2026-03-09T16:58:41-05:00 2025-06-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2024-07-01 460380552 MARSHALL COUNTY HEALTHCARE CENTER MARS 6054482253 413 9TH ST BRITTON SD 57430 ERIK PETERSON CHIEF FINANCIAL OFFICER 6054482253 2026-03-09 1 1 LAURIE HANSON CPA P00851848 6053391999 2026-03-03 2024 2025-03-06 01:10:19Z MARSHALL COUNTY HEALTHCARE CENTER AVERA NICK FOSNESS 413 9TH ST BRITTON SD 57430 13272267 0 X MCHCAVERA.ORG X 1983 SD TO PROVIDE HEALTHCARE SERVICES. 8 8 131 25 0 0 271688 14832 12480187 13005055 859709 173562 1629 1484 13613213 13194933 4511 4611 0 0 7336696 7684533 0 0 0 5144663 5324264 12485870 13013408 1127343 181525 17549985 18009697 907072 974879 16642913 17034818 X THE MISSION OF MARSHALL COUNTY HEALTHCARE CENTER IS TO OVERSEE THAT THE FULL CONTINUUM OF QUALITY HEALTHCARE SERVICES IS MADE AVAILABLE TO THE PEOPLE IN ITS REGION. 0 0 10956043 4611 13005055 MARSHALL COUNTY HEALTHCARE CENTER OPERATES A 20 BED ACUTE CARE HOSPITAL, A 25 UNIT ASSISTED & INDEPENDENT LIVING FACILITY, AND A PROVIDER BASED RURAL HEALTH CLINIC LOCATED IN BRITTON, SD. HEALTH CARE SERVICES INCLUDE ACUTE INPATIENT CARE, SWING BED CARE AND OUTPATIENT & CLINIC SERVICES. FOR YEAR ENDED JUNE 30, 2025, THE AMOUNTS AND TYPES OF CARE PROVIDED WERE: 445 ACUTE PATIENT DAYS; 346 SWING BED DAYS; 5,427 CLINIC VISITS; AND 4,160 ASSISTED & INDEPENDENT LIVING DAYS.MCHC PROVIDES HEALTHCARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. SINCE MCHC DOES NOT PURSUE COLLECTION OF THESE AMOUNTS, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE.THE ESTIMATED COST OF PROVIDING THESE SERVICES WAS $20,000 FOR THE YEAR ENDED JUNE 30, 2025, CALCULATED BY MULTIPLYING THE RATIO OF COST TO GROSS CHARGES FOR MCHC BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE TO ITS PATIENTS. 10956043 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 1 26 0 1 131 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X ERIK PETERSON 6054481125 413 9TH STREET BRITTON SD 57430 ADRIAN HEITMANN PRESIDENT 0.30 X X 0 0 0 BILL HAYWOOD VICE PRESIDENT 0.10 X X 0 0 0 KAYLA SUTHER SECRETARY 0.10 X X 0 0 0 BJ RICHTER TRUSTEE 0.10 X 0 0 0 ROGER FURMAN TRUSTEE 0.10 X 0 0 0 TRAE BERGH TRUSTEE FROM 05/2025 0.10 X 0 0 0 MATT SCHULLER TRUSTEE 0.10 X 0 0 0 TANNER WHITE TRUSTEE UNTIL 04/2025 0.10 X 0 0 0 RYAN SMITH TRUSTEE 0.10 X 0 0 0 NICK FOSNESS CEO 40.00 X 194275 0 33184 ERIK PETERSON CFO 40.00 X 98025 0 38416 AMANDA SCHMIEG NURSE PRACTIONER 36.00 X 170612 0 37216 SARA RAABE NURSE PRACTIONER 36.00 X 182447 0 32190 JILL ZUEHLKE NURSE PRACTIONER 36.00 X 152724 0 32190 JACQUELYN VEFLIN LAB/RADIOLOGY DIRECTOR 40.00 X 118316 0 21250 TONI MATTSON DIRECTOR OF NURSING 40.00 X 109338 0 32190 1025737 0 226636 6 0 1 1 COMSTOCK CONSTRUCTION 280 S 11TH STREET WAHPETON ND 58075 CONSTRUCTION 851101 AVERA HEALTH 3900 W AVERA DR STE 300 SIOUX FALLS SD 57108 MANAGEMENT FEES 810813 AVERA ST LUKE'S 305 SOUTH STATE STREET ABERDEEN SD 57401 MANAGEMENT FEES 770474 AVERA MCKENNAN 1325 S CLIFF AVE SIOUX FALLS SD 57105 MANAGEMENT FEES 150844 TRANSMED 7001 S LYNCREST PL 101 SIOUX FALLS SD 57108 RADIOLOGY SERVICES 134811 6 14832 14832 PATIENT SERVICE FEES 621110 11281570 11281570 PHARMACY REVENUE 623990 1007306 1007306 ASSISTED LIVING CARE 623990 351253 351253 364926 364926 13005055 3069 3069 9775 8291 1484 1484 1484 239536 0 69043 239536 -69043 170493 170493 13194933 13005055 0 175046 X 4611 4611 385360 385360 5425013 4960103 464910 308608 282447 26161 1170869 1037941 132928 394683 353593 41090 1686539 1314522 372017 12316 592 11724 179741 61643 118098 453955 369629 84326 210183 191086 19097 78043 69250 8793 16854 15463 1391 982602 812781 169821 71320 58994 12326 MEDICAL SUPPLIES 1281221 1135450 145771 EQUIPMENT AND MAINTENAN 209544 185302 24242 EQUIPMENT LEASE/RENTAL 58581 36029 22552 83365 66607 16758 13013408 10956043 2057365 0 696026 274310 1512509 1506926 173943 150483 58071 49139 17642697 7678403 8827944 9964294 5558620 5716402 64872 83143 658000 265000 17549985 18009697 797456 903491 4038 4038 105578 67350 907072 974879 X 16609922 16998345 32991 36473 16642913 17034818 17549985 18009697 X 181525 177233 33147 X 0 1 X 1 0 X 0 0 32991 3482 36473 26390 6601 32991 27156 -766 26390 30389 -3233 27156 25904 4485 30389 0.00000 0.36990 0.63010 1 0 105558 289557 395115 12104977 4577290 7527687 5142605 3101113 2041492 9964294 INTEREST IN AVERA HEALTH FOUNDATION 345094 F INTEREST IN AVERA POOLED INVESTMENT FUND 5371308 F 5716402 FINANCE LEASE LIABILITY 67350 67350 X 13405313 177233 33147 210380 13194933 0 13194933 13013408 0 13013408 0 13013408 PART V, LINE 4: THE ENDOWMENT FUNDS ARE RESTRICTED FOR USE AT SPRUCE COURT ASSISTED LIVING. 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN AVERA HEALTH FOUNDATION 33,147. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 15 20000 20000 0.00150 180 390371 385336 5035 0.00040 5 200 410371 385336 25035 0.00190 2785 97959 1140 96819 0.00740 2281308 1511626 769682 0.05910 20 4283 4283 0.00030 2805 2383550 1512766 870784 0.06680 3005 2793921 1898102 895819 0.06870 1 386233 42872 4639851 4697013 -57162 X 1 1 1 1 MARSHALL COUNTY MEMORIAL HOSPITAL 413 9TH STREET BRITTON SD 57430 WWW.MCHCAVERA.ORG 10528 X X X PROVIDER BASED RURAL HEALTH CLINIC MARSHALL COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X SEE PART V SECTION C X 1 24 1 SEE PART V SECTION C 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHALL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE CHNA COMMITTEE GATHERED QUALITATIVE DATA BY CONDUCTING FOUR FOCUS GROUPS AND THREE KEY INFORMANT INTERVIEWS. THESE WERE COMPLETED BETWEEN SEPTEMBER 2024 AND MARCH 2025. CAREFUL CONSIDERATION WAS GIVEN TO ENSURE THAT THE QUALITATIVE DATA COLLECTION PROCESS INCLUDED INPUT FROM MINORITY, LOW-INCOME AND MEDICALLY UNDERSERVED POPULATIONS AS WELL AS A VARIETY OF OTHER COMMUNITY STAKEHOLDERS. THE U.S. CENSUS BUREAU'S RACE STATISTICS FOR MARSHALL COUNTY INDICATE TWO MINORITY GROUPS WITH POPULATIONS OF SIGNIFICANCE. THE HISPANIC OR LATINO GROUP MAKES UP 6.7% OF THE POPULATION, AND THE AMERICAN INDIAN OR ALASKAN NATIVE GROUP ACCOUNTS FOR 9.3%. TO CAPTURE THE INPUT OF THE HISPANIC OR LATINO POPULATION, A KEY INFORMANT INTERVIEW WAS CONDUCTED WITH THE HUMAN RESOURCES CONTACT FOR A DAIRY IN VEBLEN, S.D. TO OBTAIN INPUT FROM THE AMERICAN INDIAN OR ALASKAN NATIVE POPULATION, AN INTERVIEW WAS CONDUCTED WITH THE HEALTH COORDINATOR FOR THE SISSETON-WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION. TO CAPTURE INPUT REPRESENTING LOW-INCOME POPULATIONS, A THIRD INTERVIEW WAS CONDUCTED WITH THE COUNTY HEALTH NURSE SERVING MARSHALL, DAY, AND ROBERTS COUNTIES. ACCORDING TO THE HEALTH RESOURCES AND SERVICES ADMINISTRATION WEBSITE, HTTPS://DATA.HRSA.GOV, THE WHOLE OF MARSHALL COUNTY HAS BEEN DESIGNATED A MEDICALLY UNDERSERVED AREA. THEREFORE, THE COMMITTEE CONCLUDED THAT ANY RESIDENTS FROM MARSHALL COUNTY GIVING FEEDBACK VIA FOCUS GROUPS AND INTERVIEWS WOULD PROVIDE INPUT OF THIS MEDICALLY UNDERSERVED POPULATION. ONE GENERAL AND THREE TARGETED FOCUS GROUPS WERE HELD TO ENSURE INPUT FROM A VARIETY OF LOCAL STAKEHOLDERS, INCLUDING HEALTH CARE WORKERS, COMMUNITY LEADERS AND SURROUNDING COMMUNITIES. MARSHALL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: AS PART OF THE CHNA FOR FY2025, THE COMMITTEE DISCUSSED THE DATA GATHERED AND CAME TO A CONSENSUS, RANKING THE HEALTH NEEDS OF MARSHALL COUNTY AS FOLLOWS: 1) MENTAL/BEHAVIORAL HEALTH SERVICES2) MAINTAINING EMT/AMBULANCE SERVICE3) DENTAL CARETHE NEEDS IDENTIFIED REMAIN THE SAME AS IN THE PRIOR CHNA.MENTAL/BEHAVIORAL HEALTH SERVICES:MCHC CONTINUES TO PROVIDE STAFF REPRESENTATION ON THE NORTHEASTERN MENTAL HEALTH CENTER BOARD OF DIRECTORS. FIVE MEETINGS WERE ATTENDED IN FY25. MCHC'S PARTNERSHIP WITH AVEL ALSO CONTINUED, PROVIDING MENTAL HEALTH SERVICES THROUGH TELEHEALTH. MAINTAINING EMT/AMBULANCE SERVICE:MCHC CONTINUES TO PROVIDE LAUNDRY SERVICES TO MARSHALL COUNTY AMBULANCE AT NO CHARGE AND ASSIST WITH AMBULANCE PAGING. MCHC PROVIDED RN STAFF TO ACCOMPANY PATIENTS DURING FY25.MCHC HELD HEALTHCARE IN PARTNERSHIP EDUCATION EVENTS FOR BRITTON-HECLA AND LANGFORD AREA SCHOOLS ON APRIL 2025. EMT CAREERS WERE INCLUDED IN THE PRESENTATION, AND STUDENTS WERE GIVEN TOURS OF THE AMBULANCE FACILITYDENTAL CARE:CEO NICK FOSNESS HAS BEEN INVOLVED IN RECRUITING EFFORTS TO ONCE AGAIN PROVIDE DENTAL SERVICES TO THE COMMUNITY. MARSHALL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE METHODOLOGY USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE TAKES INTO CONSIDERATION INCOME, NET ASSETS, FAMILY SIZE AND RESOURCES AVAILABLE TO PAY FOR CARE. IN ADDITION, PRESUMPTIVE CHARITY CARE MAY BE APPLIED IN SITUATIONS WHERE ALL OTHER AVENUES HAVE BEEN EXHAUSTED. MARSHALL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: A SUMMARY OF THE POLICY ALONG WITH INFORMATION ON HOW TO APPLY FOR FINANCIAL ASSISTANCE IS PROVIDED IN THE EMERGENCY ROOM, AT ADMISSIONS, AND WITH BILLING INVOICES. PART V, SECTION B, LINE 7A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MARSHALLCOUNTY PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MARSHALLCOUNTY PART V, SECTION B, LINE 16A THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT: HTTPS://WWW.AVERA.ORG/PATIENTS-VISITORS/PAY-MY-BILL-ONLINE/FINANCIAL-ASSISTANCE-FORMS/ PART V, SECTION B, LINE 16B THE FINANCIAL ASSISTANCE APPLICATION IS AVAILABLE AT: HTTPS://WWW.AVERA.ORG/PATIENTS-VISITORS/PAY-MY-BILL-ONLINE/FINANCIAL-ASSISTANCE-FORMS/ PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT: HTTPS://WWW.AVERA.ORG/PATIENTS-VISITORS/PAY-MY-BILL-ONLINE/FINANCIAL-ASSISTANCE-FORMS/ PART I, LINE 3C: THE METHODOLOGY USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE TAKES INTO CONSIDERATION INCOME, NET ASSETS, FAMILY SIZE AND RESOURCES AVAILABLE TO PAY FOR CARE. IN ADDITION, PRESUMPTIVE CHARITY CARE MAY BE APPLIED IN SITUATIONS WHERE ALL OTHER AVENUES HAVE BEEN EXHAUSTED. PART I, LINE 7: LINE 7A, CHARITY CARE EXPENSE WAS CONVERTED TO COST BASED ON AN OVERALL COST-TO-CHARGE RATIO WHICH ADDRESSES ALL PATIENT SEGMENTS.LINE 7B, UNREIMBURSED MEDICAID WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS.LINES 7E AND 7I WERE BASED ON THE ACTUAL COSTS REPORTED IN THE GENERAL LEDGER.LINE 7G, SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING THE MEDICARE COST REPORT. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2024. THEREFORE, 11.1% OF IMPLICIT PRICE CONCESSIONS CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 06/30/2025. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY.THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $25,612.MEDICARE FEE SCHEDULE REVENUE: $14,477MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS $(40,089)NET (SHORTAGE) $(25,612) PART III, LINE 9B: ACCOUNTS THAT MEET THE CRITERIA FOR THE FINANCIAL ASSISTANCE POLICY WILL BE WRITTEN OFF IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS THAT DO NOT MEET THE CRITERIA FOR FINANCIAL ASSISTANCE WILL PROCEED THROUGH THE COLLECTION PROCESS. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT AN ACCOUNT IN COLLECTION BELONGS TO A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT WILL BE REMOVED FROM COLLECTION AND RETURNED TO THE HOSPITAL FOR RESOLUTION. PART VI, LINE 2: MARSHALL COUNTY HEALTHCARE CENTER (MCHC) ASSESSES THE HEALTH CARE NEEDS OF ITS COMMUNITIES BY WORKING CLOSELY WITH ITS PROVIDERS, AND ALSO THROUGH SURVEYS COMPLETED BY PATIENTS. MCHC MAINTAINS AN ADVISORY BOARD MADE UP OF COMMUNITY MEMBERS, WHOSE FUNCTION IS TO COMMUNICATE THE NEEDS, WANTS, AND CONCERNS OF THE COMMUNITIES TO MCHC. MCHC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN FISCAL YEAR 2025, EXAMINING BOTH QUALITATIVE AND QUANTITATIVE DATA. A SERIES OF FOCUS GROUPS WERE LED BY A THIRD-PARTY FACILITATOR TO COLLECT INPUT FROM A VARIETY OF COMMUNITY MEMBERS. LOCAL, STATE, AND NATIONAL STATISTICAL DATA WAS ALSO GATHERED AND EVALUATED AS PART OF THE ASSESSMENT. PART VI, LINE 3: IN ADDITION TO WIDELY PUBLICIZING THE FINANCIAL ASSISTANCE POLICY THROUGH THE STEPS IDENTIFIED IN PART V, LINE 16, MCHC PROVIDES FINANCIAL ASSISTANCE INFORMATION TO PATIENTS AT THEIR REQUEST. MCHC REPRESENTATIVES ARE AVAILABLE TO DISCUSS WITH PATIENTS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND WILL OFFER TO ASSIST THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. PART VI, LINE 4: MCHC IS LOCATED IN BRITTON, SD, A RURAL COMMUNITY OF 1,215 RESIDENTS. THE GEOGRAPHIC SERVICE AREA OF MCHC IS APPROXIMATELY 50 MILES IN ALL DIRECTIONS. THIS AREA CONSISTS OF SMALL FARMS, RANCHES, AND 4 OTHER VERY SMALL TOWNS. MARSHALL COUNTY (POPULATION 4,306) HAS BEEN DESIGNATED AS BOTH A SOUTH DAKOTA MEDICALLY UNDERSERVED AREA AND A SOUTH DAKOTA HEALTH PROFESSIONAL SHORTAGE AREA. THE MEDIAN AGE IN MARSHALL COUNTY IS 42.5. THE MEDIAN INCOME FOR A FAMILY IN MARSHALL COUNTY IS $78,156 AND 6.1% OF ALL PERSONS ARE UNDER THE POVERTY LEVEL. BRITTON'S MEDIAN FAMILY INCOME IS $62,898 WITH 9.0% OF THE TOWN'S POPULATION LIVING UNDER THE POVERTY LEVEL. MCHC IS THE ONLY HOSPITAL IN THE DESCRIBED AREA. PART VI, LINE 5: MCHC IS THE SOLE PROVIDER OF HEALTHCARE IN MARSHALL COUNTY. THE FACILITY OPERATES A 24 HOUR EMERGENCY ROOM. A WIDE VARIETY OF OUTPATIENT SERVICES ARE AVAILABLE AT THIS FACILITY. IN ADDITION, MCHC IS INVOLVED IN THE PROMOTION OF MANY COMMUNITY HEALTH AWARENESS EVENTS. MCHC HELPS TO SPONSOR A LOCAL GROUP KNOWN AS THE WOW COALITION (AND MANY OF OUR STAFF MEMBERS VOLUNTEER) WHOSE FOCUS IS TO PROMOTE HEALTHY EATING AND EXERCISE IN THE COMMUNITY.MCHC MAINTAINS AN ADVISORY BOARD MADE UP OF COMMUNITY MEMBERS, WHOSE FUNCTION IS TO COMMUNICATE THE NEEDS, WANTS, AND CONCERNS OF THEIR COMMUNITIES TO MCHC. MCHC'S BOARD OF TRUSTEES IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITIES WITHIN MCHC'S PRIMARY SERVICE AREA. THESE BOARD MEMBERS ARE NOT EMPLOYEES OR FAMILY MEMBERS OF EMPLOYEES. ADMITTING RIGHTS ARE PROVIDED TO ALL QUALIFIED PHYSICIANS IN THE SERVICE AREA. THE HOSPITAL USES ITS SURPLUS FUNDS FOR IMPROVING OPERATIONS, FACILITY UPGRADES, TECHNOLOGY AND EQUIPMENT UPGRADES, AND OPERATIONAL COSTS. PART VI, LINE 6: MCHC IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND MCHC WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. MCHC 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 THE HOSPITAL AT A COST BELOW THAT WHICH MCHC COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. AVERA HEALTH AND MCHC 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. X 0 0 0 0 0 0 0 0 0 NICK FOSNESS CEO 194002 0 0 0 273 0 0 0 34843 0 229118 0 0 0 SARA RAABE NURSE PRACTIONER 99110 0 0 0 83337 0 0 0 32190 0 214637 0 0 0 AMANDA SCHMIEG NURSE PRACTIONER 89601 0 0 0 81011 0 0 0 37216 0 207828 0 0 0 JILL ZUEHLKE NURSE PRACTIONER 106349 0 0 0 46375 0 0 0 32190 0 184914 0 0 0 SCHEDULE J, PART II: NICK FOSNESS, ADMINISTRATOR, IS COMPENSATED THROUGH AN ARRANGEMENT WITH AVERA ST. LUKE'S HOSPITAL, 305 S STATE ST, ABERDEEN, SD 57401. FORM 990, PART VI, SECTION A, LINE 8B THE HOSPITAL DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED IN DETAIL. AFTER THE REVIEW, THE 990 WILL BE PROVIDED TO EACH BOARD MEMBER. THE 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS AT THE MEETING HELD PRIOR TO ITS FILING IF SO REQUESTED BY ANY BOARD MEMBER. WHETHER PRESENTED IN A BOARD MEETING OR NOT, THE 990 IS NOT FILED UNTIL EACH BOARD MEMBER HAS BEEN GIVEN A COPY OF IT AND GIVEN AMPLE TIME TO REVIEW IT. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF TRUSTEE MEMBERS AND KEY OFFICERS SIGN THE ANNUAL CONFLICT OF INTEREST POLICY. PRIOR TO EACH BOARD MEETING, TRUSTEES AND OFFICERS ARE ASKED TO DECLARE ANY CONFLICT OF INTEREST WITH THE AGENDA. IF A CONFLICT WERE TO BE DECLARED, THAT DIRECTOR WOULD NOT PARTICIPATE IN THE DECISION ON THAT PARTICULAR AGENDA ITEM. FORM 990, PART VI, SECTION B, LINE 15 AVERA ST. LUKE'S REVIEWS THE CEO'S JOB PERFORMANCE WITH INPUT FROM DEPARTMENT HEADS AT MCHC. THE PERFORMANCE APPRAISAL IS SHARED WITH MCHC'S BOARD OF TRUSTEES. AN INDEPENDENT SALARY SURVEY IS DONE BY AVERA ST. LUKE'S. A RECOMMENDATION OF THE CEO'S SALARY IS BROUGHT TO MCHC'S BOARD OF TRUSTEES. THE BOARD OF TRUSTEES GOES OVER THE PERFORMANCE REVIEW WITH THE CEO AND CONVEYS THE CHANGE IN SALARY TO HIM. THE DELIBERATION AND DECISION OF THE BOARD IS DOCUMENTED. THIS PROCESS WAS LAST UNDERTAKEN DURING THE FISCAL YEAR. ALL OTHER SALARIES ARE APPROVED IN A SALARY BUDGET AND DISCUSSIONS RELATING TO THE AMOUNT BUDGETED FOR SALARY ADJUSTMENTS IS DOCUMENTED. MARSHALL COUNTY HEALTHCARE CENTER PARTICIPATES IN A SEMI-ANNUAL SALARY AND BENEFITS SURVEY, CONDUCTED BY THE SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATIONS, THE RESULTS OF WHICH ARE USED IN ESTABLISHING SALARY ADJUSTMENTS FOR EACH POSITION. THIS PROCESS WAS LAST UNDERTAKEN DURING THE FISCAL YEAR. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL CONSULTING FEES: PROGRAM SERVICE EXPENSES 246,649. MANAGEMENT AND GENERAL EXPENSES 30,713. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 277,362. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,067,873. MANAGEMENT AND GENERAL EXPENSES 114,051. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,181,924. CENTRALIZED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 227,253. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 227,253. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 33,147.