2013-11-07T11:49:44-06:00 2012-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2012-01-01 460232450 Freeman Regional Health Services FREE 6059254000 PO Box 370 Freeman SD 57029 Dan Gran 6059254000 2013-11-06 1 Laurie Hanson P00851848 6053391999 2013-11-06 2012 2016-02-25 16:41:14Z Dan Gran PO Box 370 Freeman SD 57029 10176061 0 X www.freemanregional.com X 1944 SD Provide accessible, community based quality care that is competent, creative and compassionate. 9 9 209 73 0 0 285030 293664 8017092 9520689 112856 124432 93455 51934 8508433 9990719 0 0 0 0 4431617 4776214 0 0 3116 3452033 4227314 7883650 9003528 624783 987191 10467324 11539721 3526332 3564716 6940992 7975005 The mission of Freeman Regional Health Services is to provide accessible, community-based quality care that is competent, creative and compassionate. 0 0 8076942 9716697 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= 598, swing bed days= 240, nursing home resident days= 18,692. 8076942 1 1 0 0 0 0 0 0 0 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 22 0 1 209 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 0 1 1 1 0 X Neil Frizzell 6059254000 510 East 8th Street Freeman SD 57029 Dennis Wollman 2.00 X X 0 0 0 John Butkus 2.00 X X 0 0 0 Jason Aanenson 2.00 X X 0 0 0 Lori Uecker 2.00 X X 0 0 0 Delmer Hofer 2.00 X 0 0 0 Glenn Roth 2.00 X 0 0 0 Jim Julson 2.00 X 0 0 0 Laverne Diede 2.00 X 0 0 0 Steve Fuhrmann 2.00 X 0 0 0 Dan Gran 40.00 X 121726 0 3841 Neil Frizzell 40.00 X 88046 0 0 209772 0 3841 1 0 0 0 Avera McKennan 800 E 21st St Sioux Falls SD 57105 Radiology/Lab/Physician Services 966369 Avera Sacred Heart Hospital 501 Summit St Yankton SD 57078 IT Support 213517 Avera ECARE 3900 W Avera Dr Sioux Falls SD 57108 Physician services 127075 3 21799 108798 163067 293664 Patient Service Revenu 621990 9468669 9468669 Phyical Therapy 621990 24323 24323 Meals on wheels 621990 15887 15887 Misc Revenue 900099 11810 11810 9520689 29824 29824 211668 173595 38073 38073 22413 15660 94608 0 94608 94608 94608 25608 21799 11747 13861 13861 9990719 9543102 0 153953 X 213613 213613 3769424 3526199 243225 59190 55704 3486 445472 379468 66004 288515 254979 33536 19964 19964 35712 35712 1628437 1517177 111260 35210 8513 23867 2830 457168 374408 82537 223 128 128 144978 144978 19319 16593 2726 34698 20912 13786 53050 53050 596138 596138 57544 57544 Medical Supplies 742158 742158 Equipment Rental and Ma 163668 151317 12351 Provision for Bad Debts 104797 104797 Recruitment 58333 58333 76012 14546 61403 63 9003528 8076942 923470 3116 1850010 2742104 844845 1105391 111111 0 110717 145319 92795 129218 12895233 6329404 6700096 6565829 693871 801536 52841 44498 11038 5826 10467324 11539721 740524 1029150 88794 48958 620818 591176 3377 3873 1021051 900481 1051768 991078 3526332 3564716 X 6936030 7975005 4962 0 6940992 7975005 10467324 11539721 987191 46822 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 310966 310966 8649634 3858680 4790954 3619080 2299236 1319844 315553 171488 144065 6565829 Apartment Deposits 898750 Amounts Due Under Collaborative Arrangements 92328 991078 X 10106339 46822 173595 220417 9885922 104797 104797 9990719 9072326 173595 173595 8898731 104797 104797 9003528 Part IV, Line 2b: The organization maintains separate accounts for its patients and uses the funds for purchases as directed by patients. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: 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: Rental Expenses Reclassified 173,595. Part XI, Line 4b - Other Adjustments: Bad debt Expense 104,797. Part XII, Line 2d - Other Adjustments: Rental Expenses Reclassified 173,595. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 104,797. Gala 42426 19999 22427 500 525 2601 2485 3011 Golf Tournament 4981 1800 3181 832 492 493 0 808 47407 21799 25608 1332 1017 3094 2485 3819 11747 13861 1 1 X 1 X 1 X 1 1 1 0 0 48000 48000 0.00540 1250567 1001709 248858 0.02800 1298567 1001709 296858 0.03340 3 596413 191786 404627 0.04550 3 596413 191786 404627 0.04550 3 1894980 1193495 701485 0.07890 0 104797 25152 2839511 2794239 45272 X 1 0 1 1 Freeman Regional Health Services

PO Box 370 Freeman SD 57029

X X X X Freeman Regional Health Services 1 0 1 1 150.000000000000 1 200.000000000000 1 X X 1 1 X 1 0 X X X X 1 X 0 0 2 Oakview Terrace

510 E 8th Street Freeman SD 57029

Long Term Care Facility Rural Medical Clinics

804 S Walnut Freeman SD 57029

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 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 ratio of patient care costs to charges calculated in Worksheet 2. Line 7g was obtained from the Medicare cost report. Part I, L7 Col(f): Bad debt expense of $104,797 was subtracted from total operating expense. Part II: None Part III, Line 4: a) 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.b) 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. c) Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Facility 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 Facility 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 Facility 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. Part III, Line 8: Medicare allowable costs of care was calculated from the Medicare Cost Report for fiscal year ending 12/31/2012. Freeman Regional Health Services Part V, Section B, Line 14g: 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. 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. 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. 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. Part VI, Line 6: None A City of Freeman 466000164 2006-09-29 750000 To finance 1/3 of 10 unit congregate living units. 0 0 0 A 158824 750000 750000 2006 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 1 0 0 0 1 A 0 Form 990, Part VI, Section A, line 2 Lori Uecker, Secretary, and Dennis Wollman, 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 The Webster definition for "conflict of interest" is: Conflict between the private interests and the official responsibilities of the person in a position of trust. Every person acting on behalf of FRHS has been placed in a position of trust and is expected to conduct himself or herself with the highest level of integrity. Therefore, in dealing with others on behalf of FRHS and its related entities, each person is required to act honestly and fairly and shall not use their positions or knowledge gained from their position in such a way that a conflict of interest might arise between FRHS and the individual's interest. FRHS relies on the honesty and integrity of the individuals employed to avoid conflict of interest. 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. Form 990, Part VI, Section C, line 19 Available upon request Other Fees Form 990, Part IX, line 11g Anesthesia Purchase: Program service expenses 91,665. Management and general expenses 0. Fundraising expenses 0. Total expenses 91,665. Emergency Unit Medical Professional Fees: Program service expenses 349,736. Management and general expenses 0. Fundraising expenses 0. Total expenses 349,736. Laboratory Purchase Lab Professional: Program service expenses 43,465. Management and general expenses 0. Fundraising expenses 0. Total expenses 43,465. Mobile Medical Purchase Nuclear: Program service expenses 2,994. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,994. Radiology Purchase Professional fees: Program service expenses 84,113. Management and general expenses 0. Fundraising expenses 0. Total expenses 84,113. Neuro Diagnostic Purchase Other: Program service expenses 3,129. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,129. Cardiopulmonary Purchase Clinic Fee: Program service expenses 203. Management and general expenses 0. Fundraising expenses 0. Total expenses 203. Pharmacy Purchase Other: Program service expenses 124,637. Management and general expenses 0. Fundraising expenses 0. Total expenses 124,637. Physical Therapy Consulting: Program service expenses 201. Management and general expenses 0. Fundraising expenses 0. Total expenses 201. Occupational Therapy Purchase Other: Program service expenses 40,261. Management and general expenses 0. Fundraising expenses 0. Total expenses 40,261. Speech Therapy Purchase Other: Program service expenses 12,425. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,425. RMC-Freeman Purchase Other: Program service expenses 314,403. Management and general expenses 0. Fundraising expenses 0. Total expenses 314,403. RMC-Bridgewater Purchase Other: Program service expenses 189,951. Management and general expenses 0. Fundraising expenses 0. Total expenses 189,951. RMC-Marion Purchase Other: Program service expenses 149,040. Management and general expenses 0. Fundraising expenses 0. Total expenses 149,040. RMC-Menno Purchase Other: Program service expenses 101,469. Management and general expenses 0. Fundraising expenses 0. Total expenses 101,469. Medical Surgery Unit Purchase other: Program service expenses 1,413. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,413. Surgery Maintenance Contracts: Program service expenses 2,213. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,213. HIM Purchase Other Clinic: Program service expenses 1,233. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,233. Infection Control Purchase Other: Program service expenses 42. Management and general expenses 0. Fundraising expenses 0. Total expenses 42. Nurse Education Purchase Other: Program service expenses 419. Management and general expenses 0. Fundraising expenses 0. Total expenses 419. LTC Nursing Purchase Other: Program service expenses 4,165. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,165. PT Financial Services Fees: Program service expenses 0. Management and general expenses 20,162. Fundraising expenses 0. Total expenses 20,162. Administration Consulting Fees: Program service expenses 0. Management and general expenses 89,806. Fundraising expenses 0. Total expenses 89,806. Foundation Purchase Other: Program service expenses 0. Management and general expenses 1,292. Fundraising expenses 0. Total expenses 1,292.