2020-05-13T18:27:40-05:00 2019-06-30 390758449 WIPFLI LLP 101 EAST FRONT STREET 301 MISSOULA MT 59802 990 2018-07-01 810243720 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION SHER 4067653700 440 W LAUREL AVENUE PLENTYWOOD MT 59254 GREG MAURER CEO 4067653700 2020-05-04 1 PHILIP L YASENAK CPA P01248379 4067281800 2020-05-04 72.174.139.103 2020-05-04 16:15:53 MD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BE7A92E7B0152C1C6812F3C99C620D56F411D8FD 2018 2021-01-29 14:40:06Z GREG MAURER 440 W LAUREL AVENUE PLENTYWOOD MT 59254 11819364 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 7 207 98 0 0 351503 62536 11528758 11668876 670 3279 78084 84673 11959015 11819364 0 0 0 0 6776900 6857747 0 0 43170 5368151 5775835 12145051 12633582 -186036 -814218 6168743 6285031 1404601 2335107 4764142 3949924 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 10031943 11728648 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 3,400 RESIDENTS. HIGHLIGHTS OF THE ORGANIZATION'S ACCOMPLISHMENTS DURING FY19 ARE INCLUDED BELOW:THE CRITICAL ACCESS HOSPITAL PATIENT/RESIDENT CARE & QUALITY COORDINATOR ATTENDED THE BILLINGS CLINIC REGIONAL SUICIDE PREVENTION PROGRAM AND SEVERAL MONTHS LATER, THE HOSPITAL WENT LIVE WITH A SUICIDE RISK ASSESSMENT PROCEDURE FOR ER PATIENTS OVER THE AGE OF 18. THE CRITICAL ACCESS HOSPITAL ALSO COMPLETED STAFF TRAINING FOR THE PHILIPS RESPIRONICS V60 VENTILATOR THAT WAS PURCHASED IN THE PRIOR YEAR. FY19 WAS A YEAR OF MILESTONES FOR THE EMERGENCY MEDICAL SERVICES DEPARTMENT. THROUGH HARD WORK AND LOTS OF COMMUNITY EDUCATION, PROPERTY OWNERS OF SHERIDAN COUNTY PASSED AN AMBULANCE DISTRICT TO SUBSIDIZE THE COUNTY-WIDE EMERGENCY MEDICAL SERVICE. THE DEPARTMENT ALSO MADE SEVERAL PURCHASES DURING THE YEAR TO IMPROVE PATIENT CARE AND/OR PROCESSES. 10031943 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 1 0 0 0 0 0 0 0 1 0 0 0 1 5 0 1 207 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 GREG MAURER 4067653702 440 WEST LAUREL AVENUE PLENTYWOOD MT 59254 X JAKE FLADAGER CHAIR 1.00 0.00 X X 0 0 0 MYRNETTE MILLER VICE CHAIR 1.00 0.00 X X 0 0 0 JOAN TOMMERUP SECRETARY 1.00 1.00 X X 0 0 0 DON BENSON DIRECTOR 1.00 0.00 X 0 0 0 JED WALLER DIRECTOR 1.00 0.00 X 0 0 0 JESSICA SHACKELFORD DIRECTOR 1.00 1.00 X 0 0 0 NANCY JENSEN DIRECTOR 1.00 0.00 X 0 0 0 GREG MAURER CEO 40.00 1.00 X 0 0 0 KYLE GEE CFO 10.00 0.00 X 0 0 0 ADAM GRAHAM PA 36.00 0.00 X 198128 0 7534 CARLOS TREVINO MD 36.00 0.00 X 123174 0 343 LYNNE GRAHAM PA 36.00 0.00 X 120989 0 7534 KRISTIN MCCOLLY FNP 36.00 0.00 X 102958 0 7534 JENNA THOMAS FNP 36.00 0.00 X 101366 0 7534 646615 0 30479 5 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MANAGEMENT COMPANY 709787 MONTANA HEALTH NETWORK 519 PLEASANT ST MILES CITY MT 59301 TRAVEL NURSE, INSURANCE 290539 DAKOTA DRUG PO BOX 877 ANOKA MN 55303 PHARMACEUTICALS 283920 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 MANAGED SERVICE EHR 187768 WILDERNESS MEDICAL STAFFING 1124 W RIVERSIDE AVE SUITE 215 SPOKANE WA 99201 LOCUM TENENS 154682 12 38941 10843 12752 62536 PATIENT SERVICE REVENUE 621990 10931258 10931258 OTHER OPERATING REVENUE 900099 282337 282337 CONTRACT REVENUE 621990 259519 259519 340B REVENUE 621990 195762 195762 11668876 3279 3279 24901 0 24901 24901 24901 BAD DEBT RECOVERY 621990 56598 56598 GIFT SHOP REVENUE 900099 3174 3174 59772 11819364 11728648 0 28180 X 5725315 5725315 712414 712414 420018 420018 41523 41523 24653 24653 2318203 2310203 8000 29199 29199 310701 310701 13914 13914 64851 64851 18663 17613 1050 568092 352120 215972 139470 139470 SUPPLIES 959901 959901 BAD DEBT 445697 445697 REPAIRS AND MAINTENANCE 296233 296233 BED TAX 266192 266192 278543 265622 12921 12633582 10031943 2558469 43170 1006448 628769 241417 268279 5390 0 1302003 1649362 230318 270162 168313 163122 17823845 14941770 2784410 2882075 59914 59943 0 75000 370530 288319 6168743 6285031 1111504 1323006 70687 747036 222410 265065 1404601 2335107 X 4752315 3941235 11827 8689 4764142 3949924 6168743 6285031 -814218 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104286 -143 120 104263 103996 143 147 104286 113984 237 10225 103996 113916 68 145 145 113984 113916 64 64 113916 1.00000 0 1 1 384756 384756 10013781 8798408 1215373 7425308 6143362 1281946 2882075 GUARANTEE OF PATIENT LOAN 172667 BED TAXES PAYABLE 92211 OTHER PAYABLES 187 265065 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 AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL AND FOUNDATION ARE 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 ON THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR TAX YEARS 2014 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART V, LINE 1(B) AN ERROR IN THE ENDING BALANCE OF THE ENDOWMENT FUND WAS IDENTFIED DURING THE YEAR. THE $143 NEGATIVE CONTRIBUTION WAS RECORDED THIS YEAR TO CORRECT THE BALANCE OF THE ENDOWMENT FUND. 1 1 X 1 X 1 X 1 1 1 1 0 316014 316014 0.02500 1797091 1797091 0.14220 2113105 2113105 0.16720 87851 87851 0.00700 340833 118644 222189 0.01760 3687 3687 0.00030 432371 118644 313727 0.02490 2545476 118644 2426832 0.19210 1 380149 4318141 4378395 -60254 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 18 1 0 0 1 X WWW.SHERIDANMEMORIAL.NET X WWW.FACEBOOK.COM/SHERIDAN.MEMORIAL X X 1 18 1 WWW.SHERIDANMEMORIAL.NET 0 1 X 100.000000000000 400.000000000000 X 1 1 X X X 1 X WWW.SHERIDANMEMORIAL.NET X WWW.SHERIDANMEMORIAL.NET X WWW.SHERIDANMEMORIAL.NET X X X X X X 1 X 0 X X 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. WE ALSO HAD 237 MEMBERS OF SHERIDAN COUNTY RESPOND TO OUR ONLINE SURVEY. SHERIDAN MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED INDEPENDENTLY OF OTHER ORGANIZATIONS THIS TIME, BUT SEVERAL ORGANIZATIONS WERE MADE AWARE THAT THE SURVEY BEING SENT TO THE COMMUNITY AND THAT WE WERE PREPARING AN IMPLEMENTATION PLAN TO ADDRESS ISSUES THAT WERE BROUGHT TO OUR ATTENTION. WE REACHED OUT TO SEVERAL ORGANIZATIONS DIRECTLY TO GET THEIR FEEDBACK, SOME OF WHICH WERE THE FOLLOWING: LA CASA, PIONEER MANOR, SHERIDAN COUNTY SHERIFF OFFICE, AND SHERIDAN COUNTY COMMISSIONERS. 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: SEVERAL NEEDS AND/OR WANTS WERE BROUGHT UP THROUGH THE SURVEY CONDUCTED IN MARCH/APRIL 2019. FROM THOSE ANSWERS, WE TOOK THE TOP CONCERNS THAT WE KNEW OUR FACILITY COULD DO SOMETHING ABOUT. THE FOLLOWING GOALS WERE CHOSEN DUE TO THE SURVEY RESULTS: 1. IMPROVE PATIENT ACCESS TO CARE & IMPROVE CONTINUITY OF CARE - 38% STATED THEY HAVE NO ACCESS TO LOCAL HEALTH CARE/PHYSICIANS/DOCTORS/PROVIDERS, WITH OTHERS BACKING UP THE ISSUE THAT THERE WAS TOO LONG OF A WAIT TO SEE THE PROVIDER. THE GOAL OF IMPROVING PATIENT ACCESS TO CARE WILL ALSO IMPROVE THE CONTINUITY OF CARE. 2. IMPROVE SERVICE AWARENESS THIS CONCERN WAS BROUGHT UP AS 48% OF SURVEYORS RESPONDED THAT WE NEED SPECIALTY PHYSICIANS. SHERIDAN MEMORIAL CURRENTLY OFFERS TELEHEALTH SERVICES FOR SPECIALTY SERVICES AND IT IS IMPORTANT TO LET THE COMMUNITY KNOW OF THOSE SERVICES, SO THEY DON'T HAVE TO TRAVEL. 3. IMPROVE POPULATION HEALTH OF THE COMMUNITY - IN CORRELATION TO OUR GOAL TO IMPROVE SERVICE AWARENESS IS OUR GOAL TO IMPROVE POPULATION HEALTH. MANY AREN'T AWARE OF THE SERVICES OFFERED LOCALLY, THUS WE SET GOALS TO IMPLEMENT A COMMUNITY HEALTH COALITION. 4. IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES - 53% OF SURVEYORS STATED THAT MENTAL HEALTH SERVICES ARE NEEDED TO IMPROVE THE HEALTH OF THEIR FAMILY AND NEIGHBORS. THIS IS ALSO WHY THE COMMUNITY HEALTH COALITION WAS SET AS A GOAL IN ADDITION IMPROVING ACCESS TO MENTAL/BEHAVIORAL HEALTH SERVICES IN SHERIDAN COUNTY. 5. IMPROVE SUBSTANCE ABUSE OUTREACH AND EDUCATION - 52% STATED THAT SUBSTANCE ABUSE OUTREACH AND EDUCATION, INCLUDING DRUG AND ALCOHOL EDUCATION/INFORMATION SERVICES, ARE NEEDED IN OUR COMMUNITY. THEREFORE, WE SET A GOAL TO IMPROVE THAT OUTREACH. MANY OF THESE GOALS INTERTWINE WITH EACH OTHER, SUCH AS OFFERING ADDITIONAL SERVICES VIA TELE-MED AND MAKING THE COMMUNITY AWARE OF SERVICES OFFERED NOT ONLY AT SHERIDAN MEMORIAL, BUT ALSO AT THE COUNTY/REGIONAL LEVEL. OTHER CONCERNS BROUGHT UP THROUGH THE SURVEY PROCESS MAY INADVERTENTLY BE ADDRESSED THROUGH THE LISTED GOALS, BUT NOT ALL COULD BE ADDRESSED AS WE NEED TO SET GOALS THAT ARE OBTAINABLE AND THAT CAN SHOW REAL RESULTS. 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. 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: LINE 7A: CHARITY CARE WAS CALCULATED BY MULTIPLYING THE RATIO OF COST TO GROSS CHARGES BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE TO PATIENTS.LINE 7B: THE MEDICAID CALCULATION IS BASED ON THE RATIO OF PATIENT CARE COST TO CHARGES.LINE 7E: ACTUAL COSTS WERE USED TO REPORT COMMUNITY HEALTH IMPROVEMENT SERVICES. PART I, LINE 7G: A COMBINATION OF ACTUAL COSTS AND COSTS BASED ON THE COST REPORT WERE USED TO REPORT SUBSIDIZED HEALTH SERVICES. 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 IS FOUND ON PAGE 12 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 3,668 (BASED ON THE 2013 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 AN MD WHO HAS HIS OWN PRIVATE CLINIC IN THE AREA. MEDICAL PRIVILEGES ARE ALSO EXTENDED 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, PINK LADY PROGRAM AS WELL AS GIFT SHOP STAFFING* 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 198077 0 51 0 0 0 0 0 7534 0 205662 0 0 0 GREG MAURER MR. MAURER IS SHERIDAN MEMORIAL HOSPITAL ASSOCIATION'S CEO. 0 MR. MAURER IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CEO FROM BILLINGS CLINIC, INC. 0 KYLE GEE MR. GEE IS SHERIDAN MEMORIAL HOSPITAL ASSOCIATION'S CFO. 0 MR. GEE IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CFO FROM BILLINGS CLINIC, INC. 0 FORM 990, PART VI, SECTION A, LINE 1 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. GREG MAURER, CEO, IS AN EMPLOYEE OF BILLINGS CLINIC AND IS COMPENSATED BY BILLING CLINIC. KYLE GEE, CFO, IS ALSO COMPENSATED BY BILLINGS CLINIC. FORM 990, PART VI, SECTION A, LINE 6 SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 795 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 795 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 THE OUTSIDE MANAGEMENT COMPANY. 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 2,310,203. MANAGEMENT AND GENERAL EXPENSES 8,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,318,203. 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 SHERIDAN HEALTH CARE FOUNDATION INC C 38941 FMV