2023-10-24T14:33:07-05:00 2022-12-31 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2022-01-01 460219795 COMMUNITY MEMORIAL HOSPITAL INC COMM 6057752621 PO BOX 319 BURKE SD 575230319 MISTIE DREY CEO 6057752621 2023-10-23 1 MISTIE DREY 999009999 1 LAURIE HANSON CPA P00851848 6053391999 2023-10-23 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z MISTIE DREY PO BOX 319 BURKE SD 575230319 8023221 0 X WWW.CMHBURKE.ORG X 1945 SD PROVIDE MEDICAL SERVICES 9 7 65 9 0 0 2834502 547519 7025523 7346559 44332 27696 85108 59096 9989465 7980870 19165 12096 0 0 3114765 3413666 0 0 0 3796890 3826036 6930820 7251798 3058645 729072 16272801 17327418 4300805 4460855 11971996 12866563 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 5664209 12096 7346559 COMMUNITY MEMORIAL HOSPITAL, INC., 16-BED ACUTE CARE HOSPITAL, PROMOTES HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. DURING 2022, COMMUNITY MEMORIAL HOSPITAL HAD 3,501 CLINIC VISITS IN BURKE AND 485 CLINIC VISITS IN BONESTEEL. THE HOSPITAL HAD 163 ADMISSIONS, 299 ACUTE PATIENT DAYS, 758 SWINGBED DAYS AND 445 VISITS TO THE EMERGENCY ROOM. 5664209 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 47 0 1 65 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X X TAMI LYON 6057752621 PO BOX 319 BURKE SD 575230319 X X AMY JURACEK CNP 40.00 X 139770 0 17510 BRITTNEY KORTHALS CNP 40.00 X 113278 0 28280 THOMAS GLOVER CHAIRMAN 2.00 X X 0 0 0 MICHAEL KARBO VICE CHAIRMAN 1.00 X X 0 0 0 KAREN MARTIN SEC UNTIL 03/2022; DIR BEG 04/2022 1.00 X X 0 0 0 RACHELLE NORBERG DIR UNTIL 04/2022; SEC BEG 04/2022 1.00 X X 0 0 0 JASON MOSTERD DIRECTOR 1.00 X 0 0 0 BECKY JONES 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 MISTIE DREY CEO 40.00 X 0 0 0 MEGAN SMITH MD 40.00 X 0 0 0 253048 0 45790 2 0 1 0 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 571175074 MANAGEMENT SERVICES 515547 WINNER PHYSICAL THERAPY 825 E 8TH ST 204 WINNER SD 57580 PT AND OT COVERAGE SERVICES 274167 SANFORD CLINIC 1305 W 18TH ST SIOUX FALLS SD 57105 MD SERVICES 261115 TESSIERS INC PO BOX 412007 BOSTON MA 02241 NEGATIVE AIR PRESSURE ROOMS CONSTRUCTION 238610 4 40215 500104 7200 547519 PATIENT SERVICE REVENU 621110 5419237 5419237 PHARMACY REVENUE 456110 932600 932600 CLINIC REVENUE 621300 927650 927650 67072 67072 7346559 48129 48129 75194 12116 63078 63078 63078 20433 -20433 -20433 -20433 5820 40215 9802 -3982 -3982 7980870 7346559 0 86792 X 12096 12096 191061 191061 2656435 2145005 511430 73651 61513 12138 310933 218026 92907 181586 166530 15056 232335 232335 22303 22303 57400 57400 1119693 1042676 77017 28158 3642 24516 123947 51277 72670 139711 139711 91313 69484 21829 5019 3742 1277 15600 8760 6840 80314 61114 19200 551219 419446 131773 46247 46247 MEDICAL SUPPLIES 1166864 1163326 3538 EQUIPMENT & MAINTENANCE 76203 14513 61690 LICENSES, DUES & SUBSCR 34300 8852 25448 EMPLOYEE RECRUITMENT 23146 23146 12264 12264 7251798 5664209 1587589 0 7339820 7888240 164556 124557 592509 1059379 182500 122500 156035 145814 64907 77911 9221603 2374178 6529441 6847425 766910 775149 24615 21898 451508 264545 16272801 17327418 449161 628728 148977 200000 208811 100778 3493856 3214147 0 317202 4300805 4460855 X 11931996 12836563 40000 30000 11971996 12866563 16272801 17327418 729072 2495 163000 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 58805 58805 5654427 919270 4735157 3093857 1236036 1857821 414514 218872 195642 6847425 LEASE LIABILITY 22202 THIRD PARTY PAYOR SETTLEMENT 295000 317202 X 7993167 2495 9802 12297 7980870 0 7980870 7261600 9802 9802 7251798 0 7251798 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 9,802. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 9,802. GALA 46035 40215 5820 320 155 6947 2380 46035 40215 5820 320 155 6947 2380 9802 -3982 1 1 X 1 X 1 X 150.000000000000 1 1 0 0 47000 47000 0.00650 595588 418414 177174 0.02440 642588 418414 224174 0.03090 28288 8874 19414 0.00270 1474090 940357 533733 0.07360 1502378 949231 553147 0.07630 2144966 1367645 777321 0.10720 1 138178 1087 3343498 3349843 -6345 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 THE FOLLOWING NEEDS WERE IDENTIFIED: AFFORDABLE HOUSING, TRANSPORTATION, LONG-TERM CARE, NURSING HOME AND SENIOR HOUSING, ACCESS TO HEALTH CARE PROVIDERS AND PHYSICAL ACTIVITY AND HEALTHY LIVING.THE ORGANIZATION WILL NOT ADDRESS THE FOLLOWING IDENTIFIED NEEDS FOR THE FOLLOWING REASONS: AFFORDABLE HOUSINGNOT INCLUDED IN THE IMPLEMENTATION PLAN AS THE LOCAL DEVELOPMENT GROUP IS CURRENTLY ADDRESSING THE NEED AND IN THE PROCESS OF BUILDING THEIR FIRST SPEC HOME. INFORMATION FROM THE CHNA SURVEY WILL BE SHARED WITH COMMUNITY MEMBERS AND LOCAL ORGANIZATIONS AS AFFORDABLE HOUSING SOLUTIONS ARE DISCUSSED. TRANSPORTATIONNOT INCLUDED IN THE IMPLEMENTATION PLAN AS THE STAKEHOLDER GROUP INDICATED THAT IT IS NOT A TOP HEALTH CARE NEED AT THIS TIME. 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 LIVINGSENIOR 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 INDIVIDUAL NEEDS.DUE TO TIMING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION FOR 2022, THE FACILITY WAS NOT ABLE TO FOCUS ON THE IDENTIFIED NEEDS OF ACCESS TO HEALTH CARE PROVIDERS, PHYSICAL ACTIVITY, AND HEALTHY LIVING IN 2022. HOWEVER, A PORTION OF THE IDENTIFIED NEEDS ARE A CONTINUATION FROM THE PRIOR IMPLEMENTATION STRATEGY.THE FACILITY ADDRESSED THE FOLLOWING NEEDS FROM THE PREVIOUS CHNA IMPLEMENTATION STRATEGY IN THE CURRENT TAX YEAR. MENTAL HEALTH- THE HOSPITAL WAS ONCE AGAIN A SPONSOR FOR THE ANNUAL COLORED IN HOPE AWARENESS WALK THAT IS IN RECOGNITION OF MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION. THE HOSPITAL OFFERS REDUCED RENT FOR THE LOCAL COUNSELING RESOURCES MAKING IT VIABLE IN THE COMMUNITY. STAFF ALSO HAVE A CONTINUED FOCUS ON PATIENT HEALTH QUESTIONNAIRES (PHQ9S) AND MAKING SURE THEY ARE COMPLETED ON AN ANNUAL BASIS. HEALTHCARE AND WELLNESS- THE HOSPITAL HAS AN ONGOING RELATIONSHIP WITH LOCAL FITNESS CENTERS. THE HOSPITAL FUNDS LOCAL FITNESS CLASSES ALLOWING THE PUBLIC TO ATTEND FOR FREE. THIS IS A GREAT OPPORTUNITY FOR MEMBERS OF THE COMMUNITY AND SURROUNDING COMMUNITIES. IT IS VERY POPULAR AND HAS INCREASED THE NUMBER OF INDIVIDUALS ENGAGING IN PHYSICAL ACTIVITY. THE HOSPITAL ALSO SPONSORS SPRING AND FALL HEALTH FAIRS OFFERING BLOOD DRAWS FREE OF COST. THE HOSPITAL SPONSORS AN ANNUAL BLOOD DRIVE, DRIVE THRU FLU CLINICS, AND HEART AND VASCULAR SCREENINGS. THE HOSPITAL PROVIDES EDUCATION FOR VARIOUS AWARENESS MONTHS. FOR BREAST CANCER MONTH, THE HOSPITAL HAD A FITNESS CHALLENGE AND AWARDED PRIZES EACH WEEK TO PARTICIPANTS THAT MET THEIR GOALS. THE HOSPITAL ALSO CO-SPONSORS A WELLNESS CHALLENGE WITH THE LOCAL FITNESS CENTER. 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. BUSINESS OFFICE 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 $734,948 AND COSTS OF $1,123,251 WERE INCLUDED ON LINE 7G FOR A NET COMMUNITY SHORTFALL OF $388,303. 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 12/31/2022. 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. 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. 65% OF THE ORGANIZATION'S REVENUE WAS FROM SERVING THE MEDICARE POPULATION, 6% WAS FROM TITLE 19, 18% FROM COMMERCIAL INSURANCE, 7% FROM GOVERNMENT PAYERS/OTHERS, AND 4% 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 108069 0 4357 0 27344 0 4330 0 13180 0 157280 0 0 0 AMANDA STEFFEN FAMILY MEMBER OF MISTIE DREY, CEO AND DOUG SHEPPERD, BOARD MEMBER 52027 WAGES AND BENEFITS 0 PATRICIA JONES FAMILY MEMBER OF BECKY JONES, BOARD MEMBER 54494 WAGES AND BENEFITS 0 KIMBERLY SHEPPERD FAMILY MEMBER OF DOUG SHEPPERD, BOARD MEMBER 40809 WAGES AND BENEFITS 0 CRAIG DREY FAMILY MEMBER OF MISTIE DREY, CEO 43732 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 $132,547 AND $38,412 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. THE MD OF COMMUNITY MEMORIAL HOSPITAL IS AN EMPLOYEE OF SANFORD HEALTH NETWORK. COMPENSATION AND BENEFITS FOR MEGAN SMITH WERE $239,528 AND $20,465 RESPECTIVELY. 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 2022. 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 1,020,867. MANAGEMENT AND GENERAL EXPENSES 38,150. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,059,017. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 21,809. MANAGEMENT AND GENERAL EXPENSES 38,867. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 60,676.