2021-03-10T12:47:10-06:00 2020-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2019-07-01 460226283 WAGNER COMMUNITY MEMORIAL HOSPITAL WAGN 6053843611 513 THIRD STREET SW WAGNER SD 573800280 BRYAN SLABA CEO 6053843611 2021-03-08 1 LAURIE HANSON CPA P00851848 6053391999 2021-03-08 2019 2022-09-23 18:48:47Z BRYAN SLABA 513 THIRD STREET SW WAGNER SD 573800280 12257543 0 X WWW.AVERA.ORG/WAGNERHOSPITAL/ X 1947 SD TO PROVIDE HEALTHCARE SERVICES. 8 7 86 8 0 0 21370 193335 10358404 11189219 156737 104370 18902 17802 10555413 11504726 7464 5190 0 0 5124190 6130745 0 0 0 4927270 4824791 10058924 10960726 496489 544000 12488638 16659661 5423465 8931796 7065173 7727865 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 9488293 5190 11189219 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. 9488293 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 25 0 1 86 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 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 MIKEALA KOENIG PHYSICIAN 40.00 X 225513 0 29891 BRYAN SLABA CEO/ADMINISTRATOR 40.00 X 209805 0 19811 JESSICA VANDERHAM NURSE PRACTITIONER 40.00 X 141862 0 29285 LINDSEY NEDVED NURSE PRACTITIONER 40.00 X 130399 0 19586 JORDAN WEBER PHYSICIANS ASSISTANT 40.00 X 135426 0 12386 TIANNA SMITH PHYSICIAN INTERN 40.00 X 120060 0 0 DAVID KOTAB PRESIDENT 0.50 X X 0 0 0 BILL FREI VICE PRESIDENT (UNTIL SEPT 2019) 0.50 X X 0 0 0 CHAD PETERS SEC/TREAS/VICE PRESIDENT 0.50 X X 0 0 0 KAREN SOULEK DIRECTOR/SECRETARY/TREASURER 0.50 X 0 0 0 MICHELE JUFFER DIRECTOR (BEG SEPT 2019) 0.50 X 0 0 0 STEVEN COTTON DIRECTOR (UNTIL SEPT 2019) 0.50 X 0 0 0 ANN FREIER-METZGER DIRECTOR 0.50 X 0 0 0 MITCHEL BREEN DIRECTOR 0.50 X 0 0 0 RACHEL WOODS DIRECTOR 0.50 X 0 0 0 KATHE HENKE DIRECTOR (BEG DEC 2019) 0.50 X 0 0 0 963065 0 110959 7 0 1 1 AVERA SACRED HEART HOSPITAL 501 S SUMMIT STREET YANKTON SD 57078 MANAGEMENT, IT, SALARIES 766002 JEFFREY D PINTER MD 27952 323RD AVENUE WINNER SD 57580 PHYSICIAN ER COVERAGE 453149 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 57117 MOBILE RADIOLOGY SERVICES 208362 AVERA HEALTH 3900 W AVERA DR STE 301 SIOUX FALLS SD 57108 TELEMEDICINE 190405 TERESA MARTS 946 COUNTRY CLUB RD WINNER SD 57580 PHYSICIAN COVERAGE 185850 9 191310 2025 193335 PATIENT SERVICE FEES 621110 10959866 10959866 PHARMACY REVENUE 900099 174501 174501 54852 54852 11189219 7187 7187 17802 0 17802 17802 17802 850000 752817 97183 97183 97183 11504726 11189219 0 122172 X 5190 5190 241977 241977 60663 60663 4826554 4391242 435312 103289 91155 12134 560908 495012 65896 337354 297722 39632 48110 48110 1535575 1218484 317091 30922 30922 396223 323919 72304 8911 8911 149358 149358 40350 39385 965 29312 26237 3075 207686 207686 574959 528951 46008 53270 53270 MEDICAL SUPPLIES 997727 997727 BAD DEBT 384309 384309 REPAIRS AND MAINTENANCE 279168 239409 39759 88911 22933 65978 10960726 9488293 1472433 0 670458 361419 1406171 2185630 144223 152319 69445 47956 12672222 7747280 4891580 4924942 4937738 8285302 75585 434962 293438 267131 12488638 16659661 650519 719017 3305055 4679546 3907724 1000000 93400 0 5423465 8931796 X 7065173 7727865 7065173 7727865 12488638 16659661 544000 118692 0 X 0 1 X 1 0 X 4247 4247 8864022 5082201 3781821 3461701 2448032 1013669 342252 217047 125205 4924942 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENTS 8285302 F 8285302 X 11239109 118692 -384309 -265617 11504726 0 11504726 10576417 0 10576417 384309 384309 10960726 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: BAD DEBT EXPENSE -384,309. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 384,309. 1 1 X 1 X 1 X 1 1 1 0 0 299000 299000 0.02730 299000 299000 0.02730 6 20 4617 4617 0.00040 1 3 469 469 0.00000 2654363 1250132 1404231 0.12810 2 15 8490 8490 0.00080 9 38 2667939 1250132 1417807 0.12930 9 38 2966939 1250132 1716807 0.15660 1 1 393 393 0.00000 2 2 865 865 0.00010 1 400 2743 2500 243 0.00000 4 403 4001 2500 1501 0.00010 0 384309 82626 3996731 4001905 -5174 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 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, MENTAL HEALTH SERVICES, SUBSTANCE ABUSE, DIABETES, OBESITY AND VIOLENCE WERE IDENTIFIED AS COMMUNITY NEEDS. IN RESPONSE TO THE IDENTIFIED NEEDS, THE FACILITY ACCOMPLISHES THE FOLLOWING ACTIVITIES ANNUALLY:1. MENTAL HEALTH:- HOSPITAL EMPLOYEES WILL BE KNOWLEDGEABLE OF BEHAVIORAL HEALTH RESOURCES.- INCREASING UTILIZATION OF TELEMEDICINE SERVICES (EEMERGENCY AND ETRIAGE)- THE HOSPITAL WILL CONTINUE TO EMPLOY OR CONTRACT A FULL TIME OR PART TIME PSYCHIATRIC (MEDICATION MANAGEMENT) AND/OR A PSYCHOLOGIC (COUNSELING) PROVIDER.2. SUBSTANCE ABUSE:- WCMH EMPLOYEES WILL BE KNOWLEDGEABLE OF SUBSTANCE ABUSE RESOURCES AVAILABLE.- INCREASE UTILIZATION OF TELEMEDICINE SERVICES(E-ADDICTION, ETRIAGE ETC)3. DIABETES:- PROVIDE DIABETIC EDUCATION OPPORTUNITIES WITHIN THE COMMUNITY- INCREASE REFERRALS TO DIABETIC EDUCATION PROGRAMS AND RECOURSES- EDUCATE DIABETIC PATIENTS OF THE AVAILABLE GLUCOSE MONITORS IN TOWN - JAMES DRUG FOR PURCHASE OR AT INDIAN HEALTH SERVICES TO THOSE WHO QUALIFY FOR BENEFITS.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.5. VIOLENCE: - WCMH TAKES PART IN ANNUAL COMPETENCY TRAINING WHICH INCLUDES A SECTION ON VIOLENCE AND HOW TO DEAL WITH PATIENTS PRESENTING THESE ISSUES. - WCMH HAS SHARED VIOLENCE CONCERNS WITH LAW ENFORCEMENT.DURING THE CURRENT YEAR, WCMH ALSO ACCOMPLISHED THE FOLLOWING ACTIVITIES:1. MENTAL HEALTH - EMPLOYED A COUNSELOR AND CONTINUED TO EMPLOY A PART-TIME PSYCHIATRIC PROVIDER2. SUBSTANCE ABUSE - MADE STAFF AWARE OF SUBSTANCE ABUSE RESOURCES AND DECREASED TIME BETWEEN REFERRAL AND OUTPATIENT EVALUATION.3. DIABETES - DUE TO COVID-19, DIABETIC EDUCATION WAS NOT FULLY PRESENTED AS PLANNED.4. OBESITY - UTILIZED SOCIAL MEDIA TO INCREASE AWARENESS OF LOCAL EXERCISE OPPORTUNITIES WITH WAGNER HEALTH AND WELLNESS CONSORTIUM. 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. 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 $720,956 LESS EXPENSE OF $1,226,000, FOR A NET BENEFIT OF 505,044. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $384,309 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: - WCMH HOSTS AN 8TH GRADE CAREER FAIR FOR THE REGION SCHOOLS IN WHICH 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. - WCMH ADMINISTERS THE INFLUENZA VACCINE TO ELIGIBLE CHILDREN AT THE WAGNER COMMUNITY SCHOOL IN CONJUCTION WITH THE CHARLES MIX COUNTY 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 GROUPS TO FORM THE WAGNER AREA HEALTH & WELLNESS CONSORTIUM. THIS GROUP COMBINES RESOURCES TO EMPHASIZE YOUTH EDUCATION AND ACTIVITIES TO PROMOTE IMPROVED HEALTH AND WELLNESS NOW AND IN THE FUTURE. PART III, LINE 2: BAD DEBT RECOVERIES AND DISCOUNTS APPLIED DURING THE COLLECTION PROCESS ARE RARE, BUT WHEN THEY DO OCCUR THEY ARE POSTED AGAINST THE BAD DEBT ACCOUNT. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE 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 2019. THEREFORE, 21.5% 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 BAD DEBT EXPENSE IS ON PAGES 7 AND 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2020.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 OF 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 $30,773. COMPARED TO THE NATIONAL AVERAGE OF $34,103 AND $62,843. SOUTHERN CHARLES MIX COUNTY HAS A POVERTY LEVEL OF 21.5% COMPARED TO 12.8% FOR SOUTH DAKOTA. COUNTY EDUCATION DEMOGRAPHICS INCLUDE 88.5% OF RESIDENTS HAVING A HIGH SCHOOL DEGREE AND 18.6% HOLDING A BACHELOR'S DEGREE IN COMPARISON TO THE NATIONAL AVERAGE OF 88% AND 32.1%. ACCORDING TO THE US CENSUS BUREAU MOST RECENT DATA, 32.7% OF RESIDENTS IN THE COUNTY ARE OF AMERICAN INDIAN DESCENT AS 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 WITH 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 17% UNINSURED AS COMPARED TO 9.5% NATIONALLY. PART VI, LINE 5: WCMH PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES WHICH INCLUDE: COMMUNITY CPR CLASSES; BLOOD PRESSURE SCREENINGS AT AREA EVENTS; AWARD 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. AS A MANAGED FACILITY, WCMH IS ABLE TO PARTICIPATE IN AVERA E-CARE SERVICES. THESE SERVICES INCLUDE AVERA E-EMERGENCY, E-PHARMACY, E-CONSULT, E-HOSPITALIST AND ESANE. THESE SERVICES ALLOW RURAL PATIENTS TO BE CARED FOR AT THEIR LOCAL HOSPITALS, PROVIDE RURAL HOSPITALS ACCESS TO IMMEDIATE SPECIALTY CARE AND SUPPORT, AND HELP REDUCE HEALTH CARE COSTS AND TRAVEL.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 X 0 0 0 0 0 0 0 0 0 MIKEALA KOENIG PHYSICIAN 225513 0 0 0 0 0 0 0 29926 0 255439 0 0 0 BRYAN SLABA CEO/ADMINISTRATOR 207907 0 0 0 1898 0 10445 0 9703 0 229953 0 0 0 JESSICA VANDERHAM NURSE PRACTITIONER 141862 0 0 0 0 0 4534 0 24786 0 171182 0 0 0 LINDSEY NEDVED NURSE PRACTITIONER 130399 0 0 0 0 0 4095 0 15526 0 150020 0 0 0 SCHEDULE J, PART II: BRYAN SLABA, CEO/ADMINISTRATOR, IS COMPENSATED THROUGH AN ARRANGEMENT WITH AVERA SACRED HEART HOSPITAL, 501 SUMMIT STREET, YANKTON, SD 57078. JESSICA PETERS FAMILY RELATIONSHIP WITH CHAD PETERS, BOARD MEMBER 60663 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTOR MITCHEL BREEN AND DAVID KOTAB HAVE A BUSNIESS 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 762,085. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 762,085. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 456,399. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 456,399. INFO TECHNOLOGY CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 176,273. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 176,273. ADMINISTRATION CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 140,818. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,818.