2017-04-07T14:34:01-05:00 2016-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2015-07-01 466015787 Landmann-Jungman Memorial Hospital LAND 6055832226 600 Billars Street Scotland SD 570592026 Darcy Permann CFO 6055832226 2017-03-31 1 Laurie Hanson P00851848 6053391999 2017-03-31 X 2015 2021-01-29 14:40:06Z Darcy Permann 600 Billars Street Scotland SD 570592026 4126256 0 X www.ljmh.org X 1969 SD Operation of a community critical access hospital. 9 9 43 10 0 0 12058 28443 3960056 4092847 13868 4116 1750 850 3987732 4126256 0 0 0 0 1799918 1912576 0 0 0 2207732 2206427 4007650 4119003 -19918 7253 4062214 3753698 2596963 2285338 1465251 1468360 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 3547152 4092847 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. 3547152 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 9 0 1 43 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 0 0 1 0 0 X Darcy Permann 6055832226 600 Billars Street Scotland SD 57059 Greg Gemar President 1.00 X X 0 0 0 Kent Lehr President (until Dec 2015) 1.00 X X 0 0 0 Jerry Nelson Vice President 1.00 X X 0 0 0 Jared Schortzman Co-Secretary 1.00 X X 0 0 0 David Baker Co-Secretary 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 Charles Mogck Director 1.00 X 0 0 0 Doreen Schlechter Director 1.00 X 0 0 0 Craig Winckler Director (beg Jan 2016) 1.00 X 0 0 0 Jonathan Moe Administrator (until Dec 2015) 50.00 X 97409 0 14765 Darcy Permann CFO/Interim CEO 50.00 X 57366 0 3643 154775 0 18408 0 0 0 1 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 Management, IT, Education 792003 1 28443 28443 Net Patient Service Re 621110 3099950 3099950 Scotland Pharmacy 446110 630411 630411 Pharmacy 340b Contract 446110 235831 235831 West Winds Revenue 623990 101756 101756 Change in Avera Founda 900099 1091 1091 23808 23808 4092847 1051 1051 850 0 850 850 850 3065 0 3065 3065 3065 4126256 4092847 0 4966 X 144195 144195 1591137 1496095 95042 12024 12024 75863 50705 25158 89357 77818 11539 86335 86335 38325 38325 479744 467187 12557 7351 86 7265 202488 103308 99180 64577 64577 859 859 80796 80796 317610 317610 35693 35693 Medical Supplies 819015 819015 Continuing Education 28142 27822 320 Bad Debt 18208 18208 Community & Employee Re 2542 2542 24742 11901 12841 4119003 3547152 571851 0 640339 603026 420874 490061 183576 187863 27475 24097 6893645 4781485 2383463 2112160 334009 334021 72478 2470 4062214 3753698 411745 376898 16968 1905075 1652355 263175 256085 2596963 2285338 X 1465251 1468360 1465251 1468360 4062214 3753698 7253 -4144 0 X 0 1 X 1 0 X 36163 36163 4865281 3194222 1671059 1908899 1504565 404334 83302 82698 604 2112160 Interest in Net Assets of Avera Health Foundation 133949 F Assets Limited as to Use 200072 F 334021 Conditional Asset Retirement Obligation 74081 Damage Deposits Payable 7583 Capital Lease 104421 Estimated Third Party Payor Settlements 70000 256085 X 4103904 -4144 -18208 -22352 4126256 0 4126256 4100795 0 4100795 18208 18208 4119003 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 Debt -18,208. Part XII, Line 4b - Other Adjustments: Provision for Bad Debt 18,208. 1 1 X 1 X 1 X 1 1 0 1 1 670 670 0.00020 93248 87066 6182 0.00150 93918 87066 6852 0.00170 992877 633184 359693 0.08770 992877 633184 359693 0.08770 1086795 720250 366545 0.08940 0 18208 0 1542192 1553236 -11044 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 15 1 0 0 1 X http://www.avera.org/scotland X 1 15 1 http://www.avera.org/scotland 0 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X http://www.avera.org/scotland X See 16i narrative X http://www.avera.org/scotland X X X X X X 1 X 0 X X 1 X 0 0 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 11: Pursuant to the implementation strategy adopted by LJMH, all identified needs will be addressed. The needs identified and action plans include the following:1. Blood Pressure Screenings - LJMH nursing staff will plan to have one day set aside in the month for blood pressure screenings. Nursing staff will also continue to go to the Senior Center to offer blood pressure monitoring. The screening will also include education on nutrition, exercise and stress management, all key elements to keeping blood pressure under control. 2. Shortages of EMTs for the Ambulance - LJMH will discuss and explore requirements to become an EMT and costs associated with doing so. LJMH will explore ways to provide financial assistance to individuals that express interest in EMT training. 3. Diabetic Education Sessions - LJMH will conduct monthly diabetic education classes. The hospital will contract with a registered dietician from Avera McKennnan for input for the classes. 4. Health and Wellness Information - LJMH will utilize the local newspaper 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 16i: 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 16i: 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. 2 1 - West Winds Apartments 600 Billars Street Scotland SD 57059 Senior Living 2 - Landmann-Jungman Memorial Clinic 600 Billars Street Scotland SD 57059 Provider Based Clinic Part I, Line 3c: Please refer to Part V, Line 13 for additional factors used in determining free or discounted care eligibility.Part I, Line 6:LJMH prepares a community benefit report. The report is available to the public upon request. Part I, Line 7: Lines 7b and 7g were obtained utilizing the Medicaid and Medicare cost reports, respectively. Part I, Ln 7 Col(f): Bad debt expense of $18,208 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 amount of bad debt that may be attributable to charity care is unknown. LJMH is not confident that it could appropriately allocate any of the organization's bad debt expense to specific individuals that would be eligible for financial assistance. Part III, Line 4: The footnote that describes bad debt is on page 5 of the attached financial statements. Part III, Line 8: The entire amount of the shortfall on line 7 should be treated as community benefit. The shortfall is a direct result of sequestration enactments put in place by the federal government.The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.Medicare allowable cost of care was calculated from the Medicare cost report for the fiscal year ending 6/30/16. 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 VI, Line 2: Landmann-Jungman Memorial Hospital (LJMH) conducted a Community Health Needs Assessment during the fiscal year ended June 30, 2016. Please refer to Part V, Line 5 for more information concerning this process.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: Please refer to Part V, Line 16. 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 14,413 people, and Scotland has a population of 841 people. Of the 14,413 people residing in both counties, an average of 22.05% are 65 years old and over which is attributable to the average of 78.60% of inpatient 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 $40,208 with the median family income being $50,428. Both counties are considered medically underserved by HRSA and the SD Department of Health. Part VI, Line 5: Landmann Jungman Community 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. 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-ICU, 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. 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. X X X 0 0 0 0 0 0 0 0 0 Form 990 Part VII, Line 5 Jonathan Moe, Administrator, 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 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 11 The Interim 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. 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 91,320. Management and general expenses 1,977. Fundraising expenses 0. Total expenses 93,297. Phyisician professional fees : Program service expenses 280,418. Management and general expenses 0. Fundraising expenses 0. Total expenses 280,418. Other fees : Program service expenses 95,449. Management and general expenses 10,580. Fundraising expenses 0. Total expenses 106,029.