2023-11-14T13:39:49-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 MATTHEW SELLS CEO 7122461230 2023-11-14 1 MATTHEW SELLS 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MATTHEW SELLS 300 PERSHING AVENUE SHENANDOAH IA 51601 54280133 0 X WWW.SMCHOSPITAL.COM X 1978 IA TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH. 9 8 413 169 0 0 5511286 1663987 46670412 49030959 757443 148459 815559 249615 53754700 51093020 0 0 0 0 25887261 25569481 0 0 0 22680982 23725360 48568243 49294841 5186457 1798179 66279280 65095594 35500164 33812631 30779116 31282963 TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. 0 0 43907332 49206613 SHENANDOAH MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN AN INPATIENT AND OUTPATIENT SETTING. IN JUNE OF 2020 THE SHENANDOAH MEDICAL CENTER ASSUMED RESPONSIBILITY FOR THE CANCER TREATMENT CENTER. IN 2022 THE CANCER CENTER PROVIDED 1,300 VISITS. SHENANDOAH MEDICAL CENTER CONTINUES TO LEASE SPACE TO THE DIALYSIS TREATMENT CENTER. DURING 2022 THE HOSPITAL PROVIDED 1,058 DAYS OF ACUTE CARE, 620 DAYS OF SKILLED CARE, 193 NURSERY DAYS AND 201,265 OUTPATIENT OCCASIONS OF SERVICE. 43907332 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 41 0 1 413 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X KALEY NEAL CFO 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 BRIAN ROWAN PHYSICIAN 40.00 0.00 X 573315 0 40311 REBECCA ROSE PHYSICIAN 40.00 0.00 X 493339 0 46336 MARTEE MACLEOD-KOZAL PHYSICIAN 40.00 0.00 X 426756 0 45792 CHASE BROWN PHYSICIAN 40.00 0.00 X 421683 0 45692 MICHAEL WOODS PHYSICIAN 40.00 0.00 X 408130 0 36715 MATTHEW SELLS CEO 40.00 1.00 X 338358 0 42453 HEATHER BABE MD DIRECTOR 40.00 0.00 X 329463 0 19214 KALEY NEAL CFO 40.00 1.00 X 154827 0 10784 DENNIS GREBERT CHAIRMAN 3.00 1.00 X X 0 0 0 STEPHEN RUZEK VICE CHAIRMAN 3.00 0.00 X X 0 0 0 ROGER JONES SECRETARY/TREASURER 3.00 0.00 X X 0 0 0 ALISSA MCGINNIS DIRECTOR 3.00 0.00 X 0 0 0 ED KLOBERDANZ DIRECTOR 3.00 0.00 X 0 0 0 BRUCE BALDWIN DIRECTOR 3.00 0.00 X 0 0 0 JON SKILLERN DIRECTOR 3.00 0.00 X 0 0 0 BRIANNA SORENSEN DIRECTOR 3.00 0.00 X 0 0 0 3145871 0 287297 37 0 1 0 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 100875068 CONTRACT LABOR 1169453 UNMC PHYSICIANS LAB REF PO BOX 30014-1114 OMAHA NE 68103 LAB FEES 569536 BROWN'S MEDICAL IMAGING 14315 C CIRCLE OMAHA NE 68144 SERVICE CONTRACT 430878 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI AND PET SCANS 313125 NEBRASKA MEDICINE 988140 NEBRASKA MEDICAL CENTER OMAHA NE 68198 PHYSICIST SERVICES & PHARMACY COVERAGE 231071 9 461723 397741 804523 1663987 MEDICARE/MEDICAID PAYM 624100 29701835 29701835 NET PATIENT SERVICE RE 624100 16562051 16562051 340B REVENUE 624100 1462897 1462897 AMBULANCE SERVICES 621910 964354 964354 339822 339822 49030959 420233 420233 73961 0 73961 73961 73961 2914619 720 3187113 0 -272494 720 -271774 -271774 CAFETERIA REVENUE 624200 159637 159637 INSURANCE PROCEEDS 900099 16017 16017 175654 51093020 49206613 0 222420 X 895099 348677 546422 94560 94560 21036917 18497697 2539220 744885 661224 83661 1384453 1220195 164258 1413567 1215966 197601 16845 16845 118570 118570 30454 30454 5974816 5094995 879821 354283 50267 304016 2517281 2258224 259057 4965 4276 689 903954 898199 5755 138368 124136 14232 781844 756898 24946 2562302 2486319 75983 383377 372008 11369 MEDICAL SUPPLIES 5828207 5828207 0 BAD DEBT EXPENSE 2934214 2934214 0 LICENSES & FEES 819465 771479 47986 FOOD 285291 277753 7538 71124 12038 59086 49294841 43907332 5387509 0 1619 1619 13860097 8334438 4722234 5711075 1301569 1308963 343811 181901 70368835 37196376 28638613 33172459 10875866 9415489 223212 223213 6312259 6746437 66279280 65095594 5479801 6480640 4575630 0 24749646 27331991 695087 0 35500164 33812631 X 23859394 24803048 6919722 6479915 30779116 31282963 66279280 65095594 X 1798179 -1253378 -40954 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 6019 6019 0 PART II-B, LINE 1: PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION ARE ALLOCABLE TO LOBBYING ACTIVITIES. 440631 -51811 388820 404381 36250 440631 6023323 498337 238611 231663 6528608 5970820 133351 151032 231880 6023323 6073766 73697 52315 228958 5970820 0.65685 0.34315 0.00000 0 1 1 76025 76025 37988708 16329120 21659588 25276690 19938461 5338229 7027412 928795 6098617 33172459 DUE FROM SHENANDOAH AMBULANCE SERVICE 241939 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 5542665 OTHER RECEIVABLES 267072 PATIENT CUSTOMER CONTRACTS 213045 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 481716 6746437 X PART V, LINE 4: THE ENDOWMENT FUNDS WERE DESIGNATED AS SUCH BY THE SHENANDOAH MEDICAL CENTER BOARD OF DIRECTORS AND ARE MEANT TO BE HELD BY THE HOSPITAL. THE INCOME IS TYPICALLY REINVESTED IN THE ENDOWMENT FUNDS ON AN ANNUAL BASIS, BUT THE BOARD OF DIRECTORS HAS THE ABILITY TO DETERMINE THAT THE INCOME COULD BE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES. PART X, LINE 2: THE MEDICAL CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART V, LINE 1A, COLUMN B: THE BEGINNING BALANCE HAS BEEN ADJUSTED TO REMOVE FUNDS THAT WERE DETERMINED TO NOT BE CONSIDERED ENDOWMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 41402 0 41402 0.00090 7554032 6867350 686682 0.01480 7595434 6867350 728084 0.01570 1535 18070 0 18070 0.00040 494 1220 0 1220 0.00000 14436 0 14436 0.00030 2029 33726 33726 0.00070 2029 7629160 6867350 761810 0.01640 8183 585634 0 585634 0.01260 8183 585634 585634 0.01260 1 2934214 0 17130553 17416484 -285931 X 1 1 1 1 SHENANDOAH MEDICAL CENTER 300 PERSHING AVE SHENANDOAH IA 51601 WWW.SMCHOSPITAL.COM 730065H X X X X SHENANDOAH MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SMCHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 22 1 SMCHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 200.000000000000 200.000000000000 X X X X X X 1 1 X X X 1 X SMCHOSPITAL.COM/INSURANCE-FINANCIAL-ASSISTANCE/ X SMCHOSPITAL.COM/INSURANCE-FINANCIAL-ASSISTANCE/ X SMCHOSPITAL.COM/INSURANCE-FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 5: THE CHNA TOWN HALL WAS HELD OVER LUNCH ON WEDNESDAY, FEBRUARY 18, 2022 AT THE SHENANDOAH MEDICAL CENTER HARTMAN ROOM IN SHENANDOAH, IA. VINCE VANDEHAAR, MBA, FACILITATED THIS 1-1/2 HOUR SESSION WITH THIRTY (30) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. TO COMPLETE THE NEEDS ASSESSMENT WHICH WAS FINALIZED IN 2022. SMC PARTNERED WITH PAGE COUNTY PUBLIC HEALTH TO COMPLETE THE ASSESSMENT. ONGOING MEETINGS WITH CHNA STAKEHOLDERS WERE HELD THURSDAY, APRIL 4, 2022 AND MAY 22, 2022 AT SHENANDOAH MEDICAL CENTER IN SHENANDOAH, IA TO COMPOSE AN IMPLEMENTATION PLAN. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 6B: PAGE COUNTY PUBLIC HEALTH SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 11: SHENANDOAH MEDICAL CENTER HAS WORKED TO EXPAND MENTAL HEALTH SERVICES IN PAGE COUNTY BY CONTINUING TO PARTNER WITH OTHER MENTAL HEALTH ORGANIZATIONS IN SHENANDOAH, AS WELL AS THROUGH THE RECRUITMENT OF ADDITIONAL BEHAVIORAL HEALTH ARNPS AND A LICENSED SOCIAL WORKER TO INCREASE ACCESS TO CARE. SMC HAS ALSO WORKED TO IMPLEMENT PEDIATRIC TELEHEALTH SERVICES THROUGH A PARTNERSHIP WITH CHILDREN'S HOSPITAL IN AN EFFORT TO GAIN ACCESS TO PSYCHIATRIC TELEHEALTH SERVICES FOR CHILDREN. ADDITIONALLY, TELEHEALTH PARTNERSHIPS WERE DEVELOPED TO GAIN ACCESS TO BEHAVIORAL HEALTH CARE IN THE EMERGENCY ROOM, WHICH HAS PROVIDED MUCH IMPROVED ACCESS TO CARE. RECRUITMENT OF TWO BEHAVIORAL HEALTH ARNPS AND A SOCIAL WORKER HAVE BEEN MAJOR INITIATIVES FOR THE ORGANIZATION OVER THE PAST TWELVE MONTHS. SMC FIGHTS DRUG ABUSE THROUGH USE OF SPECIFIC PAIN CONTRACTS ENTERED INTO BETWEEN PROVIDERS AND PATIENTS WITH DRUG ABUSE HISTORY. SMC ALSO PARTNERS WITH SEVERAL ORGANIZATIONS SUCH AS ZION RECOVERY SERVICES TO INCREASE THE ACCESS TO TREATMENT FOR DRUG ABUSE PATIENTS. SMC'S CEO HAS ALSO BECOME THE PRESIDENT OF THE SHENANDOAH CHAMBER AND INDUSTRY ASSOCIATION TO ADDRESS ECONOMIC DEVELOPMENT NEEDS AND HE ALSO SERVES AS CHAIR OF THE COMMUNITY'S HOUSING COMMITTEE, ALTHOUGH THESE AREAS MAY NOT BE CONSIDERED MISSION CRITICAL TO SMC. SMC PARTNERS WITH SEVERAL LOCAL SENIOR LIVING PROVIDERS TO PROVIDE THE NECESSARY CARE FOR THE COMMUNITY'S SENIORS. SMC HAS DEVELOPED A ROBUST POPULATION HEALTH TEAM THAT INCLUDES FIVE HEALTH COACHES THAT MANAGE THE CARE OF ACUTE DIABETIC PATIENTS AND OTHER CHRONIC DISEASES VIA PARTNERSHIP WITH IOWA MEDICAID AND PARTICIPATION IN MULTIPLE ACCOUNTABLE CARE ORGANIZATIONS TO IMPROVE CARE THROUGHOUT THE STATE OF IOWA. SMC IS ADDRESSING THE NEED OF CANCER CARE WITH A $13 MILLION DOLLAR INVESTMENT IN A REGIONAL CANCER CENTER THAT WILL PROVIDE BOTH MEDICAL AND RADIATION ONCOLOGY SERVICES. COMPLEX CHEMOTHERAPY AND RADIATION THERAPY WILL BE DELIVERED THROUGH THE ONBOARDING OF AN EMPLOYED MEDICAL ONCOLOGIST AND AN EMPLOYED RADIATION ONCOLOGIST. WHILE THESE ITEMS ARE SIGNIFICANT INVESTMENTS, SMC UNDERSTANDS THE IMPORTANCE OF PROVIDING CANCER CARE TO THIS REGION, AS CANCER PREVALENCE RATES ARE AMONG THE HIGHEST IN THE STATE OF IOWA IN SOUTHWEST IOWA. A NEED THAT DID NOT GET DIRECTLY ADDRESSED BY SMC WAS THE IMPROVEMENT OF ACCESS TO DENTAL SERVICES FOR OUR MEDICAID PATIENTS. THIS ITEM WAS NOT CONSIDERED RELATED TO THE FACILITY'S MISSION CRITICAL OPERATIONS. AS A RESULT, SMC WILL CONTINUE TO HELP SUPPORT COMMUNITY PARTNERS IN ORDER TO ADDRESS THOSE NEEDS. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 13H: THE ELIGIBILITY OF EACH APPLICANT FOR FINANCIAL ASSISTANCE IS DETERMINED ON A CASE BY CASE BASIS THROUGH COORDINATION OF THE PATIENT FINANCIAL COUNSELOR, BUSINESS OFFICE MANAGER, AND CHIEF FINANICAL OFFICER. ELIGIBILITY IS BASED ON A REVIEW AND VERIFICATION OF INCOME OF AN INDIVIDUAL OR FAMILY, INCLUDING THE SIZE OF THE FAMILY. VERIFICATION INCLUDES BUT IS NOT LIMITED TO: TAX RETURNS, PAY STUBS, SOCIAL SECURITY CHECKS, DISABILITY CHECKS OR BANK STATEMENTS. DETERMINATION IS BASED UPON INCOME DATA DIRECTLY RELATED TO FEDERAL POVERY LEVEL AFTER APPLYING ALL OTHER RESOURCES. CHARITY CARE IS BASED ON 200% OF POVERTY LEVEL. AN UNINSURED DISCOUNT OF 35% IS GRANTED TO ALL PATIENTS WITH NO INSURANCE. FURTHER DISCOUNTING IS APPLIED BASED ON THE APPLICANT'S ABILITY TO MEET THE ELIGIBILITY CRITERIA. 4 1 - SHENANDOAH PHYSICIANS CLINIC - SIDNEY 802 ILLINOIS STREET SIDNEY IA 51652 SIDNEY CLINIC 2 - SHENANDOAH MEDICAL CENTER 2 JACK FOSTER DRIVE SHENANDOAH IA 51601 WELLNESS CENTER 3 - SHENANDOAH PHYSICIANS CLINIC - ESSEX 527 IOWA AVENUE ESSEX IA 51638 ESSEX CLINIC 4 - SHENANDOAH PHYSICIANS CLINIC - TABOR 713 MAIN STREET TABOR IA 51653 TABOR CLINIC PART I, LINE 3C: THE ORGANIZATION DID NOT USE OTHER FACTORS TO DETERMINE ELIGIBILITY. PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: THE ORGANIZATION UTILIZED AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. PART I, LINE 7G: THERE WERE NO SUBSIDIZED HEALTH SERVICES DURING THE YEAR. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,934,214. PART II, COMMUNITY BUILDING ACTIVITIES: SHENANDOAH MEDICAL CENTER PROVIDES JOB SHADOWING OPPORTUNITIES TO HIGH SCHOOL STUDENTS OF SHENANDOAH, AND PROFESSIONAL STUDENT ROTATIONS FOR PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, PHLEBOTOMY, RADIOLOGY TECHNOLOGIST, MEDICAL TECHNOLOGIST, ANESTHESIA, REHABILITATION, NURSING, AND MEDICAL STUDENTS. THESE ACTIVITIES HELP TO FURTHER THE EDUCATION OF THE COMMUNITY ON HEALTH IMPROVEMENT AND MAINTENANCE AND ALSO ASSIST IN THE DEVELOPMENT OF LOCAL INDIVIDUALS IN BECOMING HEALTH CARE PROFESSIONALS. SMC PARTICIPATES IN AND HOSTS LOCAL EVENTS SUCH AS COMMUNITY BLOOD DRIVES, LUNCH AND LEARNS ON RELEVANT HEALTH TOPICS, GRIEF GROUPS, FAMILY ADVISORY COUNCILS, PRENATAL CLASSES AND OTHER COMMUNITY EVENTS. PART III, LINE 2: CONSISTENT WITH THE MEDICAL CENTER'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE MEDICAL CENTER HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH UNINSURED BALANCES (COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE MEDICAL CENTER EXPECTS TO COLLECT BASED ON COLLECTION HISTORY WITH THOSE PATIENTS. PART III, LINE 3: THE MEDICAL CENTER PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE MEDICAL CENTER NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE MEDICAL CENTER DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE MEDICAL CENTER DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE" CAN BE FOUND ON PAGES 8, 10 THROUGH 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: ANY SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE IT REPRESENTS UNCOMPENSATED CARE PROVIDED TO INDIVIDUALS IN THE SHENANDOAH AND SURROUNDING COMMUNITIES. IT HAS BEEN DETERMINED BASED ON THE OVERALL MEDICARE ALLOWABLE COST AS A PERCENT OF TOTAL CHARGES, APPLIED TO THE TOTAL MEDICARE CHARGES. PART III, LINE 9B: ONCE A PATIENT HAS BEEN DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT IS UPDATED WITH THE APPROPRIATE AMOUNT OF FINANCIAL ASSISTANCE. IF A PATIENT HAS HAD ALL ACCOUNTS GRANTED FULL FINANCIAL ASSISTANCE, THE PATIENT RECEIVES NOTICE THAT ALL OBLIGATIONS HAVE BEEN SATISFIED. IF THERE IS A REMAINING PATIENT BALANCE, SMC'S FINANCIAL COUNSELOR WORKS CLOSELY WITH THE PATIENT TO AGREE UPON A PAYMENT PLAN THAT IS FINANCIALLY FEASIBLE FOR THE PATIENT. PART VI, LINE 2: THE ORGANIZATION'S LEADERSHIP INFORMALLY MEETS WITH LEADERS IN THE COMMUNITY TO DISCUSS COMMUNITY ISSUES, AS WELL AS ATTEMPTS TO IDENTIFY AREAS WHERE SMC CAN BE OF SERVICE TO THE EMPLOYERS IN THE COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO ALL PATIENTS ON THE WEBSITE. ADDITIONALLY, OUR THIRD PARTY SELF-PAY ORGANIZATION MAILS APPLICATIONS TO THOSE PATIENTS WHO INDICATE THAT THEY DO NOT HAVE THE MEANS TO PAY THEIR ACCOUNTS. UPON CONTACT AT SMC, OUR SOCIAL SERVICES REPRESENTATIVE AND PATIENT FINANCIAL COUNSELOR DISCUSS OPTIONS WITH PATIENTS AND ALSO ASSIST IN THE COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATIONS, MEDICARE AND MEDICAID APPLICATIONS IF APPLICABLE, AND MAKING ANY OTHER ARRANGEMENTS NECESSARY TO ASSIST PATIENTS IN FINANCIALLY SATISFYING THEIR OBLIGATIONS. PATIENTS ARE ALSO NOTIFIED OF THE FINANCIAL ASSISTANCE POLICY AT ADMISSION AND DISCHARGE. PART VI, LINE 4: THE MEDIAN HOUSEHOLD INCOME WAS $51,867 AND $56,750 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2019, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $60,523. AS A BYPRODUCT OF THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA, SHENANDOAH MEDICAL CENTER TREATS A SIGNIFICANT NUMBER OF MEDICAID, UNINSURED, AND UNDERINSURED PATIENTS. THE AREA POPULATION IS PREDOMINATELY WHITE, NON-HISPANIC. PART VI, LINE 5: IN ADDITION TO ITS EFFORTS TO ADDRESS THE NEEDS IDENTIFIED BY ITS COMMUNITY HEALTH NEEDS ASSESSMENT, THE FACILITY ALSO HAS AN ACTIVE INTERNAL WELLNESS PROGRAM THAT IT IS CURRENTLY ROLLING OUT TO THE COMMUNITY. ADDITIONALLY, THE HOSPITAL OPERATES A WELLNESS CENTER THAT PROVIDES VERY AFFORDABLE MEMBERSHIP RATES AND PERSONAL TRAINING OPTIONS TO HELP PROMOTE WELLNESS IN THE COMMUNITY. PART VI, LINE 6: SMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X X X 0 0 0 0 0 0 0 0 0 BRIAN ROWAN PHYSICIAN 566901 0 0 0 6414 0 27000 0 13311 0 613626 0 0 0 REBECCA ROSE PHYSICIAN 461925 0 25000 0 6414 0 24740 0 21596 0 539675 0 0 0 MARTEE MACLEOD-KOZAL PHYSICIAN 387342 0 33000 0 6414 0 20500 0 25292 0 472548 0 0 0 CHASE BROWN PHYSICIAN 352307 0 62962 0 6414 0 20500 0 25192 0 467375 0 0 0 MICHAEL WOODS PHYSICIAN 393716 0 8000 0 6414 0 10404 0 26311 0 444845 0 0 0 MATTHEW SELLS CEO 266092 0 66000 0 6266 0 16899 0 25554 0 380811 0 0 0 HEATHER BABE MD DIRECTOR 302806 0 20243 0 6414 0 16552 0 2662 0 348677 0 0 0 KALEY NEAL CFO 150796 0 0 0 4031 0 9331 0 1453 0 165611 0 0 0 ALICIA SELLS EMPLOYEE OF ORGANIZATION AND WIFE OF MATTHEW SELLS, CEO 94560 EMPLOYEE'S COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO, CFO, AND GOVERNING BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS ENFORCED BY THE CEO AND COMPLIANCE OFFICER. ALL BOARD MEMBERS AND EXECUTIVES ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST THAT ARE PRESENTED. ON AN ANNUAL BASIS, A SUMMARY OF ALL CONFLICTS IDENTIFIED DURING THE YEAR ARE PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AS PART OF THE ANNUAL COMPLIANCE SUMMARY. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL POSSESSING THE CONFLICT IS NOT ALLOWED TO PROVIDE INPUT ON THE SUBJECT AND IS REQUIRED TO ABSTAIN FROM ANY RELATED VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CEO WAS REVIEWED AND AUTHORIZED BY THE BOARD OF DIRECTORS. SMC ALSO UTILITIZES THE IOWA HOSPITAL ASSOCIATION SALARY SURVEY DATA TO APPROPRIATELY SET COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES. ADDITIONALLY, SALARY SURVEY DATA OBTAINED FROM MGMA AND MERRITT HAWKINS IS USED TO EVALUATE THE COMPENSATION OF ALL PROVIDERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART IX, LINE 11G LAB FEES: PROGRAM SERVICE EXPENSES 226,140. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,140. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,425,301. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,425,301. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,652,092. MANAGEMENT AND GENERAL EXPENSES 448,136. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,100,228. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,791,462. MANAGEMENT AND GENERAL EXPENSES 431,685. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,223,147. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST -40,954. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF SMC'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SHENANDOAH MEDICAL CENTER FOUNDATION 300 PERSHING AVENUE SHENANDOAH IA 51601 421471184 SUPPORT SHENANDOAH MEDICAL CENTER IA 501(C)(3) LINE 12A, I SHENANDOAH MEDICAL CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 SHENANDOAH MEDICAL CENTER FOUNDATION C 461723 FMV