2017-11-15T08:08:56-06:00 2016-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2016-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 MATTHEW SELLS PRESIDENT & CEO 7122461230 2017-11-14 1 WENDY R COOLEY P01523804 4023302660 209.34.201.180 2017-11-14 16:10:05 CS P E174F7C75A15FCA0AF1E43F729F0FF7E9FDF9AE2 FCEDDD786A52D146CD6D5AF04BB3D8B974087028 2016 2017-02-10 21:41:12Z MATTHEW SELLS 300 PERSHING AVENUE SHENANDOAH IA 51601 44885564 0 X WWW.SMCHOSPITAL.COM X 1978 IA TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH & SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION. 10 9 488 53 0 0 209245 197415 40939000 41951904 481617 -21907 321617 346419 41951479 42473831 0 0 0 0 21586785 23964088 0 0 0 19349247 22226521 40936032 46190609 1015447 -3716778 67750733 66335237 37478759 38872745 30271974 27462492 TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. 0 0 36344687 41951904 SHENANDOAH MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS AND A 50 BED INTERMEDIATE CARE NURSING FACILITY. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN AN INPATIENT AND OUTPATIENT SETTING. IN ADDITION, THE HOSPITAL PROVIDES RENTAL SPACE FOR A CANCER AND DIALYSIS TREATMENT CENTER. DURING 2016, THE HOSPITAL PROVIDED 1,362 DAYS OF ACUTE CARE, 755 DAYS OF SKILLED NURSING CARE, 205 NURSERY DAYS, AND 161,757 OUTPATIENT OCCASIONS OF SERVICE. THE NURSING FACILITY PROVIDED 15,843 INTERMEDIATE CARE DAYS AND 160 SKILLED NURSING CARE DAYS OF SERVICE. 36344687 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 33 0 1 488 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KALEY NEAL CFO 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 ALISSA MCGINNIS CHAIRMAN 3.00 0.00 X X 0 0 0 FLOYD JONES DO VICE CHAIRMAN 3.00 0.00 X X 0 0 0 GREG RITCHEY SECRETARY/TREASURER 3.00 0.00 X X 0 0 0 TIM AUGUSTINE DIRECTOR 3.00 0.00 X 0 0 0 JOEL BARRETT DIRECTOR 3.00 0.00 X 0 0 0 MARY JO CARRELL DIRECTOR 3.00 0.00 X 0 0 0 DEB ISTAS DIRECTOR 3.00 0.00 X 0 0 0 ROGER JONES DIRECTOR 3.00 0.00 X 0 0 0 ED KLOBERDANZ DIRECTOR 3.00 0.00 X 0 0 0 DAVE LASHIER DIRECTOR 3.00 1.00 X 0 0 0 LINDA LAUGHLIN DIRECTOR THRU 1/28/16 3.00 0.00 X 0 0 0 KAREN COLE CEO 40.00 1.00 X 318648 0 21323 MATTHEW SELLS CFO 40.00 0.00 X 148214 0 28021 BRIAN ROWAN PHYSICIAN 40.00 0.00 X 611166 0 25480 REBECCA ROSE PHYSICIAN 40.00 0.00 X 468855 0 31828 SANTOSH KUMAR PHYSICIAN 40.00 0.00 X 378083 0 35751 SCOTT R KING PHYSICIAN 40.00 0.00 X 376539 0 23212 MICHAEL WOODS PHYSICIAN 40.00 0.00 X 325610 0 36848 2627115 0 202463 30 0 1 0 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 606731246 ELECTRONIC HEALTH RECORD MAINTENANCE 1174021 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 100875068 CONTRACT LABOR 670098 COMPHEALTH ASSOCIATES INC PO BOX 972625 DALLAS TX 753972625 CONTRACT LABOR 534104 UNMC PHYSICIANS LAB REF PO BOX 30014-1114 OMAHA NE 68103 LAB FEES 352670 BROWN'S MEDICAL IMAGING 14315 C CIRCLE OMAHA NE 68144 RADIOLOGY EQUIPMENT MAINTENANCE 331817 8 31960 25236 140219 197415 MEDICARE/MEDICAID PAYM 624100 23607108 23607108 NET PATIENT SERVICE RE 624100 15794674 15794674 340B REVENUE 624100 1775853 1775853 AMBULANCE SERVICES 621910 672363 672363 101906 101906 41951904 165175 165175 157177 0 157177 157177 157177 2206531 18120 2411733 0 -205202 18120 -187082 -187082 CAFETERIA REVENUE 624200 189242 189242 189242 42473831 41951904 0 324512 X 516206 516206 133534 133534 19693383 15355035 4338348 351827 282343 69484 1921041 1488400 432641 1348097 1104547 243550 40822 40822 94178 94178 5953050 3721107 2231943 144942 7247 137695 1184837 674566 510271 483114 433301 49813 176716 134878 41838 46879 46879 3918102 3514110 403992 247764 222217 25547 MEDICAL SUPPLIES 6145467 6145467 BAD DEBT EXPENSE 2656010 2656010 LICENSES & FEES 352076 96673 255403 FOOD 348796 332450 16346 433768 42802 390966 46190609 36344687 9845922 0 1382 1592 23831263 9568623 10206784 11479017 1040538 1081782 262578 330995 56019362 26324842 15669977 29694520 7364792 6930051 378181 324774 8995238 6923883 67750733 66335237 6067824 8949032 1910399 1128876 25350000 25241507 4150536 3553330 37478759 38872745 X 24578643 21386140 1023321 912540 4670010 5163812 30271974 27462492 67750733 66335237 X -3716778 436901 30000 440395 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 6256 6256 0 PART II-B, LINE 1: PORTION OF DUES PAID TO THE AMERICAN ACADEMY OF FAMILY PHYSICIANS, THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION ARE ALLOCABLE TO LOBBYING ACTIVITIES. 7750354 34970 215580 220556 7780348 9342606 5632 -1413381 184503 7750354 9273345 36330 147606 114675 9342606 9734922 30006 498003 989586 9273345 7578451 2877629 565340 1286498 9734922 0.87600 0.00670 0.11730 0 0 92822 92822 31967050 10040510 21926540 22739195 15449920 7289275 1220295 834412 385883 29694520 INVESTMENT IN HOSPITAL LLC 1742 DUE FROM SHENANDOAH AMBULANCE SERVICE 51023 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 5111812 DUE FROM SHENANDOAH MEDICAL CENTER FOUNDATION 1000 OTHER RECEIVABLES 202549 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1555757 6923883 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: SHENANDOAH MEDICAL CENTER(SMC) AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE MEDICAL CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE MEDICAL CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. 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, 2016 AND 2015, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 1 X 1 X 1 1 0 1 1 55470 55470 0.00130 8641319 7368208 1273111 0.02920 8696789 7368208 1328581 0.03050 23011 23011 0.00050 1038572 363681 674891 0.01550 10113686 8247698 1865988 0.04290 24263 24263 0.00060 11199532 8611379 2588153 0.05950 19896321 15979587 3916734 0.09000 228931 228931 0.00530 284 284 0.00000 229215 229215 0.00530 1 2656010 0 13385388 13749983 -364595 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 16 1 1 0 1 X WWW.SMCHOSPITAL.COM X 1 16 1 WWW.SMCHOSPITAL.COM 0 1 X 200.000000000000 200.000000000000 X X X X X X 1 1 X X X 1 X WWW.SMCHOSPITAL.COM X WWW.SMCHOSPITAL.COM X WWW.SMCHOSPITAL.COM 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 DINNER ON TUESDAY, FEBRUARY 9, 2016 AT THE SIDNEY ELEMENTARY SCHOOL CAFETERIA IN SIDNEY, IA. VINCE VANDEHAAR MBA AND ALEXA BACKMAN FACILITATED THIS 1-1/2 HOUR SESSION WITH THIRTY SIX (36) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. TO COMPLETE THE NEEDS ASSESSMENT WHICH WAS FINALIZED IN 2016. SMC PARTNERED WITH GRAPE COMMUNITY HOSPITAL IN HAMBURG, IA TO COMPLETE THE ASSESSMENT. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 6A: GEORGE C. GRAPE COMMUNITY HOSPITAL OF HAMBURG, IA SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 11: THE NEEDS ASSESSMENT INDICATED THAT AREAS FOR IMPROVEMENT WERE AS FOLLOWS: EXPAND MENTAL HEALTH SERVICES THROUGH PREVENTION, STABILIZATION, AND PLACEMENT; FIGHT OBESITY; REDUCE DRUG ABUSE; IMPROVEMENT OF DIABETES SERVICES AND EDUCATION; EDUCATION ON SEXUALLY TRANSMITTED INFECTIONS; INCREASED ACCESS TO CHILD CARE; A FOCUS ON ECONOMIC DEVELOPMENT TO REDUCE THE IMPACT OF THE LOSS OF A MAJOR EMPLOYER.SHENANDOAH MEDICAL CENTER HAS WORKED TO EXPAND MENTAL HEALTH SERVICES IN PAGE COUNTY BY CONTINUING TO PROVIDE A RENTAL SPACE FOR WAUBONSIE MENTAL HEALTH SERVICES ON ITS PROPERTY. ADDITIONALLY, IT CONTINUES TO PARTNER WITH OTHER MENTAL HEALTH ORGANIZATIONS IN SHENANDOAH TO INCREASE ACCESS TO CARE. SMC HAS ALSO WORKED TO IMPLEMENT TELEHEALTH SERVICES THROUGH A PARTNERSHIP WITH THE UNIVERSITY OF IOWA HOSPITAL AND HEALTH CLINICS IN AN EFFORT TO GAIN ACCESS TO PSYCHIATRIC TELEHEALTH SERVICES. SMC CONTINUES TO WORK TO FIGHT OBESITY THROUGH THE EMPLOYMENT OF TWO CERTIFIED DIETICIANS THAT WORK WITH DIABETIC PATIENTS AND ALSO HOLD GROUP CLASSES IN THE COMMUNITY. SMC ALSO HAS AN ACCREDITED PATIENT CENTERED MEDICAL HOME THAT INCLUDES TWO HEALTH COACHES THAT ALSO MANAGE THE CARE OF ACUTE DIABETIC PATIENTS VIA PARTNERSHIP WITH IOWA MEDICAID. 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 CONTINUES TO WORK CLOSELY WITH SHENANDOAH COMMUNITY SCHOOLS TO PROVIDE EDUCATION ON SEXUALLY TRANSMITTED INFECTIONS AND PROVIDES A GREAT DEAL OF PATIENT COUNSELING VIA ITS THREE OB-GYN PHYSICIANS. THE FACILITY IS ALSO PARTNERING WITH THE SHENANDOAH CHAMBER AND INDUSTRY ASSOCIATION TO SUPPORT ECONOMIC GROWTH AND THE RECRUITMENT OF NEW EMPLOYERS.A NEED THAT DID NOT GET DIRECTLY ADDRESSED BY SMC WAS THE IMPROVEMENT OF ACCESS TO CHILD CARE. 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 REVENUE CYCLE DIRECTOR. 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 POVERTY LEVELS AFTER APPLYING ALL OTHER RESOURCES. CHARITY CARE IS BASED ON 200% OF POVERTY LEVEL. AN UNINSURED DISCOUNT OF 30% IS GRANTED TO ALL PATIENTS WITH NO INSURANCE. AN ADDITIONAL 20% DISCOUNT IS AUTOMATICALLY GRANTED TO THESE INDIVIDUALS ONCE THEY COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. FURTHER DISCOUNTING IS APPLIED BASED ON THE APPLICANT'S ABILITY TO MEET THE ELIGIBILITY CRITERIA. 5 1 - ELM HEIGHTS CARE CENTER 1203 SOUTH ELM STREET SHENANDOAH IA 51601 SKILLED NURSING 2 - SHENANDOAH MEDICAL CENTER 300 PARK AVENUE SHENANDOAH IA 51601 HOME HEALTH AND HOSPICE 3 - SHENANDOAH PHYSICIANS CLINIC - SIDNEY 802 ILLINOIS STREET FREMONT IA 52561 SIDNEY CLINIC 4 - SHENANDOAH MEDICAL CENTER 2 JACK FOSTER DRIVE SHENANDOAH IA 51601 WELLNESS CENTER 5 - SHENANDOAH PHYSICIANS CLINIC - ESSEX 527 IOWA AVENUE ESSEX IA 51638 ESSEX CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE MENTAL HEALTH AND SOCIAL SERVICES, OUTPATIENT RURAL HEALTH CLINIC, CONTINUING CARE/HOME CARE SERVICES, WOMEN'S & CHILDREN'S SERVICES, PEDIATRICS, MEDICAL HOME AND GENERAL ROUTINE CARE IN THE EMERGENCY ROOM. 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 $2,656,010. PART II, COMMUNITY BUILDING ACTIVITIES: SHENANDOAH MEDICAL CENTER PROVIDES JOB SHADOWING TO STUDENTS OF SHENANDOAH, PHLEBOTOMY STUDENT ROTATIONS, CLARKSON/METHODIST STUDENTS JOB SHADOWING, CNA CLASSES FOR SHENANDOAH HIGH SCHOOL STUDENTS, MENTORING OF STUDENTS BY SMC STAFF, AND IS INVOLVED IN THE FREMONT/PAGE COUNTY PREVENT CHILD ABUSE GROUP AND BREAST CANCER AWARENESS. 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. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: THE MEDICAL CENTER PROVIDES CHARITY CARE 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 CHARITY CARE. ACCORDINGLY, THE MEDICAL CENTER DOES NOT REPORT THESE AMOUNTS IN NET PATIENT SERVICE REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE," "NET PATIENT SERVICE REVENUE, AND "CHARITY CARE" CAN BE FOUND ON PAGES 8 AND 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE 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 $43,912 AND $53,324 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2015, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $53,183. 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 KAREN COLE CEO 276220 0 36320 0 6108 0 13250 0 8073 0 339971 0 0 0 MATTHEW SELLS CFO 133240 0 14780 0 194 0 6285 0 21736 0 176235 0 0 0 BRIAN ROWAN PHYSICIAN 602711 0 8187 0 268 0 0 0 25480 0 636646 0 0 0 REBECCA ROSE PHYSICIAN 440650 0 25883 0 2322 0 13250 0 18578 0 500683 0 0 0 SANTOSH KUMAR PHYSICIAN 361720 0 15883 0 480 0 13250 0 22501 0 413834 0 0 0 SCOTT R KING PHYSICIAN 361327 0 11648 0 3564 0 0 0 23212 0 399751 0 0 0 MICHAEL WOODS PHYSICIAN 322405 0 883 0 2322 0 8937 0 27911 0 362458 0 0 0 A IOWA FINANCE AUTHORITY 521699886 46246NHT6 2015-12-08 25350000 CONSTRUCT AND REMODEL HOSPITAL AND CLINIC 0 0 0 A -429458 14342657 8279254 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 ALICIA SELLS EMPLOYEE OF ORGANIZATION AND WIFE OF MATTHEW SELLS, CFO 99560 EMPLOYEE'S COMPENSATION 0 CODY AUGUSTINE EMPLOYEE OF ORGANIZATION AND SON OF TIM AUGUSTINE, BOARD MEMBER 33974 EMPLOYEE'S COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE TWO CLASSES OF MEMBERS, DESIGNATED CLASS A MEMBERS AND CLASS B MEMBERS. THE CLASS A MEMBERS SHALL BE ALL OF THOSE INDIVIDUALS THEN SERVING AS DULY ELECTED MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION, EXCEPT FOR THAT PERSON NOMINATED TO THE BOARD OF DIRECTORS BY THE CLASS B MEMBER. THE CLASS B MEMBER SHALL BE SHENANDOAH/NHS REGIONAL VENTURES, LLC, AN IOWA LIMITED LIABILITY COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE CLASS B MEMBER SHALL HAVE THE RIGHT TO NOMINATE ONE PERSON TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. 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 374,744. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 374,744. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,758,003. MANAGEMENT AND GENERAL EXPENSES 3,530. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,761,533. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 127,801. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,801. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,588,360. MANAGEMENT AND GENERAL EXPENSES 2,100,612. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,688,972. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST 493,802. LOSS ON EQUITY IN SHENANDOAH AMBULANCE SERVICE -53,407. 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