2022-04-13T12:33:45-05:00 2021-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2020-07-01 460226283 WAGNER COMMUNITY MEMORIAL HOSPITAL WAGN 6053843611 513 THIRD STREET SW WAGNER SD 573800280 BRYAN SLABA CEO 6053843611 2022-04-12 1 BRYAN SLABA 999009999 LAURIE HANSON CPA P00851848 6053391999 2022-04-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BRYAN SLABA 513 THIRD STREET SW WAGNER SD 573800280 20609754 0 X WWW.AVERA.ORG/WAGNERHOSPITAL/ X 1947 SD TO PROVIDE HEALTHCARE SERVICES. 7 6 88 7 0 0 193335 4628802 11189219 12447674 104370 345449 17802 16452 11504726 17438377 5190 4750 0 0 6130745 8234279 0 0 0 4824791 4849625 10960726 13088654 544000 4349723 16659661 17265038 8931796 4209880 7727865 13055158 X WAGNER COMMUNITY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE CARE AND TREATMENT OF THE SICK; PROVIDE CARE AND SUPPORT OF THE AGED, DISABLED, AND INDIGENT; AND TO PROVIDE FOR THOSE IN NEED OF HOSPITALIZATION REGARDLESS OF RACE, COLOR, CREED, OR ABILITY TO PAY. 0 0 11145327 4750 14705471 WCMH IS A 20 BED CRITICAL ACCESS HOSPITAL EQUIPPED WITH EXTENSIVE ADVANCED SERVICES, INCLUDING AREAS FOR MEDICAL/SURGICAL, PEDIATRIC, INTENSIVE/CORONARY CARE, AND SWING BED/LONG TERM CARE. THE CLINIC IS ADJACENT TO THE HOSPITAL MAKING IT CONVENIENT TO SEE HOSPITAL PATIENTS, AND SHARE LABORATORY SERVICES AND OTHER DIAGNOSTIC EQUIPMENT. OUTREACH SERVICES INCLUDE OB/GYN, PEDIATRICS, ORTHOPEDIC SURGERY, GENERAL SURGERY, UROLOGY, PODIATRY, ENT & AUDIOLOGY. THE PEOPLE OF THE COMMUNITY TRULY BELIEVE IN HAVING ACCESS TO CARE AND SUPPORT THEIR LOCAL MEDICAL PROVIDERS. THE FACILITY SERVES AS THE INPATIENT UNIT FOR THE LOCAL INDIAN HEALTH SERVICES CLINIC AND WORKS COLLABORATIVELY WITH THE IHS PHYSICIANS AND LEADERS TO CARE FOR THE NATIVE AMERICAN POPULATION. WCMH EXPERIENCED 391 INPATIENT DAYS, 641 SWING BED DAYS, 2,128 EMERGENCY DEPARTMENT VISITS, AND 2,507 CLINIC VISITS. 11145327 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 23 0 1 88 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X X LISA WEISSER 6053843611 513 3RD STREET SW WAGNER SD 573800280 X BRYAN SLABA CEO/ADMINISTRATOR 40.00 X 310184 0 25796 MIKEALA KOENIG PHYSICIAN 40.00 X 296681 0 32131 JESSICA VANDERHAM NURSE PRACTITIONER 40.00 X 198707 0 35191 JORDAN WEBER PHYSICIANS ASSISTANT 40.00 X 184910 0 23041 LINDSEY NEDVED NURSE PRACTITIONER 40.00 X 155836 0 24041 BRITTANY BARRON VP OF PATIENT SERVICES 40.00 X 168190 0 6417 DAVID KOTAB PRESIDENT 0.50 X X 0 0 0 CHAD PETERS VICE PRESIDENT 0.50 X X 0 0 0 KAREN SOULEK DIRECTOR/SECRETARY/TREASURER 0.50 X 0 0 0 MITCHEL BREEN DIRECTOR 0.50 X 0 0 0 RACHEL WOODS DIRECTOR 0.50 X 0 0 0 MICHELE JUFFER DIRECTOR 0.50 X 0 0 0 KATHE HENKE DIRECTOR 0.50 X 0 0 0 1314508 0 146617 11 0 1 1 AVERA SACRED HEART HOSPITAL 501 S SUMMIT STREET YANKTON SD 57078 MANAGEMENT, IT, SALARIES 788790 JEFFREY D PINTER MD 27952 323RD AVENUE WINNER SD 57580 PHYSICIAN ER COVERAGE 461747 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 57117 MOBILE RADIOLOGY SERVICES 244021 TERESA MARTS 946 COUNTRY CLUB RD WINNER SD 57580 PHYSICIAN COVERAGE 178969 SEES PHYSICAL THERAPY LLC 100 EVERGREEN ST AVON SD 57315 PHYSICAL THERAPY 168257 8 4535488 93314 4628802 PATIENT SERVICE FEES 621110 12243086 12243086 PHARMACY REVENUE 900099 149428 149428 55160 55160 12447674 5819 5819 16452 0 16452 16452 16452 3511007 3171377 339630 339630 339630 17438377 12447674 0 361901 X 4750 4750 373705 373705 52569 52569 6443817 5842875 600942 238592 219927 18665 671759 590162 81597 453837 395512 58325 51820 51820 1534162 1200074 334088 40984 40984 448325 362453 85872 12226 12226 149117 149117 41636 39760 1876 29019 22603 6416 150659 150659 632149 586141 46008 55239 55239 MEDICAL SUPPLIES 1251878 1251878 REPAIRS AND MAINTENANCE 281665 231269 50396 DUES AND SUBSCRIPTIONS 116 116 170630 33236 137394 13088654 11145327 1943327 0 361419 585480 2185630 2447203 152319 145128 47956 92864 14108022 8144079 4924942 5963943 8285302 6963097 434962 373674 267131 693649 16659661 17265038 719017 904774 3305055 0 3907724 3305106 1000000 0 8931796 4209880 X 7727865 13055158 7727865 13055158 16659661 17265038 4349723 977570 0 X 0 1 X 1 0 X 4247 4247 9838403 5416611 4421792 3802027 2481167 1320860 463345 246301 217044 5963943 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENTS 6963097 F 6963097 X 18415944 977567 977567 17438377 0 17438377 13088654 0 13088654 0 13088654 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. 1 1 X 1 X 1 X 1 1 1 0 0 219000 219000 0.01670 1605333 1463148 142185 0.01090 1824333 1463148 361185 0.02760 3716 3716 0.00030 3182 3182 0.00020 3408324 1492212 1916112 0.14640 3267 3267 0.00020 3418489 1492212 1926277 0.14710 5242822 2955360 2287462 0.17470 1 2 15576 15576 0.00120 1 1 265 265 0.00000 2 2 573 573 0.00000 4 5 16414 16414 0.00120 1 1257797 301871 4655995 4609897 46098 X 1 1 1 1 WAGNER COMMUNITY MEMORIAL HOSPITAL 513 3RD ST SW WAGNER SD 57380 WWW.AVERA.ORG/WAGNERHOSPITAL/ 10571 X X X X WAGNER COMMUNITY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE LINE 7D NARRATIVE X SEE LINE 7D NARRATIVE X X 1 18 1 SEE LINE 7D NARRATIVE 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X SEE 16J NARRATIVE X SEE 16J NARRATIVE X SEE 16J NARRATIVE X X X X X X X 1 X 0 X X X X 1 X 0 0 WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE WAGNER COMMUNITY MEMORIAL HOSPITAL REPRESENTATIVES REACHED OUT TO LOCAL COMMUNITY MEMBERS AND LEADERS TO DEVELOP A COMMUNITY FOCUS GROUP USED IN CONDUCTING THE MOST RECENT NEEDS ASSESSMENT. THE ORGANIZATIONS INCLUDED THE AMERICAN INDIAN POPULATION AND A FOCUS GROUP CONSISTING OF REPRESENTATIVES FROM WAGNER GOOD SAMARITAN SOCIETY, WAGNER/LAKE ANDES EMERGENCY MEDICAL SERVICES, WAGNER COMMUNITY MEMORIAL HOSPITAL BOARD MEMBERS, WAGNER INDIAN HEALTH SERVICES, YANKTON SIOUX TRIBE, WAGNER POLICE DEPARTMENT AND SDSU EXTENSION. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/ WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PURSUANT TO THE IMPLEMENTATION STRATEGY ADOPTED BY WAGNER COMMUNITY MEMORIAL HOSPITAL (WCMH), MENTAL HEALTH SERVICES, SUBSTANCE ABUSE, DIABETES, OBESITY AND VIOLENCE WERE IDENTIFIED AS COMMUNITY NEEDS. THE FACILITY ADDRESSED THE COMMUNITY NEEDS DURING THE FISCAL YEAR AS FOLLOWS.1. MENTAL HEALTH:- HIRED A BEHAVIORAL HEALTH SERVICES COUNSELOR/SUPERVISOR WHO WILL BE WORKING OUT OF WAGNER COMMUNITY CLINIC-AVERA (WCC) AND WILL MANAGE OUR BEHAVIORAL HEALTH PROGRAM IN THE COMING YEAR. THE GOAL IS TO HIRE ON AN ADDITIONAL TWO COUNSELORS IN THE COMING YEARS TO CONTINUE TO GROW OUR BEHAVIORAL HEALTH PROGRAM.-TELEHEALTH SERVICES (ETRIAGE) HAVE CONTINUED TO BE UTILIZED WITHIN WCC WITH AN INCREASE OVER THE PAST YEAR.-WCC CONTINUES TO UTILIZE A LPC-MH FROM AVERA ST. BENEDICT IN PARKSTON, SD. THE LPC-MH IS AVAILABLE FOR COUNSELING ONCE A WEEK.-WCC CONTINUES TO UTILIZE A CNP FROM AVERA ST. ANTHONY'S IN O'NEIL, NE AS A PSYCHIATRIC (MEDICATION MANAGEMENT) PROVIDER FOR OUR PATIENTS. THE CNP IS AVAILABLE FOR APPOINTMENTS ONCE A MONTH.-WCMH CONTINUES TO PROVIDE AND OFFER COORDINATION OF CRITICAL INCIDENT DEBRIEFING FOR STAFF MEMBERS OF WCMH IN ADDITION TO LOCAL EMS AT NO COST AND AS NEEDED.2. SUBSTANCE ABUSE:THE USE OF TELEMEDICINE SERVICES HAS REMAINED STEADY AS IT CONTINUES TO BE DIFFICULT TO REFER PATIENTS TO THE APPROPRIATE FACILITIES DUE TO THE ONGOING PANDEMIC AND SHORTAGE OF STAFF AT SPECIALTY FACILITIES.3. DIABETES:THE ONGOING PANDEMIC HAS IMPACTED PROGRAM DEVELOPMENT SIGNIFICANTLY. PROVIDERS AND NURSES CONTINUE TO SUPPLY EDUCATIONAL MATERIAL TO NEW AND CURRENT DIABETIC PATIENTS IN ADDITION TO PRE-DIABETIC PATIENTS. DIETICIAN REFERRALS CONTINUE TO GROW. MANY OF OUR LOCAL AREA SUB-PROGRAMS WERE CLOSED OR LIMITED DURING THE EARLY PORTION OF THE PANDEMIC. THESE PROGRAMS CONTINUE TO SLOWLY REOPEN AND CONTINUE TO PARTNER WITH WCMH AND WCC TO HELP IMPROVE OUR COMMUNITY'S HEALTH AND WELLBEING.4. OBESITY:- WCMH WILL INCREASE AWARENESS OF LOCAL EXERCISE OPPORTUNITIES WITHIN THE SURROUNDING AREA.- WCMH WILL CONTINUE TO COLLABORATE WITH THE WAGNER HEALTH AND WELLNESS CONSORTIUM TO PROMOTE AREA EXERCISE PROGRAMS- WCMH PROVIDERS WILL CONTINUE TO EDUCATE THEIR PATIENTS ON A HEALTHY DIET.DUE TO THE PANDEMIC MANY EXERCISE PROGRAMS IN THE COMMUNITY WERE CLOSED OR LIMITED, CAUSING A NEGATIVE IMPACT ON OBESITY.5. VIOLENCE:WE ARE UNFORTUNATELY UNABLE TO PROPERLY ADDRESS THIS ISSUE WITHIN THE COMMUNITY. WCMH DOES CONTINUE TO BE AN ACTIVE PART OF INCREASING AWARENESS OF VIOLENCE WITHIN THE SURROUNDING COMMUNITIES. WE CONTINUE TO KEEP OUR STAFF UP-TO-DATE WITH ANNUAL COMPETENCY TRAINING AS WELL AS ACTIVE SHOOTER TRAINING TO KEEP OUR STAFF EDUCATED ON HOW TO PROTECT OUR PATIENTS AND THEMSELVES AS WELL AS WORK WITH LOCAL LAW ENFORCEMENT IF SUCH OCCURRENCE WOULD ARISE. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL USES PRESUMPTIVE ELIGIBILITY TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF NEEDED. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16I: THE REFERENCE TO THE POLICY AND ITS LOCATION IS SENT WITH ALL STATEMENTS. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. 1 1 - WAGNER COMMUNITY CLINIC AVERA 513 3RD ST SW WAGNER SD 57380 CLINIC PART I, LINE 3C: IN ADDITION TO UTILIZING FPG TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE HOSPITAL REVIEWS INSURANCE STATUS AND USES PRESUMPTIVE ELIGIBILITY. 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. LINES 7E, 7F AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED PROVIDER-BASED CLINIC REVENUE OF $819,406 LESS EXPENSE OF $1,602,699, FOR A NET BENEFIT OF $783,293. PART II, COMMUNITY BUILDING ACTIVITIES: - THE CEO OF THE HOSPITAL IS THE CURRENT PRESIDENT OF THE ROTARY CLUB, WHICH IS MADE UP OF BUSINESS LEADERS WHO WORK WITH COMMUNITY SERVICE ORGANIZATIONS TO ENHANCE THE COMMUNITY. THE CEO IS ALSO ACTIVE IN THE CHAMBER OF COMMERCE. - THE HOSPITAL HOSTS AN 8TH GRADE CAREER FAIR FOR THE REGIONAL SCHOOLS. EIGHTH GRADERS MUST SELECT CAREER PATHWAYS FOR HIGH SCHOOL REGISTRATION. THE GOAL OF THE CAREER FAIR IS TO EXPOSE STUDENTS TO THE TECHNICAL SKILLS AND EDUCATION NEEDED TO BE SUCCESSFUL IN BUSINESS AND INDUSTRY. THE STUDENTS ARE EXPOSED TO MANY "HANDS-ON" ACTIVITIES WHICH REPRESENT THE EDUCATION NECESSARY IN EACH CAREER. THE HOSPITAL PARTNERS WITH SD DEPARTMENT OF HEALTH TO PROVIDE CAMP MED LANES, THE SDDOH'S RECRUITMENT PROGRAM GEARED TOWARD EIGTH GRADERS TO EXPOSE THEM TO CAREERS IN THE HEALTHCARE FIELD AT THE FAIR.- THE HOSPITAL ASSISTS IN ORGANIZING POINT OF DISTRIBUTION (POD) EVENTS, AS WELL AS ADMINISTERS THE INFLUENZA VACCINE TO STUDENTS AND POD VOLUNTEERS AT THE WAGNER COMMUNITY SCHOOL IN CONJUNCTION WITH CHARLES MIX POD MANAGER AS WELL AS CHARLES MIX COMMUNITY HEALTH NURSE.- STRENGTHENING OUR COMMUNITY (SOC) IS THE PROJECT AWARE ADVISORY COMMITTEE THAT IS MADE UP OF A CROSS SECTION OF COMMUNITY MEMBERS WHOSE GOAL IS TO BUILD RELATIONSHIPS AND CREATE CAPACITY TO BECOME A SELF-HEALING COMMUNITY. THE FOCUS IS ON MENTAL HEALTH WELL-BEING, AND SOC INCLUDES A JOINT EFFORT WITH SEVERAL COMMUNITY ORGANIZATIONS CONCERNED WITH THE MENTAL WELL-BEING OF OUR COMMUNITY'S YOUTH.- THE WAGNER COMMUNITY MEMORIAL HOSPITAL HAS PARTNERED WITH SEVERAL COMMUNITY ENTITIES TO FORM THE WAGNER AREA HEALTH & WELLNESS CONSORTIUM. THIS GROUP COMBINES RESOURCES TO EMPHASIZE HEALTH EDUCATION AND ACTIVITIES TO PROMOTE IMPROVED HEALTH AND WELLNESS. 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 THIS 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 2020. THEREFORE, 24% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGES 9 AND 10 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2021.MANY PATIENTS IN OUR SERVICE AREA QUALIFY FOR MEDICARE. THE FACILITY PROVIDES SERVICES TO THESE PATIENTS EVEN THOUGH MEDICARE REIMBURSEMENT IS NOT SUFFICIENT TO COVER THE COST OF PROVIDING THIS CARE. PROVIDING SERVICES TO THIS POPULATION PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE NEEDED IN OUR COMMUNITY, THEREBY PROVIDING A BENEFIT TO OUR COMMUNITY.TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICAID AND MEDICARE SERVICES. PART III, LINE 9B: THE COLLECTION PRACTICES AS SET FORTH IN THE POLICY REQUIRES THAT IF A PATIENT QUALIFIES FOR CHARITY CARE, NO BILL WILL BE SENT. INSTEAD, A LETTER INDICATING THAT THE PATIENT'S BILL HAS BEEN COMPLETELY FORGIVEN WILL BE SENT. WHEN SENDING A BILL TO ANY PATIENT, THE ORGANIZATION SHALL INCLUDE ON THE BILL A STATEMENT THAT INDICATES THAT IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR FOR FINANCIAL ASSISTANCE FROM THE ORGANIZATION FOR HELP IN PAYING FOR THE SERVICES THAT WERE PROVIDED, AND A STATEMENT THAT PROVIDES THE PATIENT WITH AN ORGANIZATION CONTACT RESOURCE FROM WHICH THE PATIENT MAY OBTAIN INFORMATION ABOUT THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS AND HOW TO APPLY FOR SUCH ASSISTANCE FOR THE PAYMENT OF SERVICES THAT WERE PROVIDED.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 A REASONABLE TIME PERIOD, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. AT SUCH TIME AS THE ORGANIZATION SENDS THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY SHALL REFLECT THE REDUCED-PAYMENT LEVEL FOR WHICH THE PAITENT WAS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS. WCMH DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES WCMH UTILIZES MAY REPORT TO THE CREDIT AGENCIES. PART VI, LINE 2: IN ADDITION TO PREPARING A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR ENDED JUNE 30, 2019, WCMH DETERMINES PATIENT NEEDS THROUGH CONSTANT COMMUNICATION WITH PATIENTS, PRIMARY AND SPECIALTY PROVIDERS, AND STATE AND FEDERAL GOVERNMENTAL HEALTH AGENCIES. WCMH STRIVES TO CONSISTENTLY INVESTIGATE, ANALYZE, AND DETERMINE THE GREATEST NEEDS OF OUR COMMUNITY. PART VI, LINE 3: AT EACH POINT OF ADMISSION, NOTICES ARE POSTED STATING WCMH OFFERS FINANCIAL ASSISTANCE WITH CONTACT INFORMATION. REFERENCE TO THE POLICY IS GIVEN TO THE PATIENT UPON ADMISSION AND AGAIN WITH THE NOTICE/STATEMENT FOR PAYMENT, INCLUDING CONTACT INFORMATION. IF THE PATIENT EXPRESSES INTEREST IN FINANCIAL ASSISTANCE, A PATIENT ADVOCATE WILL ASSIST IN COMPLETING THE PROPER APPLICATION. PART VI, LINE 4: WAGNER IS A RURAL COMMUNITY LOCATED IN SOUTHERN CHARLES MIX COUNTY IN SOUTH DAKOTA WHICH HAS MANY HEALTH DISPARITIES WITH UNMET NEEDS. IF ONE LOOKS AT SOUTHERN CHARLES MIX COUNTY, THE AVERAGE INDIVIDUAL INCOME IS $22,347 WITH THE MEDIAN FAMILY INCOME AT $50,481. THIS IS COMPARED TO THE NATIONAL AVERAGE OF $30,773 AND $58,275. SOUTHERN CHARLES MIX COUNTY HAS A FEDERAL POVERTY LEVEL OF 24% COMPARED TO 11.6% FOR SOUTH DAKOTA. COUNTY EDUCATION DEMOGRAPHICS INCLUDE 88.5% OF RESIDENTS HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 18.6% HOLDING A BACHELOR'S DEGREE OR HIGHER, COMPARED TO A NATIONAL LEVEL OF 91.7% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 28.8% HAVING A BACHELOR'S DEGREE OR HIGHER. ACCORDING TO THE US CENSUS BUREAU MOST RECENT DATA 32.7% OF SOUTHERN CHARLES MIX COUNTY ARE OF AMERICAN INDIAN DESCENT COMPARED TO 9.0% FOR SOUTH DAKOTA AND 1.3% NATIONALLY. THE WAGNER SERVICE AREA IS ALSO CONSIDERED A HEALTH PROFESSIONAL SHORTAGE AREA-LOW INCOME GEOGRAPHIC. THIS IS DUE TO ITS ACCESS TO FEW PROVIDERS AND LONG DISTANCES BETWEEN OTHER RURAL COMMUNITIES. OUR SERVICE AREA INCLUDES A COMMUNITY CLINIC IN ADDITION TO THE WAGNER INDIAN HEALTH SERVICES CLINIC AND THE VA CLINIC. MANY CLINICS PROVIDE ONLY PRIMARY CARE SERVICES AND ARE OFTEN STAFFED BY NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. IN CASES WHERE MORE SPECIALIZED CARE IS NEEDED, PATIENTS HAVE THE OPTION TO TRAVEL TO YANKTON, SOUTH DAKOTA, WHICH IS AN 110 MILE ROUND TRIP OR TRAVEL 222 MILES ROUND TRIP TO SIOUX FALLS, SOUTH DAKOTA, WHICH IS ALSO THE AREA'S TERTIARY CARE HUB FOR ALL TYPES OF SPECIALTY CARE. WE ALSO FIND CHARLES MIX COUNTY, SD IN AN AREA IN WHICH THERE IS A HIGH PERCENTAGE OF UNINSURED UNDER THE AGE OF 65. ACCORDING TO THE US CENSUS BUREAU, OUR COUNTY INCLUDES 19.3% UNINSURED AS COMPARED TO 12.2% NATIONALLY.*ALL STATISTICS FOR THIS REPORT WERE OBTAINED FROM CENSUS.GOV PART VI, LINE 5: WCMH PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES WHICH INCLUDE: COMMUNITY CPR CLASSES; BLOOD PRESSURE SCREENINGS AT AREA EVENTS; SCHOLARSHIPS TO LOCAL HIGH SCHOOL GRADUATES; DAKOTA SENIOR MEAL DELIVERY FOR LOCAL ELDERLY IN OUR COMMUNITY; OPERATING AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY EQUIPPED WITH THE LATEST TECHNOLOGY INCLUDING TELEMEDICINE.AVERA HEALTH AND WCMH 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. PART VI, LINE 6: WCMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. WCMH 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 WCMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. X X 0 0 0 0 0 0 0 0 0 BRYAN SLABA CEO/ADMINISTRATOR 307730 0 0 0 2454 0 15457 0 10631 0 336272 0 0 0 MIKEALA KOENIG PHYSICIAN 296681 0 0 0 0 0 0 0 32166 0 328847 0 0 0 JESSICA VANDERHAM NURSE PRACTITIONER 198707 0 0 0 0 0 7260 0 27967 0 233934 0 0 0 JORDAN WEBER PHYSICIANS ASSISTANT 184910 0 0 0 0 0 6434 0 16643 0 207987 0 0 0 LINDSEY NEDVED NURSE PRACTITIONER 155836 0 0 0 0 0 5577 0 18499 0 179912 0 0 0 BRITTANY BARRON VP OF PATIENT SERVICES 168190 0 0 0 0 0 5646 0 806 0 174642 0 0 0 SCHEDULE J, PART II: BRYAN SLABA, CEO/ADMINISTRATOR, WAS COMPENSATED THROUGH AN ARRANGEMENT WITH AVERA SACRED HEART HOSPITAL, 501 SUMMIT STREET, YANKTON, SD 57078 FROM JANUARY 1 THROUGH OCTOBER 3, 2020. BRYAN BECAME AN EMPLOYEE OF WAGNER COMMUNITY MEMORIAL HOSPITAL EFFECTIVE OCTOBER 4TH, 2020. JESSICA PETERS FAMILY RELATIONSHIP WITH CHAD PETERS, BOARD MEMBER 52569 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTOR MITCHEL BREEN AND DAVID KOTAB HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBER. ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION HAVING LEGAL ENTITY, WHO HAS CONTRIBUTED $25 OR MORE TO THE CORPORATION WITH REQUEST OF MEMBERSHIP AT THE TIME OF DONATION, SHALL BE A MEMBER THEREOF AND EACH MEMBER SHALL HAVE ONE VOTE AT ALL MEETINGS OF THE MEMBERS OF THE CORPORATION. MEMBERSHIP OF ANY INDIVIDUAL WHO SHALL BECOME DECEASED SHALL REVERT BY REQUEST TO THAT INDIVIDUAL'S NEXT OF KIN OR ACCORDING TO HIS WILL. ANY MEMBER WHO HAS CONTRIBUTED $50 OR MORE SHALL HAVE THE RIGHT TO TRANSFER SUCH MEMBERSHIP TO HIS OR HER SPOUSE. SAID TRANSFER TO BE APPROVED BY THE BOARD OF DIRECTORS. THE BASIS FOR MEMBERSHIP IS ON NON-REFUNDABLE CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 7A ONLY ONE CLASS OF MEMBER EXISTS. AT THE ANNUAL MEETING, MEMBERS APPROVE THE MINUTES OF THE LAST ANNUAL MEETING, ELECT BOARD MEMBERS OF THE WAGNER COMMUNITY MEMORIAL HOSPITAL, AND VOTE ON OTHER BUSINESS THAT MAY BE PROPERLY BROUGHT BEFORE THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS REQUIRE MEMBER APPROVAL. FORM 990, PART VI, SECTION A, LINE 8B WAGNER COMMUNITY MEMORIAL HOSPITAL DOES NOT HAVE COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE CEO WILL REVIEW THE 990. AFTER THE FORM 990 HAS BEEN REVIEWED, IT WILL BE FORWARDED TO THE MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND MANAGEMENT OFFICIALS ARE REQUIRED TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES WHICH ARE MONITORED AND TRACKED. THE QUESTIONNAIRES ARE REVIEWED BY THE BOARD FOR ANY POSSIBLE CONFLICTS WITH ANY NOTED CONFLICTS BEING BROUGHT TO MANAGEMENT'S ATTENTION. INQUIRIES OF CONFLICTS ARE ALSO REVIEWED AT THE MONTHLY BOARD MEETINGS. AFTER A CONFLICT IS DEEMED TO EXIST, THE BOARD DETERMINES THE LEVEL OF PARTICIPATION OF THE POTENTIAL CONFLICTING MEMBER. FORM 990, PART VI, SECTION B, LINE 15A AVERA SACRED HEART HEALTH SERVICES AND WAGNER COMMUNITY MEMORIAL HOSPITAL COMPENSATION COMMITTEE USE COMPARABILITY DATA TO DETERMINE APPROPRIATE COMPENSATION OF THE CEO BASED ON EXPERIENCE AND PERFORMANCE. THE COMPENSATION AMOUNT IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII IN ADDITION TO HIS ROLE AS CEO/ADMINISTRATOR, BRYAN SLABA HAS OVERSIGHT OF FINANCIAL OPERATIONS OF THE ENTITY. FORM 990, PART IX, LINE 11G CONTRACTED FEES: PROGRAM SERVICE EXPENSES 705,470. MANAGEMENT AND GENERAL EXPENSES 162,319. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 867,789. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 494,604. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 494,604. INFO TECHNOLOGY CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 171,769. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,769.