2025-07-31T16:30:31-05:00 2024-12-31 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2024-01-01 460219795 COMMUNITY MEMORIAL HOSPITAL INC COMM 6057752621 PO BOX 319 BURKE SD 575230319 MISTIE DREY CEO 6057752621 2025-07-31 1 1 LAURIE HANSON CPA P00851848 6053391999 2025-07-31 2024 2025-03-06 01:10:19Z MISTIE DREY PO BOX 319 BURKE SD 575230319 9450218 0 X WWW.CMHBURKE.ORG X 1945 SD PROVIDE MEDICAL SERVICES 9 8 69 9 0 0 120812 63347 7727376 8535363 276644 342799 -113230 86876 8011602 9028385 12505 16539 0 0 3800463 3910220 0 0 0 3783276 4228622 7596244 8155381 415358 873004 16848855 17527105 3564550 3373444 13284305 14153661 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 6276828 16539 8568761 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 2024, COMMUNITY MEMORIAL HOSPITAL HAD 174 ADMISSIONS, 313 ACUTE PATIENT DAYS, 655 SWINGBED DAYS AND 381 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 4,435 VISITS. 6276828 1 0 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 46 0 1 69 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 MICHAEL KARBO CHAIRMAN 1.00 X X 0 0 0 REBECCA JONES VICE CHAIRMAN 1.00 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 (UNTIL MAY 2024) 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 1.00 X 0 0 0 BRADY PAVEL DIRECTOR (BEG MAY 2024) 1.00 X 0 0 0 TAMARA LYON CFO 40.00 X 71576 0 36764 MISTIE DREY CEO 40.00 X 0 0 0 MEGAN SMITH MEDICAL DIRECTOR 40.00 X 0 0 0 AMY JURACEK CNP 40.00 X 137833 0 19535 BRITTNEY KORTHALS CNP 40.00 X 107985 0 31553 TYLER VAN METRE PHARMD 40.00 X 105247 0 33181 SPENCER ARMENT CNP 40.00 X 109763 0 14424 532404 0 135457 4 0 1 0 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 571175074 MANAGEMENT & OTHER SERVICES 763110 WINNER PHYSICAL THERAPY 825 E 8TH ST 204 WINNER SD 57580 PT AND OT SERVICES 300649 SANFORD CLINIC 1305 W 18TH ST SIOUX FALLS SD 57105 MD SERVICES 134308 S&S CONSTRUCTION 221 W 6TH ST BURKE SD 57523 CONSTRUCTION REMODEL 116113 4 38108 16325 8914 63347 PATIENT SERVICE REVENU 621110 6309647 6309647 CLINIC REVENUE 621300 1081608 1081608 PHARMACY REVENUE 456110 1062914 1062914 81194 81194 8535363 364753 364753 71471 13505 57966 57966 57966 376286 398240 -21954 -21954 -21954 5600 38108 10088 -4488 -4488 33398 0 33398 33398 9028385 8568761 0 396277 X 16539 16539 108923 108923 322064 322064 2841867 2255228 586639 77760 63312 14448 329181 224443 104738 230425 181242 49183 271462 271462 8295 8295 66672 66672 1158830 1071096 87734 26686 3116 23570 127930 68942 58988 155854 155854 92520 70402 22118 4609 2706 1903 18951 8420 10531 66527 50623 15904 560367 420205 140162 61002 61002 MEDICAL SUPPLIES 1483787 1479198 4589 EQUIPMENT & MAINTENANCE 75028 29866 45162 LICENSES, DUES & SUBSCR 43207 6926 36281 EMPLOYEE RECRUITMENT 2500 2500 4395 4395 8155381 6276828 1878553 0 1233141 1441902 96514 61600 884199 1102955 47500 47500 184623 186698 85886 103467 9859997 3467246 6991745 6392751 6894358 7894460 24282 24282 406607 271490 16848855 17527105 519650 661199 99778 10253 2927361 2683888 17761 18104 3564550 3373444 X 13264305 14143661 20000 10000 13284305 14153661 16848855 17527105 X 873004 2060 -5708 X 0 1 X 1 0 X 0 1 X 44228 44228 6102162 2012338 4089824 3291242 1236036 2055206 422365 218872 203493 6392751 LEASE LIABILITY 13104 THIRD PARTY PAYOR SETTLEMENTS 5000 18104 X 9013984 2060 -8151 -6091 9020075 8310 8310 9028385 8144628 10088 10088 8134540 20841 20841 8155381 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: EXPENSES INCLUDED IN REVENUE ON FINANCIAL STATEMENTS -8,151. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -10,088. AUXILIARY INCOME 18,398. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 10,088. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES INCLUDED IN REVENUE ON FINANCIAL STATEMENTS 8,151. AUXILIARY EXPENSES 12,690. GALA 43708 38108 5600 203 1390 6963 1532 43708 38108 5600 203 1390 6963 1532 10088 -4488 1 1 X 1 X 1 X 1 1 0 0 14000 14000 0.00170 493584 465604 27980 0.00340 507584 465604 41980 0.00510 2134 2134 0.00030 1654320 998764 655556 0.08040 1656454 998764 657690 0.08070 2164038 1464368 699670 0.08580 1 120565 59695 3568793 3600342 -31549 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 150.000000000000 300.000000000000 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 DID INVEST IN A PROPERTY AND FUNDED A HOUSING PROJECT THAT WAS SUCCESSFUL AND IS CURRENTLY WORKING ON ANOTHER HOUSING PROJECT.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 - 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. AFTER THE LOCAL ASSISTED LIVING FACILITY CLOSED, THE HOSPITAL LOOKED INTO THE PURCHASE OF THE BUILDING. BASED ON THE RESULTS OF THE FINANCIAL FEASIBILITY TESTING, THE DECISION WAS MADE NOT TO MOVE FORWARD AS THERE TOO MANY RISKS AND ADDING THE ASSISTED LIVING MAY JEOPARDIZE THE FINANCIAL STABILITY OF THE HOSPITAL. IN THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS:PHYSICAL ACTIVITY & HEALTHY LIVING- COMMUNITY MEMORIAL HOSPITAL CONTINUES TO PROMOTE PHYSICAL ACTIVITY AND HEALTHY LIVING. THE HOSPITAL OFFERS TWO HEALTH FAIRS DURING THE YEAR PROVIDING FREE AND DISCOUNTED LABS. THE SPRING HEALTH FAIR INCLUDES LOCAL AGENCIES PROVIDING EDUCATION AND MATERIALS AND A FREE BREAKFAST OFFERED TO THE PUBLIC. THE HOSPITAL OFFERS DIRECT ACCESS LAB TESTING AT A REDUCED COST THROUGHOUT THE YEAR. THE HOSPITAL COLLABORATES WITH THE LOCAL FITNESS CENTERS TO OFFER FREE FITNESS CLASSES THAT ARE OPEN TO THE PUBLIC ELIMINATING ANY FINANCIAL DETERRENCE. CMH AND THE LOCAL FITNESS CENTER ALSO COLLABORATE FOR AN ANNUAL WELLNESS CHALLENGE THAT INCLUDES LAB WORK AND FITNESS CHALLENGES. MEDICAL STAFF TAKE A VERY PROACTIVE APPROACH IN MANAGING THESE AREAS WITHIN OUR PATIENT POPULATION. 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. HEART & VASCULAR SCREENINGS ARE OFFERED ON SITE ANNUALLY AS WELL AS A LOCAL BLOOD DRIVE. 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 300% 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. 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 TRACKS FINANCIAL ASSISTANCE APPLICATIONS, INCLUDING APPLICATIONS THAT ARE MAILED OR GIVEN TO PATIENTS OF WHOM ARE BELIEVED ABLE TO QUALIFY FOR THE CHARITY CARE ASSISTANCE PROGRAM. MANY OF THE APPLICATIONS ARE EITHER RETURNED WITH NOT ENOUGH INFORMATION TO MAKE A DECISION OR NOT RETURNED AT ALL. THE REPORTED AMOUNT ON PART III, LINE 3 IS THE TOTAL DUE ON PATIENT ACCOUNTS IN WHICH THE FINANCIAL ASSISTANCE APPLICATION WAS NOT RETURNED OR WAS RETURNED WITH LACK OF INFORMATION. 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 12/31/2024. 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: 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. 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. 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: COMMUNITY MEMORIAL HOSPITAL TAKES REASONABLE EFFORTS TO FULLY INFORM ALL PATIENTS AND THE PUBLIC OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING THE FOLLOWING MEANS OF COMMUNICATION:1. POSTING SIGNS IN THE EMERGENCY ROOM AND ADMISSIONS/REGISTRATION AREAS AND MAKING AVAILABLE PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION AND THE PLAIN LANGUAGE SUMMARY UPON REQUEST.2. POSTING THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION AND THE PLAIN LANGUAGE SUMMARY ON THE HOSPITAL WEBSITE AT WWW.CMHBURKE.ORG.3. PROVIDING WRITTEN NOTIFICATION ON PATIENT BILLING STATEMENTS.4. MENTIONING THE AVAILABILITY OF FINANCIAL ASSISTANCE WHEN DISCUSSING THE BILL OVER THE TELEPHONE OR IN PERSON WITH PATIENTS OR GUARANTORS. 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. 63% OF THE ORGANIZATION'S REVENUE WAS FROM SERVING THE MEDICARE POPULATION, 7% WAS FROM MEDICAID, 21% FROM COMMERCIAL INSURANCE, 6% FROM GOV'T PAYERS/OTHER AND 3% 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 122368 0 0 0 15465 0 4321 0 15797 0 157951 0 0 0 AMANDA STEFFEN FAMILY MEMBER OF MISTIE DREY, CEO 21451 WAGES AND BENEFITS 0 KIMBERLY SHEPPERD FAMILY MEMBER OF DOUG SHEPPERD, BOARD MEMBER 99237 WAGES AND BENEFITS 0 CRAIG DREY FAMILY MEMBER OF MISTIE DREY, CEO 54152 WAGES AND BENEFITS 0 TYLER VANMETRE FAMILY MEMBER OF MEGAN SMITH, KEY EMPLOYEE 147223 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 $173,494 AND $32,765 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 MEDICAL DIRECTOR IS ALSO AN EMPLOYEE OF SANFORD HEALTH NETWORK. COMPENSATION AND BENEFITS FOR MEGAN SMITH WERE $268,900 AND $34,627 RESPECITVELY. HER DUTIES INCLUDE OVERSIGHT AND MANAGEMENT OF THE MEDICAL DEPARTMENT. 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 2024. 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 IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,041,305. MANAGEMENT AND GENERAL EXPENSES 35,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,076,548. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 29,791. MANAGEMENT AND GENERAL EXPENSES 52,491. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,282. FORM 990, PART XI, LINE 9: AUXILIARY NET INCOME -5,708.