2025-03-31T08:04:01-05:00 2024-06-30 390758449 WIPFLI LLP 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2023-07-01 810243720 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION SHER 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 KODY NELSON CEO 4067653700 2025-03-28 1 1 SAM BRUNSON CPA P01696998 4067281800 2025-03-28 2023 2025-03-06 01:10:19Z KODY NELSON 440 W LAUREL AVENUE PLENTYWOOD MT 59254 22728154 0 X WWW.SHERIDANMEMORIAL.NET X 1920 MT TO PROVIDE EXCEPTIONAL AND COMPASSIONATE CARE TO ENHANCE THE HEALTH, WELLBEING AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 7 7 204 29 0 0 796263 786033 19255686 21888652 26764 48619 12575 4850 20091288 22728154 0 0 0 0 8834260 10284862 0 0 54160 10280635 11639497 19114895 21924359 976393 803795 11846107 12888326 3858900 4097324 7987207 8791002 X PROVIDING QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 19256165 21888652 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION OPERATES A 19-BED CRITICAL ACCESS HOSPITAL, A 35-BED LONG-TERM CARE FACILITY, AND A RURAL HEALTH CLINIC THAT BENEFIT THE PEOPLE IN THE SURROUNDING AREA. SMHA IS THE ONLY MEDICAL FACILITY IN SHERIDAN COUNTY, WHICH HAS A POPULATION OF APPROXIMATELY 3,500 RESIDENTS. HIGHLIGHTS OF THE ORGANIZATION'S ACCOMPLISHMENTS DURING FY24 ARE INCLUDED BELOW: - SMHA INCREASED ITS CAPACITY TO PATIENTS IN THE RHC BY 14.4% IN FY24. THIS WAS ACCOMPLISHED BY INSTITUTING PRODUCTIVITY REQUIREMENTS FOR PROVIDERS, HIRING QUALIFIED AND HARD-WORKING PROVIDERS AND UPDATING PATIENT WORKFLOWS. - SMHA CONTINUED TO UPDATE ITS DIAGNOSTIC CAPABILITIES, ALLOWING FOR IMPROVED IDENTIFICATION OF AILMENTS AND HEALTH ISSUES. THIS IN-TURN HAS ALLOWED SMHA TO HAVE PATIENTS SEEN AT THE CORRECT LEVEL OF CARE FOR THEIR NEEDS AND HELPED SMHA PROVIDERS TREAT PATIENTS LOCALLY RATHER THAN HAVING TO REFER OR TRANSFER TO A HIGHER LEVEL OF CARE. THIS IS EVIDENT IN THE INCREASE IN PATIENTS SEEN IN OUR CLINIC AND UTILIZATION OF OUR ANCILLARY SERVICES.VOLUME INDICATORS FOR THE FISCAL YEAR ARE AS FOLLOWS: ACUTE CARE INPATIENT ADMISSIONS - 98ED VISITS - 1,018SWING BED PATIENTS - 74LONG-TERM CARE ADMISSIONS - 14HOME CARE VISITS - 2,437HOSPICE - 364CLINIC VISITS - 10,364 19256165 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 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 1 0 0 0 1 13 0 204 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KODY NELSON 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 X DON BENSON CHAIR 1.00 X X 0 0 0 PAUL HANSON VICE CHAIR 2.00 X X 0 0 0 JOAN TOMMERUP SECRETARY 1.00 X X 0 0 0 NANCY JENSEN DIRECTOR 2.00 X 0 0 0 MYRNETTE MILLER DIRECTOR 1.00 X 0 0 0 CHRIS WIENS DIRECTOR 2.00 X 0 0 0 LEXI OLSEN DIRECTOR 1.00 X 0 0 0 CORY SAMPSEN DIRECTOR (THRU 2/24) 1.00 X 0 0 0 KODY NELSON CEO 40.00 X 0 0 0 SIVASH SHAHBODAGHI PHYSCIAN 40.00 X 792650 0 22500 BRIT NYBY APP 40.00 X 179769 0 5392 CARLOS TREVINO PHYSCIAN 10.00 X 129788 0 11488 STEPHANIE KANNING RN 40.00 X 126996 0 3810 CHAD SYLVESTRE DON 40.00 X 112969 0 11925 1342172 0 55115 10 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MGMT, CEO, ACGT, LAB, RADIOLOGY, IS 1082142 BADLANDS 804 2ND STREET UNDERWOOD ND 58576 TRAVEL RN, LPN, CAN 1014605 PRN STAFFING 173 AUSTRIAN ROAD VIDA MT 59724 TRAVEL RN, LPN, CAN 627359 TRUSTED HEALTHCARE STAFFING 1402 HALVERSON DR MURFEESBORO TN 37128 TRAVEL RN, LPN, CAN 413013 MHN 519 PLEASANT STREET MILES CITY MT 59301 TRAVEL RN, LPN, CAN 325376 12 30717 719910 35406 786033 PATIENT SERVICE REVENUE 621990 19833163 19833163 340B REVENUE 621990 1017492 1017492 OTHER OPERATING REVENUE 621990 697308 697308 CONTRACT REVENUE 621990 340689 340689 21888652 26310 26310 4850 0 4850 4850 4850 22309 0 22309 22309 22309 22728154 21888652 0 53469 X 8532385 8532385 207183 207183 947165 947165 598129 598129 9265 9265 33114 33114 5393350 5379645 13705 39406 39406 153762 153762 416584 416584 32168 32168 72665 72665 72054 71004 1050 801813 477794 324019 231891 231891 SUPPLIES 2191902 2145206 46696 BAD DEBT 926279 926279 REPAIRS AND MAINTENANCE 432379 432379 BED TAX 373359 373359 459506 445802 13704 21924359 19256165 2614034 54160 2878020 3080941 999712 862805 2287810 2589242 250986 216776 233060 227439 20754820 15961620 4575098 4793200 621421 1117923 11846107 12888326 2549826 2165067 728389 858220 580685 1074037 3858900 4097324 X 7987207 8791002 7987207 8791002 11846107 12888326 803795 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104263 104263 104263 104263 104263 104263 104263 104263 104263 104263 1.00000 0 1 1 444289 444289 12153108 10234271 1918837 7867154 5727349 2139805 290269 290269 4793200 RIGHT OF USE LEASE 772412 GUARANTEE OF PATIENT LOANS 162761 BED TAX RECEIVABLE 182750 1117923 RIGHT OF USE LEASE 786253 GUARANTEE OF PATIENT LOANS 162761 BED TAXES PAYABLE 124473 OTHER PAYABLES 550 1074037 X PART V, LINE 4: THE ENDOWMENT, HELD BY THE SHERIDAN HEALTH CARE FOUNDATION, INC., CONSISTS OF INDIVIDUAL FUNDS ESTABLISHED BY DONORS TO PROVIDE ANNUAL FUNDING FOR SPECIFIC ACTIVITIES AND GENERAL OPERATIONS OF THE HOSPITAL. GIFTS GIVEN TO THE ENDOWMENT FUND AT SHERIDAN HEALTH CARE FOUNDATION ARE INVESTED AND CAREFULLY MANAGED TO PROTECT THE PRINCIPAL; THEY ARE INTENDED TO BE A PART OF THE PERMANENT INVESTMENT RESERVE WHICH WILL REMAIN FOR PERPETUITY. INTEREST FROM ENDOWMENTS WILL GO TOWARDS SHERIDAN HEALTH CARE FOUNDATION'S UNRESTRICTED FUND TO ALLOW FOR ADDITONAL REVENUE TO ENSURE THE FUTURE OF THE FOUNDATION AND SHERIDAN MEMORIAL HOSPITAL ASSOCIATION UNLESS OTHERWISE STIPULATED BY THE DONOR. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. FEDERAL AND STATE INCOME TAXES ARE PAID ON NONEXEMPT UNRELATED BUSINESS INCOME IN ACCORDANCE WITH THE CODE. CURRENT ACCOUNTING GUIDELINES REQUIRE AN ORGANIZATION TO DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR TAX YEARS 2020 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 X 1 X 1 X 1 1 1 0 0 470728 470728 0.02150 2610941 2610941 0.11910 3081669 3081669 0.14060 3519 3519 0.00020 145026 7059 137967 0.00630 11177 11177 0.00050 159722 7059 152663 0.00700 3241391 7059 3234332 0.14760 1 876439 7573160 7591611 -18451 X 1 1 1 1 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION 440 W LAUREL AVE PLENTYWOOD MT 59254 WWW.SHERIDANMEMORIAL.NET 13547 X X X RURAL HEALTH CLINIC, LONG-TERM CARE FACILITY SHERIDAN MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X 21 1 0 1 1 X WWW.SHERIDANMEMORIAL.NET X X 1 21 1 WWW.SHERIDANMEMORIAL.NET 0 1 X 100.000000000000 400.000000000000 X 1 1 X X X 1 X WWW.SHERIDANMEMORIAL.NET X WWW.SHERIDANMEMORIAL.NET X WWW.SHERIDANMEMORIAL.NET X X X X X X 1 X 0 X X X X 1 X 0 1 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: BOTH OUR STAFF AND BOARD MEMBERS ARE REPRESENTATIVES OF OUR COMMUNITY AND WERE A PART OF THE IMPLEMENTATION COMMITTEE. 173 MEMBERS OF SHERIDAN COUNTY RESPONDED TO OUR ONLINE SURVEY AND SEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH MONTANA STATE UNIVERSITY - OFFICE OF RURAL HEALTH. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 7D: PAPER COPIES WERE ALSO DISTRIBUTED TO LA CASA AND PIONEER MANOR (BOTH FACILITIES HELP AN OLDER GENERATION THAT DON'T UTILIZE COMPUTERS).THE CHNA WAS ALSO POSTED BY THE ADMISSIONS DESKS IN THE FACILITY AS WELL AS MAILED OUT TO 900 PATIENTS WITH THEIR STATEMENTS. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: BASED ON THE MOST RECENT CHNA SMH HAS IDENTIFIED SEVERAL ITEMS THAT THEY WILL BE WORKING ON OVER THE NEXT YEAR.GOAL 1: IMPROVE AWARENESS OF AND ACCESS TO HEALTHCARE SERVICES THROUGHOUT SHERIDAN COUNTY.STRATEGY 1.1: ENHANCE SMHA'S PRESENCE IN THE COMMUNITY AS A RESOURCE FOR HEALTH EDUCATION AND PARTNERSHIPS.ACTIVITIES: ENHANCE SHERIDAN MEMORIAL HEALTHCARE ASSOCIATION'S (SMHA) PRESENCE IN THE COMMUNITY AS A VITAL PARTNER TO ADVANCE POPULATION HEALTH EFFORTS REGIONALLY. THIS INCLUDES BUT IS NOT LIMITED TO PROVIDING STAFF REPRESENTATIVES TO PARTICIPATE AND SUPPORT EFFORTS OF THE LOCAL COUNCIL ON AGING, ETC.; INCREASE SMHA'S OUTREACH THROUGHOUT THE REGION, HIGHLIGHTING PROVIDERS AND AVAILABLE SERVICES. CREATE A COMMUNITY OUTREACH AND EDUCATION CAMPAIGN THAT LEVERAGES EXISTING TOOLS SUCH AS SOCIAL MEDIA, COMMUNITY EVENTS, ETC.; SUSTAIN SMHA'S POST-ACUTE CARE UTILIZATION. SPECIFICALLY, BY TRACKING PATIENT TRANSFERS FOR LOCAL FOLLOW UP, TRACKING REFERRALS TO SURGICAL SERVICES (I.E., TO AN ORTHOPEDIC SURGEON FOR JOINT REPLACEMENT, ETC.), REQUESTING PROVIDERS TO SUSTAIN REFERRALS TO SWS SERVICES AT TIME OF CONSULTATION REFERRAL, AND FEATURING THE REHABILITATION DEPARTMENT AND SWS PROGRAM IN AN OUTREACH CAMPAIGN. THE POSSIBILITY OF TRANSPORTING SWING BED PATIENT BACK TO SMH. THE REVENUE OF A PATIENT IN HOUSE OUTWEIGHS THE COST OF TRANSPORTATION; NURTURE SMHA'S RELATIONSHIP WITH THE SHERIDAN COUNTY PUBLIC HEALTH NURSE TO SUSTAIN AND CONTINUALLY ALIGN LOCAL EFFORTS THAT ADVANCE POPULATION HEALTH; CONTINUE TO ADVANCE TELEHEALTH SERVICES LOCALLY IN ORDER TO REDUCE THE TRAVEL AND COORDINATION BURDEN EXPERIENCED BY SHERIDAN COUNTY RESIDENTS TRAVELING OUT OF THE AREA TO ACCESS ROUTINE AND PREVENTIVE SERVICES. THIS INCLUDES DEVELOPING AN EDUCATION AND OUTREACH PLAN INTENDED TO COMMUNICATE HOW COMMUNITY MEMBERS CAN ACCESS AND UTILIZE SERVICES.STRATEGY 1.2: EXPLORE OPPORTUNITIES THAT ENHANCE ACCESS TO HEALTHCARE SERVICES AND RESOURCES LOCALLY.ACTIVITIES: STAY APPRISED OF ADDITIONAL FUNDING SOURCES THAT WOULD IMPROVE HEALTH SERVICES AND RESOURCES LOCALLY; CONTINUE TO WORK WITH COMMUNITY PARTNERS TO EXPLORE THE FEASIBILITY OF A LOCAL VISION CLINIC THEREBY REDUCING THE TRAVEL BURDEN EXPERIENCED BY SHERIDAN COUNTY RESIDENTS TRAVELING OUT OF THE AREA TO ACCESS THESE ROUTINE AND PREVENTIVE SERVICES; EXPLORE THE INTEGRATION OF DIABETES EDUCATION AT SMHA TO IMPROVE CHRONIC DISEASE PREVENTION AND MANAGEMENT LOCALLY; ENHANCE SERVICES FOR AREA WOMEN AND CHILDREN BY CONDUCTING A FEASIBILITY STUDY OF IMPLEMENTING PEDIATRIC AND/OR OBSTETRIC SERVICES LOCALLY; EXPLORE THE ENHANCEMENT OF CARE COORDINATION ACTIVITIES THROUGH SMHA (I.E., TOBACCO CESSATION, REFERRAL PROTOCOLS, ETC.).; SUPPORT CONTINUOUS PROVIDER RECRUITMENT AND RETENTION EFFORTS AT SMHA BASED ON THE FEASIBILITY AND NEEDS OF THE SERVICE AREA; DEVELOP AND IMPLEMENT THE PATIENT/FAMILY ENGAGEMENT PROGRAM TO INVOLVE COMMUNITY MEMBERS TO SERVE AS VOLUNTEERS ON A HOSPITAL COMMITTEE, SUCH AS THE QUALITY COMMITTEE OR SAFETY COMMITTEE.GOAL 2: ENHANCE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IN SHERIDAN COUNTY.STRATEGY 2.1: SUPPORT LOCAL AND REGIONAL EFFORTS THAT ADDRESS THE MENTAL AND BEHAVIORAL HEALTH NEEDS THROUGHOUT SHERIDAN COUNTY.ACTIVITIES: PARTICIPATE IN REGIONAL BEHAVIORAL HEALTH ACTIVITIES AND INITIATIVES BY SUSTAINING SMHA'S ACTIVE PARTICIPATION ON THE REGIONAL BEHAVIORAL HEALTH COALITION. THIS INCLUDES BUT IS NOT LIMITED TO PROVIDING STAFF REPRESENTATIVES TO PARTICIPATE AND SUPPORT EFFORTS OF THE COALITION, DISSEMINATING COMMUNITY OUTREACH AND EDUCATION, ETC.; CONTINUE TO IMPLEMENT THE CRISIS MANAGEMENT INTAKE QUESTIONNAIRE (PHQ-9) THROUGHOUT SMHA'S CLINIC AND HOSPITAL SETTINGS. MONITOR THE UTILIZATION OF THE QUESTIONNAIRE AND PROVIDER ROUTINE EDUCATION TO SMHA STAFF AND PROVIDERS TO ENSURE CONSISTENT USAGE; TRAIN AND EQUIP SMHA STAFF OF ALL LEVELS WITH THE TOOLS AND KNOWLEDGE SO THEY ARE PREPARED TO ADEQUATELY RESPOND TO MENTAL AND BEHAVIORAL HEALTH PATIENTS (I.E., PRESENTING IN CRISIS, RESOURCES, ROUTINE CARE, ETC.).; EXPLORE SUBSTANCE ABUSE PREVENTION AND RESOURCES BASED ON THE NEEDS OF THE REGION (I.E., PARTNERSHIP WITH THE LOCAL BEHAVIORAL HEALTH COALITION, UTILIZING STIGMA REDUCTION MESSAGING, EDUCATIONAL CAMPAIGNS, ETC.).NEEDS NOT ADDRESSED:1. 9.7% OF SURVEY RESPONDENTS INDICATED THEY HAD DIFFICULTY GETTING A PRESCRIPTION OR TAKING THEIR MEDICATION REGULARLY DUE TO COST IN THE LAST YEAR.RATIONALE: WHILE NOT INCLUDED EXPLICITLY WITHIN THIS IMPLEMENTATION PLAN, SMHA HAS A 340B PROGRAM AND CONTRACTS WITH THE PLENTYWOOD REXALL DRUG FOR THOSE IN NEED.2. 4.0% OF SURVEY RESPONDENTS WERE CONCERNED ABOUT NOT HAVING ENOUGH FOOD TO EAT IN THE LAST YEAR. RATIONALE: SMHA REGULARLY PROVIDES DONATIONS AND REFERRALS FOR COMMUNITY MEMBERS TO THE LOCAL FOOD BANK IN SHERIDAN COUNTY. 3. 36.0% OF SURVEY RESPONDENTS FEEL THAT THE COMMUNITY DOES NOT HAVE ADEQUATE AND AFFORDABLE HOUSING OPTIONS AVAILABLE.RATIONALE: WHILE NOT INCLUDED EXPLICITLY WITHIN THIS IMPLEMENTATION PLAN, SMHA IS COMMITTED TO REMAINING APPRISED OF LOCAL AFFORDABLE HOUSING CONVERSATIONS AND PARTICIPATING AS RESOURCES (TIME, WORKFORCE, ETC.) ALLOW. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 13H: IN ADDITION TO FAMILY SIZE AND FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY WILL CONSIDER SPECIAL HARDSHIPS OR UNUSUAL CIRCUMSTANCES IN DETERMINING FINANCIAL ASSISTANCE. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 24: ALL INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY ARE PROVIDED A DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO ELECTIVE PROCEDURES. THEREFORE, FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE CHARGED GROSS CHARGES ON ELECTIVE PROCEDURES - SPECIFICALLY STATED MED SPA, WEIGHT MANAGEMENT, NON - EMERGENT ERS AS WELL AS DME PRODUCT PURCHASED WITHOUT A PROVIDER SCRIPT. PART I, LINE 3C: IN ADDITION TO FAMILY SIZE AND FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY WILL CONSIDER SPECIAL HARDSHIPS OR UNUSUAL CIRCUMSTANCES IN DETERMINING FINANCIAL ASSISTANCE. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS CALCULATED USING WORKSHEET 2. ALL AMOUNTS ON LINE 7 WERE CALCULATED USING THE WORKSHEETS PROVIDED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE IS THE BAD DEBT EXPENSE LESS BAD DEBT RECOVERIES AS REPORTED ON THE FINANCIAL STATEMENTS. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE BEGINS ON PAGE 13 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: THE COST TO CHARGE RATIO IS USED TO DETERMINE COMMUNITY BENEFIT. THIS IS DONE BY APPLYING THE RATIO TO THE TOTAL MEDICARE REVENUE. A SHORTFALL OR OVERAGE IN ANY GIVEN YEAR IS A RESULT OF THE TIMING OF PAYMENTS FROM MEDICARE ON AN INTERIM BASIS AND WHEN FINAL SETTLEMENT IS MADE. MANAGEMENT USES ESTIMATES TO CALCULATE SUCH SETTLEMENTS BUT ACTUAL RESULTS VARY FROM THOSE ESTIMATES. ADDITIONALLY, SHORTFALLS CAN RESULT FROM VARIOUS EXPENSES THAT ARE INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. ALSO MEDICARE RECIPIENTS ARE PART OF A CHARITABLE CLASS AND SO THE PROVISION OF MEDICAL CARE FURTHERS THIS CHARITABLE CLASS. PART III, LINE 9B: IF A PATIENT IS APPROVED FOR FINANCIAL ASSISTANCE, THAT SAME APPROVED PERCENTAGE MAY BE APPLIED FOR ANY BILLS INCURRED WITHIN THE NEXT 3 MONTHS/90 DAYS WITHOUT THE PATIENT HAVING TO COMPLETE A NEW APPLICATION. THE 90 DAYS BEGINS FROM THE DATE THE INITIAL APPLICATION WAS APPROVED. THE FINANCIAL ASSISTANCE ADJUSTMENT WILL BE PROVIDED ONLY TO THE QUALIFYING BILLS AND ONLY IF THE PATIENT REQUESTS FINANCIAL ASSISTANCE WITHIN THE 90-DAY PERIOD. PART VI, LINE 2: WE DO DEPARTMENTAL SURVEYS ON A REGULAR BASIS AND DISCUSSIONS WITH LOCAL ORGANIZATIONS, SUCH AS THE COUNCIL ON AGING, CHAMBER, AMBULANCE DISTRICT, AS WELL AS THE FOUNDATION AND AUXILIARY. PART VI, LINE 3: SHERIDAN MEMORIAL ENSURES ALL PATIENTS ARE NOTIFIED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AT EVERY ADMISSION. AT ADMISSION, THE PATIENT SIGNS A CONDITION OF ADMISSION WHICH STATES THAT ASSISTANCE IS AVAILABLE. IN ADDITION, FINANCIAL ASSISTANCE PACKETS ARE HANDED OUT BY THE ADMISSION'S CLERK TO THOSE WHO ARE UNDERINSURED/UNINSURED OR EXPRESS NEED FOR ASSISTANCE. THE HOSPITAL DESK ALSO HAS THESE PACKETS AVAILABLE FOR PATIENTS WHO REPORT TO THE EMERGENCY ROOM. THIS PACKET INCLUDES ALL PAYMENT OPTIONS, MEDICAID INFORMATION, MARKETPLACE INSURANCE INFORMATION AND THE FINANCIAL ASSISTANCE APPLICATION. IN ADDITION THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE POSTED ON THE SHERIDAN MEMORIAL WEBSITE WWW.SHERIDANMEMORIAL.NET AND POSTERS ARE PLACED AROUND THE FACILITY EXPLAINING PAYMENT OPTIONS. EACH STATEMENT SENT OUT TO THE PATIENT STATES THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE BUSINESS OFFICE STAFF ALSO COVERS THIS INFORMATION WITH SELF-PAY PATIENTS WHEN MAKING COLLECTION/PAYMENT PLAN CALLS. PART VI, LINE 4: SHERIDAN COUNTY IS LOCATED IN THE NORTHEAST CORNER OF MONTANA AND COVERS THE GEOGRAPHIC AREA OF 1,706 SQUARE MILES. POPULATION OF THE COUNTY IS 3,522 (BASED ON THE 2021 CENSUS). THE COMMUNITY IS RURAL AND PRIMARILY A FARMING AND RANCHING AREA. PART VI, LINE 5: SHERIDAN MEMORIAL HOSPITAL HAS EXPANDED MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY AND PROVIDERS WILLING TO SEE SHERIDAN MEMORIAL PATIENTS VIA TELE-MED CONFERENCES AS WELL AS SPECIALTY PROVIDERS WHO ARE WILLING TO SEE PATIENTS LOCALLY. IN ADDITION, SHERIDAN MEMORIAL HAS OPENED ITS OUTREACH CLINIC FOR VISITING PHYSICIANS AND SPECIALISTS TO COME TO PLENTYWOOD TO BETTER SERVE OUR COMMUNITY. THIS INCLUDES SPECIALISTS/PROVIDERS FROM SIDNEY HEALTH CENTER AND MCKENZIE HEALTH, AND MONTANA HOSPITAL COMMUNITY. THE BOARD OF DIRECTORS IS MADE UP OF 7 VOLUNTEERS FROM THE COMMUNITY. WE TRY TO HAVE REPRESENTATION ON THE BOARD FROM INDIVIDUALS THROUGHOUT THE COUNTY AND NOT JUST OF THOSE LIVING IN PLENTYWOOD. SURPLUS FUNDS ARE APPLIED BACK TO PATIENT CARE AND EDUCATION. WE OFFER MANY SERVICES WHICH ARE A COMMUNITY BENEFIT TO THE COMMUNITIES WE SERVE WHICH INCLUDE THE FOLLOWING: * GRIEF COUNSELOR* USE OF TELE-MED EQUIPMENT IS OPEN TO THE COMMUNITY FOR MENTAL HEALTH VISITS, BEHAVIORAL HEALTH CLASSES, COMMUNITY GENERAL HEALTH EDUCATION AS WELL AS LIFESTYLE BALANCE CLASSES. * ER IS OPEN 24 HOURS REGARDLESS OF ABILITY TO PAY* EDUCATION OF HEALTHCARE PROFESSIONALS* PARTICIPATION IN GOVERNMENT SPONSORED HEALTH PROGRAMS* SHERIDAN MEMORIAL IS INVOLVED IN COMMUNITY OUTREACH THROUGH THE SHERIDAN COUNTY CHAMBER, COUNCIL ON AGING, SHERIDAN COUNTY PUBLIC HEALTH, REGIONAL VETERAN'S AFFAIRS MEETINGS, EMERGENCY MEDICAL SERVICES STANDBY/NON-EMERGENT CALLS, AS WELL AS OUR FACILITY PRESENCE AT OTHER COMMUNITY EVENTS SUCH AS FAIRS, PARADES AND EVENTS* ASSIST COMMUNITY MEMBERS IN APPLYING FOR STATE MEDICAID ASSISTANCE AND SSDI. APPLICATIONS CAN BE CONFUSING AND THE PROCESS FRUSTRATING THUS SHERIDAN MEMORIAL OFFERS ANY HELP WITH THESE PROCESSES* SOLE COMMUNITY PROVIDER OF MOST SERVICE LINES* OFFERS VOLUNTEER OPPORTUNITIES TO COMMUNITY THROUGH ASSOCIATION AND FOUNDATION BOARD POSITIONS, HOSPICE, EMS, ACTIVITIES, BEAUTY SHOP, AND PINK LADY PROGRAM* HAS A FOUNDATION THAT SERVES AS A VEHICLE FOR ATTRACTING AND EFFECTIVELY USING DONATED FUNDS* HAS THE SUPPORT OF AN AUXILIARY THAT HOSTS EVENTS THROUGHOUT THE YEAR TO RAISE FUNDS FOR THE FACILITY 0 0 0 0 0 0 0 0 0 SIVASH SHAHBODAGHI PHYSCIAN 775099 0 17551 0 0 0 22500 0 0 0 815150 0 0 0 BRIT NYBY APP 177427 0 2342 0 0 0 5392 0 0 0 185161 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, AS CHAIRMAN, THE VICE CHAIRPERSON AND THE SECRETARY/TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH BILLINGS CLINIC. THEY PROVIDE GENERAL ACCOUNTING, HR, AND BUSINESS SUPPORT SERVICES. THE ORGANIZATION'S CURRENT CEO, KODY NELSON, IS AN EMPLOYEE OF BILLINGS CLINIC AND COMPENSATION FOR SERVICES PROVIDED TO THE HOSPITAL INCLUDE THE FOLLOWING: BASE SALARY - $137,717 BONUS - $8,263 EMPLOYER CONTRIBUTION TO RETIREMENT PLAN - $16,058 EMPLOYER CONTRIBUTION TO MEDICAL AND DENTAL - $32,827 EMPLOYER CONTRIBUTION TO LIFE INSURANCE AND LONG-TERM DISABILITY - $1,121 FORM 990, PART VI, SECTION A, LINE 6 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 788 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 788 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS DURING THE ANNUAL MEETING HELD THE FOURTH TUESDAY OF FEBRUARY EVERY YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD REVIEWS AN ELECTRONIC COPY OF THE FORM 990 BEFORE THE FINAL COPY IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND SIGNED BY ALL TRUSTEES AND THE CEO. THE BOARD AND THE CEO MONITOR THE STATUS OF ALL TRUSTEES THROUGHOUT THE YEAR FOR CHANGES THAT COULD LEAD TO A NEW SITUATION REQUIRING DISCLOSURE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND MAKES DECISIONS ON THE COMPENSATION PACKAGE FOR THE CEO. THE CEO COMPENSATION IS PART OF THE MANAGEMENT CONTRACT PAID TO BILLINGS CLINIC. ALL MANAGERS REPORT TO THE CEO AND THE CEO REVIEWS AND MAKES DECISIONS ON THE MANAGER'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,379,645. MANAGEMENT AND GENERAL EXPENSES 13,705. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,393,350. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SHERIDAN HEALTH CARE FOUNDATION INC 440 W LAUREL AVENUE PLENTYWOOD MT 59254 810496987 SUPPORT ACTIVITIES OF SHERIDAN MEMORIAL HOSPITAL ASSOCIATION MT 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0