2022-05-02T16:42:57-05:00 2021-06-30 390758449 WIPFLI LLP 101 EAST FRONT STREET 301 MISSOULA MT 59802 990 2020-07-01 810243720 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION SHER 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 KODY NELSON CEO 4067653700 2022-04-21 1 KODY NELSON XXX-XX-XXXX SAM BRUNSON CPA P01696998 4067281800 2022-04-21 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KODY NELSON 440 W LAUREL AVENUE PLENTYWOOD MT 59254 17187432 0 X WWW.SHERIDANMEMORIAL.NET X 1920 MT PROVIDE QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE. 7 7 194 37 0 0 1386366 3302318 13322593 13798538 -17802 64576 70667 22000 14761824 17187432 0 0 0 0 7584919 8063200 0 0 42921 6161207 6409409 13746126 14472609 1015698 2714823 11785850 12705710 6829603 5034640 4956247 7671070 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 11508036 13798538 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION OPERATES A 19-BED CRITICAL ACCESS HOSPITAL, A 45-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 3,400 RESIDENTS. HIGHLIGHTS OF THE ORGANIZATION'S ACCOMPLISHMENTS DURING FY21 ARE INCLUDED BELOW:THE CRITICAL ACCESS HOSPITAL IS WORKING WITH ARCHITECTS TO DISCUSS AND GENERATE A MASTER PLAN TO MOVE UP THE CT/LAB REMODEL. THE REMODEL WILL HELP WITH THE STAFF WORKFLOW AS WELL AS IMPROVING PATIENT CARE. THE EMERGENCY MEDICAL SERVICES DEPARTMENT MADE SEVERAL PURCHASES DURING THE YEAR TO IMPROVE PATIENT CARE AND/OR PROCESSES, INCLUDING TWO NI02 PAIN MANAGEMENT DELIVERY SYSTEMS AND A ZOLL X-SERIES MONITOR. ALL DEPARTMENTS OF SMHA TOOK NECESSARY PRECAUTIONS AND ADJUSTED WORKFLOWS TO MITIGATE THE RISKS PRESENTED BY COVID-19. SMHA CONDUCTED SEVERAL SURVEYS AND NO DEFICIENCIES WERE NOTED IN RELATION TO THE ORGANIZATION'S RESPONSE TO COVID-19.VOLUME INDICATORS FOR THE FISCAL YEAR ARE AS FOLLOWS: ACUTE CARE INPATIENT ADMISSIONS - 103ED VISITS - 839SWING BED PATIENTS - 75LONG-TERM CARE ADMISSIONS - 12HOME CARE VISITS - 2,082HOSPICE - 125CLINIC VISITS - 7,994 11508036 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 1 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 194 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 4067653702 440 WEST LAUREL AVENUE PLENTYWOOD MT 59254 X DON BENSON CHAIR 1.00 X X 0 0 0 MYRNETTE MILLER VICE CHAIR 1.00 X X 0 0 0 JOAN TOMMERUP SECRETARY 1.00 X X 0 0 0 NANCY JENSEN DIRECTOR 1.00 X 0 0 0 BEV JOHNSON DIRECTOR 1.00 X 0 0 0 PAUL HANSON DIRECTOR 1.00 X 0 0 0 CORY SAMUELSON DIRECTOR 1.00 X 0 0 0 JED WALKER DIRECTOR (THRU 2/2021) 1.00 X 0 0 0 JAKE FLADAGER DIRECTOR (THRU 2/2021) 1.00 X 0 0 0 JOHN OSSE INTERIM CEO (THRU 9/2020) 40.00 X 0 0 0 KODY NELSON CEO 40.00 X 0 0 0 ADAM GRAHAM PA 40.00 X 285861 0 8416 MARTHA LAUSTER MD 40.00 X 262450 0 7715 LYNNE GRAHAM PA 40.00 X 128631 0 8416 CARLOS TREVINO MD 10.00 X 126641 0 343 ARCHANA KAYASTHA FNP 40.00 X 123875 0 8416 927458 0 33306 9 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MANAGEMENT COMPANY 760729 DAKOTA DRUG PO BOX 877 ANOKA MN 55303 PHARMACEUTICALS 287574 BADLANDS 804 2ND ST PO BOX 133 UNDERWOOD ND 58576 TRAVEL STAFFING 188178 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 EMR 185625 MONTANA HOSPITAL NETWORK 519 PLEASANT ST MILES CITY MT 59301 STAFFING AND EDUCATION 185420 17 105910 3104746 91662 3302318 PATIENT SERVICE REVENUE 621990 12629885 12629885 OTHER OPERATING REVENUE 900099 673896 673896 340B REVENUE 621990 301416 301416 CONTRACT REVENUE 621990 193341 193341 13798538 9575 9575 22000 0 22000 22000 22000 55001 0 55001 55001 55001 17187432 13798538 0 86576 X 6704510 6704510 881808 881808 476882 476882 12323 12323 42392 42392 2641050 2620850 20200 28876 28876 303703 303703 4871 4871 68270 68270 41822 40772 1050 622225 392356 229869 142807 142807 SUPPLIES 1288685 1288685 BAD DEBT 376915 376915 REPAIRS AND MAINTENANCE 294846 294846 BED TAX 286161 286161 254463 241468 12995 14472609 11508036 2921652 42921 2564011 2747692 4392823 2566106 1333164 1646626 268673 257152 172226 192426 19828795 15409411 2603871 4419384 91437 91446 28125 0 331520 784878 11785850 12705710 1801569 3071571 4047626 942880 711741 675291 268667 344898 6829603 5034640 X 4953047 7667870 3200 3200 4956247 7671070 11785850 12705710 2714823 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104263 104263 104263 104263 104286 -143 120 104263 103996 143 147 104286 113984 237 10225 103996 1.00000 0 1 1 384756 384756 10617575 9306797 1310778 7938143 6102614 1835529 888321 888321 4419384 COST REPORT SETTLEMENT RECEIVABLE 552941 OTHER RECEIVABLES 94200 GUARANTEE OF PATIENT LOANS 137737 784878 GUARANTEE OF PATIENT LOANS 137737 BED TAXES PAYABLE 85877 OTHER PAYABLES 235 RIGHT OF USE LEASE 121049 344898 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 2017 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 X 1 X 1 X 1 1 0 0 298963 298963 0.02070 1652776 1652776 0.11420 1951739 1951739 0.13490 22342 22342 0.00150 85450 1258 84192 0.00580 480 480 0.00000 108272 1258 107014 0.00730 2060011 1258 2058753 0.14220 1 333778 5480936 5472192 8744 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 18 1 0 0 1 X WWW.SHERIDANMEMORIAL.NET X WWW.FACEBOOK.COM/SHERIDAN.MEMORIAL X X 1 18 1 WWW.SHERIDANMEMORIAL.NET 0 1 X 100.000000000000 400.000000000000 X 1 1 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 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. WE ALSO HAD 237 MEMBERS OF SHERIDAN COUNTY RESPOND TO OUR ONLINE SURVEY. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED INDEPENDENTLY OF OTHER ORGANIZATIONS THIS TIME, BUT SEVERAL ORGANIZATIONS WERE MADE AWARE THAT THE SURVEY BEING SENT TO THE COMMUNITY AND THAT WE WERE PREPARING AN IMPLEMENTATION PLAN TO ADDRESS ISSUES THAT WERE BROUGHT TO OUR ATTENTION. WE REACHED OUT TO SEVERAL ORGANIZATIONS DIRECTLY TO GET THEIR FEEDBACK, SOME OF WHICH WERE THE FOLLOWING: LA CASA, PIONEER MANOR, SHERIDAN COUNTY SHERIFF OFFICE, AND SHERIDAN COUNTY COMMISSIONERS. 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. IN ADDITION, ADVERTISEMENTS WERE PLACED IN THE GREETER AND SHERIDAN COUNTY NEWS (BOTH WEEKLY PRINT MEDIA). SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: IN FY21, WE MAINTAINED OUR FOCUS. WITH COVID PROTOCALS STILL IN PLACE IT WAS CHALLENGING TO MOVE FORWARD ON SO MUCH. BUT WE CONTINUED TO ENSURE ACCESS AND AVAILABLITY OF SERVICES TO THE COMMUNITY. SEVERAL NEEDS AND/OR WANTS WERE BROUGHT UP THROUGH THE SURVEY CONDUCTED IN MARCH/APRIL 2019. FROM THOSE ANSWERS, WE TOOK THE TOP CONCERNS THAT WE KNEW OUR FACILITY COULD DO SOMETHING ABOUT. THE FOLLOWING GOALS WERE CHOSEN DUE TO THE SURVEY RESULTS: 1. IMPROVE PATIENT ACCESS TO CARE & IMPROVE CONTINUITY OF CARE - 38% STATED THEY HAVE NO ACCESS TO LOCAL HEALTH CARE/PHYSICIANS/DOCTORS/PROVIDERS, WITH OTHERS BACKING UP THE ISSUE THAT THERE WAS TOO LONG OF A WAIT TO SEE THE PROVIDER. THE GOAL OF IMPROVING PATIENT ACCESS TO CARE WILL ALSO IMPROVE THE CONTINUITY OF CARE. 2. IMPROVE SERVICE AWARENESS THIS CONCERN WAS BROUGHT UP AS 48% OF SURVEYORS RESPONDED THAT WE NEED SPECIALTY PHYSICIANS. SHERIDAN MEMORIAL CURRENTLY OFFERS TELEHEALTH SERVICES FOR SPECIALTY SERVICES AND IT IS IMPORTANT TO LET THE COMMUNITY KNOW OF THOSE SERVICES, SO THEY DON'T HAVE TO TRAVEL. 3. IMPROVE POPULATION HEALTH OF THE COMMUNITY - IN CORRELATION TO OUR GOAL TO IMPROVE SERVICE AWARENESS IS OUR GOAL TO IMPROVE POPULATION HEALTH. MANY AREN'T AWARE OF THE SERVICES OFFERED LOCALLY, THUS WE SET GOALS TO IMPLEMENT A COMMUNITY HEALTH COALITION. 4. IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES - 53% OF SURVEYORS STATED THAT MENTAL HEALTH SERVICES ARE NEEDED TO IMPROVE THE HEALTH OF THEIR FAMILY AND NEIGHBORS. THIS IS ALSO WHY THE COMMUNITY HEALTH COALITION WAS SET AS A GOAL IN ADDITION IMPROVING ACCESS TO MENTAL/BEHAVIORAL HEALTH SERVICES IN SHERIDAN COUNTY. 5. IMPROVE SUBSTANCE ABUSE OUTREACH AND EDUCATION - 52% STATED THAT SUBSTANCE ABUSE OUTREACH AND EDUCATION, INCLUDING DRUG AND ALCOHOL EDUCATION/INFORMATION SERVICES, ARE NEEDED IN OUR COMMUNITY. THEREFORE, WE SET A GOAL TO IMPROVE THAT OUTREACH. MANY OF THESE GOALS INTERTWINE WITH EACH OTHER, SUCH AS OFFERING ADDITIONAL SERVICES VIA TELE-MED AND MAKING THE COMMUNITY AWARE OF SERVICES OFFERED NOT ONLY AT SHERIDAN MEMORIAL, BUT ALSO AT THE COUNTY/REGIONAL LEVEL. OTHER CONCERNS BROUGHT UP THROUGH THE SURVEY PROCESS MAY INADVERTENTLY BE ADDRESSED THROUGH THE LISTED GOALS, BUT NOT ALL COULD BE ADDRESSED AS WE NEED TO SET GOALS THAT ARE OBTAINABLE AND THAT CAN SHOW REAL RESULTS. 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. PART V, SECTION B, LINE 20D THERE IS A 90-DAY PERIOD OF ELIGIBILITY FOLLOWING INITIAL QUALIFICATION. 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 10 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. DUE TO THE COVID-19 PANDEMIC, NOT MUCH ADDITIONAL WORK WAS DONE BUT WE STAYED INVOLVED WITH OTHER ORGANIZATIONS AS MUCH AS POSSIBLE AND ARE ALWAYS OPEN TO FEEDBACK FROM OTHER ORGANIZATIONS AS WELL AS INDIVIDUAL PATIENTS. 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. THIS PACKET INCLUDES ALL PAYMENT OPTIONS, MEDICAID INFORMATION AND 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 3,483 (BASED ON THE 2019 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. THE BOARD OF DIRECTORS IS MADE UP OF 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: * ALZHEIMER'S SUPPORT GROUP* GRIEF COUNSELOR* USE OF TELE-MED EQUIPMENT IS OPEN TO THE COMMUNITY FOR MENTAL HEALTH VISITS, BEHAVIORAL HEALTH CLASSES, MIP CLASSES, COMMUNITY GENERAL HEALTH EDUCATION AS WELL AS LIFESTYLE BALANCE CLASSES. CONTINUING EDUCATION OPPORTUNITIES ARE ALSO AVAILABLE VIA TELE-VIDEO FOR EMPLOYEES AND OTHER MEDICAL PERSONNEL OUTSIDE OF SHERIDAN MEMORIAL. ALL OF THE TELE-VIDEO OPPORTUNITIES ARE FREE OF CHARGE* 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, AND COUNTY HEALTH* 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 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* EMERGENCY STANDBY COVERAGE FOR COMMUNITY EVENTS AT NO COST TO THE COMMUNITY 0 0 0 0 0 0 0 0 0 ADAM GRAHAM PA 285789 0 72 0 0 0 0 0 8416 0 294277 0 0 0 MARTHA LAUSTER MD 252450 0 10000 0 0 0 0 0 7715 0 270165 0 0 0 JOHN OSSE MR. OSSE IS SHERIDAN MEMORIAL HOSPITAL ASSOCIATION'S INTERIM CEO. 0 MR. OSSE IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CEO FROM BILLINGS CLINIC, INC. 0 KODY NELSON MR. NELSON IS SHERIDAN MEMORIAL HOSPITAL ASSOCIATION'S CEO. 0 MR. NELSON IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CEO FROM BILLINGS CLINIC, INC. 0 FORM 990, PART VI, SECTION A, LINE 1 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. KODY NELSON, CEO, IS AN EMPLOYEE OF BILLINGS CLINIC AND IS COMPENSATED BY BILLING CLINIC. FORM 990, PART VI, SECTION A, LINE 6 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 801 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 801 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS DURING THE ANNUAL MEETING HELD THE THIRD 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 2,620,850. MANAGEMENT AND GENERAL EXPENSES 20,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,641,050. 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