SHERIDAN MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2021
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- Organization
- SHERIDAN MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0243720)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202311359349304901
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T10:11:05-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST FRONT STREET 301 | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810243720 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHER | BusinessNameControlTxt |
| Phone | 4067653700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KODY NELSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4067653700 | PhoneNum |
| Signature | 2023-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KODY | PersonFirstNm |
| Person Last | NELSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SAM BRUNSON CPA | PreparerPersonNm |
| PTIN | P01696998 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2023-05-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KODY NELSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,150,853 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SHERIDANMEMORIAL.NET | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1920 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 193 | TotalEmployeeCnt |
| Total Volunteers | 19 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,302,318 | PYContributionsGrantsAmt |
| CY Contributions Grants | $594,649 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,798,538 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,411,919 | CYProgramServiceRevenueAmt |
| PY Investment Income | $64,576 | PYInvestmentIncomeAmt |
| CY Investment Income | $92,890 | CYInvestmentIncomeAmt |
| PY Other Revenue | $22,000 | PYOtherRevenueAmt |
| CY Other Revenue | $11,453 | CYOtherRevenueAmt |
| PY Total Revenue | $17,187,432 | PYTotalRevenueAmt |
| CY Total Revenue | $16,110,911 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,063,200 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,210,598 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $71,559 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,409,409 | PYOtherExpensesAmt |
| CY Other Expenses | $8,554,869 | CYOtherExpensesAmt |
| PY Total Expenses | $14,472,609 | PYTotalExpensesAmt |
| CY Total Expenses | $16,765,467 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,714,823 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$654,556 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,705,710 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,733,629 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,034,640 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,722,815 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,671,070 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,010,814 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDING QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE, REGARDLESS OF THEIR ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,087,191 | ExpenseAmt |
| Revenue | $15,411,919 | RevenueAmt |
| Desc | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION OPERATES A 19-BED CRITICAL ACCESS HOSPITAL, A 45-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 FY22 ARE INCLUDED BELOW:THE CRITICAL ACCESS HOSPITAL PURCHASED NEW MINDRAY MONITORS DURING THE YEAR TO IMPROVE THE ABILTITY TO PROVIDE CONTINUOUS CARDIAC MONITORING, CO2 MONITORING, AND HAVE THE TEMPERATURE SENSING FOLEY. THIS NEW SYSTEM REPLACES THE OLD SYSTEM PUT IN PLACE DURING 2011. CONTINUED ON SCHEDULE O. THE EMERGENCY MEDICAL SERVICES DEPARTMENT MADE EQUIPMENT PURCHASES AND IMPLEMENTED CHANGES TO IMPROVE PATIENT CARE AND CERTAIN PROCESSES. FOR EXAMPLE, EMS PURCHASED A NEW AMBULANCE WITH DELIVERY EXPECTED IN FALL OF 2023 AND ASSISTED IN THE CREATION OF A SNOW REMOVAL PLAN FOR THE AIRPORT TO AIDE IN FLYING OUT CRITICALLY SICK AND INJURED PATIENTS TO HIGHER LEVELS OF CARE.VOLUME INDICATORS FOR THE FISCAL YEAR ARE AS FOLLOWS: ACUTE CARE INPATIENT ADMISSIONS - 108ED VISITS - 1,049SWING BED PATIENTS - 97LONG-TERM CARE ADMISSIONS - 20HOME CARE VISITS - 2,811HOSPICE - 412CLINIC VISITS - 7,842 | Desc |
| Total Program Service Expenses | $13,087,191 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 193 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KODY NELSON | PersonNm |
| Phone | 4067653702 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 WEST LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DON BENSON | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MYRNETTE MILLER | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOAN TOMMERUP | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NANCY JENSEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BEV JOHNSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL HANSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CORY SAMUELSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KODY NELSON | |||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| ADAM GRAHAM | |||||||
| PA | 40.00 | $219,098 | $0 | $7,575 | Yes (X) | ||
| LINDA ATOR | |||||||
| DON | 40.00 | $112,843 | $0 | $1,618 | Yes (X) | ||
| KATHLEEN TANGEDAL | |||||||
| CNO | 40.00 | $112,597 | $0 | $10,186 | Yes (X) | ||
| CARLOS TREVINO | |||||||
| MD | 10.00 | $125,747 | $0 | $343 | Yes (X) | ||
| ARCHANA KAYASTHA | |||||||
| FNP | 40.00 | $118,208 | $0 | $9,030 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $688,493 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $28,752 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SLETTEN CONSTRUCTION | |||||
| 1375 4TH AVE N | BILLINGS | MT | 59107 | CT/LAB REMODEL | $1,126,600 |
| BILLINGS CLINIC | |||||
| PO BOX 30357 | BILLINGS | MT | 59107 | MGMT, CEO, ACGT, LAB, RADIOLOGY, IS SUPP | $784,740 |
| WILDERNESS | |||||
| PO BOX 30729 | SPOKANE | WA | 99223 | HEATING AND AIR PROJECTS AND CONTRACTS | $305,452 |
| BADLANDS | |||||
| 804 2ND ST | UNDERWOOD | ND | 58576 | TRAVEL RN, LPN, CAN | $299,037 |
| CERNER CORPORATION | |||||
| BOX 959156 | ST LOUIS | MO | 63195 | EMR | $238,981 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $188,815 | RelatedOrganizationsAmt |
| Government Grants | $380,351 | GovernmentGrantsAmt |
| All Other Contributions | $25,483 | AllOtherContributionsAmt |
| Total Contributions | $594,649 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $14,156,232 | $14,156,232 |
| 340B REVENUE | 621990 | $531,500 | $531,500 |
| OTHER OPERATING REVENUE | 621990 | $505,043 | $505,043 |
| CONTRACT REVENUE | 621990 | $219,144 | $219,144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,411,919 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,589 | TotalRevenueColumnAmt |
| Exclusion | $13,589 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $11,453 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $11,453 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,453 | TotalRevenueColumnAmt |
| Exclusion | $11,453 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $119,243 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $39,942 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $79,301 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $79,301 | TotalRevenueColumnAmt |
| Exclusion | $79,301 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,110,911 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,411,919 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $104,343 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,683,870 | TotalAmt |
| Program Services | $6,683,870 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,284 | TotalAmt |
| Program Services | $143,284 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $893,748 | TotalAmt |
| Program Services | $893,748 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $489,696 | TotalAmt |
| Program Services | $489,696 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,689 | TotalAmt |
| Program Services | $17,689 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,275 | TotalAmt |
| Program Services | $29,275 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,978,473 | TotalAmt |
| Program Services | $3,958,000 | ProgramServicesAmt |
| Management And General | $20,473 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,877 | TotalAmt |
| Fundraising | $56,877 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $391,370 | TotalAmt |
| Management And General | $391,370 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,064 | TotalAmt |
| Management And General | $12,064 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,397 | TotalAmt |
| Management And General | $86,397 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,786 | TotalAmt |
| Management And General | $44,736 | ManagementAndGeneralAmt |
| Fundraising | $1,050 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,833 | TotalAmt |
| Program Services | $277,855 | ProgramServicesAmt |
| Management And General | $309,978 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,543 | TotalAmt |
| Management And General | $165,543 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| SUPPLIES | $1,544,037 | $1,544,037 | |
| BAD DEBT | $593,774 | $593,774 | |
| BED TAX | $367,627 | $367,627 | |
| REPAIRS AND MAINTENANCE | $325,051 | $325,051 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $353,073 | TotalAmt |
| Management And General | $339,441 | ManagementAndGeneralAmt |
| Fundraising | $13,632 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,765,467 | TotalAmt |
| Program Services | $13,087,191 | ProgramServicesAmt |
| Management And General | $3,606,717 | ManagementAndGeneralAmt |
| Fundraising | $71,559 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,747,692 | BOYAmt |
| EOY | $1,682,418 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,566,106 | BOYAmt |
| EOY | $1,615,550 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,646,626 | BOYAmt |
| EOY | $1,963,619 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $257,152 | BOYAmt |
| EOY | $256,787 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $192,426 | BOYAmt |
| EOY | $195,920 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,368,860 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,783,352 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,419,384 | BOYAmt |
| EOY | $4,585,508 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,446 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $784,878 | BOYAmt |
| EOY | $433,827 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,705,710 | BOYAmt |
| EOY | $10,733,629 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,071,571 | BOYAmt |
| EOY | $2,041,628 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $942,880 | BOYAmt |
| EOY | $562,529 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $675,291 | BOYAmt |
| EOY | $671,731 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $344,898 | BOYAmt |
| EOY | $446,927 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,034,640 | BOYAmt |
| EOY | $3,722,815 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,667,870 | BOYAmt |
| EOY | $7,007,614 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,200 | BOYAmt |
| EOY | $3,200 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,671,070 | BOYAmt |
| EOY | $7,010,814 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,705,710 | BOYAmt |
| EOY | $10,733,629 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$654,556 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$5,700 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $104,263 | BeginningYearBalanceAmt |
| End Year Balance | $104,263 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $104,263 | BeginningYearBalanceAmt |
| End Year Balance | $104,263 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $104,263 | BeginningYearBalanceAmt |
| End Year Balance | $104,263 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $104,286 | BeginningYearBalanceAmt |
| Contributions | -$143 | ContributionsAmt |
| Investment Earnings Or Losses | $120 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $104,263 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $103,996 | BeginningYearBalanceAmt |
| Contributions | $143 | ContributionsAmt |
| Investment Earnings Or Losses | $147 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $104,286 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $384,756 | OtherCostOrOtherBasisAmt |
| Book Value | $384,756 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,748,441 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,600,943 | DepreciationAmt |
| Book Value | $2,147,498 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,103,545 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,182,409 | DepreciationAmt |
| Book Value | $1,921,136 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $132,118 | OtherCostOrOtherBasisAmt |
| Book Value | $132,118 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,585,508 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| GUARANTEE OF PATIENT LOANS | $150,345 |
| BED TAXES PAYABLE | $97,185 |
| OTHER PAYABLES | $216 |
| RIGHT OF USE LEASE | $199,181 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $446,927 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. FEDERAL AND STATE INCOME TAXES ARE PAID ON NONEXEMPT UNRELATED BUSINESS INCOME IN ACCORDANCE WITH THE CODE. CURRENT ACCOUNTING GUIDELINES REQUIRE AN ORGANIZATION TO DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR TAX YEARS 2018 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $339,725 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $339,725 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02030 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,203,436 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,203,436 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13140 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,543,161 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,543,161 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15170 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,245 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,245 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $142,963 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,014 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $140,949 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $480 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $480 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $155,688 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,014 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $153,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,698,849 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,014 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,696,835 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $553,287 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,412,206 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,400,856 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $11,350 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SHERIDANMEMORIAL.NET | WebsiteAddressTxt |
| State License | 13547 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC, LONG-TERM CARE FACILITY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SHERIDANMEMORIAL.NET | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.FACEBOOK.COM/SHERIDAN.MEMORIAL | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SHERIDANMEMORIAL.NET | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.SHERIDANMEMORIAL.NET | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.SHERIDANMEMORIAL.NET | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.SHERIDANMEMORIAL.NET | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: THE CHNA WAS CONDUCTED WITH MONTANA STATE UNIVERSITY - OFFICE OF RURAL HEALTH. |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 7D: PAPER COPIES WERE ALSO DISTRIBUTED TO LA CASA AND PIONEER MANOR (BOTH FACILITIES HELP AN OLDER GENERATION THAT DON'T UTILIZE COMPUTERS).THE CHNA WAS ALSO POSTED BY THE ADMISSIONS DESKS IN THE FACILITY AS WELL AS MAILED OUT TO 900 PATIENTS WITH THEIR STATEMENTS. IN ADDITION, ADVERTISEMENTS WERE PLACED IN THE GREETER AND SHERIDAN COUNTY NEWS (BOTH WEEKLY PRINT MEDIA). |
| 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.GOAL 1: IMPROVE AWARENESS OF AND ACCESS TO HEALTHCARE SERVICES THROUGHOUT SHERIDAN COUNTY.STRATEGY 1.1: ENHANCE SMHA'S PRESENCE IN THE COMMUNITY AS A RESOURCE FOR HEALTH EDUCATION AND PARTNERSHIPS.ACTIVITIES: ENHANCE SHERIDAN MEMORIAL HEALTHCARE ASSOCIATION'S (SMHA) PRESENCE IN THE COMMUNITY AS A VITAL PARTNER TO ADVANCE POPULATION HEALTH EFFORTS REGIONALLY. THIS INCLUDES BUT IS NOT LIMITED TO PROVIDING STAFF REPRESENTATIVES TO PARTICIPATE AND SUPPORT EFFORTS OF THE LOCAL COUNCIL ON AGING, ETC.; INCREASE SMHA'S OUTREACH THROUGHOUT THE REGION, HIGHLIGHTING PROVIDERS AND AVAILABLE SERVICES. CREATE A COMMUNITY OUTREACH AND EDUCATION CAMPAIGN THAT LEVERAGES EXISTING TOOLS SUCH AS SOCIAL MEDIA, COMMUNITY EVENTS, ETC.; SUSTAIN SMHA'S POST-ACUTE CARE UTILIZATION. SPECIFICALLY, BY TRACKING PATIENT TRANSFERS FOR LOCAL FOLLOW UP, TRACKING REFERRALS TO SURGICAL SERVICES (I.E., TO AN ORTHOPEDIC SURGEON FOR JOINT REPLACEMENT, ETC.), REQUESTING PROVIDERS TO SUSTAIN REFERRALS TO SWS SERVICES AT TIME OF CONSULTATION REFERRAL, AND FEATURING THE REHABILITATION DEPARTMENT AND SWS PROGRAM IN AN OUTREACH CAMPAIGN. THE POSSIBILITY OF TRANSPORTING SWING BED PATIENT BACK TO SMH. THE REVENUE OF A PATIENT IN HOUSE OUTWEIGHS THE COST OF TRANSPORTATION; NURTURE SMHA'S RELATIONSHIP WITH THE SHERIDAN COUNTY PUBLIC HEALTH NURSE TO SUSTAIN AND CONTINUALLY ALIGN LOCAL EFFORTS THAT ADVANCE POPULATION HEALTH; CONTINUE TO ADVANCE TELEHEALTH SERVICES LOCALLY IN ORDER TO REDUCE THE TRAVEL AND COORDINATION BURDEN EXPERIENCED BY SHERIDAN COUNTY RESIDENTS TRAVELING OUT OF THE AREA TO ACCESS ROUTINE AND PREVENTIVE SERVICES. THIS INCLUDES DEVELOPING AN EDUCATION AND OUTREACH PLAN INTENDED TO COMMUNICATE HOW COMMUNITY MEMBERS CAN ACCESS AND UTILIZE SERVICES.STRATEGY 1.2: EXPLORE OPPORTUNITIES THAT ENHANCE ACCESS TO HEALTHCARE SERVICES AND RESOURCES LOCALLY.ACTIVITIES: STAY APPRISED OF ADDITIONAL FUNDING SOURCES THAT WOULD IMPROVE HEALTH SERVICES AND RESOURCES LOCALLY; CONTINUE TO WORK WITH COMMUNITY PARTNERS TO EXPLORE THE FEASIBILITY OF A LOCAL VISION CLINIC THEREBY REDUCING THE TRAVEL BURDEN EXPERIENCED BY SHERIDAN COUNTY RESIDENTS TRAVELING OUT OF THE AREA TO ACCESS THESE ROUTINE AND PREVENTIVE SERVICES; EXPLORE THE INTEGRATION OF DIABETES EDUCATION AT SMHA TO IMPROVE CHRONIC DISEASE PREVENTION AND MANAGEMENT LOCALLY; ENHANCE SERVICES FOR AREA WOMEN AND CHILDREN BY CONDUCTING A FEASIBILITY STUDY OF IMPLEMENTING PEDIATRIC AND/OR OBSTETRIC SERVICES LOCALLY; EXPLORE THE ENHANCEMENT OF CARE COORDINATION ACTIVITIES THROUGH SMHA (I.E., TOBACCO CESSATION, REFERRAL PROTOCOLS, ETC.).; SUPPORT CONTINUOUS PROVIDER RECRUITMENT AND RETENTION EFFORTS AT SMHA BASED ON THE FEASIBILITY AND NEEDS OF THE SERVICE AREA; DEVELOP AND IMPLEMENT THE PATIENT/FAMILY ENGAGEMENT PROGRAM TO INVOLVE COMMUNITY MEMBERS TO SERVE AS VOLUNTEERS ON A HOSPITAL COMMITTEE, SUCH AS THE QUALITY COMMITTEE OR SAFETY COMMITTEE.GOAL 2: ENHANCE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IN SHERIDAN COUNTY.STRATEGY 2.1: SUPPORT LOCAL AND REGIONAL EFFORTS THAT ADDRESS THE MENTAL AND BEHAVIORAL HEALTH NEEDS THROUGHOUT SHERIDAN COUNTY.ACTIVITIES: PARTICIPATE IN REGIONAL BEHAVIORAL HEALTH ACTIVITIES AND INITIATIVES BY SUSTAINING SMHA'S ACTIVE PARTICIPATION ON THE REGIONAL BEHAVIORAL HEALTH COALITION. THIS INCLUDES BUT IS NOT LIMITED TO PROVIDING STAFF REPRESENTATIVES TO PARTICIPATE AND SUPPORT EFFORTS OF THE COALITION, DISSEMINATING COMMUNITY OUTREACH AND EDUCATION, ETC.; CONTINUE TO IMPLEMENT THE CRISIS MANAGEMENT INTAKE QUESTIONNAIRE (PHQ-9) THROUGHOUT SMHA'S CLINIC AND HOSPITAL SETTINGS. MONITOR THE UTILIZATION OF THE QUESTIONNAIRE AND PROVIDER ROUTINE EDUCATION TO SMHA STAFF AND PROVIDERS TO ENSURE CONSISTENT USAGE; TRAIN AND EQUIP SMHA STAFF OF ALL LEVELS WITH THE TOOLS AND KNOWLEDGE SO THEY ARE PREPARED TO ADEQUATELY RESPOND TO MENTAL AND BEHAVIORAL HEALTH PATIENTS (I.E., PRESENTING IN CRISIS, RESOURCES, ROUTINE CARE, ETC.).; EXPLORE SUBSTANCE ABUSE PREVENTION AND RESOURCES BASED ON THE NEEDS OF THE REGION (I.E., PARTNERSHIP WITH THE LOCAL BEHAVIORAL HEALTH COALITION, UTILIZING STIGMA REDUCTION MESSAGING, EDUCATIONAL CAMPAIGNS, ETC.).NEEDS NOT ADDRESSED:1. 9.7% OF SURVEY RESPONDENTS INDICATED THEY HAD DIFFICULTY GETTING A PRESCRIPTION OR TAKING THEIR MEDICATION REGULARLY DUE TO COST IN THE LAST YEAR.RATIONALE: 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. RATIONALE: 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.RATIONALE: 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 STATED MED SPA, WEIGHT MANAGEMENT, NON - EMERGENT ERS AS WELL AS DME PRODUCT PURCHASED WITHOUT A PROVIDER SCRIPT. |
| PART V, SECTION B, LINE 20D | THERE IS A 90-DAY PERIOD OF ELIGIBILITY FOLLOWING INITIAL QUALIFICATION. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11 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. THIS PACKET INCLUDES ALL PAYMENT OPTIONS, MEDICAID INFORMATION AND 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 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. THE BOARD OF DIRECTORS IS MADE UP OF 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: * ALZHEIMER'S SUPPORT GROUP* GRIEF COUNSELOR* USE OF TELE-MED EQUIPMENT IS OPEN TO THE COMMUNITY FOR MENTAL HEALTH VISITS, BEHAVIORAL HEALTH CLASSES, MIP CLASSES, COMMUNITY GENERAL HEALTH EDUCATION AS WELL AS LIFESTYLE BALANCE CLASSES. CONTINUING EDUCATION OPPORTUNITIES ARE ALSO AVAILABLE VIA TELE-VIDEO FOR EMPLOYEES AND OTHER MEDICAL PERSONNEL OUTSIDE OF SHERIDAN MEMORIAL. ALL OF THE TELE-VIDEO OPPORTUNITIES ARE FREE OF CHARGE* 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, AND COUNTY HEALTH* 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 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* EMERGENCY STANDBY COVERAGE FOR COMMUNITY EVENTS AT NO COST TO THE COMMUNITY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ADAM GRAHAM | PersonNm |
| Title | PA | TitleTxt |
| Base Compensation Filing Org | $219,098 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $53 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $7,522 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $226,673 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 - $135,013 BONUS - $13,501 OTHER COMPENSATION - $646 EMPLOYER CONTRIBUTION TO MEDICAL AND DENTAL - $20,392 EMPLOYER CONTRIBUTION TO LIFE INSURANCE AND LONG-TERM DISABILITY - $645 |
| FORM 990, PART VI, SECTION A, LINE 6 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 788 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 788 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS DURING THE ANNUAL MEETING HELD THE THIRD 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 3,958,000. MANAGEMENT AND GENERAL EXPENSES 20,473. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,978,473. |
| FORM 990, PART XI, LINE 9: | DIRECT FUNDRAISING EXPENSES FOR FOUNDATION PAID BY HOSPITAL -5,700. |
| PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN HEALTH CARE FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810496987 | EIN |
| Primary Activities | SUPPORT ACTIVITIES OF SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |