2026-05-13T12:07:24-05:00 2025-06-30 393647910 WIPFLI ADVISORY LLC 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2024-07-01 810243720 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION SHER 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 KODY NELSON CEO 4067653700 2026-05-13 1 1 SAM BRUNSON CPA P01696998 4067281800 2026-05-13 2024 2025-03-06 01:10:19Z KODY NELSON 440 W LAUREL AVENUE PLENTYWOOD MT 59254 24062983 0 X WWW.SHERIDANMEMORIAL.NET X 1920 MT TO PROVIDE EXCEPTIONAL AND COMPASSIONATE CARE TO ENHANCE THE HEALTH, WELLBEING AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 7 7 192 23 0 0 786033 24213 21888652 24005071 48619 4264 4850 2175 22728154 24035723 0 0 0 0 10284862 10523592 0 0 189123 11639497 11960309 21924359 22483901 803795 1551822 12888326 15362567 4097324 5019743 8791002 10342824 X PROVIDING QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 18661470 0 24005071 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION OPERATES A 19-BED CRITICAL ACCESS HOSPITAL, A 35-BED LONG-TERM CARE FACILITY, AND A RURAL HEALTH CLINIC THAT BENEFIT THE PEOPLE IN THE SURROUNDING AREA. SMHA IS THE ONLY MEDICAL FACILITY IN SHERIDAN COUNTY, WHICH HAS A POPULATION OF APPROXIMATELY 3,500 RESIDENTS. HIGHLIGHTS OF THE ORGANIZATION'S ACCOMPLISHMENTS DURING FY25 ARE INCLUDED BELOW: - SMHA INCREASED ITS CAPACITY TO PATIENTS IN THE RHC BY 4% IN FY25. THIS WAS ACCOMPLISHED BY INSTITUTING PRODUCTIVITY REQUIREMENTS FOR PROVIDERS, HIRING QUALIFIED AND HARD-WORKING PROVIDERS AND UPDATING PATIENT WORKFLOWS. - SMHA CONTINUED TO UPDATE ITS DIAGNOSTIC CAPABILITIES, ALLOWING FOR IMPROVED IDENTIFICATION OF AILMENTS AND HEALTH ISSUES. THIS IN-TURN HAS ALLOWED SMHA TO HAVE PATIENTS SEEN AT THE CORRECT LEVEL OF CARE FOR THEIR NEEDS AND HELPED SMHA PROVIDERS TREAT PATIENTS LOCALLY RATHER THAN HAVING TO REFER OR TRANSFER TO A HIGHER LEVEL OF CARE. THIS IS EVIDENT IN THE INCREASE IN PATIENTS SEEN IN OUR CLINIC AND UTILIZATION OF OUR ANCILLARY SERVICES.VOLUME INDICATORS FOR THE FISCAL YEAR ARE AS FOLLOWS: ACUTE CARE INPATIENT ADMISSIONS - 108ED VISITS - 1,026SWING BED PATIENTS - 51LONG-TERM CARE ADMISSIONS - 15HOME CARE VISITS - 2,963HOSPICE - 233CLINIC VISITS - 10,820 18661470 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 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 1 0 0 0 1 10 0 192 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KODY NELSON 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 X DON BENSON CHAIR 1.00 X X 0 0 0 PAUL HANSON VICE CHAIR 2.00 X X 0 0 0 JOAN TOMMERUP SECRETARY 1.00 X X 0 0 0 NANCY JENSEN DIRECTOR 2.00 X 0 0 0 MYRNETTE MILLER DIRECTOR 1.00 X 0 0 0 CHRIS WIENS DIRECTOR 2.00 X 0 0 0 LEXI OLSEN DIRECTOR 1.00 X 0 0 0 KODY NELSON CEO 40.00 X 0 0 0 SIVASH SHAHBODAGHI PHYSCIAN 40.00 X 785690 0 18201 BRIT NYBY APP 40.00 X 223846 0 6264 CARLOS TREVINO PHYSCIAN 10.00 X 135320 0 6278 STEPHANIE KANNING RN 40.00 X 307399 0 9221 JENNIFER HOVERSLAND FNP 40.00 X 117588 0 3526 1569843 0 43490 21 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MGMT, CEO, ACGT, LAB, RADIOLOGY, IS 1209729 PRN STAFFING 173 AUSTRIAN ROAD VIDA MT 59724 TRAVEL RN, LPN, CAN 762849 BADLANDS 804 2ND STREET UNDERWOOD ND 58576 TRAVEL RN, LPN, CAN 755506 FUSION MEDICAL STAFFING LLC 18881 W DODGE RD STE 300W ELKHORN NE 68022 TRAVEL RN, LPN, CAN 364292 MHN 519 PLEASANT STREET MILES CITY MT 59301 TRAVEL RN, LPN, CAN 290745 13 5063 19150 24213 PATIENT SERVICE REVENUE 621990 20672668 20672668 OTHER OPERATING REVENUE 621990 1722029 1722029 340B REVENUE 621990 1284039 1284039 CONTRACT REVENUE 621990 326335 326335 24005071 31524 31524 2175 0 2175 2175 2175 27260 -27260 -27260 -27260 24035723 24005071 0 6439 X 8736913 7368895 1342780 25238 208426 208426 981552 477805 494454 9293 596701 596701 3225 3225 46356 46356 5369100 5347800 21300 134183 134183 149529 149529 408080 230181 176625 1274 34098 34098 85436 85436 78836 78836 913748 619513 290808 3427 260715 230362 29983 370 SUPPLIES 2281686 2245769 35917 BAD DEBT 1207601 1207601 BED TAX 412975 412975 REPAIRS AND MAINTENANCE 393112 393112 181629 166291 15338 22483901 18661470 3633308 189123 3080941 5022965 862805 927801 2589242 3695543 216776 291402 227439 260375 20916130 16646188 4793200 4269942 12000 1117923 882539 12888326 15362567 2165067 3362195 858220 791738 1074037 865810 4097324 5019743 X 8791002 10342824 8791002 10342824 12888326 15362567 1551822 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104263 104263 104263 104263 104263 104263 104263 104263 104263 104263 1.00000 0 1 1 444289 444289 12423829 10558058 1865771 8018596 6088130 1930466 29416 29416 4269942 RIGHT OF USE LEASE 575946 GUARANTEE OF PATIENT LOANS 123243 BED TAX RECEIVABLE 183350 882539 RIGHT OF USE LEASE 604425 GUARANTEE OF PATIENT LOANS 123243 BED TAXES PAYABLE 137654 OTHER PAYABLES 488 865810 PART V, LINE 4: THE ENDOWMENT, HELD BY THE SHERIDAN HEALTH CARE FOUNDATION, INC., CONSISTS OF INDIVIDUAL FUNDS ESTABLISHED BY DONORS TO PROVIDE ANNUAL FUNDING FOR SPECIFIC ACTIVITIES AND GENERAL OPERATIONS OF THE HOSPITAL. GIFTS GIVEN TO THE ENDOWMENT FUND AT SHERIDAN HEALTH CARE FOUNDATION ARE INVESTED AND CAREFULLY MANAGED TO PROTECT THE PRINCIPAL; THEY ARE INTENDED TO BE A PART OF THE PERMANENT INVESTMENT RESERVE WHICH WILL REMAIN FOR PERPETUITY. INTEREST FROM ENDOWMENTS WILL GO TOWARDS SHERIDAN HEALTH CARE FOUNDATION'S UNRESTRICTED FUND TO ALLOW FOR ADDITONAL REVENUE TO ENSURE THE FUTURE OF THE FOUNDATION AND SHERIDAN MEMORIAL HOSPITAL ASSOCIATION UNLESS OTHERWISE STIPULATED BY THE DONOR. 1 1 X 1 X 1 X 1 1 1 0 0 493617 493617 0.02200 2583622 2583622 0.11490 3077239 3077239 0.13690 6011 6011 0.00030 144686 6551 138135 0.00610 2322 2322 0.00010 153019 6551 146468 0.00650 3230258 6551 3223707 0.14340 1 1110511 6898838 6922452 -23614 X 1 1 1 1 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION 440 W LAUREL AVE PLENTYWOOD MT 59254 WWW.SHERIDANMEMORIAL.NET 13547 X X X RURAL HEALTH CLINIC, LONG-TERM CARE FACILITY SHERIDAN MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X 24 1 0 1 1 X WWW.SHERIDANMEMORIAL.NET X 1 24 0 1 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X WWW.SHERIDANMEMORIAL.NET X WWW.SHERIDANMEMORIAL.NET X WWW.SHERIDANMEMORIAL.NET X X X X X X 1 X 0 X X X X 1 X 0 1 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: BOTH OUR STAFF AND BOARD MEMBERS ARE REPRESENTATIVES OF OUR COMMUNITY AND WERE A PART OF THE IMPLEMENTATION COMMITTEE. 173 MEMBERS OF SHERIDAN COUNTY RESPONDED TO OUR ONLINE SURVEY AND SEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: SHERIDAN COUNTY AGING SERVICES SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: BASED ON THE MOST RECENT CHNA SMH HAS IDENTIFIED SEVERAL ITEMS THAT THEY WILL BE WORKING ON OVER THE NEXT YEAR. THE FOLLOWING SUMMARY BRIEFLY REPRESENTS THE GOALS AND CORRESPONDING STRATEGIES AND ACTIVITIES WHICH THE FACILITY WILL EXECUTE TO ADDRESS THE PRIORITIZED HEALTH NEEDS.GOAL 1: IMPROVE AWARENESS OF HEALTH SERVICES AND RESOURCES AVAILABLE THROUGH SHERIDAN MEMORIAL HOSPITAL.STRATEGY 1.1: CONDUCT MARKETING CAMPAIGN TO EDUCATE SERVICE AREA ABOUT SMH'S SERVICES AND RESOURCES.1.1.1. HIGHLIGHT PROVIDERS AT SMH, ESPECIALLY ADVANCED PRACTICE PROVIDERS, TO MAKE PATIENTS MORE FAMILIAR WITH THEIR CARE PROVIDERS. 1.1.2. EXTEND MARKETING AND AWARENESS EFFORTS INTO COMMUNITIES OUTSIDE OF PLENTYWOOD TO EDUCATE WIDER SERVICE AREA ABOUT AVAILABLE RESOURCES.1.1.3. HIGHLIGHT SERVICES AVAILABLE THROUGH SMH TO ENSURE THE COMMUNITY IS AWARE OF WHAT IS OFFERED LOCALLY.1.1.4. BE RECEPTIVE TO THE COMMUNITY AND IMPROVE PUBLIC RELATIONS.1.1.5. ADVERTISE EDUCATIONAL PROGRAMMING AVAILABLE THROUGH SMH OR COMMUNITY ORGANIZATIONS.1.1.6. UPDATE SMH WEBSITE TO IMPROVE AND CLARIFY USER EXPERIENCE.STRATEGY 1.2: UTILIZE SMH'S PLATFORM AND NETWORK TO IMPROVE EDUCATION AND AWARENESS OF MENTAL AND BEHAVIORAL HEALTH.1.2.1. INCREASE AWARENESS OF LOCALLY-AVAILABLE PROVIDERS AND SERVICES.1.2.2. WORK TO DECREASE STIGMA ASSOCIATED WITH SEEKING MENTAL HEALTH CARE.STRATEGY 1.3: CONTINUE TO COLLABORATE WITH AND SUPPORT LOCAL ORGANIZATIONS WORKING TOWARDS A HEALTHIER COMMUNITY.1.3.1. HELP INCREASE AWARENESS OF LOCAL FOOD BANK.1.3.2. CONTINUE TO COLLABORATE WITH COUNCIL ON AGING AND OTHER LOCAL ORGANIZATIONS. GOAL 2: INCREASE ACCESS TO HEALTHCARE SERVICES IN SHERIDAN COUNTY.STRATEGY 2.1: INCREASE SERVICES AVAILABLE THROUGH SMH.2.1.1. EXPLORE FEASIBILITY OF ADDING OPTOMETRY SERVICES THROUGH FEASIBILITY STUDY AND COST ESTIMATES.2.1.2. CONTINUE TO GROW MENTAL AND BEHAVIORAL HEALTH SERVICES IN THE COMMUNITY.2.1.3. EVALUATE FEASIBILITY OF INCREASING OB OUTREACH SERVICES.2.1.4. CONTINUE TO EXPAND DIETICIAN SERVICES TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY.STRATEGY 2.2: EXPLORE TRANSPORTATION OPTIONS TO ENSURE THE COMMUNITY CAN ACCESS HEALTHCARE SERVICES.2.2.1. CONTINUE TO WORK WITH MHN IN BILLINGS IN THEIR EFFORTS TO ACQUIRE LOCAL TRANSPORT VEHICLES.2.2.2. EXPLORE PATIENT VOLUME NEEDED FOR HELICOPTER SERVICES.STRATEGY 2.3: INCREASE EDUCATIONAL OFFERINGS FOR THE COMMUNITY THROUGH SMH AND OTHER ORGANIZATIONS.2.3.1. DESIGN QUARTERLY EDUCATIONAL OPPORTUNITIES FOR THE COMMUNITY ABOUT TOPICS OF INTEREST SUCH AS NUTRITION, FITNESS, WELLNESS, MENTAL HEALTH EDUCATION, AND SUICIDE PREVENTION.2.3.2. CONTINUE TO PROVIDE AND SUPPORT CLASSES SUCH AS STOP THE BLEED.2.3.3. INCORPORATE EDUCATION FOR SPECIFIC GROUPS IN THE COMMUNITY, E.G. END OF LIFE FINANCIAL PLANNING ASSISTANCE.STRATEGY 2.4: EVALUATE OPTIONS FOR FACILITY AND LOGISTICAL IMPROVEMENT AT SMH.2.4.1 CONTINUE TO EXPLORE HOW TO INCREASE ACCESS TO CARE.2.4.2 CONDUCT INVESTIGATION INTO AUDIT RATES OF COMPARABLE FACILITIES.2.4.3 EXPLORE THE ABILITY FOR SMH TO PROVIDE SPACE FOR NEW PROVIDERS AND SERVICES.NEEDS UNABLE TO ADDRESS AT THIS TIME: 1. 7.9% OF SURVEY RESPONDENTS INDICATED THEY HAD DIFFICULTY GETTING A PRESCRIPTION OR TAKING THEIR MEDICATION REGULARLY DUE TO COST IN THE LAST YEAR. WHILE NOT INCLUDED EXPLICITLY WITHIN THIS IMPLEMENTATION PLAN, SMHA HAS A 340B PROGRAM AND CONTRACTS WITH THE PLENTYWOOD REXALL DRUG FOR THOSE IN NEED. 2. 4.0% OF SURVEY RESPONDENTS WERE CONCERNED ABOUT NOT HAVING ENOUGH FOOD TO EAT IN THE LAST YEAR. SMHA REGULARLY PROVIDES DONATIONS AND REFERRALS FOR COMMUNITY MEMBERS TO THE LOCAL FOOD BANK IN SHERIDAN COUNTY. 3. 36.0% OF SURVEY RESPONDENTS FEEL THAT THE COMMUNITY DOES NOT HAVE ADEQUATE AND AFFORDABLE HOUSING OPTIONS AVAILABLE. WHILE NOT INCLUDED EXPLICITLY WITHIN THIS IMPLEMENTATION PLAN, SMHA IS COMMITTED TO REMAINING APPRISED OF LOCAL AFFORDABLE HOUSING CONVERSATIONS AND PARTICIPATING AS RESOURCES (TIME, WORKFORCE, ETC.) ALLOW. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 13H: IN ADDITION TO FAMILY SIZE AND FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY WILL CONSIDER SPECIAL HARDSHIPS OR UNUSUAL CIRCUMSTANCES IN DETERMINING FINANCIAL ASSISTANCE.. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 24: ALL INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY ARE PROVIDED A DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO ELECTIVE PROCEDURES. THEREFORE, FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE CHARGED GROSS CHARGES ON ELECTIVE PROCEDURES. SPECIFICALLY STATES MED SPA, WEIGHT MANAGEMENT, NON-EMERGENT ERS AS WELL AS DME PRODUCT PURCHASED WITHOUT A PROVIDER SCRIPT. PART I, LINE 3C: IN ADDITION TO FAMILY SIZE AND FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY WILL CONSIDER SPECIAL HARDSHIPS OR UNUSUAL CIRCUMSTANCES IN DETERMINING FINANCIAL ASSISTANCE. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS CALCULATED USING WORKSHEET 2. ALL AMOUNTS ON LINE 7 WERE CALCULATED USING THE WORKSHEETS PROVIDED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE IS THE BAD DEBT EXPENSE LESS BAD DEBT RECOVERIES AS REPORTED ON THE FINANCIAL STATEMENTS. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE BEGINS ON PAGE 17 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: THE COST TO CHARGE RATIO IS USED TO DETERMINE COMMUNITY BENEFIT. THIS IS DONE BY APPLYING THE RATIO TO THE TOTAL MEDICARE REVENUE. A SHORTFALL OR OVERAGE IN ANY GIVEN YEAR IS A RESULT OF THE TIMING OF PAYMENTS FROM MEDICARE ON AN INTERIM BASIS AND WHEN FINAL SETTLEMENT IS MADE. MANAGEMENT USES ESTIMATES TO CALCULATE SUCH SETTLEMENTS BUT ACTUAL RESULTS VARY FROM THOSE ESTIMATES. ADDITIONALLY, SHORTFALLS CAN RESULT FROM VARIOUS EXPENSES THAT ARE INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. ALSO MEDICARE RECIPIENTS ARE PART OF A CHARITABLE CLASS AND SO THE PROVISION OF MEDICAL CARE FURTHERS THIS CHARITABLE CLASS. PART III, LINE 9B: IF A PATIENT IS APPROVED FOR FINANCIAL ASSISTANCE, THAT SAME APPROVED PERCENTAGE MAY BE APPLIED FOR ANY BILLS INCURRED WITHIN THE NEXT 3 MONTHS/90 DAYS WITHOUT THE PATIENT HAVING TO COMPLETE A NEW APPLICATION. THE 90 DAYS BEGINS FROM THE DATE THE INITIAL APPLICATION WAS APPROVED. THE FINANCIAL ASSISTANCE ADJUSTMENT WILL BE PROVIDED ONLY TO THE QUALIFYING BILLS AND ONLY IF THE PATIENT REQUESTS FINANCIAL ASSISTANCE WITHIN THE 90-DAY PERIOD. PART VI, LINE 2: WE DO DEPARTMENTAL SURVEYS ON A REGULAR BASIS AND DISCUSSIONS WITH LOCAL ORGANIZATIONS, SUCH AS THE COUNCIL ON AGING, CHAMBER, AMBULANCE DISTRICT, AS WELL AS THE FOUNDATION AND AUXILIARY. PART VI, LINE 3: SHERIDAN MEMORIAL ENSURES ALL PATIENTS ARE NOTIFIED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AT EVERY ADMISSION. AT ADMISSION, THE PATIENT SIGNS A CONDITION OF ADMISSION WHICH STATES THAT ASSISTANCE IS AVAILABLE. IN ADDITION, FINANCIAL ASSISTANCE PACKETS ARE HANDED OUT BY THE ADMISSION'S CLERK TO THOSE WHO ARE UNDERINSURED/UNINSURED OR EXPRESS NEED FOR ASSISTANCE. THE HOSPITAL DESK ALSO HAS THESE PACKETS AVAILABLE FOR PATIENTS WHO REPORT TO THE EMERGENCY ROOM. THIS PACKET INCLUDES ALL PAYMENT OPTIONS, MEDICAID INFORMATION, MARKETPLACE INSURANCE INFORMATION AND THE FINANCIAL ASSISTANCE APPLICATION. IN ADDITION THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE POSTED ON THE SHERIDAN MEMORIAL WEBSITE WWW.SHERIDANMEMORIAL.NET AND POSTERS ARE PLACED AROUND THE FACILITY EXPLAINING PAYMENT OPTIONS. EACH STATEMENT SENT OUT TO THE PATIENT STATES THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE BUSINESS OFFICE STAFF ALSO COVERS THIS INFORMATION WITH SELF-PAY PATIENTS WHEN MAKING COLLECTION/PAYMENT PLAN CALLS. PART VI, LINE 4: SHERIDAN COUNTY IS LOCATED IN THE NORTHEAST CORNER OF MONTANA AND COVERS THE GEOGRAPHIC AREA OF 1,706 SQUARE MILES. POPULATION OF THE COUNTY IS 3,522 (BASED ON THE 2021 CENSUS). THE COMMUNITY IS RURAL AND PRIMARILY A FARMING AND RANCHING AREA. PART VI, LINE 5: SHERIDAN MEMORIAL HOSPITAL HAS EXPANDED MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS AND APPS IN THE COMMUNITY AND PROVIDERS WILLING TO SEE SHERIDAN MEMORIAL PATIENTS VIA TELE-MED CONFERENCES AS WELL AS SPECIALTY PROVIDERS WHO ARE WILLING TO SEE PATIENTS LOCALLY. IN ADDITION, SHERIDAN MEMORIAL HAS OPENED ITS OUTREACH CLINIC FOR VISITING PHYSICIANS AND SPECIALISTS TO COME TO PLENTYWOOD TO BETTER SERVE OUR COMMUNITY. THIS INCLUDES SPECIALISTS/PROVIDERS FROM SIDNEY HEALTH CENTER AND MCKENZIE HEALTH, AND MONTANA HOSPITAL COMMUNITY. THE BOARD OF DIRECTORS IS MADE UP OF 7 VOLUNTEERS FROM THE COMMUNITY. WE TRY TO HAVE REPRESENTATION ON THE BOARD FROM INDIVIDUALS THROUGHOUT THE COUNTY AND NOT JUST OF THOSE LIVING IN PLENTYWOOD. SURPLUS FUNDS ARE APPLIED BACK TO PATIENT CARE AND EDUCATION. WE OFFER MANY SERVICES WHICH ARE A COMMUNITY BENEFIT TO THE COMMUNITIES WE SERVE WHICH INCLUDE THE FOLLOWING: * GRIEF COUNSELOR* USE OF TELE-MED EQUIPMENT IS OPEN TO THE COMMUNITY FOR MENTAL HEALTH VISITS, BEHAVIORAL HEALTH CLASSES, COMMUNITY GENERAL HEALTH EDUCATION AS WELL AS LIFESTYLE BALANCE CLASSES. * ER IS OPEN 24 HOURS REGARDLESS OF ABILITY TO PAY* EDUCATION OF HEALTHCARE PROFESSIONALS* PARTICIPATION IN GOVERNMENT SPONSORED HEALTH PROGRAMS* SHERIDAN MEMORIAL IS INVOLVED IN COMMUNITY OUTREACH THROUGH THE SHERIDAN COUNTY CHAMBER, COUNCIL ON AGING, SHERIDAN COUNTY PUBLIC HEALTH, REGIONAL VETERAN'S AFFAIRS MEETINGS, EMERGENCY MEDICAL SERVICES STANDBY/NON-EMERGENT CALLS, AS WELL AS OUR FACILITY PRESENCE AT OTHER COMMUNITY EVENTS SUCH AS FAIRS, PARADES AND EVENTS* ASSIST COMMUNITY MEMBERS IN APPLYING FOR STATE MEDICAID ASSISTANCE AND SSDI. APPLICATIONS CAN BE CONFUSING AND THE PROCESS FRUSTRATING THUS SHERIDAN MEMORIAL OFFERS ANY HELP WITH THESE PROCESSES* SOLE COMMUNITY PROVIDER OF MOST SERVICE LINES* OFFERS VOLUNTEER OPPORTUNITIES TO COMMUNITY THROUGH ASSOCIATION AND FOUNDATION BOARD POSITIONS, HOSPICE, EMS, ACTIVITIES, BEAUTY SHOP, AND PINK LADY PROGRAM* HAS A FOUNDATION THAT SERVES AS A VEHICLE FOR ATTRACTING AND EFFECTIVELY USING DONATED FUNDS* HAS THE SUPPORT OF AN AUXILIARY THAT HOSTS EVENTS THROUGHOUT THE YEAR TO RAISE FUNDS FOR THE FACILITY 0 0 0 0 0 0 0 0 0 SIVASH SHAHBODAGHI PHYSCIAN 768139 0 17551 0 0 0 18201 0 0 0 803891 0 0 0 STEPHANIE KANNING RN 254380 0 21401 0 31618 0 9221 0 0 0 316620 0 0 0 BRIT NYBY APP 221217 0 2629 0 0 0 6264 0 0 0 230110 0 0 0 PART I, LINE 3 THE BOARD OF TRUSTEES REVIEWS AND MAKES DECISIONS ON THE COMPENSATION PACKAGE FOR THE CEO AS PART OF THE MANAGEMENT CONTRACT PAID TO BILLINGS CLINIC. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, AS CHAIRMAN, THE VICE CHAIRPERSON AND THE SECRETARY/TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH BILLINGS CLINIC. THEY PROVIDE GENERAL ACCOUNTING, HR, AND BUSINESS SUPPORT SERVICES. THE ORGANIZATION'S CURRENT CEO, KODY NELSON, IS AN EMPLOYEE OF BILLINGS CLINIC AND COMPENSATION FOR SERVICES PROVIDED TO THE HOSPITAL INCLUDE THE FOLLOWING: BASE SALARY - $153,296 BONUS - $15,330 EMPLOYER CONTRIBUTION TO RETIREMENT PLAN - $15,937 EMPLOYER CONTRIBUTION TO MEDICAL AND DENTAL - $22,658 EMPLOYER CONTRIBUTION TO LIFE INSURANCE AND LONG-TERM DISABILITY - $369 FORM 990, PART VI, SECTION A, LINE 6 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 823 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 823 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS DURING THE ANNUAL MEETING HELD THE FOURTH TUESDAY OF FEBRUARY EVERY YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD REVIEWS AN ELECTRONIC COPY OF THE FORM 990 BEFORE THE FINAL COPY IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND SIGNED BY ALL TRUSTEES AND THE CEO. THE BOARD AND THE CEO MONITOR THE STATUS OF ALL TRUSTEES THROUGHOUT THE YEAR FOR CHANGES THAT COULD LEAD TO A NEW SITUATION REQUIRING DISCLOSURE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND MAKES DECISIONS ON THE COMPENSATION PACKAGE FOR THE CEO. THE CEO COMPENSATION IS PART OF THE MANAGEMENT CONTRACT PAID TO BILLINGS CLINIC. ALL MANAGERS REPORT TO THE CEO AND THE CEO REVIEWS AND MAKES DECISIONS ON THE MANAGER'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,347,800. MANAGEMENT AND GENERAL EXPENSES 21,300. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,369,100. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SHERIDAN HEALTH CARE FOUNDATION INC 440 W LAUREL AVENUE PLENTYWOOD MT 59254 810496987 SUPPORT ACTIVITIES OF SHERIDAN MEMORIAL HOSPITAL ASSOCIATION MT 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0