The Salem Memorial Hospital Board of Directors met Tuesday, July 29 for its regular meeting, during which the board praised CEO Brooke Bollman for her performance over the past year. Bollman highlighted fiscal year 2025’s year-end financials and successes, including taking its Accounts Payable (AP) down from a grand total of $2.6 million to $600,000. Bollman further emphasized expectations going into the next fiscal year of 2026, with an intention to keep the momentum going.
The next meeting will be held Tuesday, Aug. 26 with the tax hearing to occur at the start. Representative John Hewkin will be attending, to include a tour of the hospital.
Upcoming events include a SMH Foundation meeting 12 p.m. Wednesday, Aug. 6 and a memorial dedication for Monty Kitchen 2 p.m. Sunday, Aug. 24.
In attendance included Bollman, board members Dr. Leigh Ann Price, Mike Swyers, Karen Brown, Zach Moser and Frank Barnitz.
Under public comments, previous Salem Memorial Hospital board member and patient residing within long-term care (LTC), Judy Thompson, provided compliments to Bollman and the hospital board members for pushing the hospital forward through its financial hardships over the past year.
“This brings back a lot of memories, this room—I’ve been in it many years,” reminisced Thompson. “I am so pleased to see what a good job Brooke has done, with the backing of the board, to turn the hospital around. You can’t believe how relieved I am. This weighed on me so heavily.”
Thompson also spoke highly of and gave commendations to Glenda Botkin, LTC director, for her care provided to both Thompson and her husband.
Thompson also shared with the board her concerns with the dietary department, including the menu that is offered to LTC residents, encouraging the board to act and ensure LTC dietary needs are being met appropriately with the aging menu. Bollman agreed the menu is antiquated and shared with the board that staff anticipate a rehaul of services in FY26.
Reflection on FY25
Coming up on the end of FY25, Bollman shared a reflection of the past year’s accomplishments, following discussion with other staff members.
One of the most notable of the accomplishments was Accounts Payable (AP) going from $2.6 million to $600,000, “which is less than our monthly spending,” shared Bollman.
Among other accomplishments, Bollman further highlighted:
• Director of Quality Improvement & Risk Management Kendra Mobray was hired, along with reorganization of the quality-risk program, between efforts of both Mobray and Tabitha Stanfast
• “Culture of Caring” project has been initiated to focus on workforce retention and development, along with prioritizing patient care
• Strategic Financial Operational Assessment (SFOA) with Stroudwater was completed last fall, with the reassessment aiding in development of an action plan to help improve operations
• Fewer staffing vacancies have been observed
• The hospital is “in a much better position” with its construction and renovation bonds, said Bollman. Staff hopes to be out of default once a formal audit report is conducted
• Referral program was set up to incentivize staff and ensure recruitment, including bonuses for difficult to hire and in demand positions, such as nurses, medical technicians, etc.
• A case manager has been hired to assist with care coordination, discharge planning, patient advocacy, support, and ED follow-up
• Participation in the HRSA-DSIP grant program, including approximately $300,000 awarded to grow a student-led program, identified as an area of improvement by staff
• Patient Connect Communication was added to SMH’s services, a text/alert system through the clinic reminding patients of upcoming appointments and allowing for automated rescheduling or cancelations, which has led to fewer “no-shows” and improving capacity within the clinic
• Staff have been sponsored for development, with LPNs participating in the Bridge program, so they were able to receive their RN license. SMH has sponsored several students and staff members for furthering their education.
• A full implementation of interoperability has been completed to ensure accessibility of records across the United States
• Implementation of employee raises and retirement matches
• Therapy and materials management departments were named MHA Champions of Care
• LTC was awarded a CMS five-star rating for its continued quality care
• Training entity licenses have been renewed
• The charge master has been updated
• SMH has added an education program to focus on building and maintaining basic skill sets in healthcare, along with new practices, modernization, and career development
• Logan Pogue has been hired as Emergency Services Director, overseeing both ED and ambulance services
• The float nurse pool has been implemented with the first nurse hired just recently
• An IT director and IT specialist have been hired
• Social determinants of health screenings have been added and expanded to maintain participation with the ToRCH program
• Increased number of patient satisfaction scores and survey results
“There was a heck of a lot that we accomplished, and there's no way that I could ever go through all of it, but I'm very, very proud of the staff for pitching in,” shared Bollman, closing out her review of the past year. “We did a lot of things in a very quick fashion, and they jumped in, and they responded, and they've done a great job.”
Moving forward into FY26
“We are incredibly proud of the progress that we've made for this fiscal year,” further reviewed Bollman. “However, that is going to very quickly diminish in FY26—so we have to stick to our guns and make sure we are doing whatever we can to adapt and try to stay flexible, come up with new ways to continue growing our revenue, adding services, trying to reduce cost, and be more efficient wherever we can.”
She shared staff are dedicated to riding the momentum and raising the bar, including expectations and accountability of staff and bringing modernization to Salem’s hospital.
Bollman laid out her ideas for things to come:
• New menus for the dietary department, with made-to-order menus and offerings depending on dietary needs
• Continued efforts for the educational program with intentions for further developments
• Implementation of a marketing plan with intentions to hire a marketing consultant
• Revenue cycle rehabilitation
• Participation in the Missouri FLEX program, an ongoing project for 2026
• Additional outpatient services to be revealed at a later date, with announcements anticipated for fall
• Decrease in vacancies with a focus on retention and recruitment. A new benefits package is being worked on for employees, including health insurance, identified as an ongoing issue. Roll-out of the new package is anticipated for next fall.
• Investing more in the hospital’s capital improvements
• Focus on recruitment of international lab technicians in order to get the lab fully staffed
• Development of internship and shadowing program with an identified focus of investing in the school system
• A five-year strategic plan is being planned for roll-out within the next month or two
Price expressed her thanks to Bollman for her and staff’s continued efforts at the hospital.
“It’s not easy,” shared Price. “We have a certain mentality in Dent County—let alone, this hospital—of things that are okay to be status quo. Well, as everything changes around us, we have to be able to adapt, or we will become obsolete.”
CEO Report
Bollman shared with the board:
• Annual performance evaluations have been conducted with only a few pending completion
• 340B optimization training has been conducted. Missouri recently passed legislation to expand retail pharmacies who participate in 340B. Staff have reengaged its 340B consultant to ensure proper 340B utilization
• SMH will be participating in the Missouri FLEX program, paid for by the state and intended to help rural hospitals optimize revenue cycle, quality, and operations. During the first FLEX meeting, participating hospitals discussed common challenges including things on the legislative horizon, revenue cycles, denials, prior authorizations, and other challenges for rural hospitals—including the most recent “Big Beautiful Bill” which is a hot topic for many rural hospitals, shared Bollman
• Staff have attended meetings discussing upcoming staff insurance and benefit renewals and ways to improve those moving forward
• OSHA and ADA site-visit has been passed—CLIA and RHC inspections are on the horizon
• Computers are to be updated to Windows 11. Some of the older computers cannot be updated to Windows 11 due to age, so a quote to purchase new computers will be provided at a later date
• Staff have high expectations for revenue cycle improvements moving forward, with discussions underway with consultants and efforts ongoing with the Missouri FLEX program
• Price transparency has recently been updated and SMH is in compliance, said Bollman
• SMH recently supported the Dent County 4-H/FFA Expo with appreciation expressed toward Frank for sponsoring a lamb, along with Wes and Kendra Mobray for sponsoring desserts, among other members of the hospital
• Upcoming events include a SMH Foundation meeting 12 p.m. Wednesday, Aug. 6 and a memorial dedication for Monty Kitchen 2 p.m. Sunday, Aug. 24
Summary of operations
Wrapping of the fiscal year, Bollman highlighted:
• 47 inpatient admissions in June with only three swing beds, lower than ideal. Observation and acute admissions were fairly consistent with previous months at 22.
• Inpatient census days saw an increase from 166 to 178
• Outpatient registrations were lower at 944 compared to 1,101, primarily within cardiopulmonary and radiology procedures
• ER visits were up to 653 compared to 618
• Ambulance increased from 203 to 227
Price noted an increase in patients within Against Medical Advice (AMA) and Left Without Being Seen (LWBS) which came in at 16 and 39 in June compared to 5 and 11 in May, respectively. A discussion between Amber Hogan and Price indicated an issue within the Emergency Department in which patients are not utilizing the department for its intended use.
Patients often use the department, noted Hogan, expecting to be taken directly to a doctor rather than utilizing their primary care physician or a clinic. Hogan noted that lowering the higher numbers within AMA and LWBS may be assisted with putting more providers within the clinic to assist with more walk-ins.
Income statement
Bollman noted that the income statement isn’t a true reflection of the statistics for June due to hiring and onboarding of a new coding company. The statement is down due to items not yet processed or coded, with anticipation that the issue will be resolved by August. Bollman also noted extra cleanup of the income statement by her and staff.
Bollman highlighted, for June 2025, that gross patient revenue came in at $4.3 million with allowances and collectibles noted at $2.9 million, which is fairly consistent. Other operating revenue was up at $580,000, as well.
Focusing on FY2025 information:
• Other operating revenue had a year-to-date variance, the difference between this year and last year, of $2 million, with Bollman noting the number as an “anomaly” due to insurance, cautioning the board not to expect a similar number next year
• Gross patient revenue was up over $2 million from last year due to the census and adjustments made for the charge master
• Total salaries and fringes decreased approximately $2.4 million compared to last year, due to organization in August and July attempting to reopen positions. Bollman noted several positions will be added back, so the number is not sustainable
• Under operating expenses, the hospital was at $29 million in FY24 but is now at $26 million in FY25, a difference of $3 million
• Under grant revenue, the hospital received $993,000 in FY25—Bollman noted not all of the grant revenue is earmarked for the hospital but being managed for the ToRCH program. Much of it will be paid out in capacity building funds for services.
• Meanwhile, the total net profit for 340B Revenue FY2025 came in at $650,963. For June, the total net profit was reported at $61,230.
• Total days cash on hand was reported at 30
This coming FY26, Bollman warned that there are several things that may impact revenue—including the mandated minimum wage increase, along with the reductions in Medicare Medicaid due to the recently passed One Big Beautiful Bill Act (OBBBA).
In discussion with Barnitz, Bollman elaborated that although some of those adjustments made by the OBBBA won’t come until 2027, there are phases that may take effect FY2026. Bollman, however, specified that there are still many unknowns with OBBBA, including what will be determined at the state or federal level.
“We’ll expect to see (some of the Medicaid population) lose their benefits,” shared Bollman. “To pinpoint how many that is and what that impact looks like would be a guess.”
Bollman further indicated many CEOs within the rural hospital network groups are also speculating what effects will occur due to OBBBA.
“It makes it very difficult to budget when you're talking about this potential impact of not just a few 100,000,” said Bollman. “But we're talking about several million the hospital stands to lose.”
The board approved the income statement unanimously.
Chief Nursing report
Amber Hogan reported that they are wrapping up employee evaluations and inventory control. For nurse staffing, three agency nurses continue to be utilized, but a float nurse was hired to be utilized by all nursing departments. Emergency Services Director Logan Pogue was also hired—previously, he started out med surg before coming to the Emergency Department. Hogan is completing her CNO certification through the National Rural Health Association.
Staff are also completing staffing grid revision.
Policies and procedures with department leaders have been worked through. A presentation on ToRCH activity and grants, provided by Stanfast, was given to department leaders. A presentation was also given by the Dent County Health Center on measles mitigation and best practices.
Human Resources report
June new hires include one full-time employee, a medical technologist, and three PRN employees, including a registered nurse, CNA, and medical lab technician. Departing employees include two PRNs, a cook and registered nurse.
Quality/risk report
Mobray spoke on the “Culture of Caring” project, noting that:
• A marketing plan is in development to help advertise open positions and networking with schools
• The SHINE award program has been launched in which peers are able to recognize each other for going above and beyond. Those that are recognized will receive a candy and have their names drawn randomly to receive a gift card or other gift.
• An LTC Fall Fair is being planned where each department will have their own booth with games for LTC residents to play, along with music and other activities. Bingo is planned for once a month in LTC.
• Plans are underway for mock codes to be re-implemented
• Staff attended an “Activating Local Leadership” workshop which was informative, said Mobray. Staff have applied for a grant to do a two-year agreement with Practicing Excellence, with a reduced rate.
In June, there were a total of 63 surveys, down from the previous month of 117. There were 22 risk management reports, mostly documentation errors which are improving.
ToRCH presentation by Tabitha Stanfast
ToRCH is the Transformation of Rural Community Health, a Medicaid pilot project that the hospital is one of six hubs for, explained Stanfast. ToRCH depends on strong community partnerships among primary behavioral health clinics and community based organizations (CBOs), offering resources that help eliminate social determinants of health, such as access to food, transportation, childcare, etc.
ToRCH utilizes a software called Unite Us, shared amongst community and medical organizations.
To find out more about ToRCH, visit https://mydss.mo.gov/mhd/ToRCH.
Also approved by the board were the following:
• Banking resolution
• Conflict of Interest resolution
• Policies and procedures, including dress code, LTC policy, IT policy, quality, and employee education
