2024-03-07T07:54:09-06:00 2023-06-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2022-07-01 460380552 MARSHALL COUNTY HEALTHCARE CENTER MARS 6054482253 413 9TH ST BRITTON SD 57430 ERIK PETERSON CHIEF FINANCIAL OFFICER 6054482253 2024-03-06 1 ERIK PETERSON 999009999 1 LAURIE HANSON CPA P00851848 6053391999 2024-02-25 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARSHALL COUNTY HEALTHCARE CENTER NICK FOSNESS 413 9TH ST BRITTON SD 57430 13122259 0 X MCHCAVERA.ORG X 1983 SD TO PROVIDE HEALTHCARE SERVICES. 9 9 137 25 0 0 357578 14815 10573431 11496919 -69371 612483 12647 -5090 10874285 12119127 4353 2624 0 0 6702865 7169024 0 0 0 3822990 4641181 10530208 11812829 344077 306298 17492325 16693651 1556668 718160 15935657 15975491 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 9921630 2624 11491829 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, SOUTH DAKOTA. HEALTH CARE SERVICES INCLUDE ACUTE INPATIENT CARE, SWING BED CARE AND OUTPATIENT & CLINIC SERVICES. FOR YEAR ENDED JUNE 30, 2023, THE AMOUNTS AND TYPES OF CARE PROVIDED WERE: 542 ACUTE PATIENT DAYS; 423 SWING-BED DAYS; 5,418 CLINIC VISITS, AND 4,872 ASSISTED & INDEPENDENT LIVING DAYS.MCHC PROVIDES HEALTH CARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAT 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 $36,000 FOR THE YEAR ENDED JUNE 30, 2023, 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. 9921630 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 29 0 1 137 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 SHANNON LEE VICE PRESIDENT 0.10 X X 0 0 0 BILL HAYWOOD SEC/TREAS 0.10 X 0 0 0 BJ RICHTER TRUSTEE 0.10 X 0 0 0 RYAN SMITH TRUSTEE 0.10 X 0 0 0 ROGER FURMAN TRUSTEE 0.10 X 0 0 0 TOM SNYDER TRUSTEE 0.10 X 0 0 0 MATT SCHULLER TRUSTEE 0.10 X 0 0 0 LINDA HAALAND TRUSTEE UNTIL OCT 2022 0.10 X 0 0 0 KAYLA SUTHER TRUSTEE BEG DEC 2022 0.10 X 0 0 0 NICK FOSNESS CEO 40.00 X 178110 0 33977 PATTY ROEHR CFO UNTIL FEB 2023 40.00 X 123180 0 4340 ERIK PETERSON CFO BEG AUG 2022 40.00 X 61560 0 13547 AMANDA SCHMIEG NURSE PRACTIONER 36.00 X 166640 0 28780 SARA RAABE NURSE PRACTIONER 36.00 X 164537 0 30262 JILL ZUEHLKE NURSE PRACTIONER 36.00 X 151239 0 26398 845266 0 137304 4 0 1 1 AVERA ST LUKE'S 305 SOUTH STATE STREET ABERDEEN SD 57401 ADMIN, IT, AND OTHER SERVICES 1293632 COMSTOCK CONSTRUCTION 280 S 11TH STREET WAHPETON ND 58075 CONSTRUCTION 689924 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 57105 PHARMACY & RADIOLOGY SERVICES 168648 AVEL ECARE LLC 4500 N LEWIS AVE SIOUX FALLS SD 57104 ECARE SERVICES 129218 4 13011 1804 14815 PATIENT SERVICE FEES 621110 10275313 10275313 PHARMACY REVENUE 623990 654799 654799 ASSISTED LIVING CARE 623990 465337 465337 101470 101470 11496919 576372 576372 500 5590 -5090 -5090 -5090 33653 1000000 0 997542 33653 2458 36111 36111 12119127 11491829 0 612483 2624 2624 431364 431364 4954122 4574909 379213 281490 257702 23788 1136529 1044366 92163 365519 326179 39340 81927 81927 961469 763079 198390 12878 849 12029 589211 521936 67275 373446 73285 300161 179782 151908 27874 58436 47558 10878 24836 23782 1054 819820 688303 131517 8404 8404 MEDICAL SUPPLIES 1189130 1187866 1264 EQUIPMENT AND MAINTENAN 248188 203369 44819 DUES AND SUBSCRIPTIONS 25505 16352 9153 APPAREL 1381 1121 260 66768 36442 30326 11812829 9921630 1891199 0 1152368 1126121 1401442 1670532 206405 184216 31988 38833 14558437 5967619 8795553 8590818 5569569 4913131 335000 170000 17492325 16693651 1554918 717105 805 0 0 1750 250 1556668 718160 X 15904998 15945598 30659 29893 15935657 15975491 17492325 16693651 X 306298 -288186 21722 X 0 1 X 1 0 X 0 0 27156 -766 26390 30389 -3233 27156 25904 4485 30389 26065 -161 25904 25172 893 26065 0.00000 0.51130 0.48870 1 0 105558 259774 365332 10200151 3569643 6630508 3991554 2397976 1593578 1400 1400 8590818 INTEREST IN AVERA HEALTH FOUNDATION 282912 F INTEREST IN AVERA POOLED INVESTMENT FUND 4630219 F 4913131 SECURITY DEPOSIT 250 250 X 11858253 -288186 5590 -282596 12140849 -21722 -21722 12119127 11818419 5590 5590 11812829 0 11812829 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: RENTAL EXPENSES 5,590. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN AVERA HEALTH FOUNDATION -21,722. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 5,590. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 25 36000 36000 0.00300 25 36000 36000 0.00300 777 60004 60004 0.00510 106 1701 1701 0.00010 1267 3818067 1904493 1913574 0.16200 51 7302 7302 0.00060 2201 3887074 1904493 1982581 0.16780 2226 3923074 1904493 2018581 0.17080 630 2436 2436 0.00020 630 2436 2436 0.00020 1 516196 68138 4019991 4038464 -18473 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 21 1 0 0 1 X SEE PART V SECTION C X 1 21 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 FIVE FOCUS GROUPS AND FOUR KEY INFORMANT INTERVIEWS. THESE WERE COMPLETED BETWEEN AUGUST 2021 AND MARCH 2022. 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 8.0 PERCENT OF THE POPULATION, AND THE AMERICAN INDIAN OR ALASKAN NATIVE GROUP ACCOUNTS FOR 9.5 PERCENT. TO CAPTURE THE INPUT OF THE HISPANIC OR LATINO POPULATION, A KEY INFORMANT INTERVIEW WAS CONDUCTED WITH IVAN REGALADO, HUMAN RESOURCES CONTACT FOR RIVERVIEW DAIRY IN VEBLEN, SD. HE STATED THAT APPROXIMATELY 90 PERCENT OF THE DAIRY'S 130 EMPLOYEES ARE HISPANIC. IN HIS ROLE AT RIVERVIEW, IVAN ASSISTS EMPLOYEES IN NEED OF MEDICAL CARE BY HELPING THEM LOCATE SERVICES AND PROVIDING TRANSLATION ASSISTANCE WHEN NECESSARY. TO OBTAIN INPUT FROM THE AMERICAN INDIAN OR ALASKAN NATIVE POPULATION, AN INTERVIEW WAS CONDUCTED WITH AUDREY GERMAN, COMMUNITY HEALTH EDUCATION PROGRAM MANAGER FOR THE SISSETON-WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION.THE LOCAL COMMUNITY HEALTH NURSE WAS RECRUITED TO THE CHNA COMMITTEE TO ENSURE HER INPUT WAS CAPTURED, AND SHE CONDUCTED IN-PERSON INTERVIEWS WITH TWO CLIENTS OF THE LOCAL COMMUNITY HEALTH OFFICE TO ENSURE THE LOW-INCOME POPULATION WAS WELL-REPRESENTED. 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.THREE TARGETED AND TWO GENERAL FOCUS GROUPS WERE HELD TO ENSURE INPUT FROM A VARIETY OF LOCAL STAKEHOLDERS. THE TARGETED FOCUS GROUPS INCLUDED THE BRITTON "FUN AFTER FIFTY" SENIOR CENTER, RESIDENTS OF LANGFORD, SD WHICH IS THE SECOND MOST POPULATED TOWN IN THE COUNTY, AND LEADERS OF MARSHALL COUNTY HEALTHCARE CENTER AVERA. OTHER STAKEHOLDERS REPRESENTED BY THOSE WHO ATTENDED THE TWO GENERAL FOCUS GROUPS INCLUDED INDIVIDUALS FROM BRITTON CITY COUNCIL, BRITTON MINISTERIAL ASSOCIATION, SEVERAL LOCAL BUSINESSES, LOCAL FARMERS, BRITTON-HECLA SCHOOL, LANGFORD AREA SCHOOL, MARSHALL COUNTY EXTENSION OFFICE, MARSHALL COUNTY WOW (WORKING ON WELLNESS) COALITION, BRITTON LIONS CLUB, MARSHALL COUNTY EMERGENCY MANAGEMENT, RETIREES, MARSHALL COUNTY UNIT OF THE AMERICAN CANCER SOCIETY, NORTH MARSHALL FIRE DEPARTMENT, MARSHALL COUNTY SHERRIFF'S OFFICE, AND MARSHALL COUNTY HEALTHCARE CENTER AVERA.THE FOCUS GROUPS WERE CONDUCTED BY TWO VOLUNTEER COMMUNITY LEADERS, AND A MEMBER OF THE CHNA COMMITTEE ATTENDED TO ACT AS A SCRIBE. A ONE-PAGE HANDOUT WAS PROVIDED TO FOCUS GROUP ATTENDEES, AND A LIST OF TOPICS DISCUSSED WAS RECORDED FOR EACH GROUP. THE SAME HANDOUT AND LIST OF QUESTIONS WAS USED IN CONDUCTING THE KEY INFORMANT INTERVIEWS. MARSHALL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: COMMUNITY HEALTH NURSE, MARSHALL COUNTY MEDICAL CLINIC. OTHER HEALTH CARE PROVIDERS SUCH AS VISION AND DENTAL. MARSHALL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: AS PART OF THE CHNA, 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 CAREMCHC ADDRESSED THE NEEDS IDENTIFIED IN THE MOST CURRENT CHNA IN THE FOLLOWING WAYS. MCHC HOSTED A MENTAL HEALTH FIRST AID CLASS ON SITE ON FRIDAY, FEBRUARY 3, 2023. MCHC STAFF COORDINATED SCHEDULING. MCHC ADVERTISED THE CLASS AND PROVIDED THE ROOM AND AUDIO-VISUAL EQUIPMENT NEEDED. REFRESHMENTS WERE ALSO PROVIDED. MCHC CONTINUES TO PROVIDE STAFF REPRESENTATION ON THE NORTHEASTERN MENTAL HEALTH CENTER BOARD OF DIRECTORS. FIVE MEETINGS WERE ATTENDED IN FY2023. MCHC'S PARTNERSHIP WITH AVEL ALSO CONTINUED, PROVIDING MENTAL HEALTH SERVICES THROUGH TELEHEALTH.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 FY2023 AT A COST OF $7,302.MCHC HELD HEALTHCARE IN PARTNERSHIP EDUCATION EVENTS FOR BRITTON-HECLA AND LANGFORD AREA SCHOOLS ON APRIL 14 AND APRIL 28, 2023. EMT CAREERS WERE INCLUDED IN THE PRESENTATION, AND STUDENTS WERE GIVEN TOURS OF THE AMBULANCE FACILITY. CEO, NICK FOSNESS IS AN ACTIVE MEMBER OF A LOCAL TASK FORCE WORKING TO RECRUIT A NEW DENTIST TO THE COMMUNITY. MCHC COLLABORATED WITH THE COUNTY HEALTH NURSE AND SPONSORED 2 VOLUNTEERS TO HELP WITH THE DENTAL VAN ON JUNE 19-21, 2023. 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/CHARITY-PATIENT-ASSISTANCE-PROGRAMS/FINANCIAL-ASSISTANCE-FORMS/ PART V, SECTION B, LINE 16B THE FINANCIAL ASSISTANCE APPLICATION IS AVAILABLE AT:HTTPS://WWW.AVERA.ORG/PATIENTS-VISITORS/CHARITY-PATIENT-ASSISTANCE-PROGRAMS/FINANCIAL-ASSISTANCE-FORMS/ PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.AVERA.ORG/PATIENTS-VISITORS/CHARITY-PATIENT-ASSISTANCE-PROGRAMS/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.LINES 7E, 7F, 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 I, LINE 7G: LINE 7G INCLUDES RURAL HEALTH CLINIC REVENUE OF $687,743 AND EXPENSE OF $1,948,851 FOR A NET COMMUNITY BENEFIT OF $1,261,108. PART II, COMMUNITY BUILDING ACTIVITIES: MARSHALL COUNTY HEALTHCARE CENTER (MCHC) IS INVOLVED IN COMMUNITY SUPPORT BY PROVIDING DONATION/SUPPORT TO THE LOCAL FOOD PANTRY DRIVE, SHRINERS, NORTHERN FORT PLAYHOUSE AND BRITTON EVENT CENTER. 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 2022. THEREFORE, 13.2% 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 PAGES 10 AND 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 06/30/2023. 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. PART III, LINE 9B: IF THE PATIENT QUALIFIES FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME, UNINSURED PATIENTS AND IS COOPERATING WITH THE ORGANIZATION WITH REGARD TO EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN CURRENT SELF-PAY COLLECTION POLICY GUIDELINES AND TIMEFRAMES, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. MARSHALL COUNTY ALLOWS INDIVIDUALS 120 DAYS FROM THE FIRST POST DISCHARGE STATEMENT TO APPLY FOR FINANCIAL ASSISTANCE BEFORE SENDING THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY. MARSHALL COUNTY WILL PROVIDE THE PATIENT WITH A STATEMENT OR FINAL NOTICE THAT CONTAINS A LISTING OF THE SPECIFIC COLLECTION ACTION(S) IT INTENDS TO INITIATE, AND A DEADLINE AFTER WHICH THEY MAY BE INITIATED NO EARLIER THAN 30 DAYS BEFORE ACTION IS INITIATED. IF THE PATIENT QUALIFIES FOR 100% CHARITY CARE, NO FURTHER BILLS WILL BE SENT. A LETTER WILL BE SENT INSTEAD INDICATING THAT THE PATIENT'S BILL HAS BEEN COMPLETELY FORGIVEN. 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 2021, 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 1,213 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 4,374) 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 43.2. THE MEDIAN INCOME FOR A FAMILY IN MARSHALL COUNTY IS $68,056 AND 13.2% OF ALL PERSONS ARE UNDER THE POVERTY LEVEL. BRITTON'S MEDIAN FAMILY INCOME IS $67,321 WITH 8.7% 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) WHO'S 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 9 MEMBER BOARD OF TRUSTEES HAS 7 MEMBERS 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 177730 0 0 0 380 0 3699 0 31591 0 213400 0 0 0 AMANDA SCHMIEG NURSE PRACTIONER 90402 0 0 0 76238 0 0 0 28780 0 195420 0 0 0 SARA RAABE NURSE PRACTIONER 93609 0 0 0 70928 0 0 0 30262 0 194799 0 0 0 JILL ZUEHLKE NURSE PRACTIONER 104607 0 0 0 46632 0 0 0 26398 0 177637 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 XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 21,722.