2024-09-26T10:32:03-05:00 2023-12-31 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2023-01-01 460219795 COMMUNITY MEMORIAL HOSPITAL INC COMM 6057752621 PO BOX 319 BURKE SD 575230319 MISTIE DREY CEO 6057752621 2024-09-25 1 1 LAURIE HANSON CPA P00851848 6053391999 2024-09-25 2023 2024-08-08 14:25:15Z MISTIE DREY PO BOX 319 BURKE SD 575230319 8061535 0 X WWW.CMHBURKE.ORG X 1945 SD PROVIDE MEDICAL SERVICES 9 8 65 9 0 0 547519 120812 7346559 7727376 27696 276644 59096 -113230 7980870 8011602 12096 12505 0 0 3413666 3800463 0 0 0 3826036 3783276 7251798 7596244 729072 415358 17327418 16848855 4460855 3564550 12866563 13284305 EXCELLENCE IN THE PROVISION OF HEALTH CARE AND RELATED SERVICES, GOVERNED AS A NOT-FOR-PROFIT COMMUNITY ORGANIZATION, SERVING THE NEEDS OF OUR PEOPLE WITH SUPERIOR QUALITY AND VALUE. 0 0 5827774 12505 7577376 COMMUNITY MEMORIAL HOSPITAL, INC., 16-BED ACUTE CARE HOSPITAL, PROMOTES HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES TO BURKE AND THE SURROUNDING RURAL COMMUNITIES. DURING 2023, COMMUNITY MEMORIAL HOSPITAL HAD 119 ADMISSIONS, 313 ACUTE PATIENT DAYS, 723 SWINGBED DAYS AND 440 VISITS TO THE EMERGENCY ROOM.COMMUNITY MEMORIAL HOSPITAL OPERATES TWO RURAL HEALTH CLINICS LOCATED IN BURKE AND BONESTEEL, SD. IN THE RURAL HEALTH CLINICS, THERE WERE 4,258 VISITS. 5827774 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 42 0 1 65 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X X MISTIE DREY 6057752621 PO BOX 319 BURKE SD 575230319 X AMY JURACEK CNP 40.00 X 133994 0 18711 BRITTNEY KORTHALS CNP 40.00 X 103769 0 29937 TYLER VAN METRE PHARMACY 40.00 X 100026 0 32008 SPENCER ARMENT CNP 40.00 X 110037 0 14252 TAMARA LYON CFO 40.00 X 64354 0 34966 THOMAS GLOVER CHAIRMAN UNTIL 05/2023 2.00 X X 0 0 0 MICHAEL KARBO VICE CHAIRMAN/CHAIRMAN FROM 05/2023 1.00 X X 0 0 0 BECKY JONES DIRECTOR/VICE CHAIRMAN FROM 05/2023 2.00 X X 0 0 0 RACHELLE NORBERG SECRETARY 1.00 X X 0 0 0 JASON MOSTERD DIRECTOR 1.00 X 0 0 0 KAREN MARTIN DIRECTOR 1.00 X 0 0 0 CLAYTON STEELE DIRECTOR 1.00 X 0 0 0 DOUG SPITZENBERGER DIRECTOR 1.00 X 0 0 0 DOUG SHEPPERD DIRECTOR 1.00 X 0 0 0 DILLON LAMBLEY DIRECTOR FROM 05/2023 1.00 X 0 0 0 MISTIE DREY CEO 40.00 X 0 0 0 512180 0 129874 4 0 1 0 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 571175074 MANAGEMENT & OTHER SERVICES 553136 JENSEN DESIGN BUILD LLC 801 QUINCE ST MITCHELL SD 57301 RESIDENTIAL HOUSE BUILD 358000 SANFORD CLINIC 1305 W 18TH ST SIOUX FALLS SD 57105 MD SERVICES 323828 WINNER PHYSICAL THERAPY 825 E 8TH ST 204 WINNER SD 57580 PT AND OT COVERAGE SERVICES 275947 GREGORY COUNTY TITLE COMPANY 742 MAIN ST BURKE SD 57523 PROPERTY PURCHASES 171005 5 38642 23172 58998 120812 PATIENT SERVICE REVENU 621110 5659397 5659397 CLINIC REVENUE 621300 1025154 1025154 PHARMACY REVENUE 456110 931917 931917 110908 110908 7727376 267644 267644 80228 39905 40323 40323 40323 9000 0 9000 9000 9000 6475 38642 10028 -3553 -3553 CREDIT LOSS ON NOTES R 900099 -150000 -150000 -150000 8011602 7577376 0 313414 X 12505 12505 99320 99320 194632 194632 2847718 2374018 473700 84134 71909 12225 349466 255464 94002 225193 182956 42237 239513 239513 5753 5753 61118 61118 1056503 971018 85485 71622 3015 68607 119396 35623 83773 145354 145354 98783 62489 36294 4687 2147 2540 10544 7068 3476 73214 55712 17502 550077 418577 131500 52210 52210 MEDICAL SUPPLIES 1155935 1145959 9976 EQUIPMENT & MAINTENANCE 85141 22543 62598 LICENSES, DUES & SUBSCR 36737 8139 28598 EMPLOYEE RECRUITMENT 4000 4000 12689 12689 7596244 5827774 1768470 0 7888240 1233141 124557 96514 1059379 884199 122500 47500 145814 184623 77911 85886 9916000 2924255 6847425 6991745 775149 6894358 21898 24282 264545 406607 17327418 16848855 628728 519650 200000 100778 99778 3214147 2927361 317202 17761 4460855 3564550 X 12836563 13264305 30000 20000 12866563 13284305 17327418 16848855 415358 2384 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 129195 129195 5689011 1469347 4219664 3231123 1236036 1995087 866671 218872 647799 6991745 LEASE LIABILITY 17761 17761 X 8013986 2384 2384 8011602 0 8011602 7596244 0 7596244 0 7596244 PART IV, LINE 2B: THE FUNDS BEING HELD ARE FROM COMMUNITY DONORS AND ARE TO BE USED TO REBUILD THE CITY OF BURKE AS A RESULT OF THE TORNADO THAT WENT THROUGH THE CITY IN AUGUST 2019. 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. GALA 45117 38642 6475 203 383 7700 1742 45117 38642 6475 203 383 7700 1742 10028 -3553 1 1 X 1 X 1 X 150.000000000000 1 1 0 0 32000 32000 0.00420 742422 638046 104376 0.01370 774422 638046 136376 0.01790 9922 6630 3292 0.00040 1461033 961208 499825 0.06580 1470955 967838 503117 0.06620 2245377 1605884 639493 0.08410 1 80096 12601 3395297 3425354 -30057 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL INC PO BOX 319 BURKE SD 57523 WWW.CMHBURKE.ORG 10530 X X X 2 RURAL HEALTH CLINICS COMMUNITY MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, LINE 7D NARRATIVE X SEE PART V, LINE 7D NARRATIVE X X 1 22 1 SEE PART V, LINE 7D NARRATIVE 0 1 X 100.000000000000 150.000000000000 X X X X X 1 1 X X X X X 1 X SEE LINE 16J NARRATIVE X SEE LINE 16J NARRATIVE X SEE LINE 16J NARRATIVE X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WAS SENT TO SEVERAL MEMBERS OF THE COMMUNITY AND WAS ALSO POSTED IN THE LOCAL PAPERS. WE WANTED TO GIVE AS MANY PEOPLE AS POSSIBLE THE OPPORTUNITY TO COMPLETE THE SURVEY AS THE MORE RESPONSES THE MORE WE CAN HELP MEET THE NEEDS OF OUR COMMUNITY MEMBERS. A FOCUS GROUP CONSISTING OF DEPARTMENT MANAGERS MET TO DISCUSS NEEDS AND PROVIDE INPUT ON HOW TO MEET SUCH NEEDS. AFTER THE SURVEYS HAD BEEN COMPILED, A STAKEHOLDERS MEETING WAS HELD VIA ZOOM THAT CONSISTED OF SEVERAL COMMUNITY MEMBERS AND BUSINESS OWNERS IN THE COMMUNITY. ALL AREAS OF INCOME AND MINORITY POPULATIONS WERE PRESENT TO INCLUDE OUR COUNTY HEALTH NURSE, LOCAL PHYSICIAN, ETC. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 7D: THE CHNA AND IMPLEMENTATION STRATEGY CAN BE FOUND AT:CMHBURKE.ORG/ABOUTSANFORDHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 11: IN THE MOST RECENT CHNA CONDUCTED THE FOLLOWING NEEDS WERE IDENTIFIED; AFFORDABLE HOUSING, TRANSPORTATION, LONG-TERM CARE, NURSING AND SENIOR HOUSING, ACCESS TO HEALTH CARE PROVIDERS (SPECIALTY), PHYSICAL ACTIVITY AND HEALTHY LIVING/WELLNESS. THE ORGANIZATION WILL NOT ADDRESS THE FOLLOWING NEEDS IDENTIFIED DUE TO THE FOLLOWING REASONS:AFFORDABLE HOUSING WAS NOT INCLUDED IN THE IMPLEMENTATION PLAN AS THE LOCAL DEVELOPMENT GROUP IS CURRENTLY ADDRESSING THE NEEDS. HOWEVER, THE HOSPITAL WORKED WITH A COMPANY TO PURCHASE A SMALL HOME THAT WAS MOVED INTO AN OPEN LOT BY THE HOSPITAL DURING 2023. TRANSPORTATION WAS NOT INDICATED AS A TOP HEALTHCARE NEED AT THIS TIME BY THE STAKEHOLDER GROUP. THE HOSPITAL OFFERS TRANSPORTATION ASSISTANCE FOR PATIENTS AS NEEDED. THERE ARE OTHER COMMUNITY GROUPS LOOKING INTO INCREASED ACCESSIBILITY INCLUDING SIDEWALKS, BIKE TRAILS, ETC.LONG-TERM CARE, NURSING HOMES, AND SENIOR LIVING - SENIOR CARE SERVICES WERE NOT INCLUDED FOR PRIORITIZATION IN THE IMPLEMENTATION PLAN. HOWEVER COMMUNITY MEMORIAL HOSPITAL ASSISTS PATIENTS AND THEIR FAMILIES IN FINDING PLACEMENT AS NEEDED, TO FIT THEIR NEEDS. IN THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS:PHYSICAL ACTIVITY & HEALTHY LIVING- COMMUNITY MEMORIAL HOSPITAL CONTINUES TO WORK TO MAKE A POSITIVE IMPACT ON IMPROVING THE HEALTH OF THE COMMUNITY MEMBERS THROUGH BOTH PHYSICAL ACTIVITY AND HEALTHY LIFESTYLE CHOICES. MEDICAL STAFF TAKE A VERY PROACTIVE APPROACH IN MANAGING THESE AREAS WITHIN OUR PATIENT POPULATION. THE HOSPITAL CURRENTLY FUNDS FITNESS CLASSES AT TWO OF THE LOCAL FITNESS CENTERS. THE FUNDING ALLOWS FITNESS CLASSES TO BE OFFERED TO THE PUBLIC AT NO COST ELIMINATING FINANCIAL DETERRENCE. PROVIDERS FOCUS ON CHRONIC DISEASE MANAGEMENT, PREVENTIVE CARE AND ENCOURAGE HEALTHY LIFESTYLES DURING VISITS. COMMUNITY MEMORIAL HOSPITAL OFFERS ANNUAL INFLUENZA CLINICS TO INCLUDE A DRIVE-THRU CLINIC FOR PATIENT CONVENIENCE. FALL AND SPRING HEALTH FAIRS ARE ALSO HELD OFFERING FREE AND REDUCED COST LAB TESTS. HEART & VASCULAR SCREENINGS ARE OFFERED ON SITE ANNUALLY AS WELL AS A LOCAL BLOOD DRIVE. THE HOSPITAL COORDINATES WITH THE LOCAL FITNESS CENTER TO HAVE A WELLNESS CHALLENGE. THE HOSPITAL HOSTED A NUTRITION WORKSHOP WITH A REGISTERED DIETICIAN TO PROVIDE EDUCATION TO THE PUBLIC. THE HOSPITAL COLLABORATED WITH THE LOCAL SCHOOL DISTRICT FOR A FUN RUN AT THE END OF THE SCHOOL YEAR. IT IS A GREAT EVENT THAT PROMOTES PHYSICAL ACTIVITY FOR BOTH CHILDREN AND ADULTS. ACCESS TO HEALTH CARE PROVIDERS- COMMUNITY MEMORIAL HOSPITAL OFFERS SERVICES LOCALLY AND THROUGH OUTREACH PROVIDERS. LABORATORY, RADIOLOGY AND EMERGENCY SERVICES ARE AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. SANFORD CARDIOLOGY IS ON SITE MONTHLY, AND SANFORD NEPHROLOGY IS ALSO AVAILABLE VIA TELE-MED MONTHLY. IT IS CHALLENGING TO INCREASE SPECIALTY SERVICES DUE TO LOCATION. THE HOSPITAL WORKED ON A MARKETING CAMPAIGN TO INCREASE AWARENESS OF THE SERVICES THAT ARE CURRENTLY PROVIDED AT THE FACILITY. SERVICES ARE POSTED IN THE LOCAL NEWSPAPER, FACEBOOK AND A QUARTERLY NEWSLETTER. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 13H: PATIENTS WHOSE FAMILY INCOME EXCEEDS 150% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE; HOWEVER, THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO COMMERCIALLY INSURED PATIENTS. A DETERMINATION BASED ON PRESUMPTIVE ELIGIBILITY MAY BE MADE IF ALL OTHER AVENUES HAVE BEEN EXHAUSTED. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 15E: THE PHONE NUMBER FOR COMMUNITY MEMORIAL HOSPITAL IS LISTED ON THE APPLICATION. THE CMH EMPLOYEE ANSWERING THE PHONE WILL DIRECT THE PATIENT TO SOMEONE WHO CAN HELP WITH THE APPLICATION. CMH ALSO OFFERS INFORMATION REGARDING OTHER ORGANIZATIONS OR GOVERNMENT AGENCIES WHICH OFFER ASSISTANCE. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 16J: LINES 16A, B, AND C: THE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE POSTED TO THE WEBSITE AT CMHBURKE.ORG/FINANCIALASSISTANCE.FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE AVAILABLE IN THE EMERGENCY DEPARTMENT AND NEAR THE ADMISSION DESK. A SIGN IS POSTED IN THE ADMISSIONS AREA TO INFORM PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE HOSPITAL PROVIDES A COPY OF THE POLICY, SUMMARY AND APPLICATION TO PATIENTS WHO MAY QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY, SUMMARY AND APPLICATION ARE ALSO LOCATED AT THE COUNTY WELFARE OFFICE. LESS THAN FIVE PERCENT OF THE POPULATION, AND FEWER THAN 1,000 INDIVIDUALS IN THE SERVICE AREA SPEAK A LANGUAGE OTHER THAN ENGLISH AS THEIR PRIMARY LANGUAGE. HOWEVER, A TRANSLATION SERVICE IS AVAILABLE IF NEEDED. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 24: THE HOSPITAL FACILITY MAY HAVE CHARGED FAP ELIGIBLE INDIVIDUALS AN AMOUNT EQUAL TO GROSS CHARGES FOR ELECTIVE SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. PART I, LINE 3C: INDIVIDUALS WILL NOT BE DENIED CHARITY CARE BASED ON RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE OR ABILITY TO PAY. STAFF TRY TO IDENTIFY ELIGIBLE INDIVIDUALS AT THE TIME OF ADMISSION, HOWEVER INDIVIDUALS CAN BECOME ELIGIBLE FOR CHARITY CARE AT ANY POINT DURING OR AFTER THEIR MEDICAL ENCOUNTER. ONCE AN INDIVIDUAL IS IDENTIFIED AS A POTENTIAL CHARITY CARE RECIPIENT, COMMUNITY MEMORIAL HOSPITAL UTILIZES BOTH AN INCOME AND AN ASSET TEST TO EVALUATE ELIGIBILITY FOR CHARITY CARE. THE HOSPITAL REVIEWS A SCHEDULE OF THE PATIENT'S CURRENT INCOME AND EXPENSES AND ASSET LEVELS TO DETERMINE IF THE PATIENT CAN REASONABLY BE EXPECTED TO MAKE PAYMENT OF MEDICAL EXPENSES. CATASTROPHIC ILLNESS AND OTHER FACTORS MAY BE CONSIDERED. A DETERMINATION BASED ON PRESUMPTIVE ELIGIBILITY MAY BE MADE IF ALL OTHER AVENUES HAVE BEEN EXHAUSTED. 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 7E WAS OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINES 7B AND 7G WAS OBTAINED FROM THE MEDICAID AND MEDICARE COST REPORTS, RESPECTIVELY.RURAL HEALTH CLINIC NET REVENUES OF $759,414 AND COSTS OF $1,157,130 WERE INCLUDED ON LINE 7G FOR A NET COMMUNITY SHORTFALL OF $397,716. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ORGANIZATION BELIEVES A SMALL AMOUNT OF THE IMPLICIT PRICE CONCESSIONS AMOUNT MAY BE ATTRIBUTABLE TO CHARITY CARE. A PERCENTAGE OF CHARITY CARE TO NET PATIENT REVENUE WAS USED TO DETERMINE THE AMOUNT OF IMPLICIT PRICE CONCESSIONS THAT MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 4: FOOTNOTE FROM FINANCIAL STATEMENTS: PLEASE SEE NOTE 1, FINANCIAL STATEMENT, PATIENT SERVICE REVENUE ON PAGES 12-13. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 12/31/2023. 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. PART III, LINE 9B: ONCE A DECISION HAS BEEN MADE GRANTING FINANCIAL ASSISTANCE AND THE PATIENT/GUARANTOR HAS BEEN NOTIFIED, CMH WILL NO LONGER ATTEMPT TO COLLECT THE DISCOUNTED AMOUNT. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT SOMEONE MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE COLLECTION PROCESS STOPS AND THE FINANCIAL ASSISTANCE APPLICATION PROCESS BEGINS. COLLECTION IS HALTED UNTIL THE FINANCIAL ASSISTANCE APPLICATION IS REVIEWED AND QUALIFICATION IS DETERMINED. APPROVED FINANCIAL ASSISTANCE REQUESTS WILL BE WRITTEN OFF WITHIN TEN DAYS FROM THE DATE APPROVED. THE DECISION TO WRITE OFF THE ACCOUNT IS PERMANENT. PART VI, LINE 2: COMMUNITY MEMORIAL HOSPITAL CONDUCTED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT DURING 2022. IN ADDITION TO CONDUCTING THE NEEDS ASSESSMENT EVERY THREE YEARS, ADMINISTRATION MEETS WITH PROVIDERS AND CLINIC MANAGERS MONTHLY AND WITH THE MEDICAL STAFF GROUP BI-MONTHLY. DURING THESE MEETINGS, TOPICS FROM PATIENT INTERACTIONS ARE DISCUSSED TO IDENTIFY ANY COMMUNITY HEALTH NEEDS. PART VI, LINE 3: INDIVIDUALS ARE MADE AWARE OF FINANCIAL ASSISTANCE THROUGH POSTING OF THE POLICY AND APPLICATION IN THE ER, CLINIC, AND ADMISSIONS OFFICE. STAFF IN THE ADMISSIONS OFFICE PROVIDE INFORMATION TO INDIVIDUALS WHO MAY QUALIFY FOR MEDICARE, MEDICAID, OR OTHER FINANCIAL ASSISTANCE.THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE ALSO AVAILABLE ON THE FACILITY WEBSITE AND AT THE COUNTY WELFARE OFFICE. PART VI, LINE 4: COMMUNITY MEMORIAL HOSPITAL SERVES SEVERAL COMMUNITIES IN SOUTH CENTRAL SOUTH DAKOTA AND NORTH CENTRAL NEBRASKA. WE SERVE A RURAL POPULATION THAT IS VERY HOMOGENEOUS IN COMPOSITION. THE AREAS SERVED ARE PRIMARILY FARMING/RANCHING AND RETIREMENT COMMUNITIES. WE HAVE A VERY LOW PERCENTAGE OF UNINSURED RESIDENTS IN OUR AREA. WE ARE LOCATED IN A FEDERAL HEALTH PROFESSIONAL SHORTAGE AREA. 60% OF THE ORGANIZATION'S REVENUE WAS FROM SERVING THE MEDICARE POPULATION, 2% WAS FROM TITLE 19, 12% FROM COMMERCIAL INSURANCE, 8% FROM GOV'T PAYERS/OTHER AND 18% SELF-PAY. PART VI, LINE 5: THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. FAMILY MEMBERS OF SOME OF THE MEMBERS OF THE GOVERNING BODY ARE EMPLOYED BY THE ORGANIZATION DUE TO THE SMALL POPULATION OF THE COMMUNITY. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. SURPLUS FUNDS, IF ANY, ARE REINVESTED FOR FACILITY AND EQUIPMENT UPGRADES, AND IMPROVING TECHNICAL SKILLS OF EMPLOYEES. COMMUNITY MEMORIAL HOSPITAL PROVIDES THE FOLLOWING TYPES OF COMMUNITY EDUCATION:A HEALTH FAIR IS PROVIDED SEMI-ANNUALLY FOR THE COMMUNITY WITH MANY DIFFERENT ASPECTS OF HEALTH CARE REPRESENTED. BLOOD DRAWS, BLOOD PRESSURES, GLUCOSE TESTING, AND DIFFERENT SCREENING TESTS ARE JUST A FEW OF THE SERVICES OFFERED BY THE HEALTH FAIR. IN ADDITION, EDUCATION FOR ALL SCHOOL AGES IS PROVIDED DURING A WEEK OF ACTIVITIES AT THE HOSPITAL. ACTIVITIES INCLUDE: TOURS OF DIFFERENT DEPARTMENTS, HAND WASHING TECHNIQUES, POISON CONTROL EDUCATION, AND A TEDDY BEAR CLINIC WHICH ENTAILS A TRIP TO THE EMERGENCY DEPARTMENT WITH THE TEDDY BEAR BEING THE PATIENT AND THE STUDENT BEING THE PARENT DESCRIBING THE COMPLAINTS. COMMUNITY MEMORIAL HOSPITAL ALSO PROVIDES CPR TRAINING TO BOTH THE STAFF AND COMMUNITY MEMBERS. DISASTER PREPAREDNESS TRAINING IS PROVIDED TO THE LOCAL FIRE DEPARTMENT. ADVANCED CARDIAC LIFE SUPPORT (ACLS) CLASSES AND TRAUMA NURSE CURRICULUM COURSES (TNCC) ARE PROVIDED TO STAFF AS WELL AS NURSES FROM SURROUNDING COMMUNITIES. COMMUNITY MEMORIAL HOSPITAL SPONSORS DIFFERENT ACTIVITIES IN THE COMMUNITY AS WELL AS PARTICIPATES IN COMMUNITY PROJECTS, INCLUDING SCHOOL YEAR BOOK, AFTER PROM PARTY, PARADES AND OTHER COMMUNITY EVENTS. A GREAT DEAL OF PRIDE IS TAKEN IN THE COMMUNITY WITH THE COMMUNITY GIVING AS MUCH TO THE HOSPITAL AS THE HOSPITAL GIVES BACK TO THE COMMUNITY. 0 0 0 0 0 0 0 0 0 AMY JURACEK CNP 118378 0 0 0 15616 0 4191 0 14521 0 152706 0 0 0 AMANDA STEFFEN FAMILY MEMBER OF MISTIE DREY, CEO 60474 WAGES AND BENEFITS 0 KIMBERLY SHEPPERD FAMILY MEMBER OF DOUG SHEPPERD, BOARD MEMBER 84495 WAGES AND BENEFITS 0 CRAIG DREY FAMILY MEMBER OF MISTIE DREY, CEO 49663 WAGES AND BENEFITS 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL INCLUDE FIVE MEMBERS ALL OF WHOM SHALL BE MEMBERS OF THE BOARD OF DIRECTORS, AND SHALL INCLUDE THE CHAIR, THE VICE CHAIR, SECRETARY, AND THE ADMINISTRATOR. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE SHALL NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, THE BYLAWS OR THE POLICIES OR EXPRESSED WISHES OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 COMMUNITY MEMORIAL HOSPITAL HAS ENTERED INTO A MANAGEMENT AGREEMENT WITH SANFORD HEALTH NETWORK TO PROVIDE MANAGEMENT SERVICES FOR THE FACILITY. THE CEO OF COMMUNITY MEMORIAL HOSPITAL IS AN EMPLOYEE OF SANFORD HEALTH NETWORK. COMPENSATION AND BENEFITS FOR MISTIE DREY WERE $166,542 AND $31,367 RESPECTIVELY. DUTIES OF THE CEO INCLUDE: SUPPORTING FACILITY OPERATIONS AND ADMINSTRATION, RECOMMENDING BUDGETS AND MANAGING RESOURCES ACCORDINGLY, AND OVERSEEING DESIGN AND DELIVERY OF QUALITY PROGRAMS, PRODUCTS, AND SERVICES. SANFORD HEALTH NETWORK REVIEWS AND DETERMINES THE CEO'S COMPENSATION ANNUALLY. COMPENSATION RANGES ARE DETERMINED USING STATE SALARY SURVEY RESULTS. THE PROCESS AND DECISION IS DOCUMENTED AND MAINTAINED INTERNALLY BY SANFORD'S VP OF ADMINISTRATION. THE BOARD OF DIRECTORS OF COMMUNITY MEMORIAL HOSPITAL, INC, APPROVES THE AMOUNT OF THE CEO'S COMPENSATION THROUGH THEIR ACCEPTANCE OF THE MANAGEMENT AGREEMENT. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY MEMORIAL HOSPITAL HAS ONE CLASS OF GENERAL MEMBERSHIP. THE GENERAL MEMBERSHIP INCLUDES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION WHO HAS CONTRIBUTED TO THE COMMUNITY MEMORIAL HOSPITAL BUILDING FUND OR CLINIC FUND AND WHO RESIDES IN THE FOUR-COUNTY AREA OF GREGORY AND TRIPP COUNTIES OF SOUTH DAKOTA AND KEYA PAHA AND BOYD COUNTIES IN NEBRASKA. THESE MEMBERSHIPS SHALL BE FOR THE LIFE OF THE CONTRIBUTOR AND ARE NOT TRANSFERABLE. IN ADDITION, ANY PATIENT OF THE HOSPITAL WHO HAS PAID THE HOSPITAL BILL IN FULL UPON DISCHARGE OR SHORTLY THEREAFTER AND WHO RESIDES IN THE PREVIOUSLY MENTIONED FOUR-COUNTY AREA SHALL BE A MEMBER OF THIS CORPORATION FOR THREE YEARS FROM THE DATE OF SAID PAYMENT IN FULL. ALSO, ALL MEMBERS OF THE LADIES AUXILIARY TO THE COMMUNITY MEMORIAL HOSPITAL, INC., OF BURKE, SOUTH DAKOTA, SHALL BE MEMBERS WITH FULL VOTING RIGHTS. PRESENT EMPLOYEES SHALL NOT BE CONSIDERED ELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A GOVERNING BOARD MEMBERS ARE ELECTED BY THE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL BY THE MEMBERS OF THE ORGANIZATION IS REQUIRED TO: ESTABLISH MISSION STATEMENT APPROVE THE SALE OF REAL PROPERTY ELECT OR REMOVE THE BOARD OF DIRECTORS APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION REVIEW THE ANNUAL REPORT AND FINANCIAL AUDIT ESTABLISH SERVICES TO MEET THE NEEDS OF THE COMMUNITY THE MEMBERS MAY DELEGATE THE ABOVE AUTHORITIES BY CONTRACT, AS THE MEMBERS DEEM NECESSARY AND APPROPRIATE. FORM 990, PART VI, SECTION A, LINE 8B THE EXECUTIVE COMMITTEE DID NOT MEET IN 2023. FORM 990, PART VI, SECTION B, LINE 11B THE CEO DOES A DETAILED REVIEW OF THE FORM 990. TWO BOARD MEMBERS ALSO PERFORM A DETAILED REVIEW OF THE 990. A COPY OF THE 990 IS DISTRIBUTED TO ALL BOARD MEMBERS PRIOR TO FILING OF THE FORM WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST DISCLOSURE IS REQUIRED TO BE COMPLETED BI-ANNUALLY AND RESPONSES ARE REVIEWED BY THE CEO. IF A CONFLICT IS DEEMED TO EXIST, THE MEMBER(S) INVOLVED IS REQUIRED TO ABSTAIN FROM DISCUSSION, DELIBERATION, AND VOTING ON THE MATTER CAUSING THE CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE DISTRIBUTED AT THE ANNUAL MEMBERSHIP MEETING, AND OTHER ITEMS ARE PROVIDED UPON REQUEST. FORM 990, PART VII: MISTIE DREY (CEO) UNDER MANAGEMENT AGREEMENT WITH SANFORD HEALTH NETWORK ACTS AS BOTH THE TOP MANAGEMENT OFFICIAL AND THE TOP FINANCIAL OFFICIAL. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 951,279. MANAGEMENT AND GENERAL EXPENSES 35,363. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 986,642. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 19,739. MANAGEMENT AND GENERAL EXPENSES 50,122. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,861.