The Salem Memorial District Hospital Board of Directors met for its monthly meeting on Tuesday, Aug. 26, during which the board discussed financials with visitor Missouri House Representative John Hewkin. Meanwhile, under new business, the hospital approved switching to a new auditor for the 2025 audit.
In attendance included Bollman, board members Dr. Leigh Ann Price, Mike Swyers, Karen Brown, Zach Moser and Frank Barnitz.
Tax hearing
The board held a public tax hearing and approved setting the rate at 0.2400. The board also approved amending the use of the funds so they may be unrestricted, allowing for them to be utilized for operational improvements.
Discussion with Rep. John Hewkin
“I’m not here tonight so much to teach, as I am to learn,” shared Hewkin.
Hewkin shared that his colleagues have asked how dire the hospital’s financials were, and if it doesn’t receive allocated state funds, if it would truly close—to which Hewkin shared he did not truly know and would have to discuss the issue with the hospital.
“I think there was $4.6 million in for the hospital, and that went away, along with many other people's asks and wishes in the appropriations bill,” stated Hewkin. “When I first talked to the chair of the house budget committee about this, he told me: ‘Well, there’s over $100 million in hospital asks this year, I’m just saying no to everybody. I can’t spend $100 million on hospitals.’”
Hewkin explained that the chair had been pressured by several officials, resulting in a few hospitals receiving some appropriations. On this note, Hewkin shared that he was “confident” that the hospital would be receiving some kind of appropriation to be agreed upon sometime in January 2026.
“I don’t know what that number is going to be yet, because we anticipated a billion dollar shortfall this year in revenues,” said Hewkin. “And so you don’t look at adding—you look at cutting.”
Hewkin emphasized his confidence in appropriations.
“What that number is going to be, I can't tell you, but we're going to get something,” said Hewkin. “The more I learn about your situation here, your processes, what's going on, how we can help, what you need, triage type things where, you know, maybe we don't get 10 million down here, but maybe we get 2 or 3 million. As far as what's our biggest need, what's our next biggest need—I need to be alone to present that to them.”
Hewkin shared he hoped to have regular meetings and conversations with the hospital to establish what it needs. Further, he acknowledged concerns from residents regarding Medicaid, noting that Missouri’s Medicaid enrollment grew from approximately 800,000 in 2021 to 1.8 million today, according to Hewkin. According to Hewkin, he expects modest reductions, from 3-5%, as some enrollees may not qualify or complete required paperwork. Due to the One Big Beautiful Bill Act (OBBA), a $50 billion federal provision is set aside for rural hospitals, said Hewkin, which could result in each state being allocated $500 million for a few years.
Hewkin noted that SMDH’s revenues are based on 340B, to which he shared a belief that “the drums are beating to change some things.”
“I haven’t seen any legislation, but I hear enough talk that I know something’s coming,” speculated Hewkin. “I don't know what that's going to look like or what it's going to be. The program is stressed under the weight that it's carrying, and it was never designed to do what it's doing.”
Hewkin shared a belief that potential changes on the horizon for 340B may not effect rural hospitals, such as SMDH.
Barnitz commented, “I think the main takeaway is that we're in a lot different position than we were a year ago, and that's thanks to our new CEO. We've made a lot of improvements, but that being said, there's a lot of improvements that need to take place. You being open to those ideas and listening to what those needs are will help you, and it will help us too.”
Hewkin asked whether SMDH is truly at risk of going out of business, to which Barnitz replied: “If we had been staying in the same pattern that we had been in the two previous years, it would have been a fact.”
“We’re better than we were a year ago, but we’re not there yet—there’s still a lot of things that have been overlooked,” commented Bollman.
Bollman further explained that the challenges facing SMDH are not entirely due to past management but also about reimbursement structures for critical access hospitals. Unlike larger rural hospitals, critical access hospitals are reimbursed based on costs, but sequestration cuts reduce payments to below actual costs, leaving no funds for capital improvements. Bollman stressed the need for representatives like Hewkin to provide clearer definitions of what qualifies as “rural” when hospitals are competing for Rural Health Transformation funds, since large hospitals with hundreds of beds and thousands of employees often claim rural status despite having very different challenges.
Hewkin echoed that funding challenge for pharmacies, citing that 16 counties in Missouri only have one. Two counties in Missouri have no pharmacies.
Hewkin encouraged Bollman and other board members to feel free to contact him with any issues or topics that he should be aware of moving forward.
New business
The hospital is still waiting on the 2024 audit and is preparing to file its 2025 cost report and audit. Bollman recommended that the hospital change firms. One that has been recommended to her by the Scott County Memorial Hospital, along with a couple of other rural hospitals, was Wipfli LLP. The firm works nationwide but have a Missouri presence. Wipfli LLP, according to Bollman, committed and guaranteed that the hospital would receive its cost report and audit on time, as it would be combining the process. Bollman further shared that the company costs significantly less than the current auditing firm.
After a short discussion, the board approved the new audit firm Wipfli LLP.
Due to a shortage of lab technicians, the hospital is pursuing international recruitment, mainly from the Philippines and Dubai, through a trusted firm. Candidates have been provided by the firm and are already being interviewed, and the cost is about $15,000–$18,000 per hire, which provides a three-year contract with the green card process able to be pursued at any time.
After discussion, the board approved pursuing the recruitment of international lab technicians.
CEO Report
The Monty Kitchen Memorial was a beautiful event, with plenty of community participation, said Bollman. She thanked all the board members who were able to come out for the event.
Bollman provided a few updates for the month of August, including the following:
• Improvements are being made with respect to insurance renewals. Bollman further noted that staff are looking into employee benefits in order to further lower costs for the hospital as well as hospital employees. The plan is to move from self-insured to the state funded plan, with staff to go through fine details and planning over the next few months
• The CLIA inspection has been completed, with Bollman stating that there were only a few minor administrative deficiencies due to documentation and not due to results or quality, which was noted as a “tremendous achievement” for SMDH by the inspectors
• Bollman discussed revenue cycle improvements utilizing the $350,000 HRSA grant received. Nearly every department is involved, and the project aims to boost efficiency, reduce errors, and better use technology and AI for tasks like documentation, coding, claims, and prior authorizations. Unlike past short-term fixes from outside consultants, this initiative emphasizes building lasting processes that reduce staff burden and strengthen operations for the future. SMDH will also be participating in the Missouri FLEX program. Bollman expressed hopes for finances to become available to help provide improvements for the EMR system, as well.
• Another project undertaken is improvements to the hospital website, as it is currently outdated and not user-friendly, said Bollman. After reviewing statistics, staff concluded that improvements to the website may increase viewers on job postings.
• Bollman completed an interview with KSMO, where they discussed the hospital’s progress and year-end financial wrap-up
• Bollman met up with legislative teams on the Rural Hospital Transformation Program to offer thoughts and suggestions
• The hospital’s anniversary week is coming up Sept. 8-12
Summary of operations
• There was a drop in inpatient admissions, reviewed Bollman. Bollman emphasized that this area must become a focus for Salem Hospital. In 2022, the average was 90; in 2023, 94; in 2024, 79; in 2025, 57; lastly, for FY 2026, the number is at 43.
• Swingbed census days received a total of 79, which is consistent with previously reported numbers.
• Outpatient registration has seen a minor increase with 1,113 reported for the month of July compared to 944 in June.
• Emergency room visits have stayed fairly consistent at 629 in July, compared to 653 in June.
Income statement
Bollman noted that the balance sheet is close to being reconciled from the prior year, and that the income statement has received improvements this month.
• Acute inpatient revenue had a severe drop from last year, with approximately $424,000 reported in the month of July 2025. This is a drop from July 2024, which ended with approximately $623,000.
• Outpatient revenue is another area that has decreased about $600,000 from July 2024—the total was $2.4 million for July 2025, compared to $3 million in July 2024.
• Gross patient revenue was $4.9 million, lower than last year’s $5.3 million
• Allowances and uncollectibles increased from $3.1 in July 2024 to $3.7
• Total net patient revenue was reported at $1.4 million
• Operating expenses for July is still down in salaries and fringes, coming in at $1.4 million compared to $1.1 million in 2024.
• Bollman emphasized that small equipment revenue featured several lease payments that will be reclassified but came in at $33,000 compared to $8,452 last year
• General administration miscellaneous expenses came in at $38,000, which Bollman explained encompasses the TORCH program
• Total expenses came in at $2.3 million for the month of July, down compared to June due to several reclassifications
• The month ended at a loss of $816,000, primarily due to the decrease in inpatient and outpatient revenue, explained Bollman
The board approved the financials.
For 340B financials, the hospital received $120,000 for the month of July with an expense of $60,000 for pharmaceuticals leaving $60,000 for a net profit.
The cash-on-hand was reported at 28 days.
Chief nursing report
Chief Nursing Officer Amber Hogan attended the Independent Hospital Networking Meeting recently, which she reported was a good experience. The meeting revolved around sharing resources. Hogan is also completing a nursing education series regarding high-risk medications—with a focus on educational training to improve quality of care.
The Dent County Jailers are now all Basic Life Support certified, with education completed just a couple weeks ago, said Hogan.
An escape room was built for educational purposes for staff. Right now, the room is set up with a focus on infection prevention. Several groups of staff have gone through the room and enjoyed it.
Staff are in the planning stages of the Skills and Competencies Fair, which will take place in the beginning of December.
Hogan reported staff openings for RNs. Two full-time RNs put in their notice within the Medical-Surgical unit.
The EMT program will begin Oct. 7. There were 10 applications submitted. Many staff within EMS are signing up to teach classes.
Tabitha Stanfast was able to submit an application for the State Homeland Security Grant for the ambulance to receive radio improvements.
Human resources report
Staff are working through updates to the employee handbook, which has not been updated for some time. Bollman anticipates that the handbook will be reviewed at next month’s meeting.
In July, there were two new hires, including one FNP-C and an executive assistant. Employees that departed included three full time employees, as well as three PRN employees.
Bollman discussed with Moser whether DCHC was also losing nursing employees. He confirmed it was an issue, especially within Dent County.
Quality/risk report
Kendra Mobray reported that survey numbers decreased a bit in the month of July. Discussions were held with staff to encourage them to ask patients to fill out a review.
Total reports submitted for July was 34, although several were documentation errors. Bollman spoke highly of the reports, stating that it indicates building a culture of reporting and encourages continuous improvement.
On QAPI, Mobray reported that departments have set their goals for the year. She was ale to work with each one individually to set measurable goals.
FY2026 priorities set included:
• Discussions and reviews surrounding AMA/LWBS
• Hospital readmissions will be looked at in order to follow trends
• Scheduling turn-around times
• Medication scan rates
Special projects include discussing the development of a Patient and Family Advisory Council (PFAC.) Another is discussing development of a Survey Readiness Plan to ensure staff are prepared when surveyors arrive.
Mobray reported that the Long Term Care Fall Fair has been scheduled for 3-6 p.m. Tuesday, Oct. 14.
