2023-05-11T09:32:13-05:00 2022-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2021-07-01 466015787 LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION LAND 6055832226 600 BILLARS ST SCOTLAND SD 570592026 MELISSA GALE CEO 6055832226 2023-05-10 1 MELISSA GALE 999009999 LAURIE HANSON CPA P00851848 6053391999 2023-05-09 X 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MELISSA GALE 600 BILLARS ST SCOTLAND SD 570592026 6864676 0 X WWW.AVERA.ORG/SCOTLAND X 1969 SD OPERATION OF A COMMUNITY CRITICAL ACCESS HOSPITAL. 6 6 79 9 0 0 2786598 437431 6073606 6414876 -1385 1428 0 0 8858819 6853735 0 0 0 0 2811514 3752491 0 0 0 3862261 3014506 6673775 6766997 2185044 86738 5817155 5774044 2320113 2023771 3497042 3750273 X LANDMANN-JUNGMAN MEMORIAL HOSPITAL IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE WITH COMPASSION AND RESPECT. OUR COMMITMENT SHALL BE TO THE ETHICAL TREATMENT OF ALL PEOPLE THROUGHOUT THE CONTINUUM OF LIFE. 1 0 5582659 6414876 LANDMANN-JUNGMAN MEMORIAL HOSPITAL (LJMH) IS A LICENSED CRITICAL ACCESS HOSPITAL WITH 20 ACUTE CARE BEDS, OF WHICH 10 MAY BE USED AS SWING BEDS. THE FACILITY OFFERS INPATIENT, OUTPATIENT (THERAPIES, LABORATORY, IMAGING), AND PHYSICIAN CLINIC SERVICES TO RESIDENTS IN AND AROUND THE CITY OF SCOTLAND, SD. SPECIALTY SERVICES SUCH AS MOBILE IMAGING, SLEEP STUDIES, CARDIOVASCULAR AND ULTRASOUND SERVICES ARE PROVIDED TO PATIENTS THROUGH CONTRACTED SERVICES. LJMH IS PROUD OF THE EXCELLENT CARE IT PROVIDES FOR PATIENTS OF THE SERVICE AREA. THE FACILITY IS ALSO NOTED FOR ITS COMMUNITY SERVICE WHICH INCLUDES COMMUNITY HEALTH EDUCATION AND HEALTH CARE SUPPORT. 5582659 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 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 0 0 0 0 1 23 0 1 79 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X ERIN ODENS 6055832226 600 BILLARS STREET SCOTLAND SD 57059 MELISSA GALE CEO 40.00 X 146539 0 22914 CODY CARSTENSEN PHARMACIST 40.00 X 108382 0 23025 LAURIE MCKEE DIRECTOR OF PATIENT SERVICES 40.00 X 102471 0 14596 ERIN ODENS CFO FROM 10/2021 40.00 X 81524 0 14690 JULIE DAVIS CFO UNTIL 10/2021 40.00 X 82090 0 10481 GREG GEMAR PRESIDENT UNTIL 12/2021 1.00 X X 0 0 0 JARED SCHORTMAN VICE PRESIDENT/PRESIDENT 0.50 X X 0 0 0 RHONDA BOUZA SECRETARY/VICE PRESIDENT 0.50 X X 0 0 0 DEVIN LUBINUS TREASURER 0.50 X X 0 0 0 REBECCA PEDERSEN SECRETARY FROM 01/2022 0.50 X X 0 0 0 TANYA BULT DIRECTOR UNTIL 10/2021 0.50 X 0 0 0 GARY PEPPER DIRECTOR UNTIL 09/2021 0.50 X 0 0 0 ANDREW ROKUSEK DIRECTOR 0.50 X 0 0 0 SARAH MEYER DIRECTOR FROM 08/2021 0.50 X 0 0 0 521006 0 85706 2 0 1 1 JOURNEY CONSTRUCTION 4500 W 58TH ST SIOUX FALLS SD 57108 CONSTRUCTION-REMODEL 1192668 AVERA MCKENNAN 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS SD 571175045 ADMIN/OTHER HEALTH SERVICES 1178194 AVERA HEALTH 3900 W AVERA DR STE 301 SIOUX FALLS SD 57108 HEALTH SERVICES 305269 HEALTH CAROUSEL LLC PO BOX 714216 CINCINNATI OH 452714216 CONTRACT NURSING 249766 GRAPETREE 2501 BOJI BEND DR STE 100 MILFORD IA 51351 CONTRACT NURSING 192177 8 437431 437431 NET PATIENT SERVICE RE 621110 5312600 5312600 PHARMACY REVENUE 446110 929261 929261 WEST WINDS REVENUE 623990 109215 109215 63800 63800 6414876 12369 12369 10941 -10941 -10941 -10941 6853735 6414876 0 1428 X 321844 109994 211850 3170048 2893564 276484 6555 4690 1865 116386 75035 41351 137658 118059 19599 62372 62372 842937 638770 204167 9396 9396 229740 152817 76923 110838 110838 5035 4402 633 64640 46076 18564 353489 257830 95659 39233 27966 11267 MEDICAL SUPPLIES 1211647 1113187 98460 LICENSE AND PERMITS 57621 13194 44427 CONTINUING EDUCATION 10057 5908 4149 17501 933 16568 6766997 5582659 1184338 0 1203677 476770 798579 669119 239369 197532 18397 28814 8242414 4740188 2763649 3502226 503484 555583 290000 344000 5817155 5774044 745813 694342 250000 0 1258976 1270389 65324 59040 2320113 2023771 X 3497042 3750273 3497042 3750273 5817155 5774044 X 86738 -33260 205473 -5720 X 0 1 X 1 1 1 X 36163 36163 6041827 3940551 2101276 2041013 706914 1334099 123411 92723 30688 3502226 INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 82861 F ASSETS LIMITED AS TO USE 472722 F 555583 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 344000 344000 CONDITIONAL ASSET RETIREMENT OBLIGATION 59040 59040 X 6814755 -33260 -5720 -38980 6853735 0 6853735 6766997 0 6766997 0 6766997 PART X, LINE 2: THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN AVERA FOUNDATION -5,720. 1 1 X 1 X 1 X 1 1 0 1 1 12000 12000 0.00180 219432 200160 19272 0.00280 231432 200160 31272 0.00460 19 2739 20104 3100 17004 0.00250 1471712 1235460 236252 0.03490 2 110 110 0.00000 21 2739 1491926 1238560 253366 0.03740 21 2739 1723358 1438720 284638 0.04200 1 373335 52267 2180027 2163059 16968 X 1 1 1 1 LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION 600 BILLARS STREET SCOTLAND SD 57059 WWW.AVERA.ORG/SCOTLAND 10561 X X X X LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPO 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V, LINE 7D X X 1 21 1 SEE PART V, LINE 7D 0 1 X 150.000000000000 400.000000000000 X X 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 LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 5: A VARIETY OF INDIVIDUALS FROM VARIOUS GROUPS AND ORGANIZATIONS WERE INVOLVED IN THE CHNA PROCESS FROM NOVEMBER 2021 THROUGH MARCH 2022. METHODS TO GATHER DATA INCLUDED: ANONYMOUS SURVEY SENT OUT ELECTRONICALLY AND PAPER SURVEYS; FORMAL INTERVIEWS GATHERED VIA TELEPHONE DUE TO THE COVID19 PANDEMIC AND PUBLIC HEALTH EMERGENCY; STATISTICAL DATA FROM RELIABLE DATA REPOSITORIES OR AGENCIES; INFORMAL DISCUSSIONS; REVIEW OF CLINICAL/MEDICAL SERVICES AND GRANT PROJECTS AT LJMH. ORGANIZATIONS TAKING PART IN THE INTERVIEWS INCLUDED: BON HOMME COUNTY HEALTH NURSE, LJMH AND SCOTLAND CLINIC, SCOTLAND PHARMACY, FIRST CHIROPRACTIC CLINIC, BON HOMME COUNTY DEPARTMENT OF SOCIAL SERVICES, SCOTLAND SCHOOL DISTRICT, PARENT TEACHER ASSOCIATION, SCOTLAND PUBLIC LIBRARY, SCOTLAND YOUTH CENTER, SCOTLAND RODEO CLUB, SCOTLAND ATHLETIC ASSOCIATION, SCOTLAND TRAP SHOOTING CLUB, SCOTLAND DAWSON CREEK GOLF COURSE, SCOTLAND WELLNESS CENTER, SCOTLAND PUBLIC POOL AND PARKS, LOCAL DAYCARE FACILITIES, CITY OF SCOTLAND, SCOTLAND FIRE DEPARTMENT, SCOTLAND EMS, SCOTLAND ECONOMIC DEVELOPMENT, SCOTLAND CHAMBER OF COMMERCE, SCOTLAND HOUSING DEVELOPMENT CORPORATION, LOW INCOME APARTMENT MANAGEMENT IN SCOTLAND, SCOTLAND FOOD PANTRY, THE GOOD STUFF, MEALS ON WHEELS, SCOTLAND ROTARY CLUB, POET RESEARCH CENTER, VFW, VFW AUXILIARY, AMERICAN LEGION. RESPONDENTS INCLUDED REPRESENTATION FROM LOW-INCOME, UNDERSERVED POPULATIONS. LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 7D: CHNA: HTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#LANDMANNIMPLEMENTATION STRATEGY: HTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#LANDMANN LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 11: LANDMANN JUNGMAN MEMORIAL HOSPITAL CONDUCTED A CHNA FROM NOVEMBER 2021 - MARCH 2022. THE PRIORITIES FROM THE NEEDS ASSESSMENT WERE BEHAVIORAL HEALTH CONCERNS, HEALTH EDUCATION, CHRONIC DISEASE TREATMENT AND PREVENTION, ACCESS TO HEALTH CARE FROM PEDIATRIC TO GERIATRIC, AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH. TO ADDRESS THESE NEEDS, AN IMPLEMENTATION PLAN WAS APPROVED WITH MANY GOALS IN EACH AREA AND CORRESPONDING ACTION PLANS. HEALTH EDUCATION - HEALTH EDUCATION FOR MANY TOPICS WAS ASSESSED AND IDENTIFIED AS A NEED. SOME OF THE EXAMPLES OF NEEDED HEALTH EDUCATION INCLUDE MORE HEALTH EDUCATION IN THE SCHOOL NOT ONLY WITH STUDENTS BUT ALSO WITH STAFF, IMMUNIZATION EDUCATION, YOUTH HEALTH EDUCATION, HEALTHY LIVING EDUCATION SPECIFICALLY INCLUDING HEALTHY EATING AND PREVENTION OF OBESITY, BENEFITS OF TELEHEALTH EDUCATION, AS WELL AS ALCOHOL AND SUBSTANCE ABUSE EDUCATION. BEHAVIORAL HEALTH CONCERNS - BEHAVIORAL HEALTH NEEDS IDENTIFIED DURING THE PROCESS INCLUDED MULTIPLE DIFFERENT TOPICS AND AREAS OF NEED. THESE NEEDS INCLUDED SUBSTANCE USE, LOCAL FACE-TO-FACE MENTAL HEALTH COUNSELING ACCESS, LACK OF ACCESS FOR BEHAVIORAL HEALTH CARE, SUBSTANCE USE EDUCATION, AND OTHER HEALTH BEHAVIOR EDUCATION FOR THE TEEN POPULATION IN GENERAL. SOCIAL DETERMINANTS OF HEALTH - MANY DIFFERENT SOCIAL DETERMINANTS OF HEALTH WERE IDENTIFIED AS NEEDS, RANGING FROM DILAPIDATED HOMES, RUNDOWN SIDEWALKS, POVERTY, AFFORDABLE HEALTHCARE NEEDS, AND TRANSPORTATION ISSUES, HOUSING NEEDS INCLUDING LOW INCOME HOUSING AND ASSISTED LIVING CENTERS, TO LACK OF CHILDCARE OPTIONS. CHRONIC DISEASE TREATMENT AND PREVENTION - NEEDS IDENTIFIED INCLUDE PROVIDING CARE FOR CHRONIC DISEASES AS WELL AS PREVENTING DISEASES IN OUR COMMUNITY. DIABETES, CANCERS, AND CARDIAC DISEASES ALL RANKED HIGH AS NEEDS IDENTIFIED IN OUR SERVICE AREA. ACCESS TO HEALTH CARE FROM PEDIATRIC TO GERIATRIC - HAVING HEALTHCARE AND MAINTAINING HEALTHCARE IN THE SERVICE AREA WAS A RECURRENT THEME AS A HEALTH NEED IDENTIFIED, INCLUDING THE NEED TO KEEP CARE LOCAL WITH HAVING SPECIALTY CARE ONSITE VERSUS SENDING PATIENTS TO SPECIALISTS OR UTILIZING TELEMED OPTIONS. THIS RANGED FROM CLINIC CARE, SPECIALTY ACCESS, EMERGENCY ROOM CARE, THERAPY SERVICES, EMS SHORTAGE, DENTAL SERVICES, OPTOMETRY SERVICES, PEDIATRIC AND GERIATRIC CARE, URGENT CARE CLINIC HOURS OR EXTENDED HOURS DURING INCREASED ILLNESS SEASONS, AND EXPANDED PHARMACY SERVICES. WE ARE ADDRESSING CHRONIC DISEASE WITHIN THE OTHER THREE IDENTIFIED NEEDS OF HEALTH EDUCATION, BEHAVIORAL HEALTH, AND ACCESS TO HEALTH CARE.ALTHOUGH MANY SOCIAL DETERMINANTS OF HEALTH FACTORS AND BUILT ENVIRONMENT NEEDS WERE CONSIDERED A NEED IN THE COMMUNITY, THE COMMITTEE FELT AT THIS TIME THAT THE HOSPITAL CANNOT ADDRESS THE BUILT ENVIRONMENT, CONCERNS OVER LACK OF HEALTHY FOOD ACCESS, DILAPIDATED HOMES AND CITY SIDEWALKS, POVERTY, LACK OF CHILD CARE OPTIONS, AND TRANSPORTATION ISSUES IN THE COMMUNITY ALONE. TO HELP ADDRESS THESE NEEDS, THE HOSPITAL WILL COMMIT TO HAVING A REPRESENTATIVE AT THE TABLE WITH LOCAL PROGRAMS AND PROJECTS THAT WORK TOGETHER TO ADDRESS BUILT ENVIRONMENT ISSUES RELATED TO EXERCISE AND HEALTHY EATING, AS WELL AS RELATED SOCIAL DETERMINANTS OF HEALTH.THE FY22 IDENTIFIED NEEDS ARE CONTINUATIONS OF NEEDS IDENTIFIED IN THE FY19 CHNA. DUE TO TIMING OF THE COMPLETION OF THE IMPLEMENTATION STRATEGY FOR THE FY22 CHNA, WE FOCUSED ON ADDRESSING THE NEEDS BASED ON THE FY19 PLAN.HEALTH EDUCATION - OVERARCHING GOAL: PROVIDE HEALTH AND BEHAVIORAL HEALTH EDUCATION IN A VARIETY OF DIFFERENT LEARNING PLATFORMS TO LANDMANN JUNGMAN'S SERVICE AREA. UTILIZED OUR SOCIAL MEDIA PLATFORM AND LOCAL NEWSPAPER ON A VARIETY OF HEALTH ISSUES INCLUDING: SUMMER HEAT THREATS, FARM SAFETY, BREAST CANCER, HEART HEALTH, COLONOSCOPY, BLOOD DONATION, STROKE AWARENESS, SAFE SUMMER TRAVELS, AND STRESS AWARENESS. EDUCATION TO SCHOOL STAFF ON COVID AND BLOOD PRESSURE. HEALTHCARE EDUCATION TO COMMUNITY DURING SUMMER EVENTS. EDUCATION AT ROTARY MEETINGS ADDRESSING HEALTH TOPICS. EDUCATION AND TRAINING TO LOCAL EMS. HELD FOOT CLINIC DAYS TO EDUCATE PEOPLE, ESPECIALLY PEOPLE LIVING WITH DIABETES, ON THE IMPORTANCE OF PROPER FOOT CARE. EDUCATED ON IMPORTANCE OF IMMUNIZATIONS WHILE HOLDING FLU AND COVID SHOT CLINICS AT FACILITY, SCHOOL, AND OTHER BUSINESSES. HEALTH CARE PREVENTION BREAKOUT SESSIONS FOR ANNUAL LADIES LOUNGE EVENT. HEALTHCARE CAREERS AT CAREER FAIR FOR GRADES 8-12.BEHAVIORAL HEALTH CONCERNS - OVERARCHING GOAL: PROVIDE ACCESS TO BEHAVIORAL HEALTH CARE AND EDUCATION ON WAYS TO ACCESS BEHAVIORAL HEALTH SUPPORT IN OUR COMMUNITY. PROVIDED BEHAVIORAL HEALTH CARE ACCESS THROUGH TELEMEDICINE OPTIONS, INCLUDING ETRIAGE. PROVIDED DEBRIEFING WITHIN THE COMMUNITY POST ACTIVE SHOOTER SITUATION.SOCIAL DETERMINANTS OF HEALTH - OVERARCHING GOAL: PARTNER WITH COMMUNITY DECISION MAKERS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH. CONTINUED "WALK WITH EASE" CLASS VIRTUALLY AND IN PERSON. CONTINUED "FIT AND STRONG" CLASS VIRTUALLY AND IN PERSON. STAFF DELIVERED MEALS ON WHEELS. HELD A HAT AND GLOVE DRIVE TO DONATE TO SCHOOL FOR CHILDREN WITHOUT THESE WINTER NECESSITIES. CREATED THE RURAL HEALTH SCHOLARSHIP TO BE GIVEN TO A LOCAL STUDENT PURSUING AN EDUCATION IN THE MEDICAL FIELD. PROVIDED FREE PAPER COPIES FOR THE YOUTH CENTER FOR HEALTH RELATED EDUCATION MATERIALS/PROJECTS. DONATED SUPPLIES FOR FIRST AID KITS TO THE SCOTLAND ATHLETIC ASSOCIATION. DONATED TO COMMUNITY YOUTH NEEDS INCLUDING NATIONAL CHILD SAFETY COUNCIL.ACCESS TO HEALTH CARE FROM PEDIATRIC TO GERIATRIC - OVERARCHING GOALS: IMPROVE ACCESS TO HEALTH CARE IN THE SERVICE AREA. CONTINUED PHARMACY DELIVERY SERVICE. CONTINUED CHRONIC CARE RN SERVICES. OFFERED STROKE SCREENING AT OUR FACILITY THROUGH SCREENING AMERICA. EXTENDED PHARMACY HOURS TO INCLUDE SATURDAY MORNINGS DURING CLINIC HOURS. REDUCED RATE FEE FOR SPORTS PHYSICALS REQUIRED BY THE SDHSAA. FREE BLOOD PRESSURE SCREENING AND WEIGHT CHECKS AT SCOTLAND MEDICAL CLINIC. PROVIDED FREE TAPING AND NEEDLING THERAPY SERVICES IN PHYSICAL THERAPY. PROVIDED STAFF AT CROSS COUNTRY MEET TO ASSESS INJURED ATHLETES. PHYSICIAN PERFORMED SKIN CHECKS ON WRESTLERS AT THE SCHOOL. PROVIDED LOCATION FOR BLOOD DRIVES THROUGHOUT THE YEAR. LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE USED AS A LAST RESORT. LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 16J: A NOTICE IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS AND IN THE FACILITY'S ADMISSIONS OFFICE ALERTING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND INSTRUCTIONS FOR OBTAINING A COPY OF THE FULL POLICY. A NOTICE IS ALSO PROVIDED ON ALL BILLING STATEMENTS SENT TO PATIENTS.PART V, SECTION B, LINES 16A-B: THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE AT:HTTPS://WWW.AVERA.ORG/PATIENTS-VISITORS/PAY-MY-BILL-ONLINE/FINANCIAL-ASSISTANCE-PROGRAMS/ LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION 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. 2 1 - WEST WINDS APARTMENTS 1140 WASHINGTON STREET SCOTLAND SD 57059 INDEPENDENT SENIOR LIVING CENTER 2 - SCOTLAND PHARMACY 620 BILLARS STREET SCOTLAND SD 57059 RETAIL PHARMACY PART I, LINE 3C: IN ADDITION TO USING FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE FACILITY ALSO CONSIDERS ASSET LEVEL AND INSURANCE STATUS, AND MAY PROVIDE PRESUMPTIVE CARE IF WARRANTED. PART I, LINE 6A: LJMH PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY. THE REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST. 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 7B AND 7G WAS OBTAINED UTILIZING THE COST REPORTS. LINES 7E AND 7I WERE OBTAINED USING GENERAL LEDGER DETAIL. PART I, LINE 7G: LINE 7G INCLUDES PROVIDER BASED CLINIC REVENUE OF $948,337, AND EXPENSE OF $1,098,189, FOR A NET COMMUNITY BENEFIT OF $149,852. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS.THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONSESSION 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 2021. THE BON HOMME COUNTY POVERTY RATE IS 14% ACCORDING TO THE UNITED STATES CENSUS BUREAU. THIS PERCENTAGE WAS APPLIED TO THE $373,335 AS IT CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSION IS ON PAGE 10 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/22. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: IF THE PATIENT QUALIFIES FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME, UNINSURED PATIENTS AND IS COOPERATING WITH THE ORGANIZATION WITH REGARD TO EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN CURRENT SELF-PAY COLLECTION POLICY GUIDELINES AND TIMEFRAMES, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. LANDMANN-JUNGMAN MEMORIAL HOSPITAL (LJMH) ALLOWS INDIVIDUALS 120 DAYS FROM THE FIRST POST DISCHARGE STATEMENT TO APPLY FOR FINANCIAL ASSISTANCE BEFORE SENDING THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY. LJMH WILL PROVIDE THE PATIENT WITH A STATEMENT OR FINAL NOTICE THAT CONTAINS A LISTING OF THE SPECIFIC COLLECTION ACTION(S) IT INTENDS TO INITIATE, AND A DEADLINE AFTER WHICH THEY MAY BE INITIATED NO EARLIER THAN 30 DAYS BEFORE ACTION IS INITIATED. IF THE PATIENT QUALIFIES FOR 100% CHARITY CARE, NO FURTHER BILLS WILL BE SENT. A LETTER WILL BE SENT INSTEAD INDICATING THAT THE PATIENT'S BILL HAS BEEN COMPLETELY FORGIVEN. PART VI, LINE 2: LANDMANN JUNGMAN MEMORIAL HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR ENDING JUNE 30, 2022.LJMH REGULARLY CONDUCTS PATIENT SATISFACTION SURVEYS WHICH CAN LEAD TO INFORMATION REGARDING NEEDED SERVICES. ADDITIONALLY, INTERACTIVE QUESTIONS ARE ASKED ABOUT SERVICES DURING HEALTH SCREENINGS. RESULTS OF THE QUESTIONNAIRE ARE REPORTED BACK TO THE OFFICERS AND BOARD. PART VI, LINE 3: PATIENTS ARE INFORMED OF THE FINANCIAL ASSISTANCE/CHARITY CARE POLICY WITH A DOCUMENT EXPLAINING THE PROCEDURE. THE DOCUMENT IS AT THE REGISTRATION DESK AND IS GIVEN TO PATIENTS AT TIME OF REGISTRATION. THE STAFF REGISTERING THE PATIENT CAN IDENTIFY ON THE FRONT END THAT THE PATIENT IS ABLE TO PAY THROUGH INSURANCE OR OTHERWISE. IF THEY IDENTIFY ON THE FRONT END THAT THE PATIENT NEEDS ASSISTANCE, THE PATIENT IS GIVEN A FINANCIAL PACKET TO COMPLETE TO SEE IF THEY QUALIFY FOR BENEFITS. IF THERE IS NO OPTION FOR AN OUTSIDE ASSISTANCE PROGRAM, THE PATIENT IS INFORMED OF AND ENCOURAGED TO COMPLETE THE APPLICATION THAT UTILIZES A COMBINATION OF INCOME, ASSETS, AND EXPENSES TO DETERMINE WHAT PERCENTAGE OF CHARITY CARE THEY WOULD QUALIFY FOR. PART VI, LINE 4: LANDMANN JUNGMAN MEMORIAL HOSPITAL IS LOCATED IN SCOTLAND, S.D IN BON HOMME COUNTY, S.D., IN THE SOUTH-CENTRAL PART OF THE STATE. AGRICULTURE IS THE PRIMARY ECONOMIC DRIVER IN THE COUNTY. LANDMANN JUNGMAN'S PRIMARY SERVICE AREA IS BON HOMME COUNTY. IN FY22, 74 PERCENT OF INPATIENT DISCHARGES AND 73 PERCENT OF ER PATIENTS WERE FROM BON HOMME COUNTY. ACCORDING TO THE U.S. CENSUS BUREAU'S JULY 2021 ESTIMATED DATA, THE POPULATION OF BON HOMME COUNTY WAS ABOUT 7,014 PEOPLE AND IS PREDOMINATELY WHITE/CAUCASIAN (88 PERCENT). ABOUT 20 PERCENT OF THE POPULATION IS OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME OF BON HOMME COUNTY IS $53,575, COMPARED WITH THE STATE OF SOUTH DAKOTA'S $63,920 MEDIAN HOUSEHOLD INCOME. THE PERCENTAGE OF PERSONS BELOW THE FEDERAL POVERTY LEVEL WAS 14 PERCENT, WHILE THE STATE OF SD HAS A RATE OF 12 PERCENT. US CENSUS DATA SHOWS HIGH SCHOOL GRADUATION IN THE COUNTY AT 87 PERCENT, WHILE THE STATE RATE IS 93 PERCENT, AND REPORTS ADULTS OVER 25 YEARS OF AGE WITH A BACHELOR'S DEGREE OR HIGHER AT 23 PERCENT COMPARED TO THE STATE RATE OF 30 PERCENT. SOUTH DAKOTA DEPARTMENT OF LABOR AND REGULATION ASSESSES THE UNEMPLOYMENT RATE OF BON HOMME COUNTY AT 2.0 PERCENT IN JUNE OF 2022, COMPARED WITH THE STATE OF SOUTH DAKOTA'S 2.0 PERCENT UNEMPLOYMENT. THE SECONDARY SERVICE AREA INCLUDES PORTIONS OF HUTCHINSON AND YANKTON COUNTIES. HUTCHINSON AND YANKTON COUNTIES ARE DEMOGRAPHICALLY SIMILAR TO BON HOMME COUNTY WITH RURAL, AGRICULTURAL LIFESTYLES. THESE TWO COUNTIES MADE UP 21 PERCENT OF INPATIENT DISCHARGES AND 22 PERCENT OF ER PATIENTS. LANDMANN JUNGMAN HAS ABOUT 5,667 CLINIC VISITS IN FY2022. PART VI, LINE 5: LJMH IS FOCUSED ON SERVING THE NEEDS OF THE COMMUNITY. THE GOVERNING BODY OF THE HOSPITAL IS MADE UP ENTIRELY OF VOLUNTEERS FOR THE COMMUNITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN ITS COMMUNITY. EXCESS FUNDS ARE USED FOR THE IMPROVEMENT OF PATIENT CARE AND FACILITIES. THE HOSPITAL IS CONTRACTED WITH SEVERAL HIGHER LEARNING HEALTH CARE RELATED INSTITUTIONS TO BE A CLINICAL SITE FOR VARIOUS HEALTH CARE FIELDS. THE FACILITY IS OPEN TO ANYONE WHO WANTS TO LEARN ABOUT CAREERS IN THE HEALTH CARE INDUSTRY THROUGH THE CLINICAL PROGRAM AND THROUGH A HIGH SCHOOL SHADOWING PROGRAM.THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL ADMINISTRATION IS VERY RECEPTIVE TO INPUT FROM THE COMMUNITY.AVERA HEALTH AND LJMH 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. WE ALSO HAVE A FITNESS CENTER SO PATIENTS AND THE COMMUNITY CAN MAINTAIN A HEALTHY LIFESTYLE. PART VI, LINE 6: LJMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTH CARE THROUGHOUT THE COMMUNITY SERVICED BY LJMH.LJMH 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 IS ABLE TO PROVIDE THESE SERVICES TO LJMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. X X 0 0 0 0 0 0 0 0 0 MELISSA GALE CEO 146002 0 0 0 537 0 3040 0 21015 0 170594 0 0 0 FORM 990 PART VII, LINE 5 MELISSA GALE, CEO, WAS COMPENSATED THROUGH AN ARRANGEMENT WITH AVERA MCKENNAN, 1325 S CLIFF AVE, SIOUX FALLS, SD 57108. FORM 990, PART III, LINE 2 PLANET HEART - SCREENINGS FOR HEART HEALTH TO INCLUDE CALCIUM SCORING, LABS AND EDUCATION WITH A RN. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE PRESIDENT, VICE-PRESIDENT, SECRETARY, AND ONE ADDITIONAL BOARD MEMBER OF THE BOARD OF TRUSTEES ELECTED BY THE BOARD. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE FACILITY DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF DIRECTORS AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 4 1. THE ORGANIZATION CHANGED THE QUORUM REQUIREMENTS FOR ANNUAL AND SPECIAL MEETINGS TO NOT LESS THAN 11 MEMBERS IN PERSON" AS COMPARED TO 15 IN THE PAST. 2. A BOARD OF TRUSTEES OF SEVEN MEMBERS OF LANDMANN-JUNGMAN MEMORIAL HOSPITAL SHALL BE ELECTED AT THE ANNUAL CORPORATION MEETING AS COMPARED TO NINE MEMEBERS IN THE PAST. FORM 990, PART VI, SECTION B, LINE 11B THE CEO WILL REVIEW THE 990 IN DETAIL. A COPY OF THE 990 IS GIVEN TO THE BOARD MEMBERS BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND MANAGEMENT. BOARD MEMBERS ARE RESPONSIBLE FOR DETERMINING WHETHER A POTENTIAL CONFLICT EXISTS WITH THE ADMINISTRATOR AND BOARD MEMBERS. THE ADMINISTRATOR IS RESPONSIBLE FOR DETERMINING IF THERE ARE POTENTIAL CONFLICTS OF INTEREST AMONGST MANAGEMENT. THE BOARD IS ULTIMATELY RESPONSIBLE FOR DETERMINING WHETHER AN ACTUAL CONFLICT EXISTS. ANY BOARD MEMBER WITH A CONFLICT IS REQUIRED TO ABSTAIN FROM VOTING ON THE MATTER OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AVERA MCKENNAN AND LANDMANN-JUNGMAN MEMORIAL HOSPITAL CORPORATION USE COMPARABILITY DATA TO DETERMINE APPROPRIATE COMPENSATION OF THE ADMINISTRATOR BASED ON EXPERIENCE AND PERFORMANCE. THE COMPENSATION AMOUNT IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. FOR OTHER KEY EMPLOYEES AVERA MCKENNAN DOES A SALARY SURVEY THAT IS THEN APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC DURING ITS ANNUAL BOARD MEETING AND UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PHYISICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 387,288. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 387,288. OTHER FEES: PROGRAM SERVICE EXPENSES 251,482. MANAGEMENT AND GENERAL EXPENSES 191,797. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 443,279. : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,370. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,370. FORM 990, PART XI, LINE 9: CHANGE IN AVERA FOUNDATION -5,720.