TY 2022 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) MELANIE PARSONS...................................................................... PRESIDENT	2.00 ................. 0.30	X	X		0	0	0
(2) PAUL CHRISTENSEN...................................................................... VICE PRESIDENT	1.00 ................. 0.30	X	X		0	0	0
(3) KIM LARSEN...................................................................... SECRETARY	1.00 ................. 0.00	X	X		0	0	0
(4) TROY LEE...................................................................... DIRECTOR	1.00 ................. 0.00	X			0	0	0
(5) RYAN PENNING...................................................................... DIRECTOR	1.00 ................. 0.00	X			0	0	0
(6) LINDA ANDAL...................................................................... DIRECTOR	1.00 ................. 0.00	X			0	0	0
(7) CHRIS PONCELET...................................................................... DIRECTOR	1.00 ................. 0.00	X			0	0	0
(8) MELISSA BUCKNEBERG...................................................................... DIRECTOR	1.00 ................. 0.00	X			0	0	0
(9) JOANNE POWELL...................................................................... DIRECTOR	1.00 ................. 0.30	X			0	0	0
(10) ANNE CHRISTIANSEN...................................................................... CFO	45.00 ................. 2.00		X		104,095	0	8,534
(11) LINDSEY HAUGER...................................................................... CEO	45.00 ................. 2.00		X		0	0	0
(12) ALEX KALSBECK...................................................................... CERTIFIED NURSE PRACTITIONER	45.00 ................. 0.00			X	123,204	0	14,702
(13) GABRIEL JOHNSON...................................................................... DO-FAMILY MEDICINE	45.00 ................. 0.00			X	241,386	0	44,387
(14) KAYLA MEHLHAF...................................................................... CERTIFIED NURSE PRACTITIONER	45.00 ................. 0.00			X	133,954	0	6,868
(15) SHARON JACOBSEN...................................................................... DIRECTOR OF NURSING - HOSPITAL	45.00 ................. 0.00			X	118,553	0	18,213
(16) ANNA HUSMAN...................................................................... CERTIFIED NURSE PRACTITIONER	45.00 ................. 0.00			X	120,367	0	11,783

(A) Name and business address	(B) Description of services	(C) Compensation
INTERIM HEALTHCARE SIOUX FALLS 3608 S SOUTHEASTERN AVE SIOUX FALLS,SD57103	TEMP NURSING SERVICES	414,065
SANFORD HEALTH NETWORK 1305 W 18TH STREET SIOUX FALLS,SD57117	CEO AND MANAGEMENT SERVICES	247,445
ALLIANCE MEDICAL STAFFING 11510 BLONDO ST STE 200 OMAHA,NE68164	TEMP NURSING SERVICES	118,663


2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 3

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2022

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2021. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2022

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2021. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2022

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2022

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2022

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2022

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES		Employer identification number 46-0260288

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 4


Name of organization PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES			Employer identification number 46-0260288
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

702

Total. Add lines 1c through 1i ....................................................................................................

702

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	THE ORGANIZATION IS A MEMBER OF CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS A PERCENTAGE OF DUES THAT WERE USED FOR LOBBYING.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	440,681	415,394	391,581	346,850	361,652
b	Contributions ...
c	Net investment earnings, gains, and losses	-52,259	25,287	23,813	44,731	-14,802
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	388,422	440,681	415,394	391,581	346,850

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

70.872 %

Term endowment SchDMd Bullet

29.128 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	482,015		482,015
b	Buildings ....	9,412,728	7,447,947	1,964,781
c	Leasehold improvements
d	Equipment ....	7,160,477	5,163,945	1,996,532
e	Other .....	580,701	478,941	101,760
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				4,545,088

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	117,119
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	12,823,299
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-3,737
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	40,745
e	Add lines 2a through 2d .....................			2e	37,008
3	Subtract line 2e from line 1..................			3	12,786,291
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	22,932
c	Add lines 4a and 4b....................			4c	22,932
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	12,809,223

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	12,208,436
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	21,229
e	Add lines 2a through 2d....................			2e	21,229
3	Subtract line 2e from line 1...................			3	12,187,207
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	12,187,207

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART IV, LINE 2B:	THE ORGANIZATION ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. RESIDENT TRUST FUNDS TOTALED $19,218 AT DECEMBER 31, 2022.
PART V, LINE 4:	THE PRINCIPAL OF THE ENDOWMENT IS PERMANENT AND WILL BE HELD IN PERPETUITY. THE INTEREST INCOME MAY BE USED FOR CURRENT PROJECTS.
PART X, LINE 2:	THE ORGANIZATION 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 ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES WERE INCURRED.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	FOUNDATION INCOME INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 40,745.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	CONTRIBUTION FROM FOUNDATION 12,475. DONOR RESTRICTED DONATION 10,457.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	FOUNDATION EXPENSES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 21,229.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	109,193		109,193	0.900 %
b	Medicaid (from Worksheet 3, column a) . . . . .	526,065	510,270	15,795	0.130 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	635,258	510,270	124,988	1.030 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	21,202		21,202	0.170 %
f	Health professions education (from Worksheet 5) . . .	160,467	7,585	152,882	1.250 %
g	Subsidized health services (from Worksheet 6) . . . .	5,763,419	4,793,394	970,025	7.960 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	15,123	4,153	10,970	0.090 %
j	Total. Other Benefits . .	5,960,211	4,805,132	1,155,079	9.470 %
k	Total. Add lines 7d and 7j .	6,595,469	5,315,402	1,280,067	10.500 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other	6,409	3,695	2,714	0.020 %
10	Total	6,409	3,695	2,714	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

261,173

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

29,904

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

2,347,702

Enter Medicare allowable costs of care relating to payments on line 5.....

2,346,877

Subtract line 6 from line 5. This is the surplus (or shortfall)........

825

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2022

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	PIONEER MEMORIAL HOSPITAL & HEALTH SERV 315 N WASHINGTON ST VIBORG,SD57070 PIONEERMEMORIAL.ORG 48451	X	X	X	3 PROVIDER BASED RURAL HEALTH CLINICS

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	PIONEER MEMORIAL HOSPITAL AND HEALTH SER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 22

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION B, LINE 7D

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION B, LINE 7D

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PIONEER MEMORIAL HOSPITAL AND HEALTH SER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 350.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, LINE 16J NARRATIVE

The FAP application form was widely available on a website (list url):

SEE PART V, LINE 16J NARRATIVE

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, LINE 16J NARRATIVE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	PIONEER MEMORIAL HOSPITAL AND HEALTH SER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	PIONEER MEMORIAL HOSPITAL AND HEALTH SER
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	PART V, SECTION B, LINE 5: PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES WORKED WITH SANFORD HEALTH TO UTILIZE A PROCESS DEVELOPED IN COORDINATION WITH PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND OTHER HEALTH CARE PROVIDERS WITHIN THE LOCAL COMMUNITY AND ACROSS SOUTH DAKOTA, NORTH DAKOTA, AND MINNESOTA TO DEVELOP A MULTI-FACETED ASSESSMENT PROGRAM DESIGNED TO ESTABLISH MULTIPLE PATHWAYS FOR HEALTH NEEDS ASSESSMENT. A SURVEY WAS SENT TO COMMUNITY STAKEHOLDERS, HEALTH EXPERTS, PUBLIC HEALTH OFFICIALS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. A TOTAL OF 74 RESPONDENTS COMPLETED THE SURVEY. COUNTY HEALTH RANKINGS WERE BASED UPON THE UW POPULATION HEALTH MODEL AND SERVE AS THE MAIN SECONDARY DATA SOURCE UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. SANFORD HEALTH'S OFFICE OF STRATEGIC PLANNING PROVIDED ANALYSIS TO IDENTIFY THE INITIAL COMMUNITY HEALTH NEEDS LIST. COMMUNITY ASSET MAPPING WAS CONDUCTED TO FIND THE COMMUNITY RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED NEEDS. EACH UNMET NEED WAS RESEARCHED TO DETERMINE WHAT RESOURCES WERE AVAILABLE TO ADDRESS THE NEEDS. ONCE GAPS WERE DETERMINED, THE PRIORITIZATION EXERCISE FOLLOWED WITH KEY STAKEHOLDER GROUPS DETERMINING THE TOP NEEDS. COMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA RESEARCH. HOSPITAL LEADERSHIP PROPOSED WHICH SPECIFIC HEALTH NEEDS WOULD BE ADDRESSED WITHIN THE IMPLEMENTATION PLAN, WITH INPUT AND SUPPORT FROM THE COMMUNITY MEMBERS.
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	PART V, SECTION B, LINE 7D: LINES 7A AND 10A: HTTPS://WWW.PIONEERMEMORIAL.ORG/CUSTOM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	PART V, SECTION B, LINE 11: IN THE MOST RECENT CHNA CONDUCTED, THE FOLLOWING NEEDS WERE IDENTIFIED: 1. AFFORDABLE HOUSING: 2. TRANSPORTATION3. ACCESS TO HEALTH CARE PROVIDERS4. HEALTHY LIVINGTHE ORGANIZATION WILL NOT ADDRESS THE FOLLOWING NEEDS IDENTIFIED:AFFORDABLE HOUSING: NOT INCLUDED IN THE IMPLEMENTATION PLAN AS THERE ARE OTHER COMMUNITY ENTITIES BETTER SUITED TO LEAD IN THIS SPACE. INFORMATION FROM THE CHNA SURVEY WAS SHARED WITH COMMUNITY MEMBERS AND LOCAL ORGANIZATIONS AS NEEDED AND AS AFFORDABLE HOUSING SOLUTIONS ARE DISCUSSED. PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES OFFERS FINANCIAL ASSISTANCE FOR HEALTH CARE COSTS FOR THOSE FACING FINANCIAL HARDSHIP.TRANSPORTATION: WHILE IMPORTANT, THIS WAS NOT INCLUDED FOR PRIORITIZATION PLAN AS IT WILL REQUIRE BROAD COMMUNITY PARTNERSHIPS BEYOND THE HEALTH CARE SECTOR. THERE ARE CURRENTLY A FEW LOCAL OPTIONS, WHICH ARE OUTLINED IN THE ASSET MAP UNDER TRANSPORTATION. PIONEER MEMORIAL FACILITATES RIDES TO APPOINTMENTS WHEN NEEDED FOR PATIENTS IF OTHER OPTIONS ARE NOT AVAILABLE AND/OR FEASIBLE. THE ORGANIZATION APPROVED THE NEW 2022 CHNA ON OCTOBER 27, 2022 AND DID NOT HAVE TIME TO START ADDRESSING THE NEEDS IDENTIFIED IN THE NEW CHNA DUE TO TIMING. IN THE CURRENT YEAR, THE ORGANIZATION HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS THE NEEDS OF THE PRIOR CHNA:AGING POPULATION SENIOR CARE EDUCATION- PROVIDED EDUCATION AND PROMOTION OF LOW COST LAB TESTS (DIRECT TESTS) ON THE HOSPITAL'S WEBSITE AND THROUGH SOCIAL MEDIA.- PROVIDED EDUCATION ON STROKE AWARENESS, HEAT EXHAUSTION VS HEAT STROKE, NUTRITION AND EATING SMART, ULTRAVIOLET LIGHT SAFETY, BENEFITS OF PHYSICAL ACTIVITY, PARKINSON'S AWARENESS, THERAPY SERVICES, (PT, OT, ST), HEART HEALTH AND CANCER PREVENTION/SCREENING (BREAST, CERVICAL, COLORECTAL AND SKIN) VIA SOCIAL MEDIA.- PROMOTED EDUCATION ON UNDERSTANDING ALZHEIMERS AND DEMENTIA AND THE 10 WARNING SIGNS OF DEMENTIA VIA SOCIAL MEDIA. - PROMOTED EDUCATION ON COVID AND THE COVID VACCINATION AND INFLUENZA VACCINATION VIA SOCIAL MEDIA AND THE PIONEER LIFELINE. - PROMOTED EDUCATION ON VIRUS PREVENTION AND HAND WASHING VIA SOCIAL MEDIA.- PROVIDED EDUCATION ON DIFFERENT LIFESTYLE OPTIONS FOR SENIOR LIVING IN THE PIONEER LIFELINE. - SPONSORED A COMMUNITY HEALTH FAIR WITH EXPERTS IN WOUND CARE, DIABETIC EDUCATION, SOCIAL SERVICES, THERAPY SERVICES, AND CARDIAC REHAB. FLU SHOTS WERE AVAILABLE. FREE VISION TESTS, BLOOD PRESSURE, CHOLESTEROL TEST, GLUCOSE TEST AND SKIN SCREENINGS WERE PROVIDED. MENTAL HEALTH EDUCATION- PROVIDED INFORMATION VIA SOCIAL MEDIA ON SEPTEMBER IS SUICIDE AWARENESS MONTH. - PROVIDED INFORMATION VIA SOCIAL MEDIA ON SOUTH DAKOTA SUICIDE PREVENTION.- PROMOTED INFORMATION VIA SOCIAL MEDIA ON MENTAL HEALTH AWARENESS MONTH IN MAY- PROVIDED INFORMATION VIA SOCIAL MEDIA ON STAYING FIT, WELLNESS AND THE BENEFITS OF ENGAGING IN PHYSICAL ACTIVITIES ON YOUR MENTAL AND PHYSICAL HEALTH. - PROMOTED INFORMATION ON RAISING AWARENESS OF SELF-HARM A CONDITION THAT OFTEN AFFECTS TEENAGERS AND YOUNG ADULTS. - PROMOTED INFORMATION VIA SOCIAL MEDIA ON JANUARY IS MENTAL WELLNESS MONTH BY REMINDING PEOPLE THAT BY FOCUSING EACH DAY ON IMPROVING MENTAL WELLNESS, A PERSON CAN INCREASE RESILIENCE, HELP MANAGE STRESS, AND BUILD AN OVERALL SENSE OF WELL-BEING. ENHANCING MENTAL WELLNESS ALSO HELPS TO WARD OFF SYMPTOMS OF SERIOUS MENTAL ILLNESS.
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	PART V, SECTION B, LINE 13B: FINANCIAL ASSISTANCE IS PROVIDED UP TO 100% FOR INDIVIDUALS WHO ARE AT 200% OR BELOW THE FEDERAL POVERTY GUIDELINES, AND A SLIDING SCALE DISCOUNT IS OFFERED TO INDIVIDUALS FROM 201% UP TO 350% OF THE FEDERAL POVERTY GUIDELINES. THE DETERMINATION OF FINANCIAL ASSISTANCE IS BASED ON THE FEDERAL POVERTY GUIDELINES, BUT WE ALSO TAKE INTO CONSIDERATION OTHER FACTORS SUCH AS SERIOUS ILLNESS, LOSS OF EMPLOYMENT, INSURANCE COVERAGE AND OTHER EXTENUATING CIRCUMSTANCES IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE OR DISCOUNTED CARE.
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	PART V, SECTION B, LINE 16J: PART V, SECTION B, LINE 16A-C: THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE POSTED AT HTTPS://WWW.PIONEERMEMORIAL.ORG/CUSTOM/FINANCIAL-ASSISTANCEPART V, SECTION B, LINE 16J: SIGNS ARE POSTED IN THE ADMISSIONS OFFICES AND EMERGENCY ROOM THAT DISCOUNTED FEES ARE AVAILABLE FOR PATIENTS MEETING THE CRITERIA, AND PATIENTS ARE ENCOURAGED TO CONTACT PATIENT FINANCIAL SERVICES TO DISCUSS THEIR CHARGES. PATIENTS ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ON THE BILLING STATEMENT AND ARE GIVEN THE TELEPHONE NUMBER TO CONTACT PATIENT FINANCIAL SERVICES WITH QUESTIONS OR TO INQUIRE ABOUT FINANCIAL ASSISTANCE. INFORMATION ON FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS IN THE REMINDER LETTERS AND COLLECTION LETTERS SENT TO PATIENTS WITH DELINQUENT BALANCES. PATIENT FINANCIAL SERVICES VISIT WITH INPATIENTS THAT ARE ADMITTED TO THE HOSPITAL WITH NO INSURANCE TO DISCUSS PAYMENT OPTIONS AND THE AVAILABILITY OF FINANCIAL ASSISTANCE.
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	PART V, SECTION B, LINE 20E: STATEMENT FOR PART V, SECTION B, LINE 20D REGARDING PRESUMPTIVE ELIBIGILITY DETERMINATIONS: ONCE A FINANCIAL ASSISTANCE APPLICATION IS COMPLETED AND APPROVED, IT WILL REMAIN IN EFFECT FOR SIX MONTHS FROM THE DATE OF APPROVAL. SERVICES PROVIDED DURING THE SIX MONTH PERIOD WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE AS DETERMINED DURING THE APPLICATION APPROVAL PROCESS.STATEMENT FOR PART V, SECTION B, LINE 20E - NOT APPLICABLE.
PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICE	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.

Schedule H (Form 990) 2022

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address		Type of Facility (describe)
1	1 - PIONEER MEMORIAL NURSING HOME 315 N WASHINGTON ST VIBORG,SD57070	SKILLED NURSING
2	2 - PIONEER INN 315 N WASHINGTON ST VIBORG,SD57070	ASSISTED LIVING
3	3 - PIONEER VILLA 315 N WASHINGTON ST VIBORG,SD57070	CONGREGATE HOUSING
4	4 - TURNER COUNTY PUBLIC HEALTH 315 N WASHINGTON ST VIBORG,SD57070	COMMUNITY PUBLIC HEALTH
5
6
7
8
9
10

Schedule H (Form 990) 2022

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	FINANCIAL ASSISTANCE IS PROVIDED UP TO 100% FOR INDIVIDUALS WHO ARE AT 200% OR BELOW THE FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT IS OFFERED TO INDIVIDUALS FROM 201% UP TO 350% OF THE FEDERAL POVERTY GUIDELINES. THE DETERMINATION OF FINANCIAL ASSISTANCE IS BASED ON THE FEDERAL POVERTY GUIDELINES, BUT WE ALSO TAKE INTO CONSIDERATION OTHER FACTORS SUCH AS SERIOUS ILLNESS, LOSS OF EMPLOYMENT, INSURANCE COVERAGE AND OTHER EXTENUATING CIRCUMSTANCES IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE OR DISCOUNTED CARE.PART I, LINE 6B:THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE FOUND ON ITS WEBSITE AT HTTPS://WWW.PIONEERMEMORIAL.ORG/CUSTOM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
PART I, LINE 7:	CHARITY CARE (LINE A) WAS CALCULATED USING THE OVERALL COST TO CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. COMMUNITY HEALTH IMPROVEMENT SERVICES (LINE E), HEALTH PROFESSIONS EDUCATION (LINE F) AND CASH AND IN-KIND CONTRIBUTIONS (LINE I) ARE BASED ON ACTUAL PROGRAM EXPENSES RECORDED IN THE GENERAL LEDGER. MEDICAID (LINE B) AND SUBSIDIZED HEALTH SERVICES(LINE G) ARE REPORTED USING THE MEDICAID AND MEDICARE COST REPORTS, RESPECTIVELY.
PART I, LINE 7G:	SUBSIDIZED HEALTH SERVICES INCLUDES CLINIC REVENUE OF $1,658,488 AND EXPENSE OF $2,201,074, FOR A NET LOSS FROM CLINIC OPERATIONS OF $542,586.
PART II, COMMUNITY BUILDING ACTIVITIES:	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES (PMHHS) PROVIDES FOR THE HEALTH AND SAFETY OF THE COMMUNITIES WE SERVE THROUGH FINANCIAL AND IN-KIND CONTRIBUTIONS TO THE LOCAL VOLUNTEER FIRE DEPARTMENTS, AMBULANCES AND FIRST RESPONDERS, SENIOR CITIZENS CENTERS, FOOD PANTRIES, DOMESTIC VIOLENCE SHELTERS, COMMUNITY AND SCHOOL EVENTS AND OTHER COMMUNITY ORGANIZATIONS THAT SERVE THE BETTERMENT OF THE COMMUNITIES WE SERVE. PMHHS IS ACTIVELY INVOLVED WITH THE TURNER COUNTY DISASTER PREPAREDNESS AND TURNER COUNTY CHILD PROTECTION TEAM. THE DESCRIBED ACTIVITY FURTHERS HEALTH IN THE COMMUNITY AS THE SUPPORT TO THESE ORGANIZATIONS PROVIDE SAFETY AND HEALTH SUPPORT TO INDIVIDUALS IN THE COMMUNITY.
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 PATIENTS AND RESIDENTS.
PART III, LINE 3:	THE ORGANIZATION BELIEVES THE AMOUNT OF IMPLICIT PRICE CONCESSIONS INCLUDES PERSONS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT WHO DID NOT COMPLETE THE APPLICATION PROCESS. THE METHODOLOGY USED WAS A PERCENTAGE OF DEMOGRAPHICS BELOW POVERTY LEVEL. THE POPULATION AND POVERTY RATES WERE OBTAINED FOR EACH OF THE COMMUNITIES IN OUR SERVICE AREA. THE PERCENTAGE OF POPULATION BY COMMUNITY TO THE TOTAL SERVICE AREA WAS CALCULATED, AND THIS PERCENTAGE WAS APPLIED TO THE COMMUNITY'S POVERTY RATE. THE AVERAGE WEIGHTED POVERTY RATE BY EACH COMMUNITY WAS TOTALED TO CALCULATE THE TOTAL AVERAGE WEIGHTED POVERTY RATE FOR OUR SERVICE AREA. THIS AVERAGE WEIGHTED POVERTY RATE WAS APPLIED TO THE AMOUNT OF THE IMPLICIT PRICE CONCESSIONS.
PART III, LINE 4:	THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSION IS LOCATED IN THE AUDITED FINANCIAL STATEMENT REPORT ON PAGES 10-12.
PART III, LINE 8:	PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECEIVE ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. IN THE EVENT MEDICARE PRODUCES A SHORTFALL, IT IS CONSIDERED A COMMUNITY BENEFIT.MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.
PART III, LINE 9B:	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES (PMHHS) IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO THOSE PATIENTS DEMONSTRATING AN INABILITY TO PAY FOR THE MEDICAL SERVICES PROVIDED. PMHHS WILL NOTIFY PATIENTS OF THEIR BALANCES BY BILLING STATEMENTS WHICH ARE MAILED APPROXIMATELY EVERY 28 DAYS FROM THE DATE THE ACCOUNT IS CONSIDERED SELF-PAY. THE BILLING STATEMENT PROVIDES INFORMATION REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE. PMHHS WILL MAKE REASONABLE EFFORTS TO DETERMINE IF PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. IF THE PATIENT/GUARANTOR HAS PROVIDED AN ACCURATE MAILING ADDRESS TO PMHHS, THE PATIENT/GUARANTOR WILL BE PROVIDED A MINIMUM OF 4 BILLING STATEMENTS BEFORE AN UNPAID SELF-PAY BALANCE WOULD BE ASSIGNED TO AN OUTSIDE COLLECTION VENDOR. IF THE PATIENT HAS FAILED TO PROVIDE A CORRECT OR DELIVERABLE MAILING ADDRESS, THEN THEIR BALANCES MAY BE ASSIGNED TO A THIRD PARTY COLLECTION VENDOR PRIOR TO 4 STATEMENTS BEING PROVIDED. IF PMHHS IS REASONABLY ABLE TO DETERMINE THAT A PATIENT IS UNABLE TO PAY THEIR MEDICAL BILL, PMHHS MAY GRANT FINANCIAL ASSISTANT PRIOR TO THE 4 STATEMENTS BEING PROVIDED. NEITHER PMHHS NOR ANY OF ITS THIRD PARTY COLLECTION VENDORS WILL TAKE ANY EXTRAORDINARY COLLECTION EFFORTS UNTIL PMHHS AND THE THIRD PARTY COLLECTION VENDOR HAVE MADE REASONABLE EFFORTS TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE PMHHS FINANCIAL ASSISTANCE POLICY. PMHHS DICTATES THAT ITS THIRD PARTY COLLECTION VENDORS CANNOT TAKE EXTRAORDINARY COLLECTION ACTIVITIES UNTIL A BALANCE IS AT LEAST 241 DAYS PAST THE FIRST SELF-PAY STATEMENT DATE PROVIDED TO THE PATIENT/GUARANTOR. THIS IS TO ENSURE THAT BOTH PMHHS AND ITS THIRD PARTY COLLECTION VENDORS ARE TAKING ANY AND ALL NECESSARY STEPS TO NOTIFY PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY AND ALLOWING THE APPROPRIATE TIME FOR A PATIENT/GUARANTOR TO FILL OUT A FINANCIAL ASSISTANCE APPLICATION. IF A PATIENT/GUARANTOR FILLS OUT A COMPLETED FINANCIAL ASSISTANCE APPLICATION, PMHHS WILL NOTIFY THE THIRD PARTY COLLECTION VENDOR TO SUSPEND ALL EXTRAORDINARY COLLECTION ACTIVITIES APPENDING THE OUTCOME OF THE FINANCIAL ASSISTANCE DETERMINATION. IF REQUIRED BY REGULATION OR LAW AND THE PATIENT HAS FILLED OUT A FINANCIAL ASSISTANCE APPLICATION PRIOR TO 240 DAYS FORM THE FIRST SELF-PAY STATEMENT DATE, THEN THE THIRD PARTY COLLECTION VENDOR WILL TAKE STEPS TO REVERSE EXTRAORDINARY COLLECTION EFFORT FOR ANY PATIENT THAT QUALIFIES FOR FINANCIAL ASSISTANCE.
PART VI, LINE 2:	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES (PMH&HS) ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES AS PART OF ITS ANNUAL STRATEGIC PLANNING PROCESS. INFORMATION IS ALSO OBTAINED THROUGHOUT THE YEAR FROM THE SATISFACTION SURVEYS COMPLETED BY PATIENTS OF THE HOSPITAL AND CLINICS AND THE RESIDENTS IN THE NURSING HOME IN ACCESSING HEALTH CARE NEEDS. PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES BASED OUT OF VIBORG, SD WORKED IN PARTNERSHIP WITH SANFORD HEALTH TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2022, AND THE PMH&HS BOARD OF DIRECTORS APPROVED THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY 2023-2025 ON OCTOBER 27,2022. THE ASSESSMENT TARGETED THE SURROUNDING COMMUNITY, CONSIDERING THE NEEDS OF INDIVIDUALS AND HOUSEHOLDS WITHIN THE DEFINED RESEARCH AREA INCLUDING ADJACENT RURAL COMMUNITIES SUCH AS CENTERVILLE, DAVIS, HURLEY, PARKER, IRENE AND WAKONDA, AMONG OTHERS. AN IMPLEMENTATION STRATEGY WAS DEVELOPED THAT IDENTIFIES THE NEED AREAS AND THEIR RESPECTIVE GOALS AND ACTIVITIES THAT PMH&HS AIMS TO ACHIEVE IN THE COMING THREE-YEAR PERIOD.
PART VI, LINE 3:	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES (1) POSTS CONTACT INFORMATION IN ADMISSIONS, EMERGENCY ROOM, AND OTHER AREAS OF THE ORGANIZATION FOR CONCERNS WITH CHARGES; (2) INCLUDES FINANCIAL ASSISTANT CONTACT INFORMATION ON PATIENT STATEMENTS AND COLLECTION LETTERS; (3) CONTACTS EMERGENCY ROOM PATIENTS WITH NO INSURANCE AND DISCUSSES PAYMENT OPTIONS AND FINANCIAL ASSISTANCE; (4) CONTACTS PATIENTS WITH NO INSURANCE WHO ARE SCHEDULED FOR PROCEDURES AND DISCUSSES PAYMENT OPTIONS AND FINANCIAL ASSISTANCE; (5) DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE.
PART VI, LINE 4:	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES SERVES THE RURAL COMMUNITIES OF VIBORG, CENTERVILLE, DAVIS, HURLEY, IRENE, PARKER AND WAKONDA. PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES IS A CRITICAL ACCESS HOSPITAL AND IS THE ONLY HOSPITAL LOCATED IN TURNER COUNTY. THERE ARE TWO TERTIARY HOSPITALS AND ONE HEART HOSPITAL LOCATED IN THE SIOUX FALLS METROPOLITAN AREA (45 MILES AWAY), AND ONE HOSPITAL LOCATED IN YANKTON (35 MILES AWAY). TURNER COUNTY IS A HEALTHCARE PROFESSIONAL SHORTAGE AREA. THE UNINSURED, MEDICAID AND MEDICARE PATIENTS REPRESENT RESPECTIVELY, 4%, 5% AND 61% OF TOTAL HOSPITAL PATIENTS.COMMUNITY POPULATION AVERAGE INCOME AVG HOUSEHOLD SIZE VIBORG 982 $ 45,179 2.3 CENTERVILLE 1,312 $ 59,125 2.4 DAVIS 170 $ 73,750 2.2 HURLEY 619 $ 63,021 2.4 IRENE 689 $ 66,652 2.3 PARKER 1,431 $ 86,699 2.7 WAKONDA 347 $ 73,971 2.2
PART VI, LINE 5:	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.THE DIRECTOR OF SAFETY AT PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES IS A MEMBER OF THE TURNER COUNTY DISASTER PREPAREDNESS TEAM. THE TEAM HAS ALSO BEEN INVOLVED WITH STATEWIDE DRILLS FOR DIFFERENT DISASTER SCENARIOS (I.E. TORNADO, PANDEMIC OUTBREAK) SO THE HOSPITAL IS PREPARED TO RESPOND IF AN ACTUAL EVENT WERE TO OCCUR. THE PUBLIC HEALTH NURSE IS A MEMBER OF THE TURNER COUNTY CHILD PROTECTION TEAM AND IS TRAINED TO STEP INTO A SITUATION INVOLVING THE WELFARE OF A CHILD IF THE NEED SHOULD ARISE.THE GOVERNING BOARD OF PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE FACILITY HAS AN OPEN MEDICAL STAFF. THE USE OF SURPLUS FUNDS IS RE-INVESTED IN CAPITAL AND PLANT AND ALSO ALLOCATED FOR IMPROVING PATIENT CARE.

Schedule H (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Yes

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2022

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1GABRIEL JOHNSON DO-FAMILY MEDICINE	(i) (ii)	241,378 ------------- 0	0 ------------- 0	8 ------------- 0	7,892 ------------- 0	36,723 ------------- 0	286,001 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 6	THE COMPENSATION PACKAGE FOR PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES INCLUDES A 0%-1% ONE-TIME BONUS BASED ON NET INCOME OF THE ORGANIZATION. ALL EMPLOYEES ARE ELIGIBLE FOR THE ONE-TIME BONUS EXCEPT THE CONTRACTED EMPLOYEES.
SCHEDULE J, PART I, LINE 3:	THE ORGANIZATION RELIES ON SANFORD HEALTH NETWORK, AN UNRELATED MANAGEMENT COMPANY, TO DETERMINE THE COMPENSATION PAID TO THE CEO. THE ORGANIZATION'S BOARD OF DIRECTORS APPROVES THE CONTRACT WITH SANFORD HEALTH NETWORK. COMPENSATION FOR LINDSEY HAUGER, CEO, IS REFLECTED AS PART OF THE MANAGEMENT FEE IN FORM 990, PART VII SECTION B FOR SERVICES RENDERED TO THE FILING ORGANIZATION.

Schedule J (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1A	THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE WHICH CONSISTS OF THE PRESIDENT, VICE PRESIDENT, AND SECRETARY. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 3	MANAGEMENT SERVICES ARE PROVIDED TO THE ORGANIZATION BY SANFORD HEALTH NETWORK UNDER A MANAGEMENT SERVICES AGREEMENT. LINDSEY HAUGER IS THE CEO. AS THE CEO SHE IS RESPONSIBLE FOR LOCAL PLANNING AND MANAGEMENT OF ALL ACTIVITIES IN THE ORGANIZATION, CARRYING OUT THE MISSION AND GOALS OF THE FACILITY AND ENSURING THE HIGHEST POSSIBLE HEALTH STATUS OF THE COMMUNITY WITHIN THE LIMITS OF AVAILABLE RESOURCES. THE BASIC MANAGEMENT FUNCTIONS OF THE POSITION INCLUDE PLANNING, ORGANIZING, MANAGING HUMAN AND FINANCIAL RESOURCES, DIRECTING STAFF AND CONTROLLING THE OPERATIONS. SANFORD HEALTH NETWORK PAID LINDSEY HAUGER $162,449 IN COMPENSATION AND $34,971 IN BENEFITS.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERSHIP CERTIFICATES SHALL BE GIVEN TO EACH PERSON CONTRIBUTING TO THE ORGANIZATION, SUBJECT HOWEVER TO THE CONDITION THAT SUCH CONTRIBUTIONS SHALL BE NOT LESS THAN THE SUM OF $100.
FORM 990, PART VI, SECTION A, LINE 7A	ALL MEMBERS SHALL BE PRIVILEGED TO ATTEND AND PARTICIPATE IN ALL SESSIONS OF THE ANNUAL OR SPECIAL MEETINGS OF THE CORPORATION AND SHALL BE ELIGIBLE TO SERVE AS A DIRECTOR OR OFFICER, EXCEPT WHERE SPECIFICALLY PROHIBITED BY LAW. THEY ARE INVITED TO ANNUAL MEETINGS AND SPECIAL MEETINGS. AT SUCH MEETINGS, EACH MEMBER SHALL BE ENTITLED TO CAST ONE VOTE. MEMBERS DO ELECT THE BOARD OF DIRECTORS - NOMINATED BY THE NOMINATING COMMITTEE. MOTION IS PASSED BY THE MEMBERS AT THE ANNUAL MEETING TO ELECT BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 8B	THE ORGANIZATION DID NOT HAVE ANY MEETINGS HELD BY THE EXECUTIVE COMMITTEE DURING THE YEAR.
FORM 990, PART VI, SECTION B, LINE 11B	THE DRAFT FORM 990 WILL BE REVIEWED BY THE CFO. IT WILL BE MAILED OR E-MAILED OUT TO THE BOARD OF DIRECTORS FOR A PERIOD OF TIME DURING WHICH IT WILL BE OPEN FOR COMMENT PRIOR TO FINALIZING.
FORM 990, PART VI, SECTION B, LINE 12C	BOARD MEMBERS AND OFFICERS COMPLETE AN ANNUAL CONFLICT OF INTEREST FORM AT EITHER THE APRIL OR MAY BOARD MEETING. THE FORM IS REVIEWED INITIALLY BY THE CEO, AND ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. CONFLICT OF INTEREST IS ENFORCED AT EVERY MEETING. BOARD MEMBERS WILL REFRAIN FROM VOTING IF A CONFLICT OF INTEREST IS PRESENT.
FORM 990, PART VI, SECTION B, LINE 15B	CEO: SANFORD PRESENTS A COMPARATIVE SCHEDULE ON CEO SALARIES WITH MEDIAN AND HIGH/LOW SALARIES, FOR COMPARABLE POSITIONS AND AREAS OF RESPONSIBILITIES. THE CURRENT MARKET AND LONGEVITY IS ALSO INCLUDED IN THE EVALUATION OF COMPENSATION. THE SANFORD NETWORK VICE PRESIDENT PRESENTS THE COMPENSATION SUBSTANTIATION TO THE BOARD OF DIRECTORS AT A MEETING THAT EXCLUDES THE CEO. PERFORMANCE EVALUATIONS ARE COMPLETED BY EACH BOARD MEMBER, THE VICE PRESIDENT AND CEO SELF EVALUATION. ADMINISTRATIVE STAFF (CFO, DIRECTOR OF HR/MATERIALS, DIRECTOR OF SUPPORT SERVICES, HOSPITAL DON, LTC DON): THE CEO COMPARES COMPENSATION TO SDAHO SALARY SURVEY AND ALSO CONTACTS SANFORD FOR COMPENSATION COMPARISON WITH LIKE-SIZED FACILITIES AND RESPONSIBILITIES. SALARY INCREASES ARE PRESENTED TO THE BOARD OF DIRECTORS AS PART OF THE BUDGET APPROVAL PROCESS. THIS PROCESS WAS LAST UNDERTAKEN IN THE CURRENT YEAR.
FORM 990, PART VI, SECTION C, LINE 19	THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 18,050. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,050. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 237,258. MANAGEMENT AND GENERAL EXPENSES 89,811. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 327,069. QUALITY CONTROL: PROGRAM SERVICE EXPENSES 5,811. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,811. PURCHASED STAFFING SERVICES: PROGRAM SERVICE EXPENSES 769,225. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 769,225. CONTRACT PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 36,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,660. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 17,751. MANAGEMENT AND GENERAL EXPENSES 125,966. FUNDRAISING EXPENSES 10,133. TOTAL EXPENSES 153,850. OUTSIDE MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 274,558. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 274,558. PURCHASED SERVICES - SANDFORD HEALTH: PROGRAM SERVICE EXPENSES 269,449. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 269,449. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 16,930. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,930. RECRUITMENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 8,005. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,005.
FORM 990, PART XI, LINE 9:	DONATION FROM FOUNDATION -12,475.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

PIONEER MEMORIAL HOSPITAL AND
HEALTH SERVICES

Employer identification number

46-0260288

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)PIONEER MEMORIAL FOUNDATION 315 NORTH WASHINGTON STREET VIBORG,SD57070 26-1832061	FUNDRAISING	SD	501(C)(3)	LINE 7	PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROMOTION OF HEALTH
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	191
6	Total number of volunteers (estimate if necessary) .............	6	200
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,174,878	324,058
9	Program service revenue (Part VIII, line 2g) .........	11,640,714	12,395,783
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	13,290	47,288
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	47,846	42,095
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	14,876,728	12,809,224
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	7,166,301	7,270,636
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 106,246
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	3,976,106	4,916,571
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	11,142,407	12,187,207
19	Revenue less expenses. Subtract line 18 from line 12.......	3,734,321	622,017
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	14,818,916	15,368,923
21	Total liabilities (Part X, line 26).............	1,125,381	1,069,584
22	Net assets or fund balances. Subtract line 21 from line 20.....	13,693,535	14,299,339

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 4,598,252 including grants of $ ) (Revenue $ 5,530,772 )
	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES OPERATES A 12-BED CRITICAL ACCESS HOSPITAL. THE ORGANIZATION PROVIDES HEALTHCARE SERVICES TO VIBORG AND SURROUNDING RURAL COMMUNITIES. DURING THE CURRENT YEAR, THE HOSPITAL HAD 104 ACUTE AND SWING BED ADMISSIONS AND 542 PATIENT DAYS, 831 VISITS TO THE EMERGENCY ROOM AND PERFORMED 42 SURGERIES/SCOPE PROCEDURES. ACUTE AND SWING BED VOLUMES AT PIONEER MEMORIAL HOSPITAL REMAINED CONSISTENT WITH THE PRIOR YEAR. OUTPATIENT VOLUMES EXPERIENCED A DECREASE IN VOLUMES OF 14% WITH THE DECREASE IN TESTING FOR COVID-19 AND PROVIDING CARE TO PATIENTS WITH COVID-19.

4b	(Code: ) (Expenses $ 3,818,637 including grants of $ ) (Revenue $ 4,128,807 )
	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES OPERATES A 46-BED SKILLED NURSING FACILITY, A 20-UNIT SENIOR HOUSING FACILITY, AND A 10-UNIT ASSISTED LIVING FACILITY. IN THE NURSING HOME, THERE WERE 34 ADMISSIONS AND 14,264 RESIDENT DAYS. THERE WERE 3,482 RESIDENT DAYS IN THE SENIOR HOUSING FACILITY, AND 3,214 RESIDENT DAYS IN THE ASSISTED LIVING FACILITY. GOING INTO THE THIRD YEAR OF THE COVID-19 PANDEMIC (2020-2022), AN INCREASE IN CENSUS WAS SEEN IN FISCAL YEAR 2022 WITH THE SKILLED NURSING FACILITY INCREASING DAYS BY 22% AND THE ASSISTED LIVING DAYS INCREASED SLIGHTLY BY 2%. A DECLINE IN CENSUS CONTINUED TO BE SEEN WITH THE SENIOR HOUSING WITH DAYS DOWN BY 29%.

4c	(Code: ) (Expenses $ 1,890,011 including grants of $ ) (Revenue $ 2,736,204 )
	PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES OPERATES THREE MEDICARE-CERTIFIED RURAL HEALTH CLINICS LOCATED IN CENTERVILLE, PARKER AND VIBORG, SD. IN THE RURAL HEALTH CLINICS, THERE WERE 11,081 CLINIC VISITS. THE THREE RURAL HEALTH CLINICS ADMINISTERED 1,727 COVID VACCINATIONS IN FISCAL YEAR 2022.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses10,306,900

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	841,559	0	104,487

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	12,475
e	Government grants (contributions)		1e	311,583

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		324,058

		Business Code
2a	NET PATIENT SERVICE REVENUE	621110	11,546,908	11,546,908
b	PHARMACY	456110	586,902	586,902
c	CONTRACT REVENUE	900099	147,323	147,323
d	OTHER REVENUE	900099	114,650	114,650
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		12,395,783

3 Investment income (including dividends, interest, and othersimilar amounts) ......			48,188			48,188
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		42,095	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		42,095	6c
d	Net rental income or (loss).......			42,095			42,095
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses	900		7b
c	Gain or (loss)	-900		7c
d	Net gain or (loss).........			-900			-900
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			12,809,224	12,395,783	0	89,383

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	112,656		112,656
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	5,919,473	5,284,241	578,624	56,608
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	110,678	99,869	9,739	1,070
9	Other employee benefits .......	723,274	635,517	80,949	6,808
10	Payroll taxes ...........	404,555	354,681	46,074	3,800
11	Fees for services (non-employees):
a	Management ......	247,503		247,503
b	Legal .........
c	Accounting ...........	70,481		70,481
d	Lobbying ...........	702		702
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,879,607	1,628,762	240,712	10,133
12	Advertising and promotion ....	19,192		4,152	15,040
13	Office expenses .......	473,764	315,020	147,196	11,548
14	Information technology ......	27,173	27,173
15	Royalties ..
16	Occupancy ...........	234,815	210,554	24,261
17	Travel ............	16,769	13,308	2,222	1,239
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	26,162	13,188	12,974
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	493,178	401,105	92,073
23	Insurance ...	111,290	7,597	103,693
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	1,077,303	1,077,303
b	FOOD	201,697	201,697
c	REPAIR & MAINTENANCE	35,045	35,045
d	MISCELLANEOUS	1,890	1,840	50
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	12,187,207	10,306,900	1,774,061	106,246
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			6,032,391	2	6,294,726
3	Pledges and grants receivable, net ......			5,357	3	9,452
4	Accounts receivable, net .............			1,108,069	4	1,247,455
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			70,000	7
8	Inventories for sale or use ............			210,985	8	214,988
9	Prepaid expenses and deferred charges ......			106,700	9	113,034
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	17,635,921
b	Less: accumulated depreciation	10b	13,090,833	4,770,472	10c	4,545,088
11	Investments—publicly traded securities .			2,468,077	11	2,661,703
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			46,865	15	282,477
16	Total assets. Add lines 1 through 15 (must equal line 33)...			14,818,916	16	15,368,923

17	Accounts payable and accrued expenses .....	848,969	17	943,997
18	Grants payable ...		18
19	Deferred revenue .........	258,575	19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D	5,587	21	8,468
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	12,250	25	117,119
26	Total liabilities. Add lines 17 through 25..	1,125,381	26	1,069,584

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	13,654,196	27	14,249,543
28	Net assets with donor restrictions ...........	39,339	28	49,796
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	13,693,535	32	14,299,339
33	Total liabilities and net assets/fund balances ........	14,818,916	33	15,368,923