2014-10-30T08:15:30-05:00 2013-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2013-01-01 460274380 WINNER REGIONAL HEALTHCARE CENTER WINN 6058427100 745 E 8TH ST WINNER SD 57580 KEVIN COFFEY CEO 6058427100 2014-10-23 1 LAURIE HANSON P00851848 6053391999 2014-10-23 2013 2015-11-30 17:44:51Z KEVIN COFFEY 745 E 8TH ST WINNER SD 57580 19640544 0 X WWW.WINNERREGIONAL.ORG X 1961 SD TO PROVIDE HEALTHCARE SERVICES. 9 9 303 14 0 0 854223 273633 19083539 18860630 43637 24273 19208 20577 20000607 19179113 0 0 0 0 10243233 10036225 0 0 0 10589675 11724393 20832908 21760618 -832301 -2581505 18029583 14981565 7127663 6626413 10901920 8355152 THE SPIRITUAL, PHYSICAL AND MENTAL WELL-BEING OF OUR PATIENTS AND RESIDENTS IS OUR PRIMARY CONCERN. EXCELLENCE IN HEALTHCARE IS OUR TRADITION. 0 0 19672281 18429630 WINNER REGIONAL HEALTHCARE CENTER, A 25-BED CRITICAL ACCESS HOSPITAL AND 79 BED LONG TERM CARE CENTER, PROMOTES HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES INCLUDING ACUTE PATIENT TREATMENT, SWING BED, LONG-TERM CARE, AND NEW BORN CARE. THE FACILITY ALSO OPERATES A HOME HEALTH AGENCY, HOMEMAKER PROGRAM, A PROVIDER BASED RURAL HEALTH CLINIC, A COMMUNITY HEALTH PROGRAM AND PROVIDES COMMUNITY EDUCATION PROGRAMS THROUGHOUT THE SERVICE AREA. WINNER REGIONAL HEALTHCARE CENTER HAD 1,935 ACUTE PATIENT DAYS; 1,010 SWING BED PATIENT DAYS; 301 NEWBORN PATIENT DAYS; AND 25,376 RESIDENT DAYS. 19672281 1 1 0 1 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 41 0 1 303 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 1 0 0 X PHILLIP HUSHER 6058427213 745 EAST 8TH STREET WINNER SD 57580 MICK ROWE PRESIDENT 1.00 X X 0 0 0 BRIAN SCHAEFFER VICE PRESIDENT 1.00 X X 0 0 0 TOM KAUER SECRETARY 1.00 X X 0 0 0 KEVIN OREL TREASURER 1.00 X X 0 0 0 ALICE DAUGHTERS DIRECTOR 1.00 X 0 0 0 NEIL LANTZ DIRECTOR 1.00 X 0 0 0 JOEL LEYDEN DIRECTOR 1.00 X 0 0 0 DOUG KARTAK DIRECTOR 1.00 X 0 0 0 DR GREGG TOBIN DIRECTOR, GENERAL SURGEON 1.00 X 0 0 0 KEVIN COFFEY CEO 40.00 X 0 0 0 PHILLIP HUSHER CFO 40.00 X 0 0 0 JOHN OSSE INTERIM CEO (UNTIL MAY 2013) 40.00 X 0 0 0 RHONDA JORGENSEN CRNA 20.00 X 170790 0 13039 170790 0 13039 1 0 1 0 SANFORD HEALTH NETWORK 1305 W 18TH ST SIOUX FALLS SD 57117 MGMT FEES/SALARY REIMB/IT SUPPORT 2133801 WINNER PHYSICAL THERAPY PO BOX 435 WINNER SD 57580 THERAPY 305563 RURAL ANESTHESIA SERVICES PO BOX 246 GREGORY SD 57528 ANESTHESIA SERVICES 180225 GREGG TOBIN 825 EAST 8TH ST WINNER SD 57580 ER COVERAGE AND SCOPE RENTAL 173602 EIDE BAILLY LLP 800 NICOLETT MALL STE 1300 MINNEAPOLIS MN 55402 ACCOUNT SERVICES 160683 6 204568 69065 273633 PATIENT AND RESIDENT SERVICE REVE 622110 18220076 18220076 MEDICAID EMR INCENTIVE 900099 431000 431000 OTHER REVENUE 900099 209554 209554 18860630 26772 26772 20577 0 20577 20577 20577 458932 461431 -2499 -2499 -2499 19179113 18860630 0 44850 X 304746 304746 7796259 7368363 427896 137996 130431 7565 1241979 1150964 91015 555245 524988 30257 37689 37689 149683 149683 4201756 4015005 186751 177979 31928 146051 342219 259357 82862 346778 25770 321008 683444 683444 32304 32304 78372 57667 20705 213830 167630 46200 1093843 1093843 128438 128438 MEDICAL SUPPLIES 1878923 1878923 BAD DEBTS 1831852 1831852 EQUIPMENT & MAINTENANCE 96100 94275 1825 LICENSES, DUES & SUBSCR 72602 18035 54567 358581 307502 51079 21760618 19672281 2088337 0 5143220 6232762 6287440 3079795 70680 85450 583166 507363 15994952 11368173 5488623 4626779 193726 228463 59251 30396 203477 190557 18029583 14981565 1788104 1705308 2410000 2175000 8260 7939 2921299 2031058 0 707108 7127663 6626413 X 10708194 8126689 193726 228463 10901920 8355152 18029583 14981565 X -2581505 34737 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 977 977 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF DUES THAT WERE USED FOR LOBBYING. ORGANIZATION OFFICERS AND DIRECTORS WILL ALSO FROM TIME TO TIME CONTACT LEGISLATORS CONCERNING HEALTH CARE ISSUES AND BILLS. 0 1 X 24638 24638 10546030 7658195 2887835 4888304 3334547 1553757 535980 375431 160549 4626779 X 17347261 -1831852 -1831852 19179113 0 19179113 19928766 0 19928766 1831852 1831852 21760618 PART IV, LINE 2B: LONG-TERM CARE RESIDENTS REQUEST THE FACILITY TO HANDLE THEIR FINANCIAL AFFAIRS. THIS IS DIRECTED BY A WRITTEN AGREEMENT BETWEEN THE FACILITY AND THE RESIDENT. SOME EXAMPLES OF FINANCIAL AFFAIRS ARE SOCIAL SECURITY CHECKS, NURSING HOME PAYMENTS, AND HAIRCUTS. PART X, LINE 2: THE 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 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. THE CENTER'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -1,831,852. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,831,852. 1 1 X 1 X 1 X 150.000000000000 1 1 1 0 1 1 439000 439000 0.02020 2990509 1963488 1027021 0.04720 3429509 1963488 1466021 0.06740 2930 1380 1550 0.00010 1000 1000 0.00000 9898300 5095310 4802990 0.22070 9902230 5096690 4805540 0.22080 13331739 7060178 6271561 0.28820 18735 9901 8834 0.00040 1045 1045 0.00000 4820 4820 0.00020 24600 9901 14699 0.00060 0 1831852 183185 4415832 4426718 -10886 X 1 1 1 1 WINNER REGIONAL HEALTHCARE CENTER 745 E 8TH ST WINNER SD 57580 WWW.WINNERREGIONAL.ORG 10713 X X X X WINNER REGIONAL HEALTHCARE CENTER 1 1 X X X X X X X X X 13 1 0 1 X HTTP://WINNERREGIONAL.ORG X X X X X X 0 0 1 1 100.000000000000 1 150.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 1 WINNER REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 3: RESIDENTS THROUGHOUT THE COMMUNITY PARTICIPATED IN THE ONLINE SURVEY PROVIDING THEIR FEEDBACK ON THE NEEDS OF THE COMMUNITY. PERSONS WITH SPECIALIZED KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH WERE INVOLVED IN THE NEEDS ASSESSMENT, AND INCLUDED THE DIRECTOR OF SOUTHERN PLAINS MENTAL HEALTH, THE WINNER MIDDLE SCHOOL COUNSELOR, A PHYSICIAN AND A NURSE. WINNER REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 5D: BOUND COPIES ARE DISPLAYED IN OPEN SITTING AREAS THROUGHOUT THE FACILITY FOR READING BY ANY CUSTOMER OR EMPLOYEE. WINNER REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST AND ON OUR WEBSITE.BASED ON THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, A PRIORITIZATION WORKSHEET WAS COMPLETED BY THE CHNA STEERING GROUP. WITH ASSISTANCE FROM SANFORD HEALTH, THE HOSPITAL IS WORKING TOWARD MEETING IDENTIFIED NEEDS. SANFORD HEALTH IS ACTIVELY SEARCHING FOR AN OUTREACH ONCOLOGIST TO SERVE THE AREA. SANFORD HEALTH HAS EMPLOYED A HOSPICE NURSE TO SERVE THE COMMUNITY. THE WINNER REGIONAL LONG TERM CARE FACILITY HAS SIGNED AN AGREEMENT WITH SANFORD HEALTH TO PROVIDE HOSPICE SERVICES TO RESIDENTS NEARING THE END OF LIFE. DIABETES SCREENING IN TRIPP COUNTY IS HIGHER THAN BOTH NATIONAL AND STATE BENCHMARKS, 89% AND 83%, RESPECTIVELY. ADULT OBESITY IS BETWEEN 30 AND 33.9% IN TRIPP COUNTY. AS A RESULT OF THE TWO FACTORS, WHICH HAVE A TENDENCY TO GO HAND-IN-HAND, THESE TWO TARGET AREAS WILL BE FOCUSED ON IN THE NEXT THREE YEARS. PHYSICIAN RECRUITMENT CONTINUES TO BE PRIORITY AT WRHC. WINNER REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 7: THE HOSPITAL INTENDS TO ADDRESS ALL PRIORITIES IDENTIFIED IN ITS IMPLEMENTATION STRATEGY. THE FOLLOWING NEEDS WILL BE ADDRESSED, BUT WERE NOT ADDRESSED AS OF THE END OF THE YEAR FOR THIS 990 BECAUSE THE IMPLEMENTATION STRATEGY WAS COMPLETED LATER IN 2013 AND THESE ITEMS TAKE A LONGER TIME TO COMPLETE:PRIORITY 2: EMPLOYEE-BASED WELLNESS PROGRAMSPRIORITY 3: CHRONIC HEALTH ISSUESTHE HOSPITAL HAS ALREADY MET PRIORITY #1, PHYSICIAN RECRUITMENT. WINNER REGIONAL CLINIC RECRUITED A FAMILY PRACTICE PHYSICIAN IN DECEMBER, 2013. THE FACILITY WILL CONTINUE TO WORK ON RECRUITMENT OF SPECIALTY AND FAMILY PRACTICE PHYSICIANS GOING FORWARD. WINNER REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 14G: PLEASE REFER TO THE NARRATIVE PROVIDED IN PART VI, LINE 3 REGARDING ADDITIONAL MEANS OF EDUCATING PATIENTS ABOUT OUR CHARITY CARE POLICY. WINNER REGIONAL HEALTHCARE CENTER PART V, SECTION B, LINE 22: THE HOSPITAL MAY HAVE CHARGED FAP-ELIGIBLE INDIVIDUALS AN AMOUNT EQUAL TO THE GROSS CHARGE FOR ELECTIVE PROCEDURES AS THE FAP POLICY DOES NOT INCLUDE ASSISTANCE FOR ELECTIVE, NON-MEDICALLY NECESSARY PROCEDURES. 2 WINNER REGIONAL NURSING HOME 745 EAST 8TH STREET WINNER SD 575802631 SKILLED NURSING FACILITY WINNER REGIONAL CLINIC 745 EAST 8TH STREET WINNER SD 575802631 RURAL HEALTH CLINIC PART I, LINE 3C: IN ADDITION TO UTILIZING FEDERAL POVERTY GUIDELINES, THE FOLLOWING ITEMS ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: PERSONAL ASSETS, LIABILITIES, INDIVIDUAL AND/OR FAMILY INCOME, NET WORTH, EMPLOYMENT STATUS OR EARNING CAPACITY, FAMILY SIZE, OTHER FINANCIAL OBLIGATIONS, FREQUENCY OF HEALTH SERVICES AND OTHER SOURCES OF PAYMENT FOR HEALTHCARE SERVICES RENDERED. THIS INFORMATION IS REVIEWED AND A DETERMINATION OF ELIGIBILITY FOR ASSISTANCE IS MADE BY THE PATIENT SERVICES REPRESENTATIVE AND THE CFO. PLEASE REFER TO PART V, LINE 12 FOR ADDITIONAL INFORMATION.PART I, LINE 6: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE FOUND ON ITS WEBSITE AT HTTP://WWW.WINNERREGIONAL.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 7E AND 7F WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINES 7B AND 7G WERE DETERMINED USING THE COST REPORTS. PART I, LN 7 COL(F): BAD DEBT BASED ON CHARGES OF $1,831,852 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: WINNER REGIONAL HOSPITAL / EMERGENCY ROOM IS OPEN 24/7, 365 DAYS A YEAR, AND IS AVAILABLE TO ALL, REGARDLESS OF THE ABILITY TO PAY. IN-HOUSE TRAINING IS PROVIDED TO ALL EMPLOYEES, INCLUDING ALL HEALTHCARE PROFESSIONALS. OUR EDUCATION COORDINATOR/RN, WORKS WITH THE ADMINISTRATION TEAM TO ENSURE ALL EMPLOYEES HAVE THE TRAINING REQUIRED/NECESSARY FOR THEM TO PERFORM THEIR JOB. THE HOSPITAL PARTICIPATES IN GOVERNMENT SPONSORED HEALTH PROGRAMS, INCLUDING MEDICARE, MEDICAID, VA AND INDIAN HEALTH SERVICES. ADDITIONALLY, WRHC IS VERY INVOLVED WITH THE WINNER CHAMBER OF COMMERCE AND PARTICIPATES IN THEIR ACTIVITIES AND MEETINGS. THE WINNER SCHOOL DISTRICT IS ALSO A PARTNER WITH WRHC AND OUR FACILITY SUPPORTS THE SCHOOL DISTRICT IN MANY WAYS. THE FACILITY ALSO SUPPORTS THE WINNER SCHOOL DISTRICT, COLOME SCHOOL DISTRICT, WHITE RIVER SCHOOL DISTRICT AND THE MISSION SCHOOL DISTRICT WITH THEIR FUND-RAISERS AND SEVERAL EVENTS. THIS YEAR EMPLOYEES HELD A BACK-TO-SCHOOL SUPPLY DRIVE FOR LOCAL SCHOOL DISTRICTS AND EMPLOYEES BROUGHT IN OVER 400 ITEMS FOR CHILDREN IN NEED. WRHC ALSO HELD A BOXED/CANNED FOOD DRIVE LAST FALL, AND BROUGHT IN OVER 200 POUNDS OF FOOD FOR THE WINNER FOOD PANTRY. EMPLOYEES ARE INVOLVED IN PHILANTHROPIC GROUPS SUCH AS ROTARY, THE PINK POSSE (AREA BREAST CANCER SUPPORT GROUP) AND WRHC IS A CORPORATE SPONSOR AND SUPPORTS THE LOCAL AMERICAN CANCER SOCIETY RELAY FOR LIFE. OUR EMPLOYEES ARE OFFERED THE OPPORTUNITY TO VOLUNTEER IN THE COMMUNITY THROUGH MANY DIFFERENT VENUES. WE HELD A BACK-TO-SCHOOL SUPPLY DRIVE IN JULY AND AUGUST, 2014, AND HELD A FOOD DRIVE LAST NOVEMBER. WRHC HELD A COMMUNITY WIDE EASTER EGG HUNT LAST APRIL, WITH ALL THE WORKERS BEING EMPLOYEES OF WRHC. OVER 500 COMMUNITY MEMBERS (MOSTLY CHILDREN) ENJOYED THE EASTER EGG HUNT AND THE OPPORTUNITY TO SPEAK AND PLAY WITH THE HOSPITAL EMPLOYEES DURING THE EVENT. THE HOSPITAL BRINGS A LABOR DAY ROAD RACE TO WINNER EVERY LABOR DAY. THIS EVENT, HELD TO PROMOTE WELLNESS IN THE COMMUNITY, ANNUALLY HAS ABOUT 100 RUNNERS/WALKERS EVERY YEAR, AND IS RUN BY WRHC EMPLOYEE VOLUNTEERS. EMPLOYEES WORK WITHIN THE COMMUNITY AS JUNIOR ACHIEVEMENT VOLUNTEERS (TEACHING SCHOOL AGE CHILDREN TO BE LEADERS IN THEIR COMMUNITY), PINK POSSE AND SISTERS AND SURVIVORS (BOTH BREAST CANCER SUPPORT GROUPS), ROTARY, WINNER QUARTERBACK CLUB (YOUTH SPORTS VOLUNTEER GROUP) AND MORE. PART III, LINE 4: A) BASED ON THE DEMOGRAPHICS OF THE AREA, APPROXIMATELY 10% OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY IF SUFFICIENT INFORMATION HAD BEEN AVAILABLE TO MAKE A DETERMINATION OF THEIR ELIGIBILITY.B) BAD DEBT EXPENSE IS RECORDED AT GROSS CHARGES. IF AN ACCOUNT IS WRITTEN OFF TO BAD DEBTS, PAYMENTS RECEIVED AFTER THE WRITE OFF FOR THAT ACCOUNT ARE POSTED TO THE CURRENT YEAR BAD DEBT ACCOUNT AS AN OFFSET AGAINST THE EXPENSE. C) THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS ON PAGE 9 OF NOTE 1 - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES UNDER PATIENT AND RESIDENT RECEIVABLES FROM THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 12/31/2013. 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 COLLECTION POLICY ALLOWS FOR CHARITY CARE TO BE OBTAINED DURING THE COLLECTION PROCESS IF THE PATIENT DID NOT QUALIFY DUE TO A LACK OF DOCUMENTATION IN THE PATIENT'S FILE. THE POLICY SPECIFICALLY STATES "A PATIENT WILL NOT BE DENIED CHARITY CARE CONSIDERATION BECAUSE OF A LACK OF DOCUMENTATION TO VERIFY INCOME." IF A PATIENT IS IN COMPLIANCE WITH FINANCIAL ARRANGEMENTS MADE DURING THE FINANCIAL ASSISTANCE PROCESS, THEIR ACCOUNT WILL NOT BE SENT TO COLLECTION. IF A PATIENT IS FOUND TO POTENTIALLY QUALIFY FOR FINANCIAL ASSISTANCE AND THE ACCOUNT IS IN COLLECTION, COLLECTION ACTIVITY WILL CEASE WHILE THE PATIENT COMPLETES THE APPLICABLE PAPERWORK. PART VI, LINE 2: THE COMMUNITY HEALTH NEEDS REPORT INCLUDED A DESCRIPTION OF WINNER REGIONAL HEALTHCARE CENTER (WRHC) AND A DESCRIPTION OF THE COMMUNITY IT SERVES. THE DESIGN STUDY AND METHODOLOGY INCLUDED QUALITATIVE AND QUANTITATIVE DATA, WHICH WAS CONDUCTED WITHIN THE QUALITY AND DECISION SUPPORT TEAMS FROM SANFORD HEALTH. WRHC IS A MANAGED FACILITY OF THE SANFORD HEALTH NETWORK. THE SECONDARY DATA MODELED THE ROBERT WOOD JOHNSON FRAMEWORK FOR COUNTY PROFILES. ASSET MAPPING WAS BASED ON THE MCKNIGHT FOUNDATION MODEL. PRIMARY DATA WAS OBTAINED VIA A SURVEY THAT WAS AVAILABLE THROUGH THE WRHC WEBSITE USING SURVEYMONKEY. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE IN THE COMMUNITY TO ADDRESS THE NEEDS. PART VI, LINE 3: OUR PROCESS FOR NOTIFYING PATIENTS OF FINANCIAL ASSISTANCE IS TO VISIT WITH THEM WHILE THEY ARE IN THE FACILITY. OUR PATIENT FINANCIAL REPRESENTATIVE REVIEWS THE CENSUS EVERY MORNING TO DETERMINE IF A PATIENT IS PRIVATE PAY. THE REPRESENTATIVE VISITS WITH THE PATIENT TO DETERMINE WHETHER THEY HAVE INSURANCE IN ADDITION TO WHAT HAS BEEN PROVIDED TO THE HOSPITAL, AND WHETHER THEY NEED ASSISTANCE WITH APPLYING FOR MEDICAID (IF APPLICABLE). THE REPRESENTATIVE PROVIDES CHARITY CARE INFORMATION IF THE PATIENT BELIEVES THIS TYPE OF FINANCIAL ASSISTANCE MAY BE NEEDED. CHARITY CARE APPLICATIONS ARE ALSO PROVIDED UPON REQUEST AND TO PERSONS WHO HAVE NOT BEEN MAKING PAYMENTS AS SCHEDULED. PART VI, LINE 4: WINNER REGIONAL HEALTHCARE CENTER (WRHC) IS LOCATED IN WINNER, SOUTH DAKOTA WHICH IS AT THE CENTER OF TRIPP COUNTY. COMMUNITIES IN TRIPP COUNTY INCLUDE CARTER, CLEARFIELD, COLOME, HAMILL, IDEAL AND WINNER. WRHC'S SERVICE AREA EXTENDS INTO GREGORY, MELLETTE, AND TODD COUNTIES IN SOUTH DAKOTA AND INCLUDES THE CITIES OF MISSION, WOOD, WHITE RIVER, GREGORY, BURKE, DALLAS, HERRICK, BONESTEEL AND FAIRFAX. THE SERVICE AREA INCLUDES NORTHERN CHERRY AND KEYA PAHA COUNTIES IN NEBRASKA AND ENCOMPASSES THE CITIES OF SPRINGVIEW, SPARKS AND VALENTINE. FARMING AND RANCHING ARE THE PRIMARY INDUSTRIES IN THIS RURAL AREA. THE POPULATION OF THE AREA IS 28,381. AVERAGE INCOME IS $37,091. PERCENTAGE OF RESIDENTS BELOW THE POVERTY LEVEL IS 27.72%. OTHER HOSPITALS SERVING THE AREA INCLUDE VALENTINE HOSPITAL, BURKE COMMUNITY MEMORIAL, GREGORY HOSPITAL AND ROSEBUD HOSPITAL. ALL COUNTIES IN THE SERVICE AREA ARE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS. PART VI, LINE 5: THE WINNER REGIONAL GOVERNING BOARD IS A 9 MEMBER VOLUNTEER BOARD COMPRISED OF BOTH MEN AND WOMEN THAT RESIDE IN THE WINNER REGIONAL HEALTHCARE CENTER SERVICE AREA. WINNER REGIONAL HEALTHCARE CENTER EXTENDS PRIVILEGES TO PHYSICIANS IN THE IMMEDIATE AREA. WINNER REGIONAL HEALTHCARE CENTER UTILIZES SURPLUS FUNDS TO FUND BUILDING IMPROVEMENTS AND TO ENHANCE SERVICES TO PATIENTS. THE FACILITY RECENTLY REMODELED THE IN-HOUSE PHARMACY TO ENHANCE THE PATIENT' EXPERIENCE AND ALIGN WITH DIRECTED MEDICATION SAFETY STANDARDS. PART VI, LINE 6: SANFORD HEALTH NETWORK PROVIDES MANAGEMENT SERVICES TO WINNER REGIONAL HEALTHCARE. X 1 1 X X 0 0 0 0 0 0 0 0 0 RHONDA JORGENSEN CRNA 170790 0 0 0 0 0 5219 0 7975 0 183984 0 0 0 PART I, LINE 1A ROTARY CLUB DUES A CITY OF WINNER 466000552 97477JBG2 2012-11-01 2410000 REFUNDING OF DECEMBER 1ST, 1998 ECONOMIC DEVELOPMENT HOSPITAL REVENUE BONDS 0 0 0 A 235000 2417981 2447293 48200 2443475 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION PART II LINE 3, RECONCILIATION OF TOTAL PROCEEDS OF ISSUE TO ISSUE PRICE: $2,410,000.00 ISSUE PRICE 7,981.27 NET REQUIRED FOR CALL DATE INTEREST $2,417,981.27 TOTAL SOURCES SCHEDULE K, PART IV, ARBITRAGE THE BOND ISSUED NOVEMBER 1, 2012, IS NOT SUBJECT TO ARBITRAGE CALCULATIONS UNTIL THE FIFTH ANNIVERSARY OF THE ISSUE DATE. THUS, ARBITRAGE CALCULATIONS ARE NOT DUE UNTIL NOVEMBER 1, 2017. FORM 990, PART VI, SECTION A, LINE 3 SANFORD HEALTH NETWORK, AN UNRELATED ORGANIZATION, MANAGES THE FACILITY. THE CEO, CFO, AND CLINIC DIRECTOR ARE EMPLOYEES OF THE MANAGEMENT COMPANY. SANFORD HEALTH IS LOCATED AT 1305 W 18TH STREET, SIOUX FALLS, SD. WRHC PAID SANFORD HEALTH NETWORK FOR SERVICES PROVIDED BY KEVIN COFFEY, CEO. AND PHILLIP HUSHER, CFO. COMPENSATION AND BENEFITS FOR THE CEO WERE $113,979 AND $10,752 RESPECTIVELY, AND COMPENSATION AND BENEFITS FOR THE CFO WERE $84,458 AND $17,545 RESPECTIVELY. WRHC PAID SANFORD HEALTH NETWORK $76,667 FOR SERVICES PROVIDED BY INTERIM CEO, JOHN OSSE. MR. OSSE WAS ACTING CEO UNTIL MAY, 2013. FORM 990, PART VI, SECTION A, LINE 8B COMMITTEES MAKE RECOMMENDATIONS TO THE GOVERNING BODY, WHICH APPROVES ALL ACTIONS. NO COMMITTEES HAVE BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 2013 FORM 990 WAS PROVIDED TO THE GOVERNING BODY ELECTRONICALLY PRIOR TO FILING. THE CFO REVIEWS A DRAFT OF THE FORM 990 IN DETAIL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE IS MONITORED THROUGH THE USE OF ANNUAL QUESTIONNAIRES THAT EACH OFFICER, DIRECTOR, TRUSTEE, AND KEY EMPLOYEE MUST COMPLETE. THE FULL BOARD SHALL BE ADVISED OF DEALINGS AND CONTRACTS TO BE MADE WITH ANY BOARD MEMBER(S), PHYSICIAN(S) OR EMPLOYEE(S). THE BOARD AND THE CEO IMPLEMENT AND CONTROL ALL CONFLICTS THAT MAY ARISE. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION OF THE CEO AND OTHER EMPLOYEES OF THE MANAGEMENT COMPANY ARE DETERMINED BY THE WINNER REGIONAL HEALTHCARE BOARD WHO EVALUATES SALARIES ANNUALLY USING COMPARABLE DATA FOR OTHER FACILITIES WITHIN THE STATE. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST FORM 990, PART IX, LINE 11G HIM PRODUCTION : PROGRAM SERVICE EXPENSES 9,138. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,138. CATT SCAN SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 1,852. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,852. NUTRITION SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 1,038. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,038. PURCHASED STAFFING SERVICES : PROGRAM SERVICE EXPENSES 76,144. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,144. ENVIRONMENTAL SERVICES SERVICE CONT : PROGRAM SERVICE EXPENSES 1,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,316. PLANT MAINT AND REPAIR SERVICE CONT : PROGRAM SERVICE EXPENSES 19,127. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,127. GENERAL MED ROUTINE SERVICE : PROGRAM SERVICE EXPENSES 91,879. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,879. RADIOLOGY DIAGNOSTICS SERVICE CONTR : PROGRAM SERVICE EXPENSES 286,405. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 286,405. MRI : PROGRAM SERVICE EXPENSES 89,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,600. MAMMOGRAM SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 43,782. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,782. CORE LAB SERVICE : PROGRAM SERVICE EXPENSES 203,273. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 203,273. SURGERY SERVICE : PROGRAM SERVICE EXPENSES 59,832. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,832. ANESTHESIA SERVICE : PROGRAM SERVICE EXPENSES 201,570. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 201,570. EMERGENCY DEPARTMENT MEDICAL : PROGRAM SERVICE EXPENSES 389,497. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 389,497. PHARMACEUTICAL SERVICES SERVICE : PROGRAM SERVICE EXPENSES 48,601. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,601. PHYSICAL THERAPY PURCHASED STAFFING : PROGRAM SERVICE EXPENSES 133,848. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,848. OCCUPATIONAL THERAPY PURCHASED STAF : PROGRAM SERVICE EXPENSES 20,916. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,916. OUTPATIENT SERVICES SERVICE CONTRAC : PROGRAM SERVICE EXPENSES 72,184. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,184. NUCLEAR MEDICINE : PROGRAM SERVICE EXPENSES 95,029. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,029. NURSING ADMINISTRATION PURCHASED ST : PROGRAM SERVICE EXPENSES 102,947. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,947. WINNER CLINIC MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 1,109,094. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,109,094. ROUTINE NURSING HOME : PROGRAM SERVICE EXPENSES 866,452. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 866,452. HOME HEALTH FEES : PROGRAM SERVICE EXPENSES 91,481. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,481. ADMINISTRATION : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 98,815. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,815. BUSINESS OFFICE SERVICE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 49,627. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,627. MARKETING PURCHASED STAFFING SERVIC : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,196. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,196. FOUNDATION PURCHASED STAFFING SERVI : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,113. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,113. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 34,737.