2022-08-11T15:41:42-05:00 2021-09-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2020-10-01 460255944 MOBRIDGE REGIONAL HOSPITAL MOBR 6058453692 1401 10TH AVE W MOBRIDGE SD 57601 JOHN AYOUB CEO 6058453692 2022-08-10 1 JOHN AYOUB 999009999 LAURIE HANSON CPA P00851848 6053391999 2022-08-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOHN AYOUB 1401 10TH AVE W MOBRIDGE SD 57601 29915928 0 X WWW.MOBRIDGEHOSPITAL.ORG X 1959 SD PROVIDING HEALTHCARE TO PEOPLE THROUGHOUT THE REGION. 12 10 233 175 0 0 561726 6124715 23151481 23499741 240566 291472 1125 0 23954898 29915928 0 0 0 0 14569448 15950092 0 0 0 8381069 8956121 22950517 24906213 1004381 5009715 39079311 37250293 17079132 10115155 22000179 27135138 THE MISSION OF MOBRIDGE REGIONAL HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES IN A COMPASSIONATE AND PROFESSIONAL MANNER FOR PEOPLE THROUGHOUT THE REGION. 0 0 21052236 23499741 MOBRIDGE REGIONAL HOSPITAL (MRH), A 25-BED CRITICAL ACCESS HOSPITAL, 16 BED ASSISTED LIVING CENTER, 8 BED SENIOR HOUSING CENTER, AND MEDICAL CLINICS, PROVIDES HEALTHCARE SERVICES TO PERSONS THROUGHOUT THE REGION. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, THE HOSPITAL PROVIDED CARE TO THE NORTH CENTRAL REGION OF SOUTH DAKOTA, AND THE SOUTH CENTRAL REGION OF NORTH DAKOTA. THE HOSPITAL HAD:1,422 PATIENT DAYS1,097 ACUTE CARE DAYS795 SWING BED CARE DAYS4,250 EMERGENCY ROOM VISITS18,961 RURAL HEALTH CLINIC VISITS5,514 ASSISTED LIVING DAYS (PRAIRIE SUNSET VILLAGE) 21052236 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 0 0 0 1 8 0 1 233 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X RENAE KARST 6058458164 PO BOX 580 MOBRIDGE SD 57601 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 40.00 0.00 X 365001 0 37161 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 40.00 0.00 X 351662 0 28084 BILL BACHMEIER CHAIRMAN 1.00 0.00 X X 0 0 0 LORI HEIL VICE CHAIR 1.00 0.00 X X 0 0 0 PATTI SCHMEICHEL SECRETARY 1.00 0.00 X X 0 0 0 HEIDI ROSHAU TREASURER 1.00 0.00 X X 0 0 0 ADAM HAYES DIRECTOR 1.00 0.00 X 0 0 0 CHRISTOPHER BOHLANDER DIRECTOR 1.00 0.00 X 0 0 0 DR LEONARD LINDE DIRECTOR UNTIL 01/2021 1.00 0.00 X 0 0 0 JAKE KRAFT DIRECTOR 1.00 0.00 X 0 0 0 RICHARD GROSS DIRECTOR 1.00 0.00 X 0 0 0 PAT FUHRMAN DIRECTOR UNTIL 01/2021 1.00 0.30 X 0 0 0 LAURIE BAUER DIRECTOR FROM 01/2021 1.00 0.00 X 0 0 0 JOSH WUDEL DIRECTOR FROM 01/2021 1.00 0.30 X 0 0 0 RENAE KARST CFO 40.00 0.00 X 116954 0 25777 JOHN AYOUB CEO 40.00 0.00 X 0 0 0 DR DONALD LUCEK SURGEON 40.00 0.00 X 420842 0 28552 DR MATT SCHAFFER PHYSICIAN 40.00 0.00 X 343781 0 34640 DR EMILY BODEN PHYSICIAN 40.00 0.00 X 343477 0 34187 DR JOSH HENDERSON INTERNAL MEDICINE 40.00 0.00 X 301686 0 34630 WAYNE JOHNSON CRNA 40.00 0.00 X 217050 0 9672 2460453 0 232703 24 0 1 0 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 ELECTRONIC MEDICAL RECORD 599582 DAVIS PARTNERSHIP ARCHITECTS 2901 BLACKE STREET SUITE 100 DENVER CO 80205 ARCHITECT FEES 511564 CHI ST ALEXIUS HEALTH PO BOX 5510 BISMARCK ND 58506 MANAGEMENT AND ADMIN SERVICES 263417 AVERA ECARE 3900 W AVERA DR SIOUX FALLS SD 57108 ECARE SERVICES 167209 NORTHERN PLAINS LAB PO BOX 2036 BISMARCK ND 58502 LAB PROCESSING SERVICES 162255 6 6123780 935 6124715 PATIENT SERVICE REVENUE 621400 21553729 21553729 PHARMACY REVENUE 621400 1676255 1676255 269757 269757 23499741 291472 291472 29915928 23499741 0 291472 950743 801094 149649 11609292 10151909 1457383 408030 373166 34864 2112437 2011425 101012 869590 782542 87048 258845 258845 8678 8678 66875 66875 1392612 1271879 120733 75762 9188 66574 199143 130076 69067 106283 27651 78632 351723 296229 55494 31028 27369 3659 57138 57138 170808 170808 1385086 1115294 269792 264274 14935 249339 MEDICAL SUPPLIES 3115269 3036246 79023 EQUIPMENT AND MAINTENAN 1253731 686511 567220 DUES AND SUBSCRIPTIONS 41500 18995 22505 177366 69781 107585 24906213 21052236 3853977 0 19733499 15829788 4003267 3789353 311002 296449 523956 655026 208652 205536 39763465 25969670 10023651 13793795 1302387 1700493 1857733 1272404 822613 39079311 37250293 2312732 1545643 7612592 3617209 1437725 985698 3274379 3183992 1829300 0 612404 782613 17079132 10115155 X 21069577 26079292 930602 1055846 22000179 27135138 39079311 37250293 X 5009715 125244 X 0 1 X 1 1 1 X 95575 95575 15907723 10402028 5505695 19227220 14893695 4333525 4532947 673947 3859000 13793795 DEFERRED COMPENSATION PLAN PAYABLE 782613 782613 X 29915928 0 29915928 0 29915928 24906213 0 24906213 0 24906213 PART X, LINE 2: 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. 1 1 X 1 X 1 X 1 1 0 0 113000 113000 0.00450 4172016 3072940 1099076 0.04410 4285016 3072940 1212076 0.04860 5752932 1588678 4164254 0.16720 5752932 1588678 4164254 0.16720 10037948 4661618 5376330 0.21580 1 2293289 259142 6456215 6392292 63923 X 1 1 1 1 MOBRIDGE REGIONAL HOSPITAL 1401 10TH AVENUE W MOBRIDGE SD 57601 WWW.MOBRIDGEHOSPITAL.ORG 48404 X X X X 4 PROVIDER BASED CLINICS MOBRIDGE REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE 7D X X 1 18 1 SEE PART V, LINE 10A NARRATIVE. 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X SEE NARRATIVE X SEE NARRATIVE X SEE NARRATIVE X X X X X X 1 X 0 X X X X 1 X 0 0 MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 5: THE FACILITY OBTAINED DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH SURVEYS AND PERSONAL INTERVIEWS INVOLVING COMMUNITY LEADERS, COMMUNITY HEALTHCARE PROVIDERS, COORDINATING AGENCIES, COMMUNITY MEMBERS AND THE UNDERSERVED POPULATION. ELECTRONIC SURVEYS WERE OBTAINED ALONG WITH PAPER SURVEYS BEING PROVIDED FOR INDIVIDUALS WHO PREFERRED NON-ELECTRONIC MEANS. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE AT HTTP://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT-990/MOBRIDGE REGIONAL HOSPITAL:PART V, SECTION B, LINE 10ATHE HOSPITAL'S IMPLEMENTATION STRATEGY IS POSTED ON THE WEBSITE AT HTTP://WWW.MOBRIDGEHOSPITAL.ORG/ABOUT-US/COMMUNITY-ASSESSMENT-REPORT-990/THE IMPLEMENTATION STRATEGY BEGINS ON PAGE 7 OF THE CHNA. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019. THE FOLLOWING COMMUNITY HEALTH PRIORITY AREAS WERE IDENTIFIED:EDUCATION REGARDING THE DANGERS ASSOCIATED WITH DRUG & ALCOHOL ABUSENEED FOR ADDITIONAL NURSING HOME BEDS/OPTIONSNEED FOR ADDITIONAL MENTAL & BEHAVIORAL HEALTH SERVICESCOMMUNITY TRANSPORTATIONDURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, THE ORGANIZATION FOCUSED ON MEETING NEEDS OF THE COMMUNITY RELATED TO COVID-19. IDENTIFIED NEEDS FROM THE IMPLEMENTATION STRATEGY WERE NOT SPECIFICALLY ADDRESSED WITH THE FOLLOWING EXCEPTION:NEED FOR ADDITIONAL NURSING HOME BEDS/OPTIONSMOBRIDGE REGIONAL HOSPITAL SUCCESSFULLY PARTNERED WITH WALWORTH COUNTY CARE CENTER TO ALLOW WALWORTH COUNTY CARE CENTER TO OBTAIN A NURSING HOME INNOVATION GRANT FROM THE STATE OF SOUTH DAKOTA. MRH FULFILLED ITS OBLIGATIONS OF THE PARTNERSHIP BY QUANTITATIVELY IDENTIFYING THE DEFINITIVE NEED, HELPING TO EXPAND EXISTING/NEW SERVICES TO MEET THAT NEED, AND LOOKING FOR OPPORTUNITIES TO REDUCE THE NEED BY FOCUSING ON BOLSTERING OR CREATING OTHER OFFERINGS WITHIN THE LONG-TERM CARE CONTINUUM FOR THE COMMUNITY.CERTAIN ISSUES WERE IDENTIFIED AS IMPORTANT, BASED ON COMMUNITY INPUT AND DISCUSSIONS, BUT MRH HAS NOT ADDRESSED THEM IN THIS PLAN AS THESE NEEDS ARE BETTER ADDRESSED BY OTHER ORGANIZATIONS WITHIN OUR COMMUNITY. MRH HAS A WILLINGNESS TO WORK WITH OTHER ENTITIES WITHIN THE COMMUNITY TO LOOK AT PROVIDING APPROPRIATE PROGRAMS, BUT WILL NOT TAKE THE LEAD ON THE FOLLOWING ISSUES:DAYCARE AND OTHER CHILDCARE SERVICESINCREASE LOCAL INCOME/DECREASE POVERTY LEVEL - ECONOMIC DEVELOPMENTINCREASE STAFFING AND LOCAL WORKFORCE DEVELOPMENT MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 13H: THE ORGANIZATION QUALIFIES FREE VERSUS DISCOUNTED CARE BASED ON PROFESSIONAL FEES VERSUS TECHNICAL FEES. WE OFFER 100% OF FREE CARE FOR PROFESSIONAL FEES AND UP TO AN 95% DISCOUNT FOR TECHNICAL FEES. BOTH ARE CALCULATED BASED ON FEDERAL POVERTY GUIDELINES IN THE FAP.PRESUMPTIVE ELIGIBILITY MAY BE USED AS A LAST RESORT. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 16J: PART V, LINE 16A, FAP WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16C, PLAIN LANGUAGE SUMMARY WEBSITE:HTTP://WWW.MOBRIDGEHOSPITAL.ORG/PATIENTS-AND-VISITORS/PAY-A-BILL/FINANCIAL-ASSISTANCE/PART V, LINE 16J: A FINANCIAL ASSISTANCE NOTICE IS MADE PART OF THE BILLING INVOICE. A FINANCIAL ASSISTANCE NOTICE IS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, AND ADMISSIONS OFFICE, AND THE FULL POLICY IS MADE AVAILABLE UPON REQUEST AND ON THE WEBSITE. MOBRIDGE REGIONAL HOSPITAL PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. 1 1 - PRAIRIE SUNSET VILLAGE 1320 W GRAND XING MOBRIDGE SD 57601 ASSISTED LIVING & SENIOR HOUSING PART I, LINE 3C: THE ORGANIZATION QUALIFIES FREE VERSUS DISCOUNTED CARE BASED ON PROFESSIONAL FEES VERSUS TECHNICAL FEES. WE OFFER 100% OF FREE CARE FOR PROFESSIONAL FEES AND UP TO AN 95% DISCOUNT FOR TECHNICAL FEES. BOTH ARE CALCULATED BASED ON FEDERAL POVERTY GUIDELINES IN THE FAP.IN ADDITION TO FPG, THE HOSPITAL USES AN ASSET TEST, REVIEWS MEDICAL INDIGENCY, AND CONSIDERS INSURANCE STATUS IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. PRESUMPTIVE ELIGIBILITY MAY BE USED AS A LAST RESORT. 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 MEDICAID PS&R REPORT AND THE GENERAL LEDGER ACCOUNTING SYSTEM. LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 9/30/21. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDES NET COSTS OF $4,107,859 ATTRIBUTABLE TO PHYSICIAN CLINICS. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PATIENTS AND RESIDENTS. 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. THE 11.3% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: FOOTNOTE FROM FINANCIAL STATEMENTS: PLEASE SEE NOTE 1, FINANCIAL STATEMENT, PATIENT AND RESIDENT SERVICE REVENUE ON PAGES 15-16. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2021. 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: THE PATIENT ACCOUNT SPECIALIST AT THE MOBRIDGE REGIONAL HOSPITAL KEEPS ON FILE ALL GUARANTORS WHO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE AND APPLIES THE FINANCIAL ASSISTANCE TO ALL ACCOUNTS WHEN THE GUARANTOR BALANCE BECOMES DUE. UPDATED FINANCIAL INFORMATION IS REQUESTED ANNUALLY FOR ANY CHANGES IN FINANCIAL ASSISTANCE THAT MAY APPLY. IF AN ACCOUNT GOES TO COLLECTION AND OUR COLLECTION AGENCY IDENTIFIES THAT A PATIENT IS MEETING FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA, THE PATIENT'S ACCOUNT MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE. COLLECTION ACTIVITY WILL BE SUSPENDED ON ACCOUNTS, AND THE FINANCIAL ASSISTANCE APPLICATION WILL BE REVIEWED. IF THE ENTIRE ACCOUNT BALANCE IS ADJUSTED, THE ACCOUNT WILL BE RETURNED. IF A PARTIAL ADJUSTMENT OCCURS, THE PATIENT FAILS TO COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS, OR IF THE PATIENT IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY WILL RESUME. PART VI, LINE 2: MOBRIDGE REGIONAL HOSPITAL (MRH) IS COMMITTED TO PROVIDING HIGH QUALITY HEALTHCARE SERVICES TO ALL PEOPLE THROUGHOUT THE REGION. THE FACILITY PROVIDES FAMILY MEDICINE, INTERNAL MEDICINE, OB, ICU, ALS, AMBULANCE SERVICE, EMERGENCY CARE, AND SURGICAL SERVICES TO ALL PEOPLE WHO ARE IN NEED OF THOSE SERVICES. MRH CURRENTLY IS WORKING IN COLLABORATION WITH WALWORTH COUNTY AND THE STATE OF SOUTH DAKOTA TO PROVIDE COMMUNITY HEALTH SERVICES, INCLUDING FAMILY PLANNING SERVICES, ADULT HEALTH, AND CHILD IMMUNIZATIONS. MRH'S MANAGEMENT STRIVES TO LISTEN TO THE COMMUNITY NEEDS. IF NEW HEALTHCARE NEEDS ARISE, ADMINISTRATION WILL COMPLETE AN ANALYSIS OF COST/BENEFIT FOR THE NEW SERVICE TO BE OFFERED. MRH'S ADMINISTRATION BELIEVES IN BEING OUT IN THE PUBLIC AT EVENTS TO ANSWER QUESTIONS THAT MAY SURFACE ABOUT THE FACILITY. PART VI, LINE 3: MRH POSTS ITS FINANCIAL ASSISTANCE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN THE ADMISSIONS AREAS AND CLINIC AREAS IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FACILITY PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS WITH DISCHARGE MATERIALS. THE PATIENTS ACCOUNT MANAGER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. PART VI, LINE 4: MRH IS LOCATED IN A SMALL RURAL COMMUNITY IN WALWORTH COUNTY, SOUTH DAKOTA, KNOWN AS MOBRIDGE. WALWORTH COUNTY HAS A POPULATION OF 5,351 PEOPLE RACIALLY COMPRISED OF MAINLY CAUCASIAN (80.08%) AND NATIVE AMERICANS/ALASKAN NATIVE (10.87%). THE COMMUNITY BORDERS THE STANDING ROCK RESERVATION AND THE CHEYENNE RIVER RESERVATION WHICH ACCOUNTS FOR THE LARGER NATIVE AMERICAN POPULATION AND RELATIONS WITH INDIAN HEALTH SERVICES. THE MEDIAN FAMILY INCOME IS $51,549. APPROXIMATELY 11.3% OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. THE FACILITY OWNS AND OPERATES CLINICS IN MOBRIDGE, MCLAUGHLIN, TIMBER LAKE AND SELBY. THESE FACILITIES SERVE PATIENTS FROM A SIX COUNTY AREA (WALWORTH, ZIEBACH, CORSON, DEWEY, CAMPBELL AND POTTER). MOBRIDGE REGIONAL HOSPITAL PROVIDES OBSTETRICS, FAMILY AND INTERNAL MEDICINE, AND SURGICAL SERVICES. IT IS APPROXIMATELY ONE HUNDRED MILES FROM ANOTHER HOSPITAL WITH A HIGHER LEVEL OF CARE OFFERED. PART VI, LINE 5: THE MOBRIDGE REGIONAL HOSPITAL IS COMMITTED TO THE PATIENTS WE SERVE, REGARDLESS OF RACE, COLOR, RELIGION, SEX, DISABILITY, OR ABILITY TO PAY. THE ORGANIZATION'S FINANCIAL ASSISTANCE ADJUSTMENTS HAVE CONTINUED TO TREND UP OVER THE PAST FEW YEARS, AND WE CONTINUE TO FOCUS BUDGET EFFORTS TO CONTINUE THIS TREND. MRH IS 100 MILES FROM ANOTHER HEALTHCARE FACILITY WITH A HIGHER LEVEL OF CARE AND PARTICIPATES IN THE NORTH DAKOTA AND SOUTH DAKOTA TRAUMA SYSTEMS WITH LEVEL IV CERTIFICATION. MRH CONTINUES A BROAD LEVEL OF BOARD INVOLVEMENT FOR CORSON, DEWEY, AND WALWORTH COUNTIES TO MONITOR COMMUNITY NEEDS IN THOSE AREAS. MRH CONTINUES TO BE A POPULAR PLACE FOR MEDICAL STUDENTS TO COMPLETE CLINICAL ROTATIONS, AND WE CONTINUE TO OFFER A WIDE VARIETY OF CERTIFICATION CLASSES TO NURSES AND THE MEMBERS OF THE COMMUNITY INCLUDING EMT-B, PALS, ACLS, TNCC, ALSO, NALS, EMT-I, AND CPR. MRH HAS DEVELOPED A WORKSITE WELLNESS PROGRAM WITHIN THE ORGANIZATION AND HAS GOALS TO WORK WITH OTHER BUSINESSES IN THE COMMUNITY TO PROMOTE OVERALL HEALTHY LIFESTYLES.THE HOSPITAL HAS A BOARD OF DIRECTORS COMPRISED OF VOLUNTEERS WHO RESIDE IN THE SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE AREA. ALL QUALIFIED PHYSICIANS WHO SHOW AN INTEREST MUST GO THROUGH A CREDENTIAL REVIEW AND BOARD APPROVAL. SURPLUS FUNDS, IF AVAILABLE, ARE REINVESTED IN THE FACILITIES TO IMPROVE PATIENT CARE. X X X 0 0 0 0 0 0 0 1 0 DR DONALD LUCEK SURGEON 420842 0 0 0 0 0 11867 0 16909 0 449618 0 0 0 DR TRAVIS HENDERSON INTERNAL MEDICINE/DIRECTOR 321901 0 43100 0 0 0 11400 0 26211 0 402612 0 0 0 DR ROBERT MARCIANO FAMILY MD/DIRECTOR 311708 0 39954 0 0 0 11400 0 16977 0 380039 0 0 0 DR MATT SCHAFFER PHYSICIAN 305223 0 38558 0 0 0 11400 0 23642 0 378823 0 0 0 DR EMILY BODEN PHYSICIAN 305977 0 37500 0 0 0 10936 0 23642 0 378055 0 0 0 DR JOSH HENDERSON INTERNAL MEDICINE 264186 0 37500 0 0 0 11400 0 23657 0 336743 0 0 0 WAYNE JOHNSON CRNA 217050 0 0 0 0 0 8560 0 1287 0 226897 0 0 0 PART I, LINE 3 THE CEO IS COMPENSATED THROUGH A MANAGEMENT AGREEMENT WITH CHI ST. ALEXIUS MEDICAL CENTER IN BISMARCK, ND. THE EXECUTIVE COMMITTEE OF MOBRIDGE REGIONAL HOSPITAL REVIEWS THE MANAGEMENT AGREEMENT AND MAKES A DETERMINATION AS TO WHETHER THE COMPENSATION FOR THE CEO'S SERVICES IS REASONABLE. PART I, LINE 7 THE PHYSICIANS ARE PAID BASED ON RELATIVE VALUE UNIT BASED PRODUCTION. A CITY OF MOBRIDGE SOUTH DAKOTA 466000320 607429BA4 2007-05-08 5773898 REFINANCE BONDS ISSUED 1997 USED FOR CONSTRUCTION; PURCHASE CT, CLINIC & EMR 0 0 0 A 4760000 5773898 265908 88005 1000000 4416499 2008 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MOBRIDGE, SOUTH DAKOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 08/15/2017 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN OF THE BOARD, WHO SHALL ACT AS CHAIRMAN OF SAID COMMITTEE, THE SECRETARY, VICE-CHAIRMAN, AND TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES OF THE EXPRESSED WISHES OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 MRH CURRENTLY HAS A MANAGEMENT AGREEMENT WITH CHI ST. ALEXIUS MEDICAL CENTER IN BISMARCK, ND. THE MANAGEMENT AGREEMENT PROVIDES THAT CHI ST. ALEXIUS HEALTH WILL PROVIDE MANAGEMENT AND ADMINISTRATIVE SERVICES. THE AGREEMENT REMAINS IN EFFECT IN PERPETUITY BUT MAY BE CANCELLED BY THE HOSPITAL FOLLOWING A 90-DAY NOTICE. JOHN AYOUB, CEO, RECEIVED COMPENSATION OF $228,418 AND ESTIMATED BENEFITS OF $30,383 DURING CALENDAR YEAR 2020. THE CEO OVERSEES ALL DAILY OPERATIONAL ACTIVITIES AND REPORTS TO THE ORGANIZATION'S BOARD OF DIRECTORS. THE CEO WORKS VERY CLOSELY WITH ALL DEPARTMENT SUPERVISORS TO ENSURE THAT ALL AREAS OF THE HOSPITAL ARE RUNNING EFFICIENTLY AND SMOOTHLY. THE CEO IS RESPONSIBLE FOR PHYSICIAN CONTRACTING AND WORKS VERY CLOSELY WITH HUMAN RESOURCES FOR RECRUITMENT OF PROFESSIONAL MEDICAL STAFF. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBER; ALL MEMBERS HAVE ONE VOTE (SAME VOTING RIGHTS). EACH PERSON WHO DONATES $100 OR MORE IS A MEMBER ENTITLED TO ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7A THE NOMINATING COMMITTEE NOMINATES CANDIDATES FOR ELECTION. THE MEMBERS VOTE ON CANDIDATES AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE CEO, CFO, AND BOARD OF DIRECTORS WILL REVIEW THE FORM 990 VIA ELECTRONIC TRANSMISSION PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE ENTIRE BOARD OF DIRECTORS. IF A CONFLICT SHOULD ARISE, IT WOULD FIRST GO TO THE CEO FOR EVALUATION, THEN TO THE BOARD OF DIRECTORS FOR FINAL EVALUATION. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR MAKING THE FINAL DECISION IN DETERMINING IF A CONFLICT EXISTS. IF A CONFLICT IS FOUND, THE PERSON(S) INVOLVED WOULD BE REQUIRED TO ABSTAIN FROM DISCUSSIONS AND VOTING ON THE ITEM CAUSING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE FINANCE COMMITTEE DETERMINES AND APPROVES THE PHYSICIAN CONTRACTS, INCLUDING COMPENSATION. THE CEO'S SALARY IS DETERMINED USING A SALARY SURVEY AND DISCUSSIONS WITH THE MANAGEMENT COMPANY. THE EXECUTIVE COMMITTEE APPROVES THE SALARY OF THE CEO ANNUALLY. SALARIES FOR OTHER OFFICERS OR MEMBERS OF MANAGEMENT ARE DETERMINED BY THE CEO THROUGH THE USE OF SALARY SURVEY INFORMATION FROM SDAHO AND EMPLOYEE SERVICE AND EXPERIENCE FILES. THIS PROCESS IS UNDERTAKEN ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FOUNDATION INTEREST 125,244. MOBRIDGE REGIONAL HEALTHCARE FOUNDATION PO BOX 580 MOBRIDGE SD 57601 460416693 OUTREACH FOR MOBRIDGE REGIONAL HOSPITAL SD 501(C)(3) LINE 12C, III-FI MOBRIDGE REGIONAL HOSPITAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0