Community Benefit Insight - Tax-exempt hospital

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Marshall County Memorial Hospital

Marshall County Healthcare Center

413 9th Street
Britton, SD 57430

Bed count	20	Medicare provider number	431312	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 460380552

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

8.7%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 18,000 0.17 %
Medicaid as % of operating expenses	$ 66,818 0.63 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 2,146 0.02 %
Subsidized health services as % of operating expenses	$ 728,331 6.92 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 93,521 0.89 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 7,199 0.07 %
Community building* as % of operating expenses	$ 4,936 0.05 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	3,435
Physical improvements and housing	0
Economic development	0
Community support	3,435
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 4,936 0.05 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 4,936 100 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 457,219 4.34 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 60,353 13.20 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 8674431 including grants of $ 4353) (Revenue $ 10586078)
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, 2022, THE AMOUNTS AND TYPES OF CARE PROVIDED WERE: 384 ACUTE PATIENT DAYS; 495 SWING-BED DAYS; 4,854 CLINIC VISITS, AND 5,118 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 $18,000 FOR THE YEAR ENDED JUNE 30, 2022, 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.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

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 CAREACTIONS PLANS1) IMPROVE MENTAL/BEHAVIORAL HEALTH SERVICES: THIS NEED IS A CONTINUATION OF A NEED IDENTIFIED IN THE PRIOR CHNA.A. IN AN EFFORT TO EDUCATE THE PUBLIC ON HOW TO RESPOND TO MENTAL HEALTH SITUATIONS AND REDUCE THE STIGMA ASSOCIATED WITH MENTAL HEALTH, MARSHALL COUNTY HEALTHCARE CENTER AVERA WILL ENSURE THAT A MENTAL HEALTH FIRST AID CLASS IS HELD IN BRITTON OR LANGFORD AT LEAST ONCE PER FISCAL YEAR. MARSHALL COUNTY HEALTHCARE CENTER AVERA WILL PROVIDE STAFF TIME TO ORGANIZE AND ADVERTISE THE CLASS, THE FACILITY TO HOLD THE CLASS, AND FINANCIAL SUPPORT OF THE CLASS IF OTHER GRANT OR SPONSORSHIP FUNDING SOURCES CANNOT BE SECURED. B. MARSHALL COUNTY HEALTHCARE CENTER AVERA WILL ENSURE FACILITY REPRESENTATION ON THE BOARD OF DIRECTORS FOR NORTHEASTERN MENTAL HEALTH CENTER (ABERDEEN, SD) TO ENSURE MARSHALL COUNTY NEEDS ARE REPRESENTED. THE ANTICIPATED IMPACT IS TO MAINTAIN COUNSELING SERVICES PROVIDED IN MARSHALL COUNTY AND WORK TOWARD EXPANDING AS NEEDED. 2) COLLABORATE WITH MARSHALL COUNTY AMBULANCE: THIS NEED IS A CONTINUATION OF A NEED IDENTIFIED IN THE PRIOR CHNA. TO HELP MAINTAIN THE FINANCIAL AND LOGISTICAL VIABILITY OF AMBULANCE SERVICE IN THE SERVICE AREA, MARSHALL COUNTY HEALTHCARE CENTER AVERA WILL CONTINUE TO COLLABORATE WITH MARSHALL COUNTY AMBULANCE SERVICE BY PROVIDING LAUNDRY SERVICE AT NO COST, ASSISTING WITH AMBULANCE PAGING, PAYING RNS TO ACCOMPANY PATIENTS WHEN TREATMENT FOR THE TRANSPORT EXCEEDS AN EMT'S SCOPE OF PRACTICE, AND PROMOTING EMT AND PARAMEDIC CAREERS THROUGH THE HIPE PROGRAM. 3) COLLABORATE WITH COMMUNITY LEADERS IN AN EFFORT TO BRING A DENTAL PROVIDER TO THE AREA:A. MARSHALL COUNTY HEALTHCARE CENTER AVERA WILL HAVE FACILITY REPRESENTATION ON A COMMUNITY TASK FORCE TO RECRUIT A NEW DENTIST TO THE COMMUNITY. B. MARSHALL COUNTY HEALTHCARE CENTER AVERA WILL COLLABORATE WITH THE COUNTY HEALTH NURSE IN EFFORTS TO BRING THE DENTAL VAN TO BRITTON FOR PEDIATRIC DENTAL VISITS ANNUALLY. MCHC CONTINUED TO MEET WITH NORTHEASTERN MENTAL HEALTH CENTER OF ABERDEEN USING VIRTUAL RATHER THAN IN PERSON MEETINGS. THE PARTNERSHIP WITH AVEL ALSO CONTINUED, PROVIDING MENTAL HEALTH SERVICES THROUGH TELEHEALTH.MCHC CONTINUES TO PROVIDE LAUNDRY SERVICE TO MARSHALL COUNTY AMBULANCE AT NO COST, ASSIST WITH PAGING, AND PAY RNS TO ACCOMPANY PATIENTS WHEN NECESSARY. PROMOTING EMT CAREERS THROUGH THE HIPE PROGRAM WAS COMPLETED IN FY 2022. COLLABORATION EFFORTS DURING THE PANDEMIC INCLUDED INFECTION CONTROL EDUCATION FOR EMTS, SHARED PERSONAL PROTECTIVE EQUIPMENT, AND QUARANTINE GUIDANCE FOR SYMPTOMATIC EMTS. WEIGHT MANAGEMENT WAS A NEED THAT WAS IDENTIFIED IN THE PRIOR IMPLEMENTATION STRATEGY. TO CONTINUE TO PROMOTE WEIGHT MANAGEMENT, MCHC WORKED THROUGH THE MARSHALL COUNTY WORKING ON WELLNESS (WOW) COALITION BY PROVIDING ANNUAL FUNDING. MCHC'S WELLNESS CENTER WAS CLOSED DURING THE PANDEMIC, BUT SET TO REOPEN IN AUGUST 2022. MCHC IS EXPLORING THE FEASIBILITY OF EMPLOYING A COMMUNITY RESOURCE NURSE TO BE AVAILABLE TO THOSE SEEKING WEIGHT MANAGEMENT SOLUTIONS. COMMUNITY EDUCATION WAS A NEED THAT WAS IDENTIFIED IN THE PRIOR IMPLEMENTATION STRATEGY. MCHC WORKED TO DEVELOP AND IMPLEMENT A COMMUNITY EDUCATION STRATEGY. IN ADDITION TO PLANNED COMMUNICATIONS ABOUT HEART DISEASE AND BREAST CANCER, MCHC PRODUCED AND DISTRIBUTED NUMEROUS INFORMATIONAL MESSAGES CONCERNING COVID-19. THESE WERE SHARED ON THE FACILITY'S FACEBOOK PAGE AND RUN IN THE LOCAL NEWSPAPER.

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/

Supplemental Information

Schedule H (Form 990) Part VI

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, 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 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 2021. 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 06/30/2022. 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 1,250 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 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."

Operating expenses	$ 10,530,208
Total amount spent on community benefits as % of operating expenses	$ 916,015 8.70 %