2018-05-10T09:51:18-05:00 2017-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2016-07-01 466015787 Landmann-Jungman Memorial Hospital LAND 6055832226 600 Billars Street Scotland SD 570592026 Melissa Gale CEO 6055832226 2018-05-03 1 Laurie Hanson P00851848 6053391999 2018-05-03 X 2016 2022-09-23 18:48:47Z Melissa Gale 600 Billars Street Scotland SD 570592026 4394509 0 X www.ljmh.org X 1969 SD Operation of a community critical access hospital. 9 9 48 12 0 0 28443 13500 4092847 4355226 4116 25083 850 700 4126256 4394509 0 0 0 0 1912576 2002390 0 0 0 2206427 2335546 4119003 4337936 7253 56573 3753698 3982815 2285338 2458037 1468360 1524778 Landmann-Jungman Memorial Hospital is committed to providing the highest quality healthcare with compassion and respect. Our commitment shall be to the ethical treatment of all people throughout the continuum of life. 0 0 3772229 4355226 Landmann-Jungman Memorial Hospital (LJMH) is a licensed critical access hospital with 25 acute care beds, of which 10 may be used as swing beds. The facility offers inpatient, outpatient and physician clinic services to residents in and around the city of Scotland, SD. Several visiting specialists spend time at LJMH conducting outreach clinics on a regular basis which include areas of cardiology, general surgery, OB/GYN, mobile MRI, CT, nuclear medicine and mammography. West Winds Apartments is also part of LJMH and serves as a 16 unit senior housing apartment building. LJMH is proud of the excellent care it provides for patients of the service area. The facility is also noted for its community service, which includes an annual health fair and bi-monthly blood drives. 3772229 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 11 0 1 48 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 X X Darcy Permann 6055832226 600 Billars Street Scotland SD 57059 Greg Gemar President 1.00 X X 0 0 0 Jerry Nelson Vice President(Until Jan 2017) 1.00 X X 0 0 0 Charles Mogck Director/VP(Began Feb 2017) 1.00 X X 0 0 0 Jared Schortzman Secretary 1.00 X X 0 0 0 David Baker Co-Secretary(Until Jan 2017) 1.00 X X 0 0 0 Carol Hofer Director 1.00 X 0 0 0 Devin Lubinus Director 1.00 X 0 0 0 Rhonda Bouza Director(Began Jan 2017) 1.00 X 0 0 0 Tanya Bult Director(Began Jan 2017) 1.00 X 0 0 0 Doreen Schlechter Director(Until Jan 2017) 1.00 X 0 0 0 Craig Winckler Director 1.00 X 0 0 0 Gary Pepper Director(Began Jan 2017) 1.00 X 0 0 0 Melissa Gale CEO (Began Nov 2016) 50.00 X 6772 0 1626 Darcy Permann CFO 50.00 X 65994 0 7771 72766 0 9397 0 0 0 1 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 Management, IT, Education 710345 1 13500 13500 Net Patient Service Re 621110 3324335 3324335 Pharmacy Revenue 446110 857738 857738 West Winds Revenue 623990 102859 102859 Change in Avera Founda 900099 16784 16784 53510 53510 4355226 6660 6660 700 0 700 700 700 18423 0 18423 18423 18423 4394509 4355226 0 25783 X 156310 156310 1664020 1588516 75504 9069 9069 78678 54243 24435 94313 83842 10471 105591 105591 37373 37373 530715 514256 16459 5735 5735 181725 93815 87910 76854 76854 3167 824 2343 78585 78585 335066 335066 33473 33473 Medical Supplies 893995 893995 Continuing Education 26027 25623 404 Bad Debt 7595 7595 Community & Employee Re 2073 2073 17572 9946 7626 4337936 3772229 565707 0 320011 553430 490061 623426 187863 166747 24097 17064 6947010 4977975 2112160 1969035 617036 653113 2470 0 3753698 3982815 376898 474161 1652355 1711336 256085 272540 2285338 2458037 X 1468360 1524778 1468360 1524778 3753698 3982815 56573 -155 0 X 0 1 X 1 0 X 36163 36163 4865281 3370538 1494743 1919444 1523140 396304 126122 84297 41825 1969035 Interest in Net Assets of Avera Health Foundation 150733 F Assets Limited as to Use 502380 F 653113 Conditional Asset Retirement Obligation 74795 Damage Deposits Payable 8583 Capital Lease 159162 Estimated Third Party Payor Settlements 30000 272540 X 4386759 -155 -7595 -7750 4394509 0 4394509 4330341 0 4330341 7595 7595 4337936 Part X, Line 2: The Hospital is organized as a South Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. 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: Provision for Bad Debts -7,595. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts 7,595. 1 1 X 1 X 1 X 1 1 0 1 1 15400 15400 0.00360 97175 73809 23366 0.00540 112575 73809 38766 0.00900 6873 575 6298 0.00150 1015086 644181 370905 0.08570 1021959 644756 377203 0.08720 1134534 718565 415969 0.09620 0 7595 1086 1625471 1635904 -10433 X 1 1 1 1 Landmann-Jungman Memorial Hospital 600 Billars Street Scotland SD 57059 www.avera.org/scotland 10561 X X X X Landmann-Jungman Memorial Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Part V, line 7d X X 1 15 1 See Part V, line 7d 0 1 X 150.000000000000 400.000000000000 X 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 1 X 0 X X X X 1 0 1 Landmann-Jungman Memorial Hospital Part V, Section B, Line 5: LJMH began the Community Health Needs Assessment by gathering the most recent statistics regarding the public health of the community from county, state and national resources. LJMH held focus groups to seek the input of the general public, key community leaders, city and county government including law enforcement, school nursing and administration, church officials, and individuals with special knowledge in public health. The Bon Homme county health nurse was also interviewed to provide input on what the needs are for the county. Landmann-Jungman Memorial Hospital Part V, Section B, Line 7d: https://www.avera.org/about/community-health-needs-assessments/ orhttps://www.avera.org/about/community-health-needs-assessments/#landmann Landmann-Jungman Memorial Hospital Part V, Section B, Line 11: The needs identified and action plans include the following:Blood Pressure Screenings - LJMH provides free blood pressure screenings on a daily basis in the clinic. LJMH nursing staff holds blood pressure screenings at an Educational booth that focuses on hypertension and heart health. This is done in conjunction with Meals on Wheels, senior citizen events, a high school basketball game, and other community happenings. The screening includes education on nutrition, exercise and stress management, all key elements to keeping blood pressure under control.Shortages of EMTs for the Ambulance - The hospital has partnered with the EMT's in the community of Scotland to provide EMT education and training for EMT staff. The staff is better educated and feels more community support. The result includes that additional EMT's have been added to the all-volunteer crew. Diabetic Education Sessions - Some diabetic education classes were provided to the community via medical providers and a contracted dietician. LJMH is working toward conducting monthly diabetic education classes. Expansion on this is scheduled to take place in 2018.Health and Wellness Information - Multiple newspaper articles on health related topics have been published in the Scotland Journal, the local newspaper. Additional health related topics for education are posted to the hospital FaceBook page.LJMH will continue to utilize the local newspaper and FaceBook to communicate health related information and upcoming health events. The staff will be provided resources to educate our community on farm safety, breast cancer, diabetes, and pharmacy program changes. The hospital's goal is to have a more informed and educated community on a variety of health related topics to improve overall health and well-being. Landmann-Jungman Memorial Hospital Part V, Section B, Line 16j: Part V, Section B, Lines 16a and 16c: The financial assistance policy and plain language summary are available at:https://www.avera.org/locations/profile/landmann-jungman-memorial-hospital-avera/Part V, Section B, Line 16b: The financial assistance application form is available at http://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/Part V, Section B, Line 16j: A notice is posted in the hospital facility's emergency rooms or waiting rooms and in the facility's admissions office alerting patients of the availability of financial assistance and instructions for obtaining a copy of the full policy. Landmann-Jungman Memorial Hospital Part V, Section B, Line 23: LJMH calculated amounts generally billed by taking the average of the three lowest paying, fully insured payors calculated annually at the most recent fiscal yearend. This method resulted in a lower amount generally billed than would have been calculated using the look-back method which is the method the hospital adopted during the fiscal year ending June 30, 2018. Landmann-Jungman Memorial Hospital Part V, Section B, Line 24: Elective services and non-emergent services are billed at gross charges. 2 1 - West Winds Apartments 1140 Washington Street Scotland SD 57059 Senior Living 2 - Scotland Pharmacy 620 Billards Street Scotland SD 57059 Retail Pharmacy Part I, Line 3c: In addition to using FPG to determine eligibility for free or discounted care, the facility also considers asset level and insurance status, and may provide presumptive care if warranted.Part I, Line 6:LJMH prepares a community benefit report. The report is available to the public upon request. 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 7b and 7g were obtained utilizing the Medicaid and Medicare cost reports, respectively. Part I, Ln 7 Col(f): Bad debt expense of $7,595 was subtracted from total operating expense. Part III, Line 2: The amount reported on line 2 represents the bad debt expense per the audited financial statements.LJMH bad debt system takes into account contractual allowances and/or discounts. If an account is written off to bad debts, payments received after the write off for that account are posted to the Bad Debt Recovery 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 2016. The 14.3% can reasonably be considered a community benefit as it would have been written off to charity care. Part III, Line 4: The footnote that describes bad debt is on page 5 and 6 of the attached financial statements. Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for fiscal year ending 6/30/17. 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. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: Financial arrangements will be made on accounts meeting financial need and having a remaining balance on their account. Arrangements may be altered according to need at the discretion of the Administrator. Part V, Lines 22-23 Limitation on Charges LJMH failed to use an allowable method under IRC 501(r)(5) in calculating amounts generally billed to patients under its financial assistance policy. LJMH had used a method that was allowable under the proposed Regulations, but failed to update its financial assistance policy in accordance with the final Regulations. The failure occurred during the fiscal year ended June 30, 2017. The failure involved two patients. On February 23, 2018, LJMH updated its financial assistance policy and procedures by adopting the limitation on charges look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that paid claims to the hospital facility during the prior 12-month period. LJMH determined the patients received a greater discount under the method utilized than they would have if the look-back method been used. Therefore, the patients were not charged more than allowed. The updated policy was posted to LJMH's website on March 23, 2018. Part VI, Line 2: Landmann-Jungman Memorial Hospital (LJMH) conducted a Community Health Needs Assessment during the fiscal year ended June 30, 2016.LJMH regularly conducts patient satisfaction surveys which can lead to information regarding needed services. Additionally, interactive questions are asked about services during health screenings. Results of the questionnaire are reported back to the officers and board. Part VI, Line 3: Patients are informed of the financial assistance/charity care policy with a document explaining the procedure. The document is at the registration desk and is given to patients at time of registration. The staff registering the patient can identify on the front end that the patient is able to pay through insurance or otherwise. If they identify on the front end that the patient needs assistance, the patient is given a financial packet to complete to see if they qualify for benefits. If there is no option for an outside assistance program, the patient is informed and encouraged to complete the application that utilizes a combination of income, assets, and expenses to determine what percentage of charity care they would qualify for. Part VI, Line 4: LJMH is located in Scotland, SD, and primarily serves the counties of Bon Homme and Hutchinson. The population of the service area is roughly 14,286 people, and Scotland has a population of 841 people. Of the 14,286 people residing in both counties, an average of 21.95% are 65 years old and over which is attributable to the average of 87% of acute and swing bed days being provided to patients 65 years old and over. If one looks at the counties as a whole, the average median household income is $49,229. Both counties are considered medically underserved by HRSA and the SD Department of Health. Both counties have uninsured patients of 13% per the 2017 County Health Rankings. Bon Homme and Hutchinson Counties are rural agriculture areas. Part VI, Line 5: Landmann Jungman Memorial Hospital is focused on serving the needs of the community. The governing body of the Hospital is made up entirely of volunteers from the community. The Hospital extends medical staff privileges to qualified physicians in its community. Excess funds are used for the improvement of patient care and facilities. The Hospital is used by the University of South Dakota for nursing clinicals, as well as by the pharmacy and HIM programs. It is open to anyone who wants to learn about careers in the health care industry.The Hospital operates an emergency room that is available to all regardless of their ability to pay. The Hospital administration is very receptive to input from the community.Avera Health and LJMH 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. We also have a fitness center so patients can maintain a healthy lifestyle. Additional information on community benefits are available in the annual community benefits report. Part VI, Line 6: LJMH is a managed facility of Avera Health. Avera Health and the Hospital work cooperatively to enhance healthcare throughout the community served by LJMH. As a managed facility, LJMH is able to participate in Avera e-CARE services. These services include Avera,e-Emergency, e-Pharmacy and e-Consult. 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.LJMH 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 LJMH 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 Melissa Gale CEO (Began Nov 2016) 6764 0 0 0 8 0 0 0 1704 0 8476 0 0 0 Form 990 Part VII, Line 5 Melissa Gale, CEO, was compensated through an arrangement with Avera McKennan, 1325 S Cliff Ave, Sioux Falls, SD 57108. Form 990, Part VI, Section A, line 1 The Executive Committee is composed of the board President and three board members. The Executive Committee shall have power to transact all regular business of the facility during the interim between the meetings of the Board of Directors, provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors and that it shall refer all matters of major importance to the Board of Directors. Form 990, Part VI, Section B, line 11b The CEO will review the 990 in detail. A copy of the 990 is given to the board members before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The conflict of interest policy applies to all board members and management. Board members are responsible for determining whether a potential conflict exists with the Administrator and board members. The Administrator is responsible for determining if there are potential conflicts of interest amongst management. The board is ultimately responsible for determining whether an actual conflict exists. Any board member with a conflict is required to abstain from voting on the matter of conflict. Form 990, Part VI, Section B, line 15a Avera McKennan and Landmann-Jungman Memorial Hospital use comparability data to determine appropriate compensation of the Administrator based on experience and performance. The compensation amount is approved annually by the Board of Directors. For other key employees Avera McKennan does a salary survey that is then approved by the Board of Directors. Form 990, Part VI, Section C, line 19 The organization makes its financial statements available to the public during its annual board meeting and upon request. The organization does not make its governing documents and conflict of interest policy available to the public. Form 990, Part IX, line 11g Temporary and contract labor : Program service expenses 102,564. Management and general expenses 0. Fundraising expenses 0. Total expenses 102,564. Phyisician professional fees : Program service expenses 292,409. Management and general expenses 0. Fundraising expenses 0. Total expenses 292,409. Other fees : Program service expenses 119,283. Management and general expenses 0. Fundraising expenses 0. Total expenses 119,283. Temporary and contract labor : Program service expenses 0. Management and general expenses 2,540. Fundraising expenses 0. Total expenses 2,540. Other fees : Program service expenses 0. Management and general expenses 13,919. Fundraising expenses 0. Total expenses 13,919.