2026-05-14T15:48:38-05:00 2025-06-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2024-07-01 460226283 WAGNER COMMUNITY MEMORIAL HOSPITAL WAGN 6053843611 513 THIRD STREET SW WAGNER SD 573800280 JOSHUA CHRISTENSEN CFO 6053843611 2026-05-14 1 1 LAURIE HANSON CPA P00851848 6053391999 2026-05-14 2024 2025-03-06 01:10:19Z BRYAN SLABA 513 THIRD STREET SW WAGNER SD 573800280 22521528 0 X WWW.AVERA.ORG/WAGNERHOSPITAL/ X 1947 SD TO PROVIDE HEALTHCARE SERVICES. 5 4 140 5 0 0 81768 739657 17862033 21194874 175432 580876 3450 3800 18122683 22519207 4500 41327 0 0 11463553 13226822 0 0 0 5354256 6060139 16822309 19328288 1300374 3190919 20064377 24383644 4178793 4767580 15885584 19616064 X WAGNER COMMUNITY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE CARE AND TREATMENT OF THE SICK; PROVIDE CARE AND SUPPORT OF THE AGED, DISABLED, AND INDIGENT; AND TO PROVIDE FOR THOSE IN NEED OF HOSPITALIZATION REGARDLESS OF RACE, COLOR, CREED, OR ABILITY TO PAY. 0 0 16248313 41327 21194874 WCMH IS A 15-BED CRITICAL ACCESS HOSPITAL EQUIPPED WITH EXTENSIVE ADVANCED SERVICES, INCLUDING AREAS FOR MEDICAL/SURGICAL, PEDIATRIC, SWING BED, 24/7 EMERGENCY CARE AND IN-HOUSE CT. THE CLINIC IS ADJACENT TO THE HOSPITAL MAKING IT CONVENIENT TO SEE HOSPITAL PATIENTS AND SHARE LABORATORY SERVICES AND OTHER DIAGNOSTIC EQUIPMENT. OUTREACH SERVICES INCLUDE NEPHROLOGY, ORTHOPEDICS, DIETITIAN, UROLOGY AND CARDIOLOGY. WCMH PROVIDES IN-HOUSE BEHAVIORAL HEALTH COUNSELING WITH A STAFF OF 4 PROVIDERS TO INCLUDE THE FOLLOWING TYPES OF COUNSELING: GRIEF, FAMILY OR FINANCIAL STRESS, SELF-HARM, LIFE CHANGES, TRAUMATIC EVENTS, SUBSTANCE ABUSE AND DEPRESSION.THE FACILITY SERVES AS THE INPATIENT UNIT FOR THE LOCAL INDIAN HEALTH SERVICES CLINIC AND WORKS COLLABORATIVELY WITH THE IHS PHYSICIANS AND LEADERS TO CARE FOR THE NATIVE AMERICAN POPULATION. THE PEOPLE OF THE COMMUNITY TRULY BELIEVE IN HAVING ACCESS TO CARE AND SUPPORTING THEIR LOCAL MEDICAL PROVIDERS.WCMH EXPERIENCED 353 INPATIENT DAYS, 927 SWING BED DAYS, 2,731 EMERGENCY DEPARTMENT VISITS, AND 5,849 CLINIC VISITS. 16248313 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 18 0 1 140 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X X JOSHUA CHRISTENSEN 6053847216 513 3RD STREET SW WAGNER SD 573800280 DAVID KOTAB PRESIDENT 0.50 X X 0 0 0 CHAD PETERS VICE PRESIDENT 0.50 X X 0 0 0 KAREN SOULEK SECRETARY/TREASURY 0.50 X X 0 0 0 RACHEL WOODS DIRECTOR 0.50 X 0 0 0 MICHELE JUFFER DIRECTOR 0.50 X 0 0 0 BRYAN SLABA CEO 40.00 X 297701 0 45556 JOSHUA CHRISTENSEN CFO 40.00 X 95926 0 26667 TIANNA SMITH CMO 40.00 X 355827 0 19348 BRITTANY BARRON VP OF PATIENT SERVICES 40.00 X 178102 0 47671 MIKEALA KOENIG PHYSICIAN 40.00 X 211916 0 39609 CASSSIE NELSON NURSE PRACTITIONER 40.00 X 180463 0 30872 JORDAN WEBER PHYSICIANS ASSISTANT 40.00 X 287887 0 39265 JAROD MYER NURSE PRACTITIONER 40.00 X 182085 0 47873 JOSEPH SEES PHYSICAL THERAPIST 40.00 X 189343 0 43910 1979250 0 340771 29 0 1 0 AVERA HEALTH 3900 W AVERA DR STE 301 SIOUX FALLS SD 57108 MINOR EQUIP/SOFTWARE FEES 1057853 SCOTT DOOM CONTRACTING 39370 MOON MEDOW DR WAGNER SD 57380 CONSTRUCTION/REMODEL 995487 SACRED HEART HEALTH SERVICES 501 S SUMMIT STREET YANKTON SD 57078 IT-ADM-SOFTWARE FEES 439307 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 57117 OUTREACH SERVICES 204581 AVEL ECARE MEDICAL GROUP 4500 N LEWIS AVE SIOUX FALLS SD 57104 TELEMEDICINE 122253 5 737653 2004 739657 PATIENT SERVICE FEES 621110 20502852 20502852 PHARMACY REVENUE 900099 645691 645691 46331 46331 21194874 516472 516472 3800 0 3800 3800 3800 66725 2321 64404 64404 64404 22519207 21194874 0 584676 10015 10015 31312 31312 1146780 607940 538840 408581 408581 9399203 8350242 1048961 394147 355151 38996 1140734 1119449 21285 737377 633867 103510 1813063 1127406 685657 58948 58948 147927 78625 69302 190907 22411 168496 185487 171018 14469 41610 38077 3533 49635 42981 6654 139492 139492 929628 850523 79105 82499 70919 11580 MEDICAL SUPPLIES 1861146 1801029 60117 REPAIRS AND MAINTENANCE 378331 339124 39207 DUES AND SUBSCRIPTIONS 72980 46538 26442 108486 3613 104873 19328288 16248313 3079975 0 544194 551260 654566 2819293 3797504 137676 165129 110577 101322 18015559 10148601 6369309 7866958 9588909 10752467 475073 376240 19346 118198 20064377 24383644 1150240 1819439 3028553 2948141 4178793 4767580 X 15885584 19616064 15885584 19616064 20064377 24383644 3190919 539561 0 X 0 1 X 1 1 1 X 4247 4247 12403251 7026922 5376329 4884701 2756695 2128006 723360 364984 358376 7866958 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENTS 10527467 F INVESTMENT IN WDCBLF LLC 225000 F 10752467 X 23058768 539561 539561 22519207 0 22519207 19328288 0 19328288 0 19328288 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. 1 1 X 1 X 1 X 1 1 1 0 0 404800 404800 0.02090 404800 404800 0.02090 11619 11619 0.00060 987 987 0.00010 4338664 3118565 1220099 0.06310 12453 12453 0.00060 4363723 3118565 1245158 0.06440 4768523 3118565 1649958 0.08530 27923 27923 0.00140 618 618 0.00000 3142 3142 0.00020 303 303 0.00000 31986 31986 0.00160 1 330181 51838 6343932 6372863 -28931 X 1 1 1 1 WAGNER COMMUNITY MEMORIAL HOSPITAL 513 3RD ST SW WAGNER SD 57380 WWW.AVERA.ORG/WAGNERHOSPITAL/ 10571 X X X X ONE RURAL HEALTH CLINIC WAGNER COMMUNITY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X SEE LINE 7D NARRATIVE X SEE LINE 7D NARRATIVE X X 1 24 1 SEE LINE 7D NARRATIVE 0 1 X 100.000000000000 200.000000000000 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 X 1 X 0 X X X X 1 X 0 0 WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE WAGNER COMMUNITY MEMORIAL HOSPITAL REPRESENTATIVES REACHED OUT TO LOCAL COMMUNITY MEMBERS AND LEADERS TO DEVELOP A COMMUNITY FOCUS GROUP. THE AMERICAN INDIAN POPULATION WAS IDENTIFIED AS AN UNDERSERVED POPULATION SPECIFIC TO THE HOSPITAL SERVICE AREA. THE FOCUS GROUP CONSISTED OF REPRESENTATIVES FROM THE FOLLOWING: WAGNER COMMUNITY MEMORIAL HOSPITAL BOARD MEMBERS, WAGNER INDIAN HEALTH SERVICES, YANKTON SIOUX TRIBAL POLICE, EMERGENCY MEDICAL TECHNICIAN, COMMUNITY HEALTH NURSE AND SDSU EXTENSION. THE HOSPITAL REPRESENTATIVES INCLUDED THE CEO/ADMINISTRATOR, DIRECTOR OF NURSING, CLINICAL COORDINATOR AND BEHAVIORAL HEALTH DIRECTOR. THE CHNA COMMUNITY FOCUS GROUP MET FOR FOUR MEETINGS THROUGHOUT DECEMBER 2024 TO DISCUSS THE PURPOSE OF THE CHNA, THE GOALS OF THE FOCUS GROUP, AND THE IMPACT ON THE COMMUNITY. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT HTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PURSUANT TO THE FY25 IMPLEMENTATION STRATEGY ADOPTED BY WAGNER COMMUNITY MEMORIAL HOSPITAL (WCMH), MENTAL HEALTH SERVICES, SUBSTANCE ABUSE, DIABETES, OBESITY AND HEART DISEASE WERE IDENTIFIED AS COMMUNITY NEEDS. THE NEEDS ARE A CONTINUATION OF THE NEEDS IDENTIFIED AND ADDRESSED IN THE PRIOR CHNA. THE FACILITY WILL ADDRESS THE IDENTIFIED NEEDS IN CURRENT AND FUTURE YEARS, AS FOLLOWS.1. MENTAL HEALTH:A. THE HOSPITAL WILL CONTINUE TO PROVIDE REFERRALS TO APPROPRIATE BEHAVIORAL HEALTH SERVICES.B. THE HOSPITAL WILL PROVIDE COORDINATION OF CRITICAL INCIDENT DEBRIEFING FOR STAFF MEMBERS.C. THE HOSPITAL WILL CONTINUE TO EMPLOY OR CONTRACT A FULL TIME OR PART TIME PSYCHIATRIC (MEDICATION MANAGEMENT) AND/OR A PSYCHOLOGIC (COUNSELING) PROVIDER.2. SUBSTANCE ABUSE:A. WCMH WILL CONTINUE TO PROVIDE REFERRALS TO APPROPRIATE SUBSTANCE ABUSE SERVICES.B. WCMH WILL STAFF FULL-TIME MENTAL HEALTH PROVIDERS WITH LICENSES THAT SUPPORT THE TREATMENT AND EVALUATION OF SUBSTANCE USE DISORDERS.3. DIABETES:A. THE HOSPITAL WILL CONTINUE TO PROVIDE DIABETIC EDUCATION OPPORTUNITIES TO THE PUBLIC.B. WCMH WILL INCREASE REFERRALS TO DIABETIC EDUCATION PROGRAMS AND RECOURSES, AS APPROPRIATE.C. WCMH WILL STRIVE TO PRODUCE A STANDARD PLAN OF CARE FOR CURRENT AND FUTURE DIABETIC AND PRE-DIABETIC PATIENTS.4. OBESITY:A. WCMH WILL INCREASE AWARENESS OF EXERCISE OPPORTUNITIES WITHIN THE SURROUNDING AREA.B. THE HOSPITAL WILL CONTINUE TO EDUCATE PATIENTS ON A HEALTHY DIET.5. HEART DISEASE:A. WCMH PROVIDERS WILL CONTINUE TO EDUCATE THEIR PATIENTS ON A HEALTHY DIET AND EXERCISE.B. THE HOSPITAL WILL WORK TO INCREASE PATIENT'S COMPLIANCE WITH MEDICATION MANAGEMENT.C. WCMH PROVIDERS WILL CONTINUE TO REFER QUALIFIED PATIENTS TO CARDIOLGIST.WAGNER COMMUNITY MEMORIAL HOSPTIAL AVERA HAS BEEN ABLE TO CONTINUOUSLY ADDRESS ALL NEEDS IDENTIFIED IN THE MOST RECENT CHNA. IN THE CURRENT YEAR WCMH HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS THE IDENTIFIED NEEDS IN THE MOST RECENT CHNA: WCMH HAS HIRED 2 ADDITIONAL BEHAVORIAL HEALTH COUNSELORS. THIS NOW BRINGS OUR STAFF TO A TOTAL OF 4. WE CONTINUE TO PLACE THE APPROPRIATE REFERRALS TO OUTSIDE FACILITIES AS NEEDED. WCMH CONTINUES TO MAKE PROGRESS IN EMPLOYING A SUBSTANCE ABUSE COUNSELOR BY LINING UP INTERNS IN ADDITION TO PLACING APPROPRIATE REFERRALS TO OUTSIDE FACILITIES. WCMH CONTINUES TO PROVIDE INFORMAL DIABETIC EDUCATION BY PROVIDERS AT WAGNER COMMUNITY CLINIC AND PLACE THE NECESSARY REFERRALS FOR DIABETIC EDUCATION PROGRAMS. WCMH CONTINUES TO PROVIDE REFERRALS TO A DIETICIAN AND INFORM PATIENTS OF COMMUNITY RESOURCES FOR EXERCISE OPPORTUNITIES. WCMH ALSO CONTINUES TO PROVIDE CARDIOLOGY OUTREACH SERVICES ON A MONTHLY BASIS AND CONTINUES TO INCREASE PATIENT AWARENESS OF COMPLIANCE WITH MEDICATION MANAGEMENT. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL USES PRESUMPTIVE ELIGIBILITY TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF NEEDED. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16J: THE REFERENCE TO THE POLICY AND ITS LOCATION IS SENT WITH ALL STATEMENTS. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. PART I, LINE 3C: IN ADDITION TO UTILIZING FPG TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE HOSPITAL REVIEWS INSURANCE STATUS AND USES PRESUMPTIVE ELIGIBILITY. 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 7E ,7F AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT. PART II, COMMUNITY BUILDING ACTIVITIES: THE CEO IS INVOLVED IN THE ROTARY CLUB, WHICH IS MADE UP OF BUSINESS LEADERS WHO WORK WITH COMMUNITY SERVICE ORGANIZATION TO ENHANCE THE COMMUNITY.THE CEO DEDICATED TIME TO THE WAGNER DAYCARE BUILDING LOAN FUND LLC TO HELP GROW THE LOCAL DAYCARE BUSINESS THAT IS MUCH NEEDED FOR ALL EMPLOYERS WITHIN THE COMMUNITY. THE PROJECT IS IMPORTANT TO ENABLING MORE DAYCARE OPPORTUNITIES IN THE COMMUNITY WHICH HAS LOW NUMBERS OF AVAILABILITY WITH MANY YOUNG FAMILIES HAVING CHILDREN.WCMH HOSTED AN EIGHTH GRADE CAREER FAIR FOR THE REGIONAL SCHOOLS. EIGHTH GRADERS MUST SELECT CAREER PATHWAYS FOR HIGH SCHOOL REGISTRATION; THUS, THE GOAL OF THE CAREER FAIR IS TO EXPOSE STUDENTS TO THE TECHNICAL SKILLS AND EDUCATION NEEDED TO BE SUCCESSFUL IN BUSINESS AND INDUSTRY. ALSO, THE CAMP MED EVENT WAS COMBINED WITH THE CAREER FAIR TO PROVIDE YOUTH HANDS-ON DEMONSTRATIONS ABOUT CAREERS & HEALTH CARE CAREERS. EACH STUDENT RECEIVED A CINCH BAG (DRAWSTRING) AND SDAHO BROCHURE. STUDENTS RECEIVE HANDS-ON HEALTHCARE EXPERIENCES WITH GERM/HANDWASHING USING GLOW GERM AND BLACK LIGHT; TOOLS TO TREAT CONDITIONS AT THE PHYSICAL THERAPY BOOTH; STUDENTS WERE ABLE TO REMOVE SUTURES FROM A BANANA AND PLACE AND REMOVE STAPLES FROM AN ORANGE. STUDENTS WERE ABLE TO WALK THROUGH A VIRTUAL INFLATABLE BRAIN AND LEARN ABOUT MENTAL HEALTH AND HOW SUBSTANCES CAN CHANGE YOUR BRAIN. STUDENTS WERE ALSO ABLE TO MAKE A CALMING JAR WITH A 988 STICKER ON IT, WHILE LEARNING COPING SKILLS AND ABOUT BEHAVIORAL HEALTH CAREERS. APPROXIMATELY 460 STUDENTS FROM 21 DIFFERENT REGIONAL SCHOOLS ATTENDED IN ADDITION TO SCHOOL COUNSELORS AND OTHER STAFF AND VENDORS. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS 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 2024. THEREFORE, 15.7% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGES 12-13 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2025.MANY PATIENTS IN OUR SERVICE AREA QUALIFY FOR MEDICARE. THE FACILITY PROVIDES SERVICES TO THESE PATIENTS REGARDLESS OF IF THERE IS A SHORTFALL OR SURPLUS. PROVIDING SERVICES TO THIS POPULATION PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE NEEDED IN OUR COMMUNITY, THEREBY PROVIDING A BENEFIT TO OUR COMMUNITY.TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICAID AND MEDICARE SERVICES. PART III, LINE 9B: ACCOUNTS THAT MEET THE CRITERIA FOR THE FINANCIAL ASSISTANCE POLICY WILL BE WRITTEN OFF IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS THAT DO NOT MEET THE CRITERIA FOR FINANCIAL ASSISTANCE WILL PROCEED THROUGH THE COLLECTION PROCESS. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT AN ACCOUNT IN COLLECTION BELONGS TO A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT WILL BE REMOVED FROM COLLECTION AND RETURNED TO THE HOSPITAL FOR RESOLUTION. PART VI, LINE 2: IN ADDITION TO PREPARING A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR ENDED JUNE 30, 2025, WCMH DETERMINES PATIENT NEEDS THROUGH CONSTANT COMMUNICATION WITH PATIENTS, PRIMARY AND SPECIALTY PROVIDERS, AND STATE AND FEDERAL GOVERNMENTAL HEALTH AGENCIES. WCMH STRIVES TO CONSISTENTLY INVESTIGATE, ANALYZE, AND DETERMINE THE GREATEST NEEDS OF OUR COMMUNITY. PART VI, LINE 3: AT EACH POINT OF ADMISSION, NOTICES ARE POSTED STATING WCMH OFFERS FINANCIAL ASSISTANCE WITH CONTACT INFORMATION FOR ASSISTANCE. REFERENCE TO THE POLICY IS GIVEN TO THE PATIENT UPON ADMISSION AND AGAIN WITH THE NOTICE/STATEMENT FOR PAYMENT, INCLUDING CONTACT INFORMATION FOR ASSISTANCE. IF THE PATIENT EXPRESSES INTEREST IN FINANCIAL ASSISTANCE, A PATIENT ADVOCATE WILL ASSIST IN COMPLETING THE PROPER APPLICATION. PART VI, LINE 4: WAGNER IS A RURAL COMMUNITY LOCATED IN SOUTHERN CHARLES MIX COUNTY IN SOUTH DAKOTA WHICH HAS MANY HEALTH DISPARITIES WITH UNMET NEEDS. IF ONE LOOKS AT SOUTHERN CHARLES MIX COUNTY, THE AVERAGE INDIVIDUAL INCOME IS $38,750 WITH THE MEDIAN HOUSEHOLD INCOME AT $64,038. THIS IS COMPARED TO THE NATIONAL AVERAGE OF $49,848 AND $81,604. SOUTHERN CHARLES MIX COUNTY HAS A FEDERAL POVERTY LEVEL OF 24.0% COMPARED TO 10.4% FOR SOUTH DAKOTA. COUNTY EDUCATION DEMOGRAPHICS INCLUDE 91% OF RESIDENTS HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 25.7% HOLDING A BACHELOR'S DEGREE OR HIGHER, COMPARED TO A NATIONAL LEVEL OF 89.9% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 36.8% HAVING A BACHELOR'S DEGREE OR HIGHER. ACCORDING TO THE US CENSUS BUREAU MOST RECENT DATA 33% OF SOUTHERN CHARLES MIX COUNTY ARE OF AMERICAN INDIAN DESCENT COMPARED TO 8.7% FOR SOUTH DAKOTA AND .6% NATIONALLY. THE WAGNER SERVICE AREA IS ALSO CONSIDERED A HEALTH PROFESSIONAL SHORTAGE AREA-LOW INCOME GEOGRAPHIC. THIS IS DUE TO ITS ACCESS TO FEW PROVIDERS AND LONG DISTANCES BETWEEN OTHER RURAL COMMUNITIES. OUR SERVICE AREA INCLUDES A COMMUNITY CLINIC IN ADDITION TO THE WAGNER INDIAN HEALTH SERVICES CLINIC AND THE VA CLINIC. MANY CLINICS PROVIDE ONLY PRIMARY CARE SERVICES AND ARE OFTEN STAFFED BY NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. IN CASES WHERE MORE SPECIALIZED CARE IS NEEDED, PATIENTS HAVE THE OPTION TO TRAVEL TO YANKTON, SOUTH DAKOTA, WHICH IS AN 110 MILE ROUND TRIP OR TRAVEL 222 MILES ROUND TRIP TO SIOUX FALLS, SOUTH DAKOTA, WHICH IS ALSO THE AREA'S TERTIARY CARE HUB FOR ALL TYPES OF SPECIALTY CARE.WE ALSO FIND CHARLES MIX COUNTY, SD IN AN AREA IN WHICH THERE IS A HIGH PERCENTAGE OF UNINSURED UNDER THE AGE OF 65. CHARLES MIX COUNTY INCLUDES 17.1% UNINSURED AS COMPARED TO 8.1% NATIONALLY. THE UNINSURED NATIVE AMERICAN POPULATION IN CHARLES MIX CO IS 38.6% WITH THE NATIONAL AVERAGE NATIVE AMERICAN POPULATION AT 18.9%. PART VI, LINE 5: THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA OF THE ORGANIZATION, AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. WCMH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. WCMH USES SURPLUS FUNDS TO IMPROVE PATIENT CARE THROUGH EXPANDING ITS QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT (QAPI) PROGRAM AND SUPPORTING RECOMMENDATIONS FORWARDED BY THE QAPI COMMITTEE. ADDITIONALLY, WCMH ALLOCATES BETWEEN $2,500 AND $5,000 IN EDUCATIONAL STIPENDS FOR ALL PROVIDERS (PHYSICIAN, ADVANCED PRACTICE PROVIDER) AS WELL AS PURCHASES ONLINE AND ON CAMPUS TRAINING FOR ALL DIRECT CARE STAFF.WCMH PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES WHICH INCLUDE: 1) COMMUNITY CPR CLASSES AND PARENTING CLASSES THROUGH OUR BEHAVIORAL HEALTH DEPARTMENT. 2) 24/7 EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY; 3) AN ER EQUIPPED WITH THE LATEST TECHNOLOGY INCLUDING TELEMEDICINE; 4) SPONSORSHIPS FOR STUDENTS THROUGH THE BUILD DAKOTA SCHOLARSHIP PROGRAM WHICH IS LINKED TO 4 SOUTH DAKOTA TECHNICAL COLLEGE. PART VI, LINE 6: WCMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE WAGNER COMMUNITY MEMORIAL HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED IN APPROXIMATELY A 60 MILE RADIUS. WCMH 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 CAN PROVIDE THESE SERVICES TO WCMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS CAN DEVOTE MORE RESOURCES TO PATIENT CARE. AVERA HEALTH AND WCMH 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. 1 SCHOLARSHIP 5 31312 PART I, LINE 2: WCMH ENSURES THE FUNDS USED FOR SCHOLARSHIPS TO DOMESTIC INDIVIDUALS ARE AT SCHOOLS WITHIN THE STATE OF SOUTH DAKOTA AND ARE LOCAL RESIDENTS WHO HAVE SIGNED AN AGREEMENT TO WORK FOR WCMH AFTER THE COMPLETION OF THEIR EDUCATION. THEIR ENROLLMENT IS VERIFIED WITH THE APPROPRIATE SCHOOLS. THESE SCHOLARSHIPS ARE AVAILABLE TO AN INDIVIDUAL WHO IS INTERESTED IN ADDITIONAL EDUCATION AND IS WILLING TO PROVIDE THEIR SERVICES TO WCMH UPON GRADUATION. X X 0 0 0 0 0 0 0 0 0 TIANNA SMITH CMO 355827 0 0 0 0 0 17801 0 1547 0 375175 0 0 0 BRYAN SLABA CEO 297701 0 0 0 0 0 15230 0 30326 0 343257 0 0 0 JORDAN WEBER PHYSICIANS ASSISTANT 287887 0 0 0 0 0 14742 0 24523 0 327152 0 0 0 MIKEALA KOENIG PHYSICIAN 211916 0 0 0 0 0 0 0 39609 0 251525 0 0 0 JOSEPH SEES PHYSICAL THERAPIST 189343 0 0 0 0 0 9880 0 34029 0 233252 0 0 0 JAROD MYER NURSE PRACTITIONER 182085 0 0 0 0 0 9731 0 38142 0 229958 0 0 0 BRITTANY BARRON VP OF PATIENT SERVICES 178102 0 0 0 0 0 9529 0 38142 0 225773 0 0 0 CASSSIE NELSON NURSE PRACTITIONER 180463 0 0 0 0 0 9290 0 21582 0 211335 0 0 0 JESSICA PETERS FAMILY RELATIONSHIP WITH CHAD PETERS, BOARD MEMBER 131723 EMPLOYEE COMPENSATION 0 TORI THALER FAMILY RELATIONSHIP WITH TIANNA SMITH, CMO 144910 EMPLOYEE COMPENSATION 0 TIMOTHY THALER FAMILY RELATIONSHIP WITH TIANNA SMITH, CMO 131948 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBER. ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION HAVING LEGAL ENTITY, WHO HAS CONTRIBUTED $25 OR MORE TO THE CORPORATION WITH REQUEST OF MEMBERSHIP AT THE TIME OF DONATION, SHALL BE A MEMBER THEREOF AND EACH MEMBER SHALL HAVE ONE VOTE AT ALL MEETINGS OF THE MEMBERS OF THE CORPORATION. MEMBERSHIP OF ANY INDIVIDUAL WHO SHALL BECOME DECEASED SHALL REVERT BY REQUEST TO THAT INDIVIDUAL'S NEXT OF KIN OR ACCORDING TO HIS WILL. ANY MEMBER WHO HAS CONTRIBUTED $50 OR MORE SHALL HAVE THE RIGHT TO TRANSFER SUCH MEMBERSHIP TO HIS OR HER SPOUSE. SAID TRANSFER TO BE APPROVED BY THE BOARD OF DIRECTORS. THE BASIS FOR MEMBERSHIP IS ON NON-REFUNDABLE CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 7A ONLY ONE CLASS OF MEMBER EXISTS. AT THE ANNUAL MEETING, MEMBERS APPROVE THE MINUTES OF THE LAST ANNUAL MEETING, ELECT BOARD MEMBERS OF THE WAGNER COMMUNITY MEMORIAL HOSPITAL, AND VOTE ON OTHER BUSINESS THAT MAY BE PROPERLY BROUGHT BEFORE THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS REQUIRE MEMBER APPROVAL. FORM 990, PART VI, SECTION A, LINE 8B WAGNER COMMUNITY MEMORIAL HOSPITAL DOES NOT HAVE COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE CEO WILL REVIEW THE 990. AFTER THE FORM 990 HAS BEEN REVIEWED, IT WILL BE FORWARDED TO THE MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND MANAGEMENT OFFICIALS ARE REQUIRED TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES WHICH ARE MONITORED AND TRACKED. THE QUESTIONNAIRES ARE REVIEWED BY THE BOARD FOR ANY POSSIBLE CONFLICTS WITH ANY NOTED CONFLICTS BEING BROUGHT TO MANAGEMENT'S ATTENTION. INQUIRIES OF CONFLICTS ARE ALSO REVIEWED AT THE MONTHLY BOARD MEETINGS. AFTER A CONFLICT IS DEEMED TO EXIST, THE BOARD DETERMINES THE LEVEL OF PARTICIPATION OF THE POTENTIAL CONFLICTING MEMBER. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS ACTS AS THE COMPENSATION COMMITTEE AND USES THE GALLAGHER COMPENSATION SURVEY TO DETERMINE COMPENSATION FOR EXECUTIVE MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. WDCBLF LLC 315 E 4TH AVE MITCHELL SD 57301 993724169 DAYCARE SD WAGNER COMMUNITY MEMORIAL HOSPITAL EXCLUDED -2168 0 0 0.83330 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WDCBLF LLC D 225000 CASH