Fundraising Expenses -12,282. Part XII, Line 2d - Other Adjustments: Rental Expenses Reclassified 158,946. Direct Fundraising Expenses 12,282. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 202,777. Gala 24622 17972 6650 605 5532 1000 2154 Golf Tournament 13495 9415 4080 711 2280 38117 27387 10730 605 6243 1000 4434 12282 -1552 1 1 X 1 X 1 X 1 1 1 0 1 1 11000 11000 0.00110 1421750 1270892 150858 0.01520 1432750 1270892 161858 0.01630 711357 229977 481380 0.04840 455 455 0.00000 711812 229977 481835 0.04840 2144562 1500869 643693 0.06470 222934 208941 13993 0.00140 97345 77140 20205 0.00200 15310 7425 7885 0.00080 335589 293506 42083 0.00420 0 202777 48666 3132601 3125140 7461 X 1 1 1 1 Freeman Regional Health Services PO Box 370 Freeman SD 57029 www.freemanregional.com 10541 X X X X 1 provider based clinic Freeman Regional Health Services 1 0 0 1 X X X X X 13 1 0 0 1 X www.freemanregional.com/community-needs X 1 13 1 www.freemanregional.com/community-needs 0 0 1 X 150.000000000000 200.000000000000 X X X 1 1 X X X 1 X www.freemanregional.com/services/charity-care X www.freemanregional.com/services/charity-care X www.freemanregional.com/services/charity-care X X X X X 1 X 0 X X X X 1 X 0 0 Freeman Regional Health Services Part V, Section B, Line 5: Freeman Regional Health Services took into account input from persons who represent the community through a joint effort with SD Planning & Development District. Five individuals were selected to represent a "workforce" group and a seven community members represented the "senior citizens" group. Both groups were made up of selected community members not related to the facility. The median age of the workforce group was 47, and the median age of the senior citizens group was 75. Freeman Regional Health Services Part V, Section B, Line 11: Pursuant to the implementation strategy adopted by FRHS, the following needs were addressed as of the end of the year for this 990:- Positioning FRHS to meet the changing needs of the aging population. FRHS addressed this need by looking into options for increasing availability of foot care clinics; - Researching the feasibility of expanding mental health services through psychiatry outreach and the use of telehealth applications and of working collaboratively with existing mental health providers to ensure their continued availability to provide services to our community. FRHS addressed this need by obtaining representation on the Wellspring board (provider of mental health services) and monitoring the availability of mental health services to the community; - Promotion of community-based education programs which focus on health-related topics of interest and which target specific common interest groups and the community as a whole. FRHS addressed this need by holding monthly education programs which included topics such as Diabetes, Heart Health, End of Life Care, Oral Health, Nutrition, Growth and Development, Farm Safety, and When to take your child to the ER; - Undertake community outreach initiatives aimed at benefiting our communities; evaluate unmet community needs and organize efforts, when possible, to address those needs. FRHS addressed this need through hosting free health screenings for community members; and- Support and advocate to its employees the value and importance of being involved in their communities; encourage volunteerism by its employees and continually explore opportunities that serve as a benefit to the community. FRHS addressed this need through staff volunteering in the community, specially getting involved with the Development Corporation Board.The following needs will continue to be met:- Explore the feasibility of building a wellness center and indoor pool which would be accessible to the community and used by FRHS for therapy and other wellness-related programs. This has not been addressed because it appears to not be financially viable at this time. Freeman Regional Health Services Part V, Section B, Line 13b: See Part I, Line 3c narrative. Freeman Regional Health Services Part V, Section B, Line 13h: For some patients, FRHS uses documentation from other government based agencies of the patient's financial situation and resources as a way to help determine the patient's financial situation. The Chief Financial Officer reviews all applications and makes the determination of assistance offered. Freeman Regional Health Services Part V, Section B, Line 16i: A summary of the policy was posted in the hospital facility's emergency rooms and waiting rooms, posted in the admissions offices, made available upon request, and attached to billing invoices. Freeman Regional Health Services Part V, Section B, Line 22d: FRHS shall bill patients who qualify for financial assistance under the Look Back Method of not more than the IP and OP combined Medicaid and private pay overall adjustment rate determined on an annual basis. 4 1 - Oakview Terrace 510 E 8th Street Freeman SD 57029 Long Term Care Facility 2 - Menno Clinic 301 South High Street Menno SD 57045 Rural Medical Clinic 6 - Marion Clinic 307 State Marion SD 57043 Rural Medical Clinic 7 - Bridgewater Clinic 209 N Main Bridgewater SD 57319 Rural Medical Clinic Part I, Line 3c: Freeman Regional Health Services (FRHS) requires that the patient complete a financial assistance application showing his/her income and expenses. The application is reviewed to see what funds and assets the patient has and whether the patient has the resources to pay his/her medical bills. For some patients, FRHS uses documentation from other government based agencies of the patient's financial situation and resources as a way to help determine the patient's financial situation. The Chief Financial Officer reviews all applications and makes the determination of assistance offered.Part I, Line 6b:The FRHS made the community benefit report available to the public by posting it on their website (http://www.freemanregional.com/home). 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 and 7g were obtained from the Medicaid and Medicare cost reports, respectively. Line 7i was obtained utilizing the actual general ledger system. Part I, Ln 7 Col(f): Bad debt expense of $202,777 was subtracted from total operating expense. Part II, Community Building Activities: We provided congregate living services to seniors in order to keep them in their home community longer. Subsidized the Meals on Wheels program to provide at least one good nutritious meal per day to seniors in need of that service. Part III, Line 2: Before an account is written off to bad debt all discounts and payments are applied, including contractual allowances. After every attempt is made to collect the unpaid balance, the account is written off to bad debt. Payments on accounts that were written off as bad debt reduces bad debt expense.Bad debt expense is reported based on charges for the year ending 12/31/15 as stated in the audited financial statement. Part III, Line 3: In knowing the prevailing income level and typical family size, a majority of the accounts charged off to Bad Debts would qualify for Charity Care. FRHS encourages its patients to complete the application to determine if the patient qualifies for assistance; however, very few forms are returned to FRHS for processing. The amount was determined based on an estimated percentage derived from a review of the accounts and statistics for the counties served. Part III, Line 4: The footnote that describes bad debt expense is on page 6 Note 1 - Organization and Significant Accounting Policies under Patient and Resident Receivables from the attached Financial Statements. Part III, Line 8: Medicare allowable costs of care was calculated from the Medicare Cost Report for fiscal year ending 12/31/2015.The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: The collection policy contains provisions for patients known to qualify for financial assistance. If financial assistance eligible patients make payments as determined through completion of the financial assistance process, their account will not be sent to collection. However, if payments are not made as planned, the account of a financial assistance eligible patient may go to collection. FRHS will allow 240 days from the first post discharge billing statement for patients to apply for financial assistance. FRHS will allow all patients 120 days from first post discharge billing statement to apply for financial assistance before initiating any extraordinary collection activities. If, during the collection process, it is determined that a patient may be eligible for financial assistance, collection efforts would cease until the patient has ample time to prepare and submit information needed to determine eligibility under the financial assistance policy. If the patient qualifies for assistance, the account will be pulled from collection. Part VI, Line 2: Annually, on the 4th Monday of February, Freeman Regional Health Services (FRHS) has a community meeting that is advertised in the local newspapers inviting the community to attend and provide input regarding its needs and ideas on how FRHS can improve its services. On a quarterly basis, FRHS meets with the medical staff to discuss operations and any suggestions they may have on services provided by FRHS and the needs of the community. Twice a month FRHS has Department Manager meetings where the needs of the community and other issues can be discussed. Community members are encouraged to come to the facility at any time to discuss concerns or issues with the Administration.In addition, FRHS prepared a community health needs assessment in 2013. Please see Part V, Section B, Line 3 for more information. Part VI, Line 3: FRHS has posted signage about charity care and financial assistance programs in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present. FRHS addresses the financial assistance program and provides information on how to apply for assistance at discharge and in patient bills. The Business Office and Social Workers advise patients on the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable. A notice related to available charity care is printed at the bottom of all service statements. Part VI, Line 4: FRHS is a healthcare facility that primarily serves residents in rural Hutchinson, McCook and Turner Counties in southeastern South Dakota. Service Area Demographics Hutchinson McCook TurnerPopulation (2010 Census) 7,343 5,618 8,347Households 3,351 2,491 3,939Average Household Size (People) 2.33 2.48 2.40Median Household Income $42,386 $46,964 $50,143Median Age 46.8 42.7 43.7% of Population under 18 24% 26% 24%% of Population 19-64 51% 55% 57%% of Population 65+ 25% 19% 19%% of Population below poverty income level 11.8% 7.1% 7.3%A majority of the employers in these areas are small employers who offer little to no employee benefits. Of the employers who do offer health insurance to their employees, deductibles and co-pays have risen from 300-500% over the past 10 years. Many employers have passed the increase in health insurance premiums to their employees making paying the higher deductibles and co-pays very difficult. Part VI, Line 5: FRHS's governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization, nor family members thereof. FRHS extends medical staff privileges to all qualified providers in its community and surrounding area. FRHS reinvests surplus funds to improvements in patient care, including but not limited to expansion of services offered, patient education, employee education, and equipment and facility renovations. FRHS is comprised of a 56 Bed Nursing Home and a 25 Bed Critical Access Hospital with a 24/7 Emergency Room. The Emergency Room has local providers on call and Telemedicine capabilities with a regional trauma center. A City of Freeman 466000164 2006-09-29 750000 To help finance unit congregate living units. 0 0 0 A 256336 750000 750000 2006 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Form 990, Part VI, Section A, line 2 Lori Uecker, President, and Dennis Wollman, Former President, have a business relationship. Form 990, Part VI, Section A, line 8b Freeman Regional Health Services does not utilize committees. Form 990, Part VI, Section B, line 11 The CEO and CFO review the Form 990 in detail, it is then presented and reviewed by the Board at a board meeting prior to filing. Form 990, Part VI, Section B, line 12c FRHS requires annual compliance with and disclosure of conflicts in accordance with the written policy. Conflicts of interest or potential conflicts of interest must be reported to the Compliance Officer. If a conflict is deemed to exist, appropriate action is taken such as a board member may be required to abstain from discussion, deliberation, and voting on the issue at hand. Form 990, Part VI, Section B, line 15 Compensation is initially set by the Board and/or Administration following a review and assessment of the SDAHO comparability study. The annual increases are subject to the approval of the Board of Directors. The compensation determination is documented in a written contract. Form 990, Part VI, Section C, line 19 Available upon request Form 990, Part IX, line 11g Collection Fees: Program service expenses 6,117. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,117. Purchase Other Clinic : Program service expenses 1,022,300. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,022,300. Medical Professional Fees: Program service expenses 440,138. Management and general expenses 0. Fundraising expenses 0. Total expenses 440,138. Purchase Courier: Program service expenses 13,693. Management and general expenses 0. Fundraising expenses 0. Total expenses 13,693. Consulting Fees: Program service expenses 2,291. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,291. Other Purchased Services: Program service expenses 493,310. Management and general expenses 0. Fundraising expenses 0. Total expenses 493,310. Maintenance Contracts: Program service expenses 42,220. Management and general expenses 0. Fundraising expenses 0. Total expenses 42,220. UltraSound & MRI Contracts: Program service expenses 64,016. Management and general expenses 0. Fundraising expenses 0. Total expenses 64,016. Pt Financial Svc Collection Fees : Program service expenses 0. Management and general expenses 28,563. Fundraising expenses 0. Total expenses 28,563. Administration Consulting Fees : Program service expenses 0. Management and general expenses 123,902. Fundraising expenses 0. Total expenses 123,902. Purchase Printing : Program service expenses 0. Management and general expenses 4,998. Fundraising expenses 0. Total expenses 4,998. Marketing Purchase : Program service expenses 0. Management and general expenses 152. Fundraising expenses 0. Total expenses 152.