2013-07-15T11:42:17-05:00 2012-09-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2011-10-01 466015787 LANDMANN-JUNGMAN MEMORIAL HOSPITAL LAND 6055832226 600 BILLARS STREET SCOTLAND SD 570592026 DARCY KEPPLINGER 6055862226 2013-07-15 1 LAURIE HANSON P00851848 6053391999 2013-07-15 X 2011 2016-02-24 21:20:13Z DARCY KEPPLINGER 600 BILLARS STREET SCOTLAND SD 570592026 3763456 0 X WWW.LJMH.ORG X 1969 SD OPERATION OF A COMMUNITY CRITICAL ACCESS HOSPITAL. 10 10 49 10 0 0 15583 54808 3539996 3696534 9165 10314 700 1800 3565444 3763456 0 0 0 0 1436150 1353574 0 0 0 2552591 2546220 3988741 3899794 -423297 -136338 4153875 4116606 2419454 2505614 1734421 1610992 LANDMANN-JUNGMAN MEMORIAL HOSPITAL IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE WITH COMPASSION AND RESPECT. OUR COMMITMENT SHALL BE TO THE ETHICAL TREATMENT OF ALL PEOPLE THROUGHOUT THE CONTINUUM OF LIFE. 0 0 3478738 3672173 LANDMANN-JUNGMAN MEMORIAL HOSPITAL (LJMH) IS A LICENSED CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS AND 10 SWING BEDS. THE FACILITY OFFERS INPATIENT, OUTPATIENT AND PHYSICIAN CLINIC SERVICES TO RESIDENTS IN AND AROUND THE CITY OF SCOTLAND, SD. SEVERAL VISITING SPECIALISTS SPEND TIME AT LJMH CONDUCTING OUTREACH CLINICS ON A REGULAR BASIS WHICH INCLUDE AREAS OF CARDIOLOGY, GENERAL SURGERY, OB/GYN, MOBILE MRI, CT, NUCLEAR MEDICINE AND MAMMOGRAPHY. WEST WINDS APARTMENTS IS ALSO PART OF LJMH AND SERVES AS A 16 UNIT SENIOR HOUSING APARTMENT BUILDING. LJMH IS PROUD OF THE EXCELLENT CARE IT PROVIDES FOR PATIENTS OF THE SERVICE AREA. THE FACILITY IS ALSO NOTED FOR ITS COMMUNITY SERVICE, WHICH INCLUDES AN ANNUAL HEALTH FAIR AND BI-MONTHLY BLOOD DRIVES. 3478738 1 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 12 0 1 49 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 X DARCY KEPPLINGER 6055832226 600 BILLARS STREET SCOTLAND SD 57059 KENT LEHR 1.00 X X 0 0 0 GREG GEMAR 1.00 X X 0 0 0 SHIRLEY HERRBOLDT 1.00 X X 0 0 0 DAVID BAKER 1.00 X 0 0 0 RICK MEYER 1.00 X 0 0 0 JENNIFER SEDLACEK 1.00 X 0 0 0 CHARLES MOGCK 1.00 X 0 0 0 STEVE FLETT 1.00 X 0 0 0 DENNIS BIETZ 1.00 X 0 0 0 JARAD SCHORTZMAN 1.00 X 0 0 0 LEE BALDWIN 50.00 X 73865 0 7379 DARCY KEPPLINGER 40.00 X 54263 0 1085 128128 0 8464 0 0 0 1 AVERA MCKENNAN 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS SD 571175045 MANAGEMENT, IT, EDUCATION 273501 1 54808 54808 NET PATIENT SERVICE RE 621110 2719356 2719356 SCOTLAND PHARMACY 446110 844119 844119 WEST WINDS REVENUE 623990 93349 93349 CHANGE IN AVERA FOUNDA 900099 15349 15349 24361 24361 3696534 10314 10314 1800 0 1800 1800 1800 3763456 3672173 0 36475 148516 148516 1025928 952157 73771 10111 9869 242 90737 85537 5200 78282 69003 9279 39365 39365 731268 701165 30103 10262 85 10177 146040 89638 56402 72762 72762 4791 4714 77 102013 102013 350385 350385 28453 9000 19453 MEDICAL SUPPLIES 932077 932077 BAD DEBT 86931 86931 COMMUNITY & EMPLOYEE RE 25350 25350 CONTINUING EDUCATION 14515 13251 1264 2008 151 1857 3899794 3478738 421056 0 84048 175231 112728 40173 516996 668256 163947 157018 7075 20022 7150291 4660115 2682064 2490176 466764 496747 120253 68983 4153875 4116606 323642 646218 1925314 1737042 170498 122354 2419454 2505614 X 1621693 1567928 112728 43064 1734421 1610992 4153875 4116606 X -136338 12909 X 0 1 0 X 0 X 36163 36163 4461668 2219248 2242420 2567184 2408518 158666 85276 32349 52927 2490176 DEBT RESERVE FUNDS 46524 C INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 102019 F CAPITAL EXPENDITURES AND DEBT REDEMPTION 348204 F 496747 LJM APARTMENT RESIDENT FEE PAYABLE 52000 CONDITIONAL ASSET RETIREMENT OBLIGATION 63371 DAMAGE DEPOSITS PAYABLE 6983 122354 3763456 3899794 -136338 12909 12909 -123429 3667995 12909 -86931 -74022 3742017 21439 21439 3763456 3812863 0 3812863 86931 86931 3899794 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL 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 HOSPITAL 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 XII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS REPORTED IN REVENUE ON FINANCIAL STATEMENTS -86,931. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS REPORTED IN FUND BALANCE FOR FINANCIAL STATEMENTS 21,439. PART XIII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS REPORTED IN REVENUE ON FINANCIAL STATEMENTS 86,931. 1 1 X 1 X 1 X 150.000000000000 1 1 0 1 1 231 231 0.00010 127436 70988 56448 0.01480 127667 70988 56679 0.01490 784949 300622 484327 0.12700 784949 300622 484327 0.12700 912616 371610 541006 0.14190 0 86931 0 1317493 1304448 13045 X 0 1 1 LANDMANN-JUNGMAN MEMORIAL HOSPITAL

600 BILLARS STREET SCOTLAND SD 57059

X X X X LANDMANN-JUNGMAN MEMORIAL HOSPITAL 1 0 1 0 0 1 X X 1 1 X X X 0 0 1 X 1 1 2 WEST WINDS APARTMENTS

600 BILLARS STREET SCOTLAND SD 57059

SENIOR LIVING LANDMANN-JUNGMAN MEMORIAL CLINIC

600 BILLARS STREET SCOTLAND SD 57059

PROVIDER BASED CLINIC PART I, LINE 6A: LJMH PREPARES A COMMUNITY BENEFIT REPORT THAT IS SUBMITTED TO AVERA HEALTH. THE INFORMATION IS MADE AVAILABLE TO THE PUBLIC THROUGH AVERA HEALTH'S COMMUNITY BENEFIT REPORT. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7 BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7B AND 7G WERE OBTAINED UTILIZING THE MEDICARE COST REPORT. PART I, L7 COL(F): BAD DEBT EXPENSE OF $86,931 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART III, LINE 4: A) THE AMOUNT REPORTED ON LINE 2 REPRESENTS THE BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS.B) LJMH BAD DEBT SYSTEM TAKES INTO ACCOUNT CONTRACTUAL ALLOWANCES AND/OR DISCOUNTS. IF AN ACCOUNT IS WRITTEN OFF TO BAD DEBTS, PAYMENTS RECEIVED AFTER THE WRITE OFF FOR THAT ACCOUNT ARE POSTED TO THE BAD DEBT RECOVERY ACCOUNT. C) THE AMOUNT OF BAD DEBT THAT MAY BE ATTRIBUTABLE TO CHARITY CARE IS UNKNOWN. D) FOOTNOTE FROM FINANCIAL STATEMENT: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S PROCESS FOR CALCULATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS HAS NOT SIGNIFICANTLY CHANGED FROM SEPTEMBER 30, 2011 TO SEPTEMBER 30, 2012. THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYORS. THE HOSPITAL HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2011 OR 2012. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2012. LANDMANN-JUNGMAN MEMORIAL HOSPITAL PART V, SECTION B, LINE 9: LJMH USED A SLIDING SCALE TO DETERMINE ELIGIBILITY FOR FREE CARE, HOWEVER,THE POLICY DOES NOT INCLUDE THE STATED FPG INCOME LIMIT. THE FPG LIMIT USED DURING THE YEAR WAS 150%. LANDMANN-JUNGMAN MEMORIAL HOSPITAL PART V, SECTION B, LINE 10: LJMH USES A SLIDING SCALE TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE, HOWEVER, THE POLICY DOES NOT INCLUDE THE STATED FPG INCOME LIMIT. DURING THE YEAR ENDED 9/30/12, THE HOSPITAL DID NOT PROVIDE DISCOUNTED CARE (ONLY FREE CARE). LANDMANN-JUNGMAN MEMORIAL HOSPITAL PART V, SECTION B, LINE 15E: BILLS ARE DUE WITHIN 30 DAYS OF THE BILLING DATE. A 10 DAY NOTICE IS SENT AFTER THE 30 DAY PERIOD HAS PASSED. IF THERE IS NO RESPONSE TO EITHER BILL, THE ACCOUNT IS SENT TO COLLECTIONS. THE HOSPITAL IS IN THE PROCESS OF REVIEWING THEIR PROCEDURES TO ENSURE THEY ARE IN COMPLIANCE WITH 501(R). LANDMANN-JUNGMAN MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CHARGED THE STANDARD CHARGEMASTER RATE LESS THE APPLICABLE PERCENTAGE DISCOUNT AS DETERMINED BASED ON A SLIDING SCALE. THE HOSPITAL WILL REVIEW THE PROPOSED METHODS FOR AMOUNTS GENERALLY BILLED TO ENSURE ITS DISCOUNT UNDER THE FINANCIAL ASSISTANCE POLICY MEETS THE REQUIREMENTS OF 501(R). LANDMANN-JUNGMAN MEMORIAL HOSPITAL PART V, SECTION B, LINE 20: LJMH CHARGED ALL PATIENTS THE STANDARD CHARGEMASTER RATE, REGARDLESS OF THEIR ABILITY TO PAY. DISCOUNTS WERE APPLIED DIRECTLY AGAINST THE CHARGEMASTER RATE. DISCOUNTS PROVIDED UNDER THE FINANCIAL ASSISTANCE POLICY DURING THE YEAR ENDED 9/30/12 RESULTED SOLELY IN FREE CARE. LJMH IS IN THE PROCESS OF DEVELOPING A FORMULA FOR CALCULATING AMOUNTS GENERALLY BILLED TO BE IN COMPLIANCE WITH 501(R). LANDMANN-JUNGMAN MEMORIAL HOSPITAL PART V, SECTION B, LINE 21: LJMH CHARGED ALL PATIENTS THE STANDARD CHARGEMASTER RATE, REGARDLESS OF THEIR ABILITY TO PAY. DISCOUNTS WERE APPLIED DIRECTLY AGAINST THE CHARGEMASTER RATE. LJMH IS IN THE PROCESS OF DEVELOPING A FORMULA FOR CALCULATING AMOUNTS GENERALLY BILLED TO BE IN COMPLIANCE WITH 501(R). PART VI, LINE 2: LANDMANN-JUNGMAN MEMORIAL HOSPITAL (LJMH) CONDUCTS PATIENT SATISFACTION SURVEYS WHICH CAN LEAD TO INFORMATION REGARDING NEEDED SERVICES. IN ADDITION WHILE CONDUCTING THE HEALTH SCREENINGS, INTERACTIVE QUESTIONS ARE ASKED ABOUT SERVICES AND THE RESULTS ARE REPORTED BACK TO THE OFFICERS AND BOARD. PART VI, LINE 3: PATIENTS ARE EDUCATED ABOUT ELIGIBILITY AS THEY INQUIRE ABOUT ASSISTANCE. IN ADDITION, THE POLICY IS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, AND IN THE ADMISSIONS OFFICE. PART VI, LINE 4: LJMH IS LOCATED IN SCOTLAND, SD, AND PRIMARILY SERVES THE COUNTIES OF BON HOMME AND HUTCHINSON. THE POPULATION OF THE SERVICE AREA IS ROUGHLY 14,413 PEOPLE, AND SCOTLAND HAS A POPULATION OF 841 PEOPLE. OF THE 14,413 PEOPLE RESIDING IN BOTH COUNTIES, AN AVERAGE OF 22.05% ARE 65 YEARS OLD AND OVER WHICH IS ATTRIBUTABLE TO THE AVERAGE OF 78.60% OF INPATIENT DAYS BEING PROVIDED TO PATIENTS 65 YEARS OLD AND OVER. IF ONE LOOKS AT THE COUNTIES AS A WHOLE, THE AVERAGE MEDIAN HOUSEHOLD INCOME IS $40,208 WITH THE MEDIAN FAMILY INCOME BEING $50,428. BOTH COUNTIES ARE CONSIDERED MEDICALLY UNDERSERVED BY HRSA AND THE SD DEPARTMENT OF HEALTH. PART VI, LINE 5: LANDMANN JUNGMAN COMMUNITY HOSPITAL IS FOCUSED ON SERVING THE NEEDS OF THE COMMUNITY. THE GOVERNING BODY OF THE HOSPITAL IS MADE UP ENTIRELY OF VOLUNTEERS FROM THE COMMUNITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN ITS COMMUNITY. EXCESS FUNDS ARE USED FOR THE IMPROVEMENT OF PATIENT CARE AND FACILITIES. THE HOSPITAL IS USED BY THE UNIVERSITY OF SOUTH DAKOTA FOR NURSING CLINICALS, AS WELL AS BY THE PHARMACY AND HIM PROGRAMS. IT IS OPEN TO ANYONE WHO WANTS TO LEARN ABOUT CAREERS IN THE HEALTH CARE INDUSTRY.THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL ADMINISTRATION IS VERY RECEPTIVE TO INPUT FROM THE COMMUNITY. AN AUXILLIARY SUPPORTS THE HOSPITAL AND PROVIDES THE HOSPITAL WITH FEEDBACK ON AN INFORMAL BASIS. THE HOSPITAL IS THE ONLY HEALTHCARE FACILITY IN TOWN, WITH THE EXCEPTION OF A CLINIC WHICH IS NOT AFFILIATED WITH THE HOSPITAL. PART VI, LINE 6: LJMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY LJMH. AS A MANAGED FACILITY, LJMH 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.LJMH 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 LJMH 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 HEALTH AND LJMH 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, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. 0 0 0 0 0 0 0 0 0 LEE BALDWIN 73708 0 0 0 157 0 769 0 6796 0 81430 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, QUESTION 3: THE CEO IS COMPENSATED THROUGH A MANAGEMENT AGREEMENT WITH AVERA MCKENNAN, 800 E 21ST STREET, SIOUX FALLS, SD 57105. AVERA MCKENNAN UTILIZES A STUDY OF COMPARABLE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR THE CEO POSITION TO THE HOSPITAL. THE STUDY IS PROVIDED BY AVERA HEALTH. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT AND THREE BOARD MEMBERS. 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. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION PAYS A MANAGEMENT COMPANY FOR THE CEO'S SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE CEO AND CFO REVIEW THE 990 IN DETAIL. A COPY OF THE 990 IS GIVEN TO THE BOARD MEMBERS BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND MANAGEMENT. BOARD MEMBERS ARE RESPONSIBLE FOR DETERMINING WHETHER A POTENTIAL CONFLICT EXISTS WITH THE CEO AND BOARD MEMBERS. THE CEO IS RESPONSIBLE FOR DETERMINING IF THERE ARE POTENTIAL CONFLICTS OF INTEREST AMONGST MANAGEMENT. THE BOARD IS ULTIMATELY RESPONSIBLE FOR DETERMINING WHETHER AN ACTUAL CONFLICT EXISTS. ANY BOARD MEMBER WITH A CONFLICT IS REQUIRED TO ABSTAIN FROM VOTING ON THE MATTER OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION DOES NOT PAY ITS CEO DIRECTLY, RATHER THE HOSPITAL IS PAYING THE CEO THROUGH AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH AVERA MCKENNAN. THE PROCESS USED TO SET THE TOP MANAGEMENT'S ANNUAL SALARY IS BASED ON A COMBINATION OF FACTORS WHICH INCLUDES THE ORGANIZATION'S AND AVERA MCKENNAN'S REVIEW OF SALARY SURVEYS ON A YEARLY BASIS COMPARING THE ORGANIZATIONS TO OTHERS OF SIMILAR SIZE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC DURING ITS ANNUAL BOARD MEETING AND UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 12,909.