4A (Expenses $ 9318798 including grants of $ 0) (Revenue $ 11250421)
DOUGLAS COUNTY MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO PERSONS IN THE ARMOUR, CORSICA, AND STICKNEY COMMUNITIES. DURING THE FISCAL YEAR ENDED MAY 31, 2021, THE HOSPITAL PROVIDED 503 INPATIENT DAYS, 344 SUBACUTE DAYS, 475 EMERGENCY ROOM VISITS, 8,675 OUTPATIENT VISITS AND 5,102 ASSISTED LIVING DAYS. THE FACILITY PROVIDED 817 HOME DELIVERED MEALS TO HOME BOUND COMMUNITY MEMBERS ALONG WITH 2,111 MEALS TO SENIOR MEALS PROGRAM. DUE TO COVID THE ANNUAL HEALTH FAIRS WERE NOT HELD.

FACILITY 1, DOUGLAS COUNTY MEMORIAL HOSPITAL - PART V, LINE 5
IN CONDUCTING THE CHNA THE HOSPITAL FACILITY RELIED HEAVILY UPON THE KNOWLEDGE OF THE ARMOUR MAYOR, DOUGLAS COUNTY COMMUNITY HEALTH NURSE, DOUGLAS COUNTY COMMISSIONER, ARMOUR HIGH SCHOOL PRINCIPAL, CORSICA HIGH SCHOOL PRINCIPAL, ARMOUR NURSING HOME ADMINISTRATOR, PHYSICIAN ASSISTANT, CORSICA CLINIC NURSE MANAGER, THE CEO, AND CFO OF THE DOUGLAS COUNTY MEMORIAL HOSPITAL. THE HOSPITAL RELIED ON THEIR INPUT AS TO WHAT THE NEEDS OF THE COMMUNITY ARE BASED ON THEIR WORKING KNOWLEDGE OF THE ILLNESSES THAT ARE OCCURRING IN THE DOUGLAS COUNTY.

FACILITY 1, DOUGLAS COUNTY MEMORIAL HOSPITAL - PART V, LINE 11
THE HOSPITAL CONDUCTED A CHNA IN THE CURRENT TAX PERIOD. THE PRIORITIES IDENTIFIED IN THE ASSESSMENT WERE: MENTAL HEALTH; SHORTAGE OF DENTAL RESOURCES; WELLNESS; INCREASED ACCESS TO SPECIALTY SERVICES; TRANSPORTATION ISSUES FOR INDIVIDUALS WITH LIMITED MOBILITY; ACCESS TO LONG TERM CARE SERVICES. FOR MENTAL HEALTH THE HOSPITAL IS CONTINUING TO COLLABORATE WITH SANFORD HEALTH TO HAVE DR. EGGERS, WHO IS A PSYCHIATRIST, AVAILABLE TO PROVIDE TELE-MENTAL HEALTH SERVICES TO YOUTH. DCMH IS EXPLORING THE TELE- MENTAL HEALTH SERVICES OPPORTUNITIES BY ADDITIONAL COLLABORATION WITH SANFORD, AVERA, OR ANOTHER PROVIDER OF THESE SERVICES (SUCH AS A LOCAL NURSING HOME). ESPECIALLY TO SOMEONE WHO COULD PROVIDE THIS CARE TO ELDERLY PATIENTS. TO HAVE THE TELEMEDICINE SERVICES AVAILABLE IT COSTS THE FACILITY OVER 36,000 PER YEAR. THE FACILITY WILL COMMIT TO DISCUSSING THE AVAILABLE SERVICES DIRECTLY WITH OUR PATIENTS AS WELL AS ANY OTHER LOCAL COMMUNITY ORGANIZATIONS THAT MAY BE ABLE TO SUPPORT THIS INITIATIVE. THE ANTICIPATED IMPACT OF THIS WOULD BE AN INCREASED MENTAL & BEHAVIORAL HEALTH WITHIN THE COMMUNITY ALONG WITH POTENTIALLY ALLOWING PATIENTS TO REMAIN CLOSER TO FAMILY AND FRIENDS WHILE RECEIVING THEIR HEALTHCARE. THE SHORTAGE IN DENTAL SERVICES HAS SEVERAL CHALLENGES IN HAVING THIS AVAILABLE. FIRST, FINDING SPACE IS DIFFICULT ESPECIALLY BASED ON THE COST TO CONSTRUCT THE SPACE. IT IS COST PROHIBITIVE BASED ON THE NUMBER OF PEOPLE BEING CARED FOR TO BE ABLE TO HAVE A PRACTICE START FROM NOTHING. SECOND, DENTISTS WITHIN A REASONABLE DRIVING DISTANCE ALREADY HAVE FULL PRACTICES. FINALLY, MANY DENTISTS DO NOT TAKE MEDICAID FOR INSURANCE, WHICH IS A SIGNIFICANT PART OF THE POPULATION IN DOUGLAS COUNTY THAT NEEDS THESE SERVICES. THE HOSPITAL DOES NOT HAVE AN ABILITY TO ADDRESS THESE ISSUES ON ITS OWN. CURRENTLY DCMH PROVIDERS ARE ABLE TO PROVIDE REFERRALS TO OTHER DENTAL PROVIDERS THAT WILL PROVIDE NEEDED DENTAL CARE. THERE ARE SEVERAL OPTIONS WITHIN A THIRTY MILE RADIUS, AND DCMH WILL USE THESE PROVIDERS WHILE WE AWAIT THE ARRIVAL OF THE NEW DENTAL PRACTICE. THERE IS AN INDIVIDUAL WHO HAS PURCHASED A BUILDING WITHIN THE COMMUNITY WITH THE INTENTION OF PUTTING A DENTAL PRACTICE WITHIN THE STRUCTURE. THE HOSPITAL WILL SEE HOW IT MAY SUPPORT THIS NEEDED ENDEAVOR WITHIN OUR COMMUNITY. DCMH INTENDS TO COMMIT TIME OF PROVIDERS AND NURSES TO DISCUSS DENTAL OPTIONS FOR PATIENTS NEEDING THIS CARE. WITH WELLNESS THE DOUGLAS COUNTY HOSPITAL INTENDS TO CONTINUE TO OFFER ITS WELLNESS EQUIPMENT TO THE PUBLIC FOR 10/MONTH. THE EQUIPMENT FOR THE WELLNESS AREA HAS COST THE FACILITY OVER 18,000 AND OCCUPIES 326 SQUARE FEET OF SPACE. DCMH INTENDS TO HAVE HOSPITAL STAFF CONTINUE TO GIVE TALKS TO STUDENTS REGARDING HYGIENE, IMPORTANCE OF EXERCISE AND SEXUALLY TRANSMITTED DISEASES. THE HOSPITAL WILL CONTINUE TO EVALUATE OTHER OPPORTUNITIES TO PROMOTE GENERAL WELLNESS TO COMMUNITY. THE ANTICIPATED IMPACT OF THESE EDUCATIONAL EFFORTS WILL BE TO CREATE A GREATER UNDERSTANDING OF THE PHYSICAL EXERCISE IN OVERALL WELLNESS (INCLUDING BENEFITS TO MENTAL HEALTH). THE GOAL IS FINALLY TO IMPROVE HEALTH TO THE COMMUNITY. THE HOSPITAL INTENDS TO INCREASE ACCESS TO SPECIALTY SERVICES BY AVERA'S INFECTIOUS DISEASE DEPARTMENT WAS RECENTLY ADDED TO OUR SPECIALTIES AVAILABLE THROUGH TELEMEDICINE. THIS NEW CONNECTION MAY LEAD TO ADDITIONAL SPECIALTY OPPORTUNITIES AVAILABLE FOR OUR PATIENTS AS NEW OPPORTUNITIES SHOW THEMSELVES WITH THIS DEVELOPING RELATIONSHIP. TO HAVE THE TELEMEDICINE SERVICES AVAILABLE IT COSTS THE FACILITY OVER 36,000 PER YEAR. MANY SPECIALTIES HAVE BEEN ADDED THROUGH THE TELEMEDICINE PROGRAM WHICH DECREASES THE COST OF TRAVEL AND SAVES TIME FOR OUR PATIENTS. NEW SPECIALISTS CONTINUE TO BE ADDED BASED ON THEIR COMMITMENT TO PROVIDE THESE SERVICES TO OUR RURAL AREA. DCMH ANTICIPATES THE IMPACT OF TELEMEDICINE TO DECREASE THE COST OF TRAVEL TO SEE SPECIALISTS, SAVE TIME FOR TRAVEL, IMPROVED ACCESS TO SPECIALTY SERVICES, SHORTER WAIT TIMES, IMPROVED HEALTH OUTCOMES, AND IMPROVED PATIENT AND COMMUNITY SATISFACTION. WITH TRANSPORTATION ISSUES FOR INDIVIDUALS WITH LIMITED MOBILITY DCMH HAS LIMITED ABILITY TO MEET THIS NEED, BUT IS COMMITTED TO EXPLORING PARTNERSHIPS AND/OR OPTIONS FOR A THIRD PARTY TO PROVIDE THIS SERVICE TO COMMUNITY MEMBERS. THE DESIRED IMPACT WOULD BE TO PROVIDE COMMUNITY MEMBERS AN ABILITY TO OVERCOME TRANSPORTATION/MOBILITY CHALLENGES SO THAT THEY MAY RECEIVE THE QUALITY MEDICAL CARE AND SUPPORT THAT THEY NEED IN A ROUTINE AND TIMELY MANNER AS THEIR HEALTH NEEDS REQUIRE. FINALLY, WITH RESPECT TO ACCESS TO LONG TERM CARE SERVICES THE DOUGLAS COUNTY MEMORIAL HOSPITAL CURRENTLY HAS A 16 BED ASSISTED LIVING. THE NURSING HOME LOCATED IN ARMOUR IS SET TO CLOSE IN OCTOBER OF 2022. THE HOSPITAL EVALUATED THE POSSIBILITY OF PURCHASING THIS ORGANIZATION AND COMBINING IT WITH THE CURRENT OPERATIONS. AFTER REVIEWING STATE SURVEY REPORTS OF THE FACILITY, NEEDS OF THE PHYSICAL STRUCTURE, POSSIBILITY OF BUILDING A CONNECTED STRUCTURE TO THE HOSPITAL, AND THE FINANCIAL IMPACT THAT COMBINING THE TWO ORGANIZATIONS WOULD HAVE ON THE HOSPITAL, IT WAS DECIDED FOR THE HOSPITAL NOT TO PURCHASE THE NURSING HOME. THERE WERE TOO MANY RISKS THAT THE CONCERN WAS THAT ADDING THE NURSING HOME MAY JEOPARDIZE THE FINANCIAL STABILITY OF THE HOSPITAL. LICENSING OF BEDS FOR LONG TERM CARE SERVICES IS STRICTLY CONTROLLED BY THE STATE. NEW BED LICENSES ARE NOT GRANTED EASILY, SO IT WOULD BE DIFFICULT FOR THE HOSPITAL TO BE ABLE TO OBTAIN LICENSURE FOR ADDITIONAL BEDS. EVEN IF LICENSURE COULD BE OBTAIN, TO BUILD THE FACILITIES THAT ARE NECESSARY TO HOUSE SUCH SERVICES ARE COST PROHIBITIVE FOR THE HOSPITAL TO TAKE ON. DUE TO THESE FACTORS, THE BEST SOLUTION IS FOR THE OTHER FIVE NURSING HOMES WITHIN THE THIRTY MILE RADIUS TO PROVIDE THIS CARE. STATE OCCUPANCY FOR NURSING HOMES IS CURRENTLY BELOW 65%, SO THERE ARE BEDS AVAILABLE FOR PEOPLE NEEDING CARE. OTHER OPPORTUNITIES WILL BE EVALUATED BY THE ORGANIZATION ON A CASE-BY-CASE BASIS. DCMH WILL WORK WITH THE OTHER LOCAL NURSING HOMES, PARTICULARLY THE GOOD-SAM NURSING HOME IN CORSICA (OR OTHERS AS DESIRED BY PATIENTS/FAMILIES), TO REFER PATIENTS AS THEY ARE IN NEED OF THIS CARE. THE DESIRED OUTCOME FOR THIS WOULD BE THAT OUR PATIENTS ARE ABLE TO RECEIVE QUALITY LONG TERM CARE SERVICES AS NEEDED LOCALLY SO THEY MAY CONTINUE THIS PART OF THEIR LIFE WITH THE AVAILABLE CONNECTION TO FAMILY AND FRIENDS.

SCHEDULE H, PART I, LINE 7
THE COSTING METHODOLOGY USED FOR LINE 7A IS THE FACILITY'S AUDITED FINANCIAL STATEMENT'S INFORMATION FOR ALL PATIENT SEGMENTS INPUT INTO SCHEDULE H INSTRUCTIONS WORKSHEETS 1 & 2. LINE 7E USES COSTS FROM THE FACILITIES MEDICARE COST REPORT AND OFFSETTING REVENUE FROM THE GENERAL LEDGER SYSTEM. THIS INFORMATION WAS THEN INPUT IN THE SCHEDULE H INSTRUCTIONS WORKSHEET 4 TO COME TO THE FINAL FIGURES

SCHEDULE H, PART III, LINE 2
BAD DEBTS WERE BASED 65% OF HOSPITAL'S AUDITED FINANCIAL STATEMENTS FIGURE. THE 65% CAME FROM THE CALCULATION FIGURED ON WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.

SCHEDULE H, PART III, LINE 3
BASED ON A SAMPLE OF ACCOUNTS WRITTEN OFF TO COLLECTION AGENCIES THAT WERE NOT INCLUDED IN THE COMMUNITY BENEFIT.

SCHEDULE H, PART III, LINE 4
THE FOOTNOTE TO THE FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 10.

SCHEDULE H, PART III, LINE 8
THE FIGURE REPORTED ON LINE 6 COMES DIRECTLY FROM THE FACILITY'S FILED COST REPORT.

SCHEDULE H, PART VI, LINE 2
IN ADDITION TO THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED 05/31/2022, DCMH DETERMINES PATIENT NEEDS THROUGH THE SATISFACTION SURVEYS COMPLETED BY PATIENTS OF THE HOSPITAL AND CLINICS. ASSESSMENT OF THE NEEDS FOR HEALTHCARE ARE CONSIDERED MONTHLY WITH THE MEDICAL STAFF MEETINGS AS THE PROVIDERS EVALUATE THE CLINICAL SITUATIONS THAT HAVE PRESENTED IN THE PREVIOUS MONTH AND THOSE SITUATIONS THEY CAN FORESEE NEEDING TO MEET THE NEEDS OF IN THE COMING MONTH. THE VOLUTEER BOARD OF DIRECTORS, WHO ARE ALL LOCAL COMMUNITY MEMBERS WITHIN THE HOSPITAL'S SERVICE AREA, ALSO CONSIDER, AS APPROPRIATE, THE NEEDS OF THE COMMUNITY AS THEY ARE ABLE TO SEE BASED ON THEIR OWN NEEDS AND THE NEEDS OF THEIR FAMILY AND NEIGHBORS WHO MAY BRING CONCERNS TO THEM DIRECTLY. DCMH ALSO COMMUNICATES WITH OUTSIDE SPECIALITY PROVIDERS, OTHER HOSPITALS, STATE AND FEDERAL GOVERNMENTAL HEALTH AGENCIES. CONTINUED ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS IS A CONSTANT EFFORT FOR DCMH TO CONSIDER IN ORDER TO PROVIDE SERVICES THAT THE COMMUNITY REQUIRES AND THE HOSPITAL IS ABLE TO PROVIDE.

SCHEDULE H, PART VI, LINE 3
PATIENT FINANCIAL SERVICES EVALUATES ACCOUNTS FOR PATIENT ELIGIBILITY UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, AND PROVIDES ELIGIBLE PATIENTS WITH INFORMATION REGARDING THESE PROGRAMS ALONG WITH THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE WRITTEN OFF THROUGH FINANCIAL ASSISTANCE.

SCHEDULE H, PART VI, LINE 4
THE COMMUNITY SERVED IS DEFINED AS DOUGLAS COUNTY AS 69% OF THE HOSPITAL'S PATIENTS COME FROM DOUGLAS COUNTY. THE HOSPITAL ALSO PROVIDES SERVICES TO PATIENTS FROM NEIGHBORING COUNTIES. DCMH CONSIDERS PART OF ITS COMMUNITY ALL PEOPLE REGARDLESS OF ABILITY TO PAY AND/OR WHETHER THEY ARE ELIGIBLE FOR ASSISTANCE UNDER FINANCIAL ASSISTANCE. THE PRIMARY INDUSTRIES IN DOUGLAS COUNTY INCLUDE AGRICULTURE AND HEALTH AND SOCIAL SERVICES. AS OF THE 2020 CENSUS ESTIMATE, THERE WERE 2,835 PEOPLE WITH AN AVERAGE POPULATION DENSITY OF 7 RESIDENT PER SQUARE MILE. THE COUNTY IS ESTIMATED TO EXPERIENCE A SLIGHT DECREASE IN TOTAL POPULATION BY 0.42% FROM 2022 TO 2027 ACCORDING TO ENVIRONICS ANALYTICS. THIS IS LESS THAN THE PREVIOUS TRENDS OF DECREASE: 2000 TO 2010 DECREASED BY 13.19% AND 2010 TO 2022 DECREASED BY 4.10%. THE RACIAL MAKEUP OF THE COUNTY WAS 95.1% WHITE, 2.6% AMERICAN INDIAN AND THE REMAINDER OTHER. MEDIAN HOUSEHOLD INCOME IN THE COMMUNITY IS 67,373 WHICH IS ABOVE THE STATE MEDIAN HOUSEHOLD INCOME OF 65,841. THE AVERAGE HOUSEHOLD INCOME IN THE COMMUNITY IS 83,128 WHICH IS BELOW THE STATE AVERAGE HOUSEHOLD INCOME OF 87,071 APPROXIMATELY 8% OF THE COMMUNITY HAS AN INCOME BELOW THE POVERTY LINE. THIS IS LESS THAN THE STATE ESTIMATE OF 12.8% AND THE UNITED STATES ESTIMATE OF 12.8%. CORRELATIONS EXIST BETWEEN HEALTH OUTCOMES AND SOCIOECONOMIC STATUS. HIGH INCOME INDIVIDUALS TEND TO BE IN BETTER HEALTH THAN LOW INCOME INDIVIDUALS. THE UNEMPLOYMENT RATE IS ESTIMATED TO BE 2.2% ACCORDING TO BLS DATA SERIES AS OF DECEMBER 2021. THIS COMPARES TO THE STATE UNEMPLOYMENT RATE OF 2.8% AND UNITED STATES UNEMPLOYMENT RATE OF 3.9% DURING THIS SAME TIME. EMPLOYMENT STATUS CAN IMPACT MENTAL HEALTH AND HEALTH CARE UTILIZATION. UNEMPLOYED PERSONS HAVE MORE DEPRESSION AND ANXIETY SYMPTOMS THAN THOSE WHO ARE EMPLOYED. 85% OF INDIVIDUALS HAD HEALTH INSURANCE COVERAGE WITH THE REMAINING 15% HAVING NO COVERAGE.

SCHEDULE H, PART VI, LINE 5
DURING THE FISCAL YEAR ENDED MAY 31, 2022, THE HOSPITAL PROVIDED 493 INPATIENT DAYS, 245 SUBACUTE DAYS, 540 EMERGENCY ROOM VISITS, 13,002 OUTPATIENT VISITS AND 4,153 ASSISTED LIVING DAYS. THE FACILITY PROVIDED 2,426 HOME DELIVERED MEALS TO HOME BOUND COMMUNITY MEMBERS ALONG WITH 2,928 MEALS TO SENIOR MEALS PROGRAM. THE BOARD OF DIRECTORS IS COMPLETELY MADE UP OF COMMUNITY MEMBERS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYED BY NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. THE HOSPITAL ALSO PROVIDES THE PHYSICAL LOCATION FOR THE DOUGLAS COUNTY COMMUNITY HEALTH OFFICE WHICH ALSO ALLOWS THE HOSPITAL TO WORK CLOSELY WITH OUR LOCAL HEALTH AGENCY. AN OPEN MEDICAL STAFF ALSO ALLOWS PROVIDERS WHO ARE NOT EMPLOYED BY THE ORGANIZATION TO SEE PATIENTS, AND PROVIDE MEDICAL TREATMENT AT THE FACILITY. THE DOUGLAS COUNTY MEMORIAL HOSPITAL IS ALSO EXPANDING ITS TELEMEDICINE CAPABILITIES ALLOWING PATIENTS WHO WOULD OTHERWISE HAVE TO TRAVEL DISTANCES IN EXCESS OF NINETY MILES TO SEE SPECIALISTS WHO CAN NOW BE SEEN LOCALLY. GIVEN THE INCLEMENT WEATHER OF SOUTH DAKOTA THIS PROVIDES PATIENTS THE ABILITY TO SEE THEIR PROVIDERS WITHOUT HAVING TO RUN A RISK OF BEING CAUGHT IN POTENTIALLY DANGEROUS CONDITIONS. THIS IS MOST ESPECIALLY TRUE FOR THE EDERLY POPULATION AS THEY ARE OFTEN THE ONES IN MOST NEED OF SEEING THESE SPECIALTY PROVIDERS.

SCHEDULE H, PART VI
PART I, LINE 6A - THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS NOT CONDUCTED WITH A RELATED ORGANIZATION. PART III, LINE 2 - THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PAYORS. PART III, LINE 3 - THE ESTIMATED AMOUNT RELATED TO RELATED TO CHARITY CARE IS 8% OF IMPLICIT PRICE CONCESSIONS, WHICH IS BASED ON THE POVERTY LEVEL OF THE DOUGLAS COUNTY ACCORDING TO THE US CENSUS BUREAU DATA AS OF 2020. PART III, LINE 4 - THE FOOTNOTES ON IMPLICIT PRICE CONCESSIONS TO THE FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 19 & 21. PART III, LINE 8 - THE FIGURE REPORTED ON LINE 6 COMES DIRECTLY FROM THE FACILITY'S FILED COST REPORT. THE DOUGLAS COUNTY MEMORIAL HOSPITAL PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THAT THE HOSPITAL WILL NOT RECEIVE ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO OUR MEDICARE PATIENTS, OUR COMMUNITY, AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THERE, THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS OF CARE ON LINE 6 ARE DIRECTLY FROM THE FILED MEDICARE COST REPORT ENDED ON 05/31/2022. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.