2023-05-15T10:11:05-05:00 2022-06-30 390758449 WIPFLI LLP 101 EAST FRONT STREET 301 MISSOULA MT 59802 990 2021-07-01 810243720 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION SHER 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 KODY NELSON CEO 4067653700 2023-05-15 1 KODY NELSON XXX-XX-XXXX SAM BRUNSON CPA P01696998 4067281800 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KODY NELSON 440 W LAUREL AVENUE PLENTYWOOD MT 59254 16150853 0 X WWW.SHERIDANMEMORIAL.NET X 1920 MT PROVIDE QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE. 7 7 193 19 0 0 3302318 594649 13798538 15411919 64576 92890 22000 11453 17187432 16110911 0 0 0 0 8063200 8210598 0 0 71559 6409409 8554869 14472609 16765467 2714823 -654556 12705710 10733629 5034640 3722815 7671070 7010814 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 13087191 15411919 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 13087191 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 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 4 0 193 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 4067653702 440 WEST LAUREL AVENUE PLENTYWOOD MT 59254 X DON BENSON CHAIR 1.00 X X 0 0 0 MYRNETTE MILLER VICE CHAIR 1.00 X X 0 0 0 JOAN TOMMERUP SECRETARY 1.00 X X 0 0 0 NANCY JENSEN DIRECTOR 1.00 X 0 0 0 BEV JOHNSON DIRECTOR 1.00 X 0 0 0 PAUL HANSON DIRECTOR 1.00 X 0 0 0 CORY SAMUELSON DIRECTOR 1.00 X 0 0 0 KODY NELSON CEO 40.00 X 0 0 0 ADAM GRAHAM PA 40.00 X 219098 0 7575 LINDA ATOR DON 40.00 X 112843 0 1618 KATHLEEN TANGEDAL CNO 40.00 X 112597 0 10186 CARLOS TREVINO MD 10.00 X 125747 0 343 ARCHANA KAYASTHA FNP 40.00 X 118208 0 9030 688493 0 28752 7 0 1 0 SLETTEN CONSTRUCTION 1375 4TH AVE N BILLINGS MT 59107 CT/LAB REMODEL 1126600 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MGMT, CEO, ACGT, LAB, RADIOLOGY, IS SUPP 784740 WILDERNESS PO BOX 30729 SPOKANE WA 99223 HEATING AND AIR PROJECTS AND CONTRACTS 305452 BADLANDS 804 2ND ST UNDERWOOD ND 58576 TRAVEL RN, LPN, CAN 299037 CERNER CORPORATION BOX 959156 ST LOUIS MO 63195 EMR 238981 13 188815 380351 25483 594649 PATIENT SERVICE REVENUE 621990 14156232 14156232 340B REVENUE 621990 531500 531500 OTHER OPERATING REVENUE 621990 505043 505043 CONTRACT REVENUE 621990 219144 219144 15411919 13589 13589 11453 0 11453 11453 11453 119243 39942 79301 79301 79301 16110911 15411919 0 104343 X 6683870 6683870 143284 143284 893748 893748 489696 489696 17689 17689 29275 29275 3978473 3958000 20473 56877 56877 391370 391370 12064 12064 86397 86397 45786 44736 1050 587833 277855 309978 165543 165543 SUPPLIES 1544037 1544037 BAD DEBT 593774 593774 BED TAX 367627 367627 REPAIRS AND MAINTENANCE 325051 325051 353073 339441 13632 16765467 13087191 3606717 71559 2747692 1682418 2566106 1615550 1646626 1963619 257152 256787 192426 195920 20368860 15783352 4419384 4585508 91446 784878 433827 12705710 10733629 3071571 2041628 942880 562529 675291 671731 344898 446927 5034640 3722815 X 7667870 7007614 3200 3200 7671070 7010814 12705710 10733629 X -654556 -5700 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104263 104263 104263 104263 104263 104263 104286 -143 120 104263 103996 143 147 104286 1.00000 0 1 1 384756 384756 11748441 9600943 2147498 8103545 6182409 1921136 132118 132118 4585508 GUARANTEE OF PATIENT LOANS 150345 BED TAXES PAYABLE 97185 OTHER PAYABLES 216 RIGHT OF USE LEASE 199181 446927 X 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. 1 1 X 1 X 1 X 1 1 0 0 339725 339725 0.02030 2203436 2203436 0.13140 2543161 2543161 0.15170 12245 12245 0.00070 142963 2014 140949 0.00840 480 480 0.00000 155688 2014 153674 0.00910 2698849 2014 2696835 0.16080 1 553287 5412206 5400856 11350 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 21 1 0 1 1 X WWW.SHERIDANMEMORIAL.NET X WWW.FACEBOOK.COM/SHERIDAN.MEMORIAL X X 1 21 1 WWW.SHERIDANMEMORIAL.NET 0 1 X 100.000000000000 400.000000000000 X 1 1 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 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: 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. 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 0 0 0 0 0 0 0 0 0 ADAM GRAHAM PA 219098 0 0 0 0 0 53 0 7522 0 226673 0 0 0 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. 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