2026-07-30T08:17:45-05:00 2025-12-31 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2025-01-01 460219795 COMMUNITY MEMORIAL HOSPITAL INC COMM 6057752621 PO BOX 319 BURKE SD 575230319 MISTIE DREY CEO 6057752621 2026-07-29 1 LAURIE HANSON CPA P00851848 6053391999 2026-07-23 2025 2025-03-06 01:10:19Z MISTIE DREY PO BOX 319 BURKE SD 575230319 10153397 0 X WWW.CMHBURKE.ORG X 1945 SD PROVIDE MEDICAL SERVICES 9 7 71 11 0 0 63347 105102 8535363 9541738 342799 379063 86876 93858 9028385 10119761 16539 14361 0 0 3910220 4138259 0 0 0 4228622 4472267 8155381 8624887 873004 1494874 17527105 18860861 3373444 3218349 14153661 15642512 DEDICTED TO DELIVERING HIGH-QUALITY, TRUSTED, LOCAL CARE. 0 0 6646264 14361 9588091 COMMUNITY MEMORIAL HOSPITAL, INC. (CMH) IS A CRITICAL ACCESS HOSPITAL RECEIVING THIS DESIGNATION IN 1998. CMH IS A 16-BED FACILITY PROVIDING INPATIENT, OUTPATIENT, 24-HOUR EMERGENCY ROOM, ANCILLARY & OUTREACH SERVICES TO BURKE AND SURROUNDING RURAL COMMUNITIES. DURING FY2025, COMMUNITY MEMORIAL HOSPITAL HAD 132 ADMISSIONS, 224 INPATIENT DAYS, 620 SWINGBED DAYS AND 420 EMERGENCY ROOM VISITS.COMMUNITY MEMORIAL HOSPITAL OPERATES TWO RURAL HEALTH CLINICS LOCATED IN BURKE AND BONESTEEL, SD. THE BURKE CLINIC SAW 3,724 PATIENTS & BONESTEEL CLINIC SAW 523 PATIENTS FOR A TOTAL OF 4,247 PATIENTS DURING 2025. 6646264 1 1 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 45 0 1 71 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 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 (UNTIL MAY 2025) 1.00 X 0 0 0 LISA JURAN DIRECTOR (BEG MAY 2025) 1.00 X 0 0 0 DOUG SPITZENBERGER DIRECTOR (UNTIL MAY 2025) 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 1.00 X 0 0 0 SHARON VOGT DIRECTOR (BEG MAY 2025) 1.00 X 0 0 0 TAMARA LYON CFO 40.00 X 78915 0 40990 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 144063 0 21391 BRITTNEY KORTHALS CNP 40.00 X 114139 0 36041 TYLER VAN METRE PHARMD 40.00 X 111181 0 37116 TAMMI HOTZ DON 40.00 X 103074 0 20382 551372 0 155920 4 0 1 0 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 571175074 MANAGEMENT & OTHER SERVICES 943469 WINNER PHYSICAL THERAPY 825 E 8TH ST 204 WINNER SD 57580 PT AND OT SERVICES 289547 SOUTH DAKOTA HOUSING DEVELOPMENT AUTHORI PO BOX 1237 PIERRE SD 57501 CONSTRUCTION 172150 3 41337 37832 25933 105102 PATIENT SERVICE REVENUE 621110 6945348 6945348 PHARMACY REVENUE 456110 1267843 1267843 CLINIC REVENUE 621300 1228217 1228217 100330 100330 9541738 385442 385442 69282 13868 55414 55414 55414 6379 -6379 -6379 -6379 5480 41337 13389 -7909 -7909 46353 0 46353 46353 10119761 9588091 0 426568 X 14361 14361 120498 120498 308973 308973 3031609 2420951 610658 80135 64766 15369 353481 245544 107937 243563 192020 51543 259950 259950 18730 18730 94989 94989 1240937 1177521 63416 24668 3497 21171 119143 53811 65332 187528 187528 92202 69371 22831 3572 2583 989 10572 5636 4936 61799 46496 15303 581827 437755 144072 63293 63293 MEDICAL SUPPLIES 1565220 1561512 3708 EQUIPMENT & MAINTENANCE 78204 26773 51431 LICENSES, DUES & SUBSCR 41842 10607 31235 EMPLOYEE RECRUITMENT 4087 4087 23704 23704 8624887 6646264 1978623 0 1441902 1796865 61600 26600 1102955 988448 47500 0 186698 230677 103467 102979 10378802 3973715 6392751 6405087 7894460 8991491 24282 29872 271490 288842 17527105 18860861 661199 668502 10253 29439 2683888 2505687 18104 14721 3373444 3218349 X 14143661 15642512 10000 0 14153661 15642512 17527105 18860861 X 1494874 3984 -10007 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 44228 44228 6578810 1599837 4978973 3360052 2026543 1333509 395712 347335 48377 6405087 LEASE LIABILITY 8221 THIRD PARTY PAYOR SETTLEMENTS 6500 14721 X 10115781 3984 3984 10111797 7964 7964 10119761 8626930 13389 13389 8613541 11346 11346 8624887 PART IV, LINE 2B: CMH ACTS AS A FISCAL AGENT FOR A FUND ESTABLISHED FOR REBUILDING THE CITY OF BURKE FOLLOWING A TORNADO IN THE CITY IN AUGUST 2019. REMAINING FUNDS HELD ARE TO BE USED AS DETERMINED BY THE BOARD OF DIRECTORS OF THE FUND. 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 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -13,389. AUXILIARY INCOME 21,353. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 13,389. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 11,346. GALA 46817 41337 5480 2906 534 7239 2710 46817 41337 5480 2906 534 7239 2710 13389 -7909 1 1 X 1 X 1 X 1 1 1 0 0 92000 92000 0.01070 580194 554330 25864 0.00300 672194 554330 117864 0.01370 18754 4605 14149 0.00160 786363 463863 322500 0.03740 805117 468468 336649 0.03900 1477311 1022798 454513 0.05270 1 35970 19034 3763987 3808532 -44545 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 25 1 0 0 1 X SEE PART V, LINE 7D NARRATIVE X X 1 25 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: INPUT WAS TAKEN FROM VARIOUS INDIVIDUALS AND COMMUNITY GROUPS. COMMUNITY MEMBERS WERE ASKED TO COMPLETE A SURVEY THAT WAS OPEN FOR SEVERAL MONTHS. ADMINISTRATION MET WITH LOCAL COMMUNITY GROUPS AND ALSO ATTENDED A LOCAL CITY COUNCIL MEETING TO GET INPUT FROM COMMUNITY MEMBERS. ALL AREAS OF INCOME AND MINORITY POPULATIONS WERE PRESENT. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 7D: THE CHNA AND IMPLEMENTATION STRATEGY CAN BE FOUND AT CMHBURKE.ORG/ABOUT COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 11: IN THE 2025 CHNA, THE FOLLOWING NEEDS WERE IDENTIFIED: ACCESS TO HEALTH CARE PROVIDERS, ACCESS TO AFFORDABLE HEALTH CARE, HEALTHY LIVING, MENTAL HEALTH, PUBLIC TRANSPORTATION, LONG-TERM SENIOR LIVING AND AFFORDABLE HOUSING.THE ORGANIZATION WILL NOT ADDRESS THE FOLLOWING NEEDS DUE TO THE FOLLOWING REASONS:PUBLIC TRANSPORTATION IS NOT INCLUDED IN THE IMPLEMENTATION PLAN AS THE STAKEHOLDER GROUP INDICATED THAT IT IS NOT A TOP HEALTH CARE NEED AT THIS TIME. THE HOSPITAL OFFERS TRANSPORTATION ASSISTANCE FOR PATIENTS AS NEEDED. THERE ARE OTHER COMMUNITY GROUPS LOOKING INTO INCREASED ACCESSIBILITY INCLUDING SIDEWALKS, BIKE TRAILS, ETC. MENTAL HEALTH - TREMENDOUS STRIDES HAVE BEEN MADE IN MENTAL HEALTH AND BEHAVIORAL HEALTH WITHIN THE COMMUNITY. RISING HOPE COUNSELING IS NOW LOCATED IN BURKE ON THE HOSPITAL CAMPUS AND EMPLOYS FOUR COUNSELORS. ACCESS TO AFFORDABLE HEALTH CARE - AFFORDABILITY REMAINS PART OF COMMUNITY MEMORIAL HOSPITAL'S ONGOING OPERATIONAL EFFORTS. CMH WORKS WITH PATIENTS WHO DO NOT HAVE HEALTH INSURANCE AND ASSISTS THEM TO FIND AN APPROPRIATE PLAN OR GOVERNMENT PROGRAM TO IMPROVE THEIR ABILITY TO AFFORD CARE. IN THE EVENT A PATIENT IS UNABLE TO ACQUIRE INSURANCE COVERAGE, THEY ARE REFERRED TO OUR CHARITY CARE PROGRAM.DUE TO THE TIMING OF ITS COMPLETION, THE HOSPITAL DID NOT HAVE TIME TO START ADDRESSING THE NEEDS IDENTIFIED IN THE 2025 CHNA. IN THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS THE NEEDS IDENTIFIED IN THE PRIOR YEAR CHNA:HOUSING - LACK OF HOUSING HAS BEEN AN ONGOING CONCERN IN THE COMMUNITY. THE HOSPITAL HAS TAKEN MAJOR STRIDES TO IMPROVE HOUSING IN THE COMMUNITY. HAVING AVAILABLE HOUSING IS ESSENTIAL FOR RECRUITMENT OF STAFF, BUSINESS DEVELOPMENT AND ECONOMIC DEVELOPMENT. THE HOSPITAL HAS INVESTED IN SEVERAL RENTAL PROPERTIES. THE HOSPITAL WORKED WITH SOUTH DAKOTA HOUSING TO PURCHASE A DAKOTA PLEX UNIT THAT WAS MOVED TO TOWN IN 2025. THE UNIT CONSISTS OF (2) THREE- BEDROOM, TWO- BATH UNITS WITH A TWO-STALL GARAGE. THE UNITS WERE FILLED BEFORE CONSTRUCTION WAS COMPLETE AND TWO NEW STAFF MEMBERS MOVED TO THE COMMUNITY. THE PROJECT WAS A HUGE SUCCESS AND CLEANED UP AN OLD RUN-DOWN LOT IN THE COMMUNITY. 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 THERE IS ALSO 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. THE HOSPITAL ALSO PARTNERED WITH THE LOCAL SCHOOL FOR A RUNNING INTO SUMMER FUN RUN TO END THE SCHOOL YEAR. IN 2025, THE HOSPITAL IMPLEMENTED A NEW PROGRAM CALLED HEALTH EXPLORERS. STAFF GO INTO THE SCHOOL TO MEET WITH ELEMENTARY STUDENTS FOUR TIMES THROUGHOUT THE YEAR. THE PROGRAM IS DESIGNED TO EDUCATE KIDS ON VARIOUS HEALTHCARE TOPICS AND KEEP THEM ENGAGED IN PHYSICAL ACTIVITY/HEALTHY LIVING. 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. THE HOSPITAL WORKED HARD AND IS SCHEDULED TO ADD A NEW OUTREACH SERVICE, PODIATRY, IN 2026. 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, SEXUAL ORIENTATION, 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 13-14. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 12/31/2025. 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.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $25,500.MEDICARE FEE SCHEDULE REVENUE: $24,552MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS ($50,052)NET SHORTAGE ($25,500) 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 2025. 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. 58% OF THE ORGANIZATION'S REVENUE WAS FROM SERVING THE MEDICARE POPULATION, 7% WAS FROM MEDICAID, AND 35% FROM COMMERCIAL INSURANCE, OTHER GOV'T PAYERS/OTHER AND 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. X 0 0 0 0 0 0 0 0 0 AMY JURACEK CNP 121633 0 0 0 22430 0 4513 0 17470 0 166046 0 0 0 BRITTNEY KORTHALS CNP 102324 0 0 0 11815 0 3848 0 32785 0 150772 0 0 0 KIMBERLY SHEPPERD FAMILY MEMBER OF DOUG SHEPPERD, BOARD MEMBER 96656 WAGES AND BENEFITS 0 CRAIG DREY FAMILY MEMBER OF MISTIE DREY, CEO 54922 WAGES AND BENEFITS 0 TYLER VANMETRE FAMILY MEMBER OF MEGAN SMITH (KEY EMPLOYEE) AND LISA JURAN (BOARD MEMBER) 157395 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 2 LISA JURAN, TYLER VANMETRE, AND MEGAN SMITH HAVE A FAMILY RELATIONSHIP. 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 $182,091 AND $34,392 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 $282,111 AND $27,731 RESPECTIVELY. 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 2025. 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 B, LINE 15B ALL EMPLOYEES FOLLOW THE SAME COMPENSATION REVIEW PROCESS. SDAHO ANNUAL COMPENSATION DATA IS USED TO EVALUATE WAGES COMPARED TO OTHER FACILITIES. THIS DATA IS REVIEWED ON AN ANNUAL BASIS ALONG WITH STAFF PERFORMANCE REVIEWS. COMPENSATION IS APPROVED WITH THE ANNUAL BUDGET BY THE BOARD OF DIRECTORS. 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 1,139,708. MANAGEMENT AND GENERAL EXPENSES 35,444. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,175,152. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 37,813. MANAGEMENT AND GENERAL EXPENSES 27,972. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,785. FORM 990, PART XI, LINE 9: AUXILIARY NET INCOME -10,007.