2018-10-09T15:07:55-05:00 2017-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2017-01-01 460219795 COMMUNITY MEMORIAL HOSPITAL INC COMM 6057752621 PO BOX 319 BURKE SD 575230319 MISTIE SACHTJEN CEO 6057752621 2018-09-26 1 LAURIE HANSON P00851848 6053391999 2018-09-26 8.39.233.43 2018-09-26 13:14:40 CD P C60744DF19E5C03A9C437C749616A21E1534802F A01853E6EF032EEC7D4C024333A5FA8796B776CD 2017 2018-06-14 16:35:46Z MISTIE SACHTJEN PO BOX 319 BURKE SD 575230319 5329925 0 X WWW.BURKEHOSPITAL.COM X 1945 SD PROVIDE MEDICAL SERVICES 9 4 65 10 0 0 903999 401381 4677016 4739594 32559 61544 58426 120796 5672000 5323315 2430 1125 0 0 2414947 2538966 0 0 0 1995400 2088153 4412777 4628244 1259223 695071 5533647 7556829 413368 1641977 5120279 5914852 X EXCELLENCE IN THE PROVISION OF HEALTH CARE AND RELATED SERVICES, GOVERNED AS A NOT-FOR-PROFIT COMMUNITY ORGANIZATION, SERVING THE NEEDS OF OUR PEOPLE WITH SUPERIOR QUALITY AND VALUE. 0 0 3977368 1125 4803194 COMMUNITY MEMORIAL HOSPITAL, INC., A 16-BED ACUTE CARE HOSPITAL, PROMOTES HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. DURING 2017, COMMUNITY MEMORIAL HOSPITAL HAD 4,170 CLINIC VISITS IN BURKE AND 549 CLINIC VISITS IN BONESTEEL. THE HOSPITAL HAD 125 ADMISSIONS, 331 PATIENT DAYS, AND 958 SWINGBED DAYS.COMMUNITY MEMORIAL HOSPITAL HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE ON A YEARLY BASIS FOR PEOPLE OF ALL AGES THROUGH THE DEVELOPMENT OF SPECIALTY CLINICS TO ENSURE THAT THOSE WHO COME HERE FOR PREVENTIVE CARE RECEIVE THE SCREENINGS AND RECOMMENDATIONS APPROPRIATE TO THEIR PERSONAL AND FAMILY HISTORY. JUST A FEW OF THE SPECIALTY CLINICS PROVIDED ARE A WOMEN'S HEALTH CLINIC, VASCULAR SCREENING CLINIC, FLU CLINIC, AND A SKIN CLINIC. FREE CHOLESTEROL SCREENINGS ARE OFFERED TWICE PER YEAR. COMMUNITY MEMORIAL HOSPITAL TAKES GREAT PRIDE IN THE CARE PROVIDED TO THE COMMUNITY IT SERVES. 3977368 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 13 0 1 65 1 0 0 0 0 0 0 0 0 0 0 X 9 4 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X X TAMI LYON 6057752621 PO BOX 319 BURKE SD 575230319 X X TOM GLOVER CHAIRMAN 2.00 X X 0 0 0 JIM WATERBURY VICE CHAIRMAN 1.00 X X 0 0 0 KAREN MARTIN SECRETARY/TREASURER 1.00 X X 0 0 0 AJ STEFFEN DIRECTOR 1.00 X 0 0 0 RICH DOBESH DIRECTOR 1.00 X 0 0 0 MICHAEL KARBO DIRECTOR 1.00 X 0 0 0 CLAYTON STEELE DIRECTOR 1.00 X 0 0 0 KATE WITT DIRECTOR 1.00 X 0 0 0 SUE CHYTKA DIRECTOR 1.00 X 0 0 0 MISTIE SACHTJEN CEO 40.00 X 0 0 0 DEB LEIBEL CNP 40.00 X 113517 0 16645 113517 0 16645 1 0 0 0 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 571175074 MANAGEMENT FEES, CEO WAGES 395774 SANFORD CLINIC 1305 W 18TH ST SIOUX FALLS SD 57105 MD WAGES 253059 ARCHITECTURE INCORPORATED PO BOX 2140 SIOUX FALLS SD 571012140 BUILDING PROJECT 220377 CARDINAL HEALTH PO BOX 70539 CHICAGO IL 60673 MEDICAL DRUGS/SUPPLIES 213276 WINNER PHYSICAL THERAPY PO BOX 435 WINNER SD 57580 PT COVERAGE FOR IN HOUSE PATIENTS 120910 6 14791 17458 369132 297100 401381 PATIENT SERVICE REVENU 621110 3569270 3569270 CLINIC REVENUE 621498 914557 914557 PHARMACY REVENUE 446110 146000 146000 109767 109767 4739594 61044 61044 63600 0 63600 63600 63600 500 0 500 500 500 63806 14791 6610 57196 57196 5323315 4803194 0 118740 X 950 950 175 175 383380 383380 1696766 1528559 168207 51167 47029 4138 257445 236627 20818 150208 138062 12146 170036 170036 6695 6695 897748 817330 80418 10471 3554 6917 74538 56690 17848 104458 104458 48140 44904 3236 8418 7300 1118 19437 8406 11031 145795 145795 26797 26797 MEDICAL SUPPLIES 421733 421733 BAD DEBT EXPENSE 100843 100843 EQUIPMENT & MAINTENANCE 26617 22459 4158 LICENSES, DUES & SUBSCR 13339 8472 4867 13088 5100 7988 4628244 3977368 650876 0 2937121 2497829 517290 377757 650832 528206 85934 85351 41307 41523 5389202 2603720 715251 2785482 576770 840587 9142 9899 0 390195 5533647 7556829 366368 751958 0 890019 47000 0 413368 1641977 X 4172562 5530553 947717 384299 5120279 5914852 5533647 7556829 695071 99502 0 X 0 1 X 1 0 X 44228 44228 1463165 1385776 77389 1817254 1176810 640444 2064555 41134 2023421 2785482 THIRD PARTY PAYOR SETTLEMENT 156000 RESERVE FUND 234195 390195 X 5328584 99502 -94233 5269 5323315 0 5323315 4534011 -94233 -94233 4628244 0 4628244 PART X, LINE 2: THE HOSPITAL IS ORGANIZED AS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE SERVICE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. 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: BAD DEBT EXPENSE -100,843. FUNDRAISING EXPENSES 6,610. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -100,843. FUNDRAISING EXPENSES 6,610. 2017 GALA 71969 9795 62174 108 3030 2183 GOLF TOURNAMENT 6628 4996 1632 200 480 442 167 78597 14791 63806 200 108 480 3472 2350 6610 57196 1 1 X 1 X 1 X 150.000000000000 1 1 1 0 1 1 13000 13000 0.00290 13000 13000 0.00290 19309 1425 17884 0.00400 1061159 814835 246324 0.05440 1225 1225 0.00030 1081693 816260 265433 0.05870 1094693 816260 278433 0.06160 0 100843 21177 2288409 2304637 -16228 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL INC PO BOX 319 BURKE SD 57523 WWW.BURKEHOSPITAL.COM 10530 X X X 2 PROVIDER BASED RURAL HEALTH CLINICS COMMUNITY MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.BURKEHOSPITAL.COM X HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/CHNA 1 16 1 SEE 7A AND 7B ABOVE 0 1 X 100.000000000000 150.000000000000 X X X X X 1 1 X X X X X 1 X SEE PART V, LINE 16J NARRATIVE X SEE PART V, LINE 16J NARRATIVE X SEE PART V, LINE 16J NARR X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 5: COMMUNITY MEMORIAL SURVEYED SEVERAL CROSS SECTIONS OF THE COMMUNITY INCLUDING THE CITY COUNCIL, STAFF OF THE BURKE PUBLIC SCHOOL, BURKE COMMUNITY CLUB, AND COUNTY EMPLOYEES, BOARD OF DIRECTORS, COMMUNITY MEMORIAL EMPLOYEES AND BANK EMPLOYEES. IN ADDITION A SURVEY LINK WAS PUBLISHED IN THE LOCAL PAPER FOR OTHER INTERESTED PARTIES TO COMPLETE IF THEY WERE INTERESTED. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 11: THE HOSPITAL INTENDS TO ADDRESS ALL NEEDS PRIORITIZED IN ITS IMPLEMENTATION STRATEGY. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS REVIEWED AND APPROVED BY THE BOARD DURING ITS OCTOBER 2016 MEETING. THE IMPLEMENTATION STRATEGY WAS APPROVED IN THE MARCH 2017 BOARD MEETING. MEASURABLE OUTCOMES WILL BE REVIEWED ANNUALLY FROM 2017-2019 FOR THE FOLLOWING: PRIORITY 1: PHYSICAL HEALTH. AS A HEALTH CARE FACILITY WE ARE COMMITTED TO PROMOTING HEALTHY LIFESTYLE & ENCOURAGING OUR PATIENTS TO BE MORE ACTIVE. WE HAVE BEEN AND CONTINUE TO WORK WITH OUR LOCAL FITNESS ORGANIZATION AND COVER THE COST OF VARIOUS EXERCISE CLASSES AT NO CHARGE TO THE PUBLIC AND WILL CONTINUE TO IMPROVE ON THOSE SERVICES. WE CONTINUE TO OFFER FREE OR DISCOUNTED COMMUNITY HEALTH FAIRS FOR A VARIETY OF SCREENINGS, LAB TEST, ETC. IN APRIL 2017 OUR STAFF MET WITH MEMBERS OF THE BURKE SCHOOL DISTRICT TO PROMOTE ACTIVE LIFESTYLES OF OUR YOUTH WITH THE SANFORDFIT PROGRAM. THE SANFORDFFIT PROGRAM IS A FREE RESOURCE AVAILABLE TO PROMOTE MOVEMENT AND HEALTHY EATING, AS WELL AS OTHER FUN ACTIVITIES. PRIORITY 2: MENTAL HEALTH. SERIOUS ISSUES CAN ARISE FROM NOT ADDRESSING MENTAL HEALTH PROBLEMS WITH THE INDIVIDUAL OR THEIR FAMILIES. MENTAL HEALTH EFFECTS PEOPLE OF ALL AGES. OUR FOCUS WILL BE TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AS WELL AS IMPROVING CARE FOR PATIENTS WITH DEPRESSION. MENTAL HEALTH FIRST AID COURSES FOR STAFF ARE OUR FIRST STEPS IN WORKING ON THE MENTAL HEALTH OF THE COMMUNITY. LATE FALL OF 2017, 2 OF OUR MANAGEMENT EMPLOYEES ATTENDED AN 8-HOUR COURSE THAT GIVES PEOPLE THE SKILLS TO HELP SOMEONE WHO IS DEVELOPING A MENTAL HEALTH PROBLEM OR EXPERIENCING A MENTAL HEALTH CRISIS. THE EVIDENCE BEHIND MENTAL HEALTH FIRST AID IS TO BUILD MENTAL HEALTH LITERACY, HELP THE PUBLIC IDENTIFY, UNDERSTAND, AND RESPOND TO SIGNS OF MENTAL ILLNESS. IN OCTOBER 2018, WE HAVE 5 EMPLOYEES ATTENDING A 5-DAY MENTAL HEALTH FIRST AID TRAIN THE TRAINOR COURSE. ONCE THEY HAVE THE NECESSARY TRAINING, THEY WILL BRING THAT KNOWLEDGE BACK TO THE REMAINING STAFF SO EVERYONE CAN HELP THOSE SUFFERING FROM MENTAL ILLNESS. WE WILL ALSO HOLD A PUBLIC COURSE TO TRAIN COMMUNITY MEMBERS ON WARNING SIGNS. ANOTHER FOCUS WILL BE ON DRUG USE WITHIN THE COMMUNITY; MAINLY OPIOID MISUSE. REVISIONS HAVE BEEN MADE TO THE HOSPITAL POLICY FOR CONTROLLED SUBSTANCES AND OPIOID PRESCRIPTIONS. COLLABORATIONS HAVE ALSO BEGUN AMONGST VARIOUS FACILITY PROFESSIONALS IN DEVELOPING PLANS TO REDUCE OPIOID PRESCRIPTIONS. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 13H: PATIENTS WHOSE FAMILY INCOME EXCEEDS 150% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE; HOWEVER, THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED COMMERCIALLY INSURED PATIENTS. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 15E: THE HOSPITAL PHONE NUMBER IS LISTED ON THE APPLICATION. THIS NUMBER DIRECTS THE PATIENT TO SOMEONE WHO CAN HELP WITH THE APPLICATION. IN THE HOSPITAL'S BUSINESS OFFICE THERE IS INFORMATION REGARDING OTHER ORGANIZATION OR GOVERNMENT AGENCIES TO HELP WITH OTHER ASSISTANCE. THE HOSPITAL OFFERS THE INFORMATION TO PATIENTS WHO MAY BENEFIT FROM IT. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 16J: PART V, LINE 16A, 16B, & 16C:THE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE POSTED TO THE WEBSITE AT WWW.BURKEHOSPITAL.COM; WWW.SANFORDHEALTH.ORG/LOCATIONS/COMMUNITY-MEMORIAL-HOSPITAL.PART V, LINE 16J: FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE IN THE ER, CLINIC AND HOSPITAL ADMISSION OFFICE. THE POLICY AND APPLICATION ARE LOCATED AT THE COUNTY WELFARE OFFICE. A SIGN IS POSTED IN THE ADMISSIONS AREA TO INFORM PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE HOSPITAL PROVIDES A COPY OR SUMMARY OF THE POLICY TO PATIENTS WHO MAY QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY.LESS THAN FIVE PERCENT OF THE POPULATION, AND FEWER THAN 1,000 INDIVIDUALS IN THE SERVICE AREA SPEAK A LANGUAGE OTHER THAN ENGLISH AS THEIR PRIMARY LANGUAGE. PART I, LINE 3C: INDIVIDUALS WILL NOT BE DENIED CHARITY CARE BASED ON RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE OR ABILITY TO PAY. BUSINESS OFFICE STAFF TRY TO IDENTIFY ELIGIBLE INDIVIDUALS AT THE TIME OF ADMISSION, HOWEVER INDIVIDUALS CAN BECOME ELIGIBLE FOR CHARITY CARE AT ANY POINT DURING OR AFTER THEIR MEDICAL ENCOUNTER. ONCE AN INDIVIDUAL IS IDENTIFIED AS A POTENTIAL CHARITY CARE RECIPIENT, COMMUNITY MEMORIAL HOSPITAL UTILIZES BOTH AN INCOME AND AN ASSET TEST TO EVALUATE ELIGIBILITY FOR CHARITY CARE. THE HOSPITAL REVIEWS A SCHEDULE OF THE PATIENT'S CURRENT INCOME AND EXPENSES AND ASSET LEVELS TO DETERMINE IF THE PATIENT CAN REASONABLY BE EXPECTED TO MAKE PAYMENT OF MEDICAL EXPENSES. PART I, LINE 6A: COMMUNITY MEMORIAL HOSPITAL MAKES THE COMMUNITY BENEFIT REPORT AVAILABLE TO THE PUBLIC THROUGH THE WEBSITE (HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-BENEFIT/COMMUNITY-BENEFIT-ANNUAL-REPORT) AND AVAILABLE 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. LINE 7E AND LINE 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT.RURAL HEALTH CLINIC NET REVENUES OF $711,662 AND COSTS OF $934,807 WERE INCLUDED ON LINE 7G FOR A NET COMMUNITY BENEFIT OF $223,145. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE BASED ON CHARGES OF $100,843 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART III, LINE 2: BAD DEBT WRITE-OFFS ARE RECORDED USING GROSS CHARGES. IF AN ACCOUNT IS WRITTEN OFF TO BAD DEBTS, PAYMENTS RECEIVED AFTER THE WRITE OFF OF THE ACCOUNT ARE POSTED TO THE ALLOWANCE FOR BAD DEBT ACCOUNT. THE ALLOWANCE FOR BAD DEBT IS CALCULATED USING AN ESTIMATED UNCOLLECTIBLE PERCENTAGE OF ACCOUNTS RECEIVABLE. THE DIFFERENCE BETWEEN THE ESTIMATE AND THE AMOUNT RECORDED TO THE ALLOWANCE FOR BAD DEBT IS RECORDED TO BAD DEBT EXPENSE.BAD DEBT EXPENSE REPORTED ON LINE 2 IS AT CHARGES AS REPORTED ON THE FINANCIAL STATEMENTS. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE IS ESTIMATED BASED AVERAGING THE COUNTY AND CITY US CENSUS BUREAU REPORTS OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL. 21% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: FOOTNOTE FROM FINANCIAL STATEMENT: PLEASE SEE NOTE 1, FINANCIAL STATEMENT, PATIENT RECEIVABLES ON PAGES 7-8. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 12/31/2017. 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. PART III, LINE 9B: ONCE A DECISION HAS BEEN MADE GRANTING FINANCIAL ASSISTANCE AND THE PATIENT/GUARANTOR HAS BEEN NOTIFIED, CMH WILL NO LONGER ATTEMPT TO COLLECT THE DISCOUNTED AMOUNT. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT SOMEONE MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE COLLECTION PROCESS STOPS AND THE FINANCIAL ASSISTANCE APPLICATION PROCESS BEGINS. COLLECTION IS HALTED UNTIL THE FINANCIAL ASSISTANCE APPLICATION IS REVIEWED AND QUALIFICATION IS DETERMINED. APPROVED FINANCIAL ASSISTANCE REQUESTS WILL BE WRITTEN OFF WITHIN TEN DAYS FROM THE DATE APPROVED. THE DECISION TO WRITE OFF THE ACCOUNT IS PERMANENT. PART VI, LINE 2: COMMUNITY MEMORIAL HOSPITAL CONDUCTED A FORMAL COMMUNITY NEEDS ANALYSIS DURING 2016. IN ADDITION TO CONDUCTING THE NEEDS ASSESSMENT EVERY THREE YEARS, ADMINISTRATION MEETS WITH PROVIDERS AND CLINIC MANAGERS MONTHLY AND WITH THE MEDICAL STAFF GROUP BI-MONTHLY. DURING THESE MEETINGS, TOPICS FROM PATIENT INTERACTIONS ARE DISCUSSED TO IDENTIFY ANY COMMUNITY HEALTH NEEDS. PART VI, LINE 3: INDIVIDUALS ARE MADE AWARE OF FINANCIAL ASSISTANCE THROUGH POSTING OF THE POLICY AND APPLICATION IN THE ER, CLINIC, AND ADMISSIONS OFFICE. STAFF IN THE ADMISSIONS OFFICE PROVIDE INFORMATION TO INDIVIDUALS WHO MAY QUALIFY FOR MEDICARE, MEDICAID, OR OTHER FINANCIAL ASSISTANCE. PART VI, LINE 4: COMMUNITY MEMORIAL HOSPITAL SERVES SEVERAL COMMUNITIES IN SOUTH CENTRAL SOUTH DAKOTA AND NORTH CENTRAL NEBRASKA. THE AREAS SERVED ARE PRIMARILY FARMING/RANCHING AND RETIREMENT COMMUNITIES. WE HAVE A VERY LOW PERCENTAGE OF UNINSURED RESIDENTS IN OUR AREA. WE ARE LOCATED IN A FEDERAL HEALTH PROFESSIONAL SHORTAGE AREA. 64% OF THE ORGANIZATION'S REVENUE WAS FROM SERVING THE MEDICARE POPULATION, 9% WAS FROM TITLE 19, 12% FROM COMMERCIAL INSURANCE, AND 15% FROM OTHER SOURCES. PART VI, LINE 5: THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. FAMILY MEMBERS OF FIVE MEMBERS OF THE GOVERNING BODY ARE EMPLOYED BY THE ORGANIZATION DUE TO THE SMALL POPULATION OF THE COMMUNITY. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. SURPLUS FUNDS, IF ANY, ARE REINVESTED FOR FACILITY AND EQUIPMENT UPGRADES, AND IMPROVING TECHNICAL SKILLS OF EMPLOYEES. MOST IMPROVEMENTS IN THE FACILITY AND EQUIPMENT IN THE PAST FEW YEARS WERE PURCHASED USING DONATIONS BY COMMUNITY MEMBERS DUE TO LACK OF SURPLUS FUNDS.COMMUNITY MEMORIAL HOSPITAL PROVIDES THE FOLLOWING TYPES OF COMMUNITY EDUCATION:A HEALTH FAIR IS PROVIDED SEMI-ANNUALLY FOR THE COMMUNITY WITH MANY DIFFERENT ASPECTS OF HEALTH CARE REPRESENTED. BLOOD DRAWS, BLOOD PRESSURES, GLUCOSE TESTING, AND DIFFERENT SCREENING TESTS ARE JUST A FEW OF THE SERVICES OFFERED BY THE HEALTH FAIR. IN ADDITION, EDUCATION FOR ALL SCHOOL AGES IS PROVIDED DURING A WEEK OF ACTIVITIES AT THE HOSPITAL. ACTIVITIES INCLUDE: TOURS OF DIFFERENT DEPARTMENTS, HAND WASHING TECHNIQUES, POISON CONTROL EDUCATION, AND A TEDDY BEAR CLINIC WHICH ENTAILS A TRIP TO THE EMERGENCY DEPARTMENT WITH THE TEDDY BEAR BEING THE PATIENT AND STUDENT BEING THE PARENT DESCRIBING THE COMPLAINTS. COMMUNITY MEMORIAL HOSPITAL ALSO PROVIDES CPR TRAINING TO BOTH THE STAFF AND COMMUNITY MEMBERS. DISASTER PREPAREDNESS TRAINING IS PROVIDED TO THE LOCAL FIRE DEPARTMENT. ADVANCED CARDIAC LIFE SUPPORT (ACLS) CLASSES AND TRAUMA NURSE CURRICULUM COURSE (TNCC) IS PROVIDED TO STAFF AS WELL AS NURSES FROM SURROUNDING COMMUNITIES. COMMUNITY MEMORIAL HOSPITAL SPONSORS DIFFERENT ACTIVITIES IN THE COMMUNITY AS WELL AS PARTICIPATES IN COMMUNITY PROJECTS, INCLUDING SCHOOL YEAR BOOK, AFTER PROM PARTY, PARADES AND OTHER COMMUNITY EVENTS. A GREAT DEAL OF PRIDE IS TAKEN IN THE COMMUNITY WITH THE COMMUNITY GIVING AS MUCH TO THE HOSPITAL AS THE HOSPITAL GIVES BACK TO THE COMMUNITY. DEBRA LEIBEL FAMILY MEMBER OF TOM GLOVER, BOARD CHAIRMAN 118809 BASE WAGES 0 JOLENE VANMETRE FAMILY MEMBER OF KAREN MARTIN, BOARD SECRETARY 33515 BASE WAGES 0 KIM SHEPPERD FAMILY MEMBER OF AJ STEFFEN, BOARD DIRECTOR 36020 BASE WAGES 0 ANDREA STEFFEN FAMILY MEMBER OF AJ STEFFEN, BOARD DIRECTOR 38102 BASE WAGES 0 AMY JURACEK FAMILY MEMBER OF KATE WITT, BOARD DIRECTOR 115353 BASE WAGES 0 AMANDA STEFFEN FAMILY MEMBER OF AJ STEFFEN, BOARD DIRECTOR 23323 BASE WAGES 0 SHARON NEUHARTH FAMILY MEMBER OF SUE CHYTKA, BOARD DIRECTOR 18258 BASE WAGES 0 X MEDICAL EQUIPMENT 1 297100 FAIR MARKET VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL INCLUDE FIVE MEMBERS ALL OF WHOM SHALL BE MEMBERS OF THE BOARD OF DIRECTORS, AND SHALL INCLUDE THE CHAIR, THE VICE CHAIR, SECRETARY, AND THE ADMINISTRATOR. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE SHALL NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, THE BYLAWS OR THE POLICIES OR EXPRESSED WISHES OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 COMMUNITY MEMORIAL HOSPITAL HAS ENTERED INTO A MANAGEMENT AGREEMENT WITH SANFORD HEALTH NETWORK TO PROVIDE MANAGEMENT SERVICES FOR THE FACILITY. THE CEO OF COMMUNITY MEMORIAL HOSPITAL IS AN EMPLOYEE OF SANFORD HEALTH NETWORK. COMPENSATION AND BENEFITS FOR MISTIE SACHTJEN WERE $103,462 AND $28,233 RESPECTIVELY. DUTIES OF THE CEO INCLUDE: SUPPORTING FACILITY OPERATIONS AND ADMINSTRATION, RECOMMENDING BUDGETS AND MANAGING RESOURCES ACCORDINGLY, AND OVERSEEING DESIGN AND DELIVERY OF QUALITY PROGRAMS, PRODUCTS, AND SERVICES. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY MEMORIAL HOSPITAL HAS ONE CLASS OF GENERAL MEMBERSHIP. THE GENERAL MEMBERSHIP INCLUDES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION WHO HAS CONTRIBUTED TO THE COMMUNITY MEMORIAL HOSPITAL BUILDING FUND OR CLINIC FUND AND WHO RESIDES IN THE FOUR-COUNTY AREA OF GREGORY AND TRIPP COUNTIES OF SOUTH DAKOTA AND KEYA PAHA AND BOYD COUNTIES IN NEBRASKA. THESE MEMBERSHIPS SHALL BE FOR THE LIFE OF THE CONTRIBUTOR AND ARE NOT TRANSFERABLE. IN ADDITION, ANY PATIENT OF THE HOSPITAL WHO HAS PAID THE HOSPITAL BILL IN FULL UPON DISCHARGE OR SHORTLY THEREAFTER AND WHO RESIDES IN THE PREVIOUSLY MENTIONED FOUR-COUNTY AREA SHALL BE A MEMBER OF THIS CORPORATION FOR THREE YEARS FROM THE DATE OF SAID PAYMENT IN FULL. ALSO, ALL MEMBERS OF THE LADIES AUXILIARY TO THE COMMUNITY MEMORIAL HOSPITAL, INC., OF BURKE, SOUTH DAKOTA, SHALL BE MEMBERS WITH FULL VOTING RIGHTS. PRESENT EMPLOYEES SHALL NOT BE CONSIDERED ELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A GOVERNING BOARD MEMBERS ARE ELECTED BY THE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL BY THE MEMBERS OF THE ORGANIZATION IS REQUIRED TO: ESTABLISH MISSION STATEMENT APPROVE THE SALE OF REAL PROPERTY ELECT OR REMOVE THE BOARD OF DIRECTORS APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION REVIEW THE ANNUAL REPORT AND FINANCIAL AUDIT ESTABLISH SERVICES TO MEET THE NEEDS OF THE COMMUNITY FORM 990, PART VI, SECTION A, LINE 8B THE EXECUTIVE COMMITTEE DID NOT MEET IN 2017. FORM 990, PART VI, SECTION B, LINE 11B THE CEO DOES A DETAILED REVIEW OF THE FORM 990. TWO BOARD MEMBERS ALSO PERFORM A DETAILED REVIEW OF THE 990. A COPY OF THE 990 IS DISTRIBUTED TO ALL BOARD MEMBERS PRIOR TO FILING OF THE FORM WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST DISCLOSURE IS REQUIRED TO BE COMPLETED BI-ANNUALLY AND RESPONSES ARE REVIEWED BY THE CEO. IF A CONFLICT IS DEEMED TO EXIST, THE MEMBER(S) INVOLVED IS REQUIRED TO ABSTAIN FROM DISCUSSION, DELIBERATION, AND VOTING ON THE MATTER CAUSING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A SANFORD HEALTH NETWORK REVIEWS AND DETERMINES THE CEO'S COMPENSATION ANNUALLY. COMPENSATION RANGES ARE DETERMINED USING STATE SALARY SURVEY RESULTS. THE PROCESS AND DECISION IS DOCUMENTED AND MAINTAINED INTERNALLY BY SANFORD'S VP OF ADMINISTRATION. THE BOARD OF DIRECTORS OF COMMUNITY MEMORIAL HOSPITAL, INC, APPROVES THE AMOUNT OF THE CEO'S COMPENSATION THROUGH THEIR ACCEPTANCE OF THE MANAGEMENT AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE DISTRIBUTED AT THE ANNUAL MEMBERSHIP MEETING, AND OTHER ITEMS ARE PROVIDED UPON REQUEST. FORM 990, PART VII: MISTIE SACHTJEN (CEO) UNDER MANAGEMENT AGREEMENT WITH SANFORD HEALTH NETWORK ACTS AS BOTH THE TOP MANAGEMENT OFFICIAL AND THE TOP FINANCIAL OFFICIAL. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 817,330. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 817,330. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 80,418. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,418.