2024-11-13T12:42:24-06:00 2023-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-01-01 420860039 STEWART MEMORIAL COMMUNITY HOSPITAL STEW 7124644200 1301 W MAIN ST LAKE CITY IA 51449 JIM HENKENIUS CHIEF FINANCIAL OFFICER 7124644200 2024-11-13 1 1 WENDY R COOLEY CPA P01523804 4023302660 2024-11-12 2023 2024-10-15 13:58:12Z JIM HENKENIUS 1301 W MAIN ST LAKE CITY IA 51449 41820499 0 X WWW.STEWARTMEMORIAL.ORG X 1958 IA TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF LAKE CITY AND THE SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION. 8 7 313 46 0 0 1570104 455009 30859895 38208398 122303 202132 527477 568453 33079779 39433992 0 0 0 0 19632256 22078397 0 0 334347 12550524 15200884 32182780 37279281 896999 2154711 46408156 55937691 29542013 36788612 16866143 19149079 X STEWART MEMORIAL COMMUNITY HOSPITAL IS COMMITTED TO QUALITY HEALTH AND WELLNESS FOR YOU AND YOUR FAMILY. 0 0 20595116 21450759 STEWART MEMORIAL COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL THAT ALSO OPERATES 4 RURAL HEALTH CLINICS. STEWART MEMORIAL EMPLOYS 14 FAMILY PRACTICE PROVIDERS, 2 BEHAVIORAL HEALTH PROVIDER, 2 GENERAL SURGEONS AND 3 CRNAS. BESIDES OFFERING 24/7 EMERGENCY ROOM SERVICES, STEWART MEMORIAL ALSO PROVIDES GENERAL RADIOLOGY, CT SCANS, ULTRASOUND, MOBILE MRI, NUCLEAR SCANS, LABORATORY, BLOOD ADMINISTRATION, CARDIAC REHABILITATION, EKGS, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, OPERATING ROOM, PHARMACY, INFUSIONS AND OBSTETRICS. DURING 2023, STEWART MEMORIAL HAD 889 ACUTE PATIENT DAYS, 2,402 EMERGENCY ROOM VISITS, 1,598 OPERATING ROOM PROCEDURES AND 35,542 CLINIC ENCOUNTERS. 6875148 7973320 STEWART MEMORIAL COMMUNITY HOSPITAL OWNS AND OPERATES RURAL HEALTH CLINICS IN THE COMMUNITIES OF LAKE CITY, GOWRIE, LAKE VIEW AND ROCKWELL CITY. WE EMPLOY 18 PROVIDERS WHICH ARE COMPOSED OF PHYSICIANS, PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS. THEY PROVIDE MEDICAL PROFESSIONAL SERVICES TO MEMBERS OF THESE COMMUNITIES AND SURROUNDING AREAS IN A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA. 2222007 4909142 THE LABORATORY DEPARTMENT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY TESTING FOR PATIENTS OF STEWART MEMORIAL COMMUNITY HOSPITAL. IT ALSO PROVIDE SERVICES TO THE MCCRARY-ROST CLINIC IN LAKE CITY. REAGENT AND SALARY COSTS OF PERSONNEL ACCOUNT FOR THE MAJORITY OF THE DEPARTMENT'S EXPENSES. 2330229 3875177 THE OPERATING AND RECOVERY ROOMS DEPARTMENT PROVIDE GENERAL SURGICAL AND ORTHOPEDIC PROCEDURES ALONG WITH PROCEDURES FOR ENT, CATARACT AND PODIATRY. THE SUPPLIES USED IN SUCH PROCEDURES ACCOUNT FOR A LARGE PORTION OF EXPENSES. 2330229 3875177 32022500 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 39 0 1 313 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X JIM HENKENIUS CFO 7124644200 1301 W MAIN STREET LAKE CITY IA 51449 DEREK DUNCAN D.O. 40.00 X 815777 0 44993 DR SUSAN HORNBACK MEDICAL COUNSEL 40.00 X 1007833 0 45758 JOSH SMITH D.O. 40.00 X 525543 0 23465 RONALD CHENEY D.O. 40.00 X 487590 0 21768 JAMES LEWIS CRNA 40.00 X 286495 0 20890 DANNIELE ANDERSON PA-C 40.00 X 251825 0 24246 JIM HENKENIUS CFO 40.00 X 176165 0 17803 SCOTT NESBITT BOARD CHAIR 2.00 X X 0 0 0 CHADRIC DIETRICH BOARD CHAIR/DIRECTOR THRU 11/23 2.00 X X 0 0 0 THERESA HILDRETH VICE CHAIR 2.00 X X 0 0 0 JORDAN LIETZ SECRETARY 2.00 X X 0 0 0 SCOTT KLUVER TREASURER THRU 9/23 2.00 X X 0 0 0 JENNIFER LANE DIRECTOR 1.00 X 0 0 0 MARY LAUVER DIRECTOR 1.00 X 0 0 0 STACY COREY DIRECTOR 1.00 X 0 0 0 CHARLES SCHMITT DIRECTOR 1.00 X 0 0 0 CYNTHIA CARSTENS CEO 40.00 X 0 0 0 3551228 0 198923 23 0 1 1 FOCUSONE SOLUTIONS LLC PO BOX 850861 MINNEAPOLIS MN 55485 LOCUM TENENS SERVICES 404134 WAPITI MEDICAL STAFFING 912 INDUSTRIAL DR MILBANK SD 57252 ER LOCUM TENENS 338443 SHARED MEDICAL SERVICES LLC 209 LIMESTONE PASS COTTAGE GROVE WI 53551 MOBILE MRI SERVICES 245250 ANATOMY IT PO BOX 23888 NEW YORK NY 10087 IT OUTSOURCING & MANAGEMENT 216949 LOCUM TENENSCOM LLC PO BOX 405547 ATLANTA GA 30384 LOCUM TENENS SERVICES 213775 9 68097 386912 455009 PATIENT SERVICE REVENUE 621110 36695338 36695338 PHARMACY REVENUE 621110 1298180 1298180 214880 214880 38208398 127920 127920 340117 0 340117 340117 340117 2443739 8000 2372716 4811 71023 3189 74212 74212 4028 68097 8980 -4952 -4952 CAFETERIA SALES 900099 233288 233288 233288 39433992 38208398 0 770585 X 1247559 1053591 193968 41837 41837 16297429 14787391 1280123 229915 321579 291599 29980 3051879 2262207 755489 34183 1118114 997538 104111 16465 236540 236540 63505 63505 117737 117737 21932 21932 3949261 3448314 486833 14114 125422 77235 9718 38469 1143010 1101137 41665 208 783168 719503 63665 438254 437930 324 116004 82228 32783 993 625674 3786 621888 2472088 2271129 200959 229552 41005 188547 MEDICAL SUPPLIES 4274669 4274669 MISCELLANEOUS 500220 52333 447887 0 DUES & SUBSCRIPTIONS 103848 79068 24780 0 37279281 32022500 4922434 334347 142413 844221 1831007 458213 225492 137691 2631291 4041686 1471894 93334 48333 438443 362287 42962 85171 65180769 26476417 34143925 38704352 2811562 3066509 4047727 6717334 46408156 55937691 5194132 4598913 24162571 31923270 185310 266429 29542013 36788612 X 14909428 18560454 1956715 588625 16866143 19149079 46408156 55937691 2154711 128225 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3563 3563 0 PART II-B, LINE 1: STEWART MEMORIAL COMMUNITY HOSPITAL PAID DUES TO THE IOWA HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 123913 123913 22151539 5375494 16776045 42160550 21100923 21059627 744767 744767 38704352 OTHER RECEIVABLE 3486918 ESTIMATED 3RD PARTY SETTLEMENTS 3029864 RIGHT-OF-USE ASSETS - OPERATING LEASES 200552 6717334 DEFERRED COMPENSATION LIABILITIES 266429 266429 X 39571197 128225 8980 137205 39433992 0 39433992 37288261 8980 8980 37279281 0 37279281 PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023 AND 2022, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 8,980. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 8,980. TRIVIA NIGHT 48350 45102 3248 250 3528 500 2125 SWINGING FOR PATIENTS 23775 22995 780 1080 414 415 668 72125 68097 4028 1330 414 415 4196 500 2125 8980 -4952 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 126000 0 126000 0.00340 4248082 4248082 4374082 4248082 126000 0.00340 11 4902 89091 11939 77152 0.00210 6 32 254270 0 254270 0.00680 5 44 25092 0 25092 0.00070 22 4978 368453 11939 356514 0.00960 22 4978 4742535 4260021 482514 0.01300 2 4899 0 4899 0.00010 1 2387 0 2387 0.00010 3 7286 7286 0.00020 1 576004 0 13831616 13714517 117099 X 1 0 1 1 STEWART MEMORIAL COMMUNITY HOSPITAL 1301 WEST MAIN STREET LAKE CITY IA 51449 WWW.STEWARTMEMORIAL.ORG 130029H X X X X STEWART MEMORIAL COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 21 1 0 1 1 X PART V, PAGE 8 X 1 21 1 PART V, PAGE 8 0 1 X 200.000000000000 500.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.STEWARTMEMORIAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.STEWARTMEMORIAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.STEWARTMEMORIAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 STEWART MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: STEWART MEMORIAL COMMUNITY HOSPITAL, IN CONJUNCTION WITH CALHOUN COUNTY PUBLIC HEALTH DEVELOPED A SURVEY MONKEY QUESTIONNAIRE TO GET INPUT FROM COMMUNITY MEMBERS. THE QUESTIONNAIRE WAS DISTRIBUTED THROUGHOUT THE SMCH SERVICE AREA TO VARIOUS ORGANIZATIONS INCLUDING PUBLIC HEALTH, SCHOOLS, OTHER HEALTH CARE PROVIDERS AND LOCAL BUSINESSES ALONG WITH EMPLOYEES OF THE HOSPITAL AND ITS AUXILIARY. STEWART MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: CALHOUN COUNTY PUBLIC HEALTH STEWART MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THREE COMMUNITY NEEDS WERE IDENTIFIED IN THE ASSESSMENT - 1) MENTAL HEALTH SERVICES; 2) RECREATION/WELLNESS; 3) ACCESS TO SERVICES.1. MENTAL HEALTH SERVICES - THERE WERE 3 GOALS UNDER THIS NEED. THE FIRST GOAL IS TO INCREASE ACCESS TO MENTAL HEALTH SERVICES. THE ACTION ITEMS ARE TO EXPAND MENTAL HEALTH THERAPY SERVICES TO ROCKWELL CITY AND LAKE CITY CLINICS; COLLABORATE WITH SOUTH CENTRAL CALHOUN SCHOOL DISTRICT TO PROMOTE HEALTH RESOURCES AND REVIEW STUDENT NEEDS & OFFER REFERRALS; WORK WITH PUBLIC HEALTH'S FAMILY FOUNDATION AND WORK TOWARDS BECOMING A "MODEL PARENTS AS TEACHERS" EVIDENCED-BASED PROGRAM TO BETTER SUPPORT PARENTS AND CHILDREN WITH MENTAL HEALTH ISSUES. THE SECOND GOAL IS TO REDUCE THE SUICIDE RATE. THE ACTION ITEMS ARE TO ORGANIZE A LOCAL MENTAL HEALTH AWARENESS WALK, ORGANIZE "SLAM THE STIGMA" BASKETBALL EVENT AND IMPLEMENT "TALK IT UP, LOCK IT UP" GUN SAFETY PROGRAM IN CALHOUN COUNTY. THE 3RD GOAL TO REDUCE NUMBER OF MISUSE OF DRUGS AND ALCOHOL HAS 4 ACTION ITEMS. THE ACTION ITEMS ARE TO DEVELOP AN AWARENESS CAMPAIGN TO SHARE DURING OCTOBER FOR NATIONAL SUBSTANCE ABUSE PREVENTION MONTH. THE SCHOOL DISTRICT WILL IMPLEMENT AN EVIDENCE-BASED STUDENT GROUP FOR THOSE AFFECTED BY SUBSTANCE ABUSE AND MENTAL HEALTH, IMPLEMENT AND PROMOTE SBIRT TRAINING IN CALHOUN COUNTY, AND PROVIDE NARCAN TRAINING FOR COMMUNITY MEMBERS AND LOCAL SCHOOLS. IN 2023, STEWART MEMORIAL COMMUNITY HOSPITAL HIRED A LISW TO PROVIDE MENTAL HEALTH SERVICES AND CONTRACTED WITH ANOTHER TO INCREASE THE AVAILABILITY OF MENTAL HEALTH PROVIDERS. OUR MENTAL HEALTH ENCOUNTERS INCREASED BY 520 OR 19% FROM 2022.2. RECREATION/WELLNESS - THE THREE GOALS UNDER THIS COMMUNITY NEED ARE AS FOLLOWS: THE FIRST GOAL IS TO IMPROVE HEALTH, FITNESS, AND QUALITY OF LIFE THROUGH INCREASED ACCESS TO EXERCISE OPPORTUNITIES. THE CURRENT BASELINE IS 43% WITH ACCESS TO EXERCISE OPPORTUNITIES. THIS GOAL HAS SEVEN ACTION ITEMS: 1) RAISE FUNDS TO BUILD PICKLEBALL COURTS IN LAKE CITY, 2) CONDUCT A SURVEY FOR COMMUNITY INPUT TO IDENTIFY INTEREST IN NEW AMENITIES, 3) POST A LIST OF FREE ACTIVITIES FOR COMMUNITY USE ON WEBSITES, 4) OBTAIN THE REQUIRED PERMIT AND FINANCIALS BACKING TO INSTALL A SPLASH PAD IN LOHRVILLE, 5) OFFER PICKLEBALL OPPORTUNITIES AT THE OPPORTUNITY LIVING ACTIVITY CENTER DURING THE WINTER MONTHS, 6) RESEARCH POSSIBILITIES FOR UNIQUE EXERCISE CLASSES TO BE OFFERED AT THE ACTIVITY CENTER GYM AND THERAPEUTIC POOL, INCLUDING RESEARCHING FUNDING OPPORTUNITIES, PROGRAMS, INSTRUCTORS, COSTS, AND NEEDS FOR THE CLASSES AND THE FEASIBILITY OF IT BEING AVAILABLE IN OUR COMMUNITY, AND 7) DEVELOP A ROSTER OF ADDITIONAL CLASSES TO OFFER AT MAC CENTER AND PROMOTE WITHIN THE COMMUNITY VIA MANSON AND MAC CENTER FACEBOOK PAGES & WEBSITE. IN 2023, SMCH FINANCIALLY SUPPORTED THE CAMPAIGN TO BUILD PICKLEBALL COURTS IN LAKE CITY. WE HAVE 2 STAFF MEMBERS THAT ARE ON THE PICKLEBALL COMMITTEE TO SUPPORT THIS INITIATIVE. SMCH ALSO EXPANDED OUR EMPLOYEE WELLNESS PROGRAM TO SUPPORT THE HEALTH AND WELLNESS OF OUR EMPLOYEES.THE SECOND GOAL IS TO REDUCE CALHOUN COUNTY OBESITY RANKING BY HELPING PEOPLE EAT HEALTHY AND GET PHYSICALLY ACTIVE. THE TWO ACTION ITEMS UNDER THIS GOAL ARE TO OFFER A COMPREHENSIVE NUTRITION PROGRAM TO INCLUDE NUTRITION ASSESSMENT AND INDIVIDUALIZED PHYSICAL ACTIVITY PROGRAMS AND TO OFFER A MONTHLY FARMERS MARKET WITH HEALTHY FOODS THROUGHOUT THE SUMMER MONTHS TO SERVE CALHOUN COUNTY. THE THIRD GOAL IS TO PROMOTE HEALTH AND SAFE HOME ENVIRONMENTS. THE THREE ACTION ITEMS ARE: 1) PUBLICLY SHARE/ADVERTISE PROGRAMS AVAILABLE THROUGH PUBLIC HEALTH TO HAVE HOME WATER AND AIR QUALITY TESTING; 2) IMPLEMENT HOUSING ASSESSMENT QUESTIONNAIRES TO ALL FAMILIES WITH CHILDREN BEING TESTED AT WIC; 3) OFFER INCREASED IN-HOME VISUAL ASSESSMENTS TO FAMILIES WITH HIGH-RISK HOUSING TO PREVENT/DECREASE LEAD EXPOSURE AND ADDRESS OTHER OBSERVED HEALTH CONCERNS.3. ACCESS TO SERVICES - THE GOAL UNDER THIS NEED ASSESSMENT IS TO INCREASE ACCESS TO AMBULANCE SERVICES, CHILDCARE SERVICES AND SENIOR LIVING SERVICES. THE CURRENT ACTION ITEM IS TO FULLY STAFF 3 EMS CREWS IN CALHOUN COUNTY. IN 2023, SMCH WORKED WITH THE COUNTY EMS TO RECRUIT AND SUPPORT THEIR GOAL OF FULLY STAFFING 3 CREWS IN CALHOUN COUNTY. WE PROVIDE A DEDICATED SPACE AND SLEEPING QUARTERS FOR EMS STAFF WHEN THEY ARE ONSITE AT STEWART MEMORIAL. STEWART MEMORIAL ALSO FINANCIALLY SUPPORTED THE KIDS SPOT DAYCARE BUILDING PROJECT IN LAKE CITY.THERE WERE 2 PRIORITIES IDENTIFIED IN THE CHNA THAT WERE NOT ADDRESSED -1) ADDICTIVE BEHAVIORS IN CHILDREN AND; 2) UNINTENTIONAL INJURY RATES FOR ADULTS. 1) ADDICTIVE BEHAVIORS IN CHILDREN: THE FOCUS HAS CHANGED TO THE OPIOID CRISIS FROM OTHER ADDICTIVE BEHAVIORS. SMCH HAS FOCUSED ON THE OPIOID CRISIS THIS PAST YEAR THROUGH PARTICIPATION IN THE OPIOID TASK FORCE RATHER THAN LOOKING AT SPECIFIC ADDICTIVE BEHAVIORS SUCH AS ILLEGAL DRUGS, ALCOHOL ABUSE OR GAMBLING. SMCH IS STARTING TO IMPLEMENT PROCESSES THAT REQUIRE A PROVIDER TO CHECK PRESCRIPTION DRUG MONITORING. SMCH SHARED A WEBINAR SERIES WITH CALHOUN COUNTY SCHOOLS FROM UNITY POINT TITLED PRESCRIPTION DRUG SAFETY PROGRAM EDUCATION PROGRAM. 2) UNINTENTIONAL INJURY RATES FOR ADULTS: SMCH IS ADDRESSING THE UNINTENTIONAL FALL RATES BY PARTNERING WITH CALHOUN COUNTY PUBLIC HEALTH TO OFFER MATER OF BALANCE CLASSES. SMCH HAS ALSO IMPLEMENTED A SENIOR STRONG PROGRAM AIMED AT IMPROVING OLDER ADULTS BALANCE, MOBILITY, AND STRENGTH. TAI CHI CLASSES ARE ALSO OFFERED TO MEMBERS OF OUR COMMUNITY. THE ONE ISSUE SMCH HAS NOT ADDRESSED IS HOW TO REDUCE THE NUMBER OF MOTOR VEHICLE ACCIDENTS RELATED TO ALCOHOL. SMCH HAS NOT ADDRESSED HOW TO REDUCE THE UNINTENTIONAL INJURY RATES FOR CHILDREN OTHER THAN HAVING AN EMPLOYEE THAT IS CERTIFIED IN THE PROPER INSTALLATION AND EVALUATION OF CAR SEATS. STEWART MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: STEWART MEMORIAL COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING NECESSARY HOSPITAL CARE AND TREATMENT TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ANY PATIENT WHO HAS RECEIVED SERVICES AND WHO FALLS BELOW CERTAIN INCOME AND ASSET LIMITS MAY BE ELIGIBLE FOR HOSPITAL CARE FREE OF CHARGE, OR AT A REDUCTION OF OUR ESTABLISHED CHARGES.THE HOSPITAL USES THE POVERTY INCOME GUIDELINES ISSUED BY THE COMMUNITY SERVICE ADMINISTRATION AS A BASIS FOR ELIGIBILITY CRITERIA FOR DISCOUNTED CARE. THESE GUIDELINES ARE ADJUSTED ANNUALLY BASED ON INCREASES IN THE CONSUMER PRICE INDEX. SUPPORT TO GRANT FINANCIAL ASSISTANCE MUST BE FULLY DOCUMENTED IN OUR FILES. SMCH HAS A SPREADSHEET BASED ON THE FEDERAL POVERTY GUIDELINES TO DETERMINE DISCOUNTED CARE. THE SPREADSHEET ALSO ACCOUNTS FOR THE FAMILY SIZE IN DETERMINING ELIGIBILITY. FOR THOSE APPLYING, IF THEIR INCOME FALLS BETWEEN 225-250% OF THE GUIDELINES, 75% OF THE PATIENT'S BILL IS FORGIVEN; IF THE INCOME IS BETWEEN 300-400% OF THE GUIDELINES, 50% IS FORGIVEN; IF THE INCOME AT 450% OF THE GUIDELINES, 35% IS FORGIVEN; IF THE INCOME IS AT 500% OF THE GUIDELINES, 25% IS FORGIVEN. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATIONSTRATEGY WEBSITE:HTTPS://WWW.STEWARTMEMORIAL.ORG/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 4 1 - MCCRARY-ROST CLINIC 1351 WEST MAIN STREET LAKE CITY IA 51449 HEALTH CLINIC 2 - GOWRIE CLINIC 1800 MAIN GOWRIE IA 50543 HEALTH CLINIC 3 - LAKE VIEW CLINIC 1160 3RD STREET LAKE VIEW IA 51450 HEALTH CLINIC 4 - ROCKWELL CITY CLINIC 505 EAST LAKE STREET ROCKWELL CITY IA 50579 HEALTH CLINIC PART I, LINE 7: STEWART MEMORIAL COMMUNITY HOSPITAL USED THE WORKSHEETS PROVIDED IN THE IRS INSTRUCTIONS FOR SCHEDULE H IN ADDITION TO THE INTERNAL COST ACCOUNTING SYSTEM. PART II, COMMUNITY BUILDING ACTIVITIES: SMCH PROVIDES THE COMMUNITIES WITH LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS ON PROMOTING HEALTHY LIFESTYLES. THEY PROVIDE CARE TO THE INDIGENT REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL HAS ALSO JOINED WITH THE COUNTY DEPARTMENT OF HEALTH IN ESTABLISHING A PROGRAM CALLED "CARING HANDS CLOSET." CARING HANDS CLOSET IS A PROGRAM FOR EXPECTING MOTHERS AND NEW MOTHERS TO EARN POINTS TOWARDS BABY ITEMS BY ATTENDING THEIR DOCTOR APPOINTMENTS AND/OR EDUCATIONAL PROGRAMS. SMCH PROVIDES MONTHLY LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS BI-MONTHLY. PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 4: PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS PROVIDES A DESCRIPTION OF IMPLICIT PRICE CONCESSIONS. PART III, LINE 8: SINCE THERE IS NO MEDICARE SHORTFALL CALCULATED FOR 2023, THERE IS NO SHORTFALL THAT IS TREATED AS COMMUNITY BENEFIT. THE 2023 FILED MEDICARE COST REPORT WAS USED TO DETERMINE THE ALLOWABLE COSTS. PART VI, LINE 2: SMCH COLLABORATES WITH THE COUNTY HEALTH DEPARTMENT IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES THEY SERVE. SMCH ALSO EVALUATES USAGE DATA THROUGH THE IOWA HOSPITAL ASSOCIATION TO SEE THE PRIMARY MEDICAL DIAGNOSIS IN THEIR COMMUNITIES. PART VI, LINE 3: SMCH HAS A PATIENT ACCOUNTS MANAGER AS WELL AS A SOCIAL WORKER ON STAFF THAT IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR ASSISTANCE OR QUALIFY FOR CHARITY CARE. THEY ASSIST THE PATIENT WITH AVAILABLE OPTIONS AND/OR THE NECESSARY PAPERWORK. PART VI, LINE 4: THE SERVICE AREA IS A 35 MILE RADIUS SURROUNDING THE SMCH COMMUNITY. THIS AREA CONSISTS OF MANY SMALL, RURAL COMMUNITIES THAT ARE AGRICULTURAL BASED. THE PATIENT BASE CONSISTS OF A LARGE MEDICARE POPULATION. PART VI, LINE 5: ONE MEMBER OF THE ORGANIZATION IS A VOLUNTEER MEMBER ON THE LOCAL BETTERMENT ORGANIZATION. AT THE MONTHLY MEETINGS, THEY USE THEIR TIME TO PROMOTE THE SERVICES AND WELLNESS ACTIVITIES THE HOSPITAL PROVIDES. CURRENT AND PROSPECTIVE BUSINESSES UNDERSTAND THE VARIOUS HEALTH SERVICES THAT ARE MADE AVAILABLE TO THEM AND THEIR EMPLOYEES. OTHER STAFF MEMBERS SERVE ON VARIOUS PROJECT TEAMS IN OUR SURROUNDING COMMUNITIES TO REPRESENT THE HOSPITAL AND BUILD COMMUNITY AWARENESS. THE CNO AND AN EMPLOYED PHYSICIAN ARE MEMBERS OF THE CALHOUN COUNTY BOARD OF HEALTH. STEWART MEMORIAL COMMUNITY HOSPITAL WORKED IN CONJUNCTION WITH CALHOUN COUNTY PUBLIC HEALTH TO COMPLETE A COMMUNITY NEEDS ASSESSMENT AND DEVELOP A HEALTH IMPROVEMENT PROGRAM. THE BOARD OF DIRECTORS ARE REPRESENTED BY THE VARIOUS COMMUNITIES SERVED BY THE HOSPITAL. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X 0 0 0 0 0 0 0 0 0 DEREK DUNCAN D.O. 475141 0 298778 0 41858 0 29381 0 15612 0 860770 0 0 0 DR SUSAN HORNBACK MEDICAL COUNSEL 661244 0 326589 0 20000 0 32181 0 13577 0 1053591 0 0 0 JOSH SMITH D.O. 504168 0 21375 0 0 0 8493 0 14972 0 549008 0 0 0 RONALD CHENEY D.O. 487590 0 0 0 0 0 6796 0 14972 0 509358 0 0 0 JAMES LEWIS CRNA 242935 0 43560 0 0 0 7946 0 12944 0 307385 0 0 0 DANNIELE ANDERSON PA-C 229136 0 0 0 22689 0 7312 0 16934 0 276071 0 0 0 JIM HENKENIUS CFO 176165 0 0 0 0 0 4952 0 12851 0 193968 0 0 0 FORM 990, PART VII, LINE 5: CYNTHIA CARSTENS, CEO, RECEIVED COMPENSATION FROM UNITYPOINT HEALTH, AN UNRELATED ENTITY, WHICH PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS. MS. CARSTENS RECEIVED COMPENSATION AND BENEFITS IN THE AMOUNT OF $265,742 FOR HER SERVICES DURING THE CALENDAR YEAR 2023. HER COMPENSATION IS REPORTED IN PART IX, LINE 11A. DEREK DUNCAN HIGHEST COMPENSATED EMPLOYEE SPLIT DOLLAR LIFE INSURANCE ARRANGEMENT X 1471894 1471894 0 1 1 1471894 JODI HENKENIUS EMPLOYEE & SPOUSE OF JIM HENKENIUS, CFO 41837 EMPLOYEE WAGES 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 UNITYPOINT HEALTH AND STEWART MEMORIAL COMMUNITY HOSPITAL HAVE AN AGREEMENT FOR ADMINISTRATIVE SERVICES. UNITYPOINT HEALTH PROVIDED THE SERVICES OF CYNTHIA CARSTENS, CEO. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE CORPORATION SHALL BE THOSE PERSONS, CORPORATIONS, OR ASSOCIATIONS WHO HAVE CONTRIBUTED THE SUM OF ONE HUNDRED DOLLARS ($100) OR MORE TO THE CORPORATION TO FURTHER THE OBJECTIVES OF THE CORPORATION, WHICH MEMBERSHIP SHALL BE LIFELONG AND NON-TRANSFERABLE. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS SHALL HAVE THE RIGHTS TO ELECT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS SHALL HAVE THE RIGHTS TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION, APPROVE ANY MERGER, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION, TO VOTE ON ANY OTHER MATTER SUBMITTED TO THE MEMBERS BY THE BOARD OF DIRECTORS, AND TO VOTE ON ANY MATTER THAT IS REQUIRED TO RECEIVE MEMBER APPROVAL UNDER IOWA LAW. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE PROVIDED ELECTRONICALLY TO THE BOARD OF DIRECTORS AND REVIEWED BY THE CEO AND CFO PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST FORM ANNUALLY STATING THAT THEY WILL ABSTAIN FROM VOTING AND DISCUSSING ITEMS FOR WHICH THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS MEET ANNUALLY TO DISCUSS THE TERMS OF THE CEO'S CONTRACT. THEY USE DATA FROM THE LATEST IOWA HOSPITAL ASSOCIATION SALARY SURVEY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G RADIOLOGIST FEES: PROGRAM SERVICE EXPENSES 678,619. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 678,619. EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 574,491. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 574,491. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 2,195,204. MANAGEMENT AND GENERAL EXPENSES 486,833. FUNDRAISING EXPENSES 14,114. TOTAL EXPENSES 2,696,151. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.