2017-05-12T16:28:19-05:00 2016-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 201347269 Renown Skilled Nursing RENO 7759824404 1155 Mill St C/O Tax Treasury Z-4 Reno NV 89502 Dawn D Ahner EVP & Chief Administrative Officer 7759824404 2017-05-11 1 Kim Hunwardsen CPA P00484560 6122536500 2017-05-10 2015 2021-01-29 14:40:06Z Dawn D Ahner 1155 Mill St C/O Tax Treasury Z-4 Reno NV 89502 9968576 0 X www.renown.org X 2004 NV A 160 bed long-term acute care nursing facility specializing in rehabilitative care. 10 8 0 8 0 0 2633559 2809233 6992793 7159343 -1895 -5093 0 0 9624457 9963483 0 0 0 0 7651909 7593475 0 0 0 4041637 4082570 11693546 11676045 -2069089 -1712562 2389625 2419069 33075885 43320609 -30686260 -40901540 X Renown Health makes a genuine difference in the health and well-being of the people and communities we serve. 0 0 9422734 7159343 See Schedule ORenown Skilled Nursing is a 160-bed nursing facility designed to serve the healthcare needs of long and short-term, acute-care patients. Services include physical, occupational and speech rehabilitation and restorative therapy programs. This valuable facility serves a need that otherwise would be unmet in northern Nevada. By accepting the long-term, acute-care patients for rehabilitative services, other hospital beds in the health network are available for higher-acuity, shorter-term care. Renown Skilled Nursing provided 27,812 patient care days for patients transferred from other hospital beds in the health network because they required a level of care delivered most appropriately in a skilled nursing facility. Included in the total patient care days was 1,125 days of long-term care services that were not funded and were designated for patients awaiting Medicaid qualification. It also includes 912 days of care provided for individuals with no source of payment.Our patients at Renown Skilled Nursing have access to transportation, laundry, a barber and beauty shop, on-site dental and podiatry services, financial advice, and spiritual support - in short, everything patients need to enjoy the best possible quality of life. In an effort to provide patients with the opportunity for social interaction, Renown Skilled Nursing also offered musical performances and pet therapy visits. The facility is proud to have been chosen to be a focus center for the Centers for Medicare & Medicaid Services' Nursing Home Quality Initiative.For the fiscal year ending June 30, 2016, Renown Skilled Nursing, along with its parent, Renown Health and its subsidiaries, provided more than $85 million in benefit to the community (using community benefit numbers gathered by the Nevada Hospital Association using state-approved criteria to ensure consistency). For a full report on the benefit Renown Health provided to our community, as well as our community needs assessment and community benefit plan, go to www.renown.org/communitybenefit. 9422734 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 X 0 0 0 0 0 0 0 0 0 0 0 X 10 8 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Dawn D Ahner 7759824404 1155 Mill St Z-4 Reno NV 89502 Anthony Slonim President (Jul-Dec)/CEO 1.00 59.00 X X 0 1281325 137049 Derrick Glum Pres (Jan-Jun)/VP Transitional Care 15.00 45.00 X X 0 14083 0 Dawn Ahner Director (Jan-Jun)/EVP & CAO 3.00 57.00 X X 0 833543 118398 Janette Townsend Sec-Treas/VP & CAO (Jul-Dec) 1.00 59.00 X X 0 416557 26173 Todd McKenzie Sec/Treas (Jan-Jun) 3.00 6.00 X X 0 1500 0 Ellen Kelly Director (Jul-Dec)/Administrator 60.00 0.00 X 115186 0 11407 Eric Boyden Director (Jan-Jun) 3.00 3.00 X 0 0 0 Doug Clary Director (Jan-Jun) 3.00 6.00 X 0 15074 0 Jennifer Satre Director (Jan-Jun) 3.00 6.00 X 0 3000 0 James De Volld Director (Jan-Jun) 3.00 9.00 X 0 22000 0 Jennifer Smith Director (Jan-Jun) 3.00 6.00 X 0 0 0 Melissa Molyneaux Pick Director (Jan-Jun) 3.00 9.00 X 0 12731 0 Ronnie Solaro Director (Jan-Jun) 3.00 6.00 X 0 3750 0 Barbara Coruna Registered Nurse 60.00 0.00 X 116438 0 19189 Aletha Paciente-Baquiano Registered Nurse 60.00 0.00 X 106761 0 13489 Susan Nasir Supervisor of Rehab Therapy Svs 60.00 0.00 X 100213 0 10681 James Miller Former President/CEO 0.00 0.00 X 0 631302 18945 438598 3234865 355331 4 1 1 0 0 2809233 2809233 Patient Service Revenue 623000 7149041 7149041 Other Revenue 900099 10302 10302 7159343 5093 -5093 -5093 -5093 9963483 7159343 0 -5093 124362 124362 6163960 5218099 945861 1305153 1080406 224747 721650 376764 344886 481871 447380 34491 545264 120570 424694 1975 1919 56 2873 2873 331783 276527 55256 38431 38431 Medical Supplies 945272 945272 Provider Tax 716472 716472 Bad Debt 228831 228831 Misc License, Tax & Sub 35390 7621 27769 32758 32758 11676045 9422734 2253311 0 10359 18247 575317 712362 15841 11317 4883 9824 3690578 2033712 1772514 1656866 10711 10453 2389625 2419069 812337 765886 9407 17347 32254141 42537376 33075885 43320609 X -30686260 -40901540 -30686260 -40901540 2389625 2419069 X -1712562 -8502718 X X 0 1 X 1 0 X 2825316 2738244 2713441 2633559 2809233 13719793 7689721 8298522 7370968 6992793 7159343 37511347 10515037 11036766 10084409 9626352 9968576 51231140 0 0 0 51231140 1763 587 2350 10516800 11037353 10084409 9626352 9968576 51233490 1.00000 0.99990 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1488499 731167 757332 2161251 1302545 858706 40828 40828 1656866 Due to Affliates 42533356 Third Party Settlements 4020 42537376 X Part IV, Line 2b: The organization acts as custodian for the funds of the residents of the skilled nursing facility. These funds are included in cash and custodial liability in the financial statements. Part X, Line 2: Renown Skilled Nursing is organized as a Nevada nonprofit entity and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). In addition, Renown Skilled Nursing is subject to income tax on net income derived from business activities that are unrelated to its tax exempt purpose. Renown Skilled Nursing believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the combined financial statements. Renown Skilled Nursing would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. X X X X X 1 1 0 0 0 0 0 0 0 Anthony Slonim President (Jul-Dec)/CEO 0 845350 0 431760 0 4215 0 130600 0 7175 0 1419100 0 0 Dawn Ahner Director (Jan-Jun)/EVP & CAO 0 599598 0 225000 0 8945 0 100600 0 18822 0 952965 0 0 Janette Townsend Sec-Treas/VP & CAO (Jul-Dec) 0 236366 0 42100 0 138091 0 9390 0 17127 0 443074 0 0 James Miller Former President/CEO 0 14491 0 0 0 616811 0 10600 0 8943 0 650845 0 0 Part I, Line 3 Renown Skilled Nursing relies on Renown Health, a related organization, to establish compensation for officers and other key employees. Renown Health uses the identified methods to establish compensation. See Schedule O, Form 990, Part VI, Section B, Line 15 for a description of the process utilized by Renown Health. Part I, Lines 4a-b James Miller and Janette Townsend received severance payments. Payments of $563,958 to James Miller and $119,424 to Janette Townsend included in Schedule J, Part II, Column (B)(iii). Anthony Slonim and Dawn Ahner are parties to a supplemental nonqualified retirement plan. Contribution of $120,000 to Anthony Slonim and $90,000 to Dawn Ahner were included in Schedule J, Part II, Column (C). Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: Renown Skilled Nursing has independent contractors, however, Renown Health, the parent organization, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. The highest compensated independent contractors are reported on Part VII, Section B. Form 990, Part V, Line 2a, Number of employees on W-3: Renown Skilled Nursing has its own employees, however, Renown Health, the parent organization, pays all compensation and employee benefit amounts under a common paymaster arrangement. The actual compensation of each employee is directly charged to their assigned entity. Salaries are reported on line 7 of Part IX. Form 990, Part VI, Section A, line 2 Derrick Glum has a business relationship with Anthony Slonim, Janette Townsend and Dawn Ahner. Janette Townsend, Doug Clary, Jennfier Satre, James De Volld, Melissa Molyneaux Pick, Ronnie Solaro, and Todd McKenzie have a business relationship with Anthony Slonim and Dawn Ahner. Form 990, Part VI, Section A, line 6 Renown Health is the sole corporate member of Renown Skilled Nursing. Form 990, Part VI, Section A, line 7a Renown Health, acting through its Board of Directors, appoints the members of the Board of Governors of Renown Skilled Nursing. Form 990, Part VI, Section A, line 7b Renown Health must approve any merger, consolidation or dissolution of Renown Skilled Nursing, any borrowing in excess of $1 million in any fiscal year, and encumbrances of assets and certain other actions not in the ordinary course of business. Form 990, Part VI, Section A, line 8b There was no committee during the year that had the broad authority to act on behalf of the board. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by the organization's tax department with support from a certified tax preparer. The form is reviewed by the organization's current Controller and current EVP and Chief Administrative Officer prior to the final Form 990 being sent to the board. The IRS Form 990, as filed with the IRS, is sent to each voting member of the Renown Health Board prior to filing. Along with the forms, the Renown Health board is provided with a narrative that explains the various parts of the Form and their content. Form 990, Part VI, Section B, line 12c On an annual basis at or prior to the first regular meeting following the election of new board members, the members of the Renown Skilled Nursing Board are given an Annual Disclosure Statement. They are expected to perform a reasonable investigation into their business, financial, family or significant personal relationships to disclose any actual or potential conflicts of interest. If, in connection with a proposed transaction or arrangement involving a Renown Health entity, a board member discovers that an actual or possible conflict of interest has arisen that was not disclosed on the Annual Statement, then the board member must disclose the existence and nature of his or her financial interests to the remaining directors that are considering the proposed transaction or arrangement in a timely manner. If a board member discloses an actual or possible conflict of interest, the board member shall leave the board or committee meeting while the remaining board members discuss the financial interest. The remaining board members shall vote upon and decide whether a conflict of interest actually exists. If the remaining board members determine that a conflict does exist, then appropriate measures are taken to ensure the issue is addressed. Form 990, Part VI, Section B, line 15a Renown Health's executive compensation, including compensation for the CEO and certain executives, is reviewed and approved by the Renown Health Executive Committee. All decisions are submitted for final ratification at the next scheduled board meeting. The discussion is documented in the Executive Committee minutes and Board minutes. The Executive Committee is comprised of members of the Renown Health Board of Directors unrelated to and not subject to the control or undue influence of executives, with no material financial interest in transactions of the Company or any other perceived or actual conflicts of interest. Total cash compensation for the organization's executives is targeted at competitive compensation levels, relative to market surveys of comparable healthcare organizations, based upon the level of performance required to achieve the targeted compensation levels. Base compensation and total cash compensation is reviewed at a minimum of every two years in comparison to the surveys for comparable businesses and responsibilities and adjusted as to maintain equity with the survey information. The Executive Committee undertook the process outlined above for the fiscal year 2016 executive compensation. Form 990, Part VI, Section C, line 19 Renown Skilled Nursing does not make its governing documents, conflict of interest policy, or financial statements available to the general public. Form 990, Part XI, line 9: Intercompany Settlements -8,502,718. Renown Health 1155 Mill Street Z-4 Reno NV 89502 942972845 Health Care NV 501(c)(3) III-Fi Renown Health 0 Renown Health Foundation 1155 Mill Street Z-4 Reno NV 89502 942972749 Foundation NV 501(c)(3) 7 Renown Health 0 Renown Regional Medical Center 1155 Mill Street Z-4 Reno NV 89502 880213754 Hospital NV 501(c)(3) 3 Renown Health 0 Renown South Meadows Medical Center 1155 Mill Street Z-4 Reno NV 89502 460517825 Hospital NV 501(c)(3) 3 Renown Health 0 Hometown Health Plan 1155 Mill Street Z-4 Reno NV 89502 880231433 HMO NV 501(c)(4) Renown Health 0 Renown Transitional Care Services 1155 Mill Street Z-4 Reno NV 89502 880231828 Pregnancy Center NV 501(c)(3) 3 Renown Health 0 Routt Dialysis LLC 1155 Mill St Z-4 Reno NV 89502 263558729 Kidney Dialysis NV N/A Renown Businesses 1155 Mill St Z-4 Reno NV 89502 880228030 Health Care NV N/A C 0 Hometown Health Managment Company 1155 Mill St Z-4 Reno NV 89502 880236758 Management Services NV N/A C 0 The Provider Network Inc 1155 Mill St Z-4 Reno NV 89502 880376369 Health Care NV N/A C 0 Remittance Assistance Corporation 1155 Mill St Z-4 Reno NV 89502 880277761 Collections NV N/A C 0 Hometown Health Providers Insurance Co 1155 Mill St Z-4 Reno NV 89502 880177026 Insurance NV N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 1 Hometown Health Plan Inc L 889538 General Ledger