Community Benefit Insight - Tax-exempt hospital

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Landmann-jungman Memorial Hospital Corporation

Landmann-Jungman Memorial Hospital

600 Billards Street
Scotland, SD 57059

Bed count	20	Medicare provider number	431317	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 466015787

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

4.21%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 12,000 0.18 %
Medicaid as % of operating expenses	$ 19,272 0.28 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 236,252 3.49 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 17,004 0.25 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 110 0.00 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 373,335 5.52 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 52,267 14.00 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 5582659 including grants of $ 0) (Revenue $ 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.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

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.

Supplemental Information

Schedule H (Form 990) Part VI

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 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."

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.

Operating expenses	$ 6,766,997
Total amount spent on community benefits as % of operating expenses	$ 284,638 4.21 %