2017-08-14T14:48:26-05:00 2016-09-30 990 2015-10-01 420710268 KEOKUK AREA HOSPITAL KEOK 3195247150 1600 MORGAN STREET KEOKUK IA 52632 WALT STEPHENS BOARD CHAIR 3195247150 2017-08-14 2015 2021-01-29 14:40:06Z WALT STEPHENS 1600 MORGAN STREET KEOKUK IA 52632 19461216 0 X KEOKUKHEALTHSYSTEMS.ORG X 1975 IA IMPROVING COMMUNITY HEALTH & ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. 10 9 329 209 0 0 110116 142906 19197178 19085213 731 44625 279066 147097 19587091 19419841 0 0 0 0 10103574 10474708 0 0 0 10279573 10644791 20383147 21119499 -796056 -1699658 12707741 10055919 12717872 11765708 -10131 -1709789 IMPROVING COMMUNITY HEALTH AND ENSURING ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. 0 0 20073685 0 19232310 KEOKUK AREA HOSPITAL (KAH) IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL FULLY ACCREDITED BY THE JOINT COMMISSION. ANNUALLY, KAH SERVICES APPROXIMATELY 1,000 ADMISSIONS, 230,000 OUTPATIENT PROCEDURES AND 12,000 EMERGENCY ROOM VISITS TO THE RESIDENTS OF KEOKUK, IOWA AND SURROUNDING AREAS. KAH ALSO HAS A HOME HEALTH AGENCY THAT SERVICES OVER 7,200 PATIENTS PER YEAR FROM LEE COUNTY, IA AND HANCOCK COUNTY, IL. THE HOSPITAL HAS APPROXIMATELY 120 CREDENTIALED PHYSICIANS ON THE MEDICAL STAFF AND IS GOVERNED BY THE KEOKUK HEALTH SYSTEMS BOARD OF DIRECTORS WHICH IS MADE UP OF LOCAL COMMUNITY MEMBERS. 20073685 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 42 0 1 329 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEOKUK AREA HOSPITAL ATTNACCOUNTING 3195247150 1600 MORGAN STREET KEOKUK IA 52632 NEVILLE CRENSHAW DO BOARD MEMBER 1.00 1.00 X 0 0 0 KIRAN KHANOLKAR MD BOARD MEMBER 1.00 40.00 X 1350 112605 8867 MIKE MAHER BOARD MEMBER 1.00 1.00 X 0 0 0 TOM MARION BOARD MEMBER (TO 12/15) 1.00 1.00 X 0 0 0 KENT NIXON BOARD VICE CHAIR/TREASURER 1.00 1.00 X X 0 0 0 TOM RICHARDSON BOARD MEMBER 1.00 1.00 X 0 0 0 RON SCOTT BOARD MEMBER 1.00 1.00 X 0 0 0 JACK SMITH BOARD MEMBER 1.00 1.00 X 0 0 0 WALT STEPHENS BOARD CHAIR 1.00 1.00 X X 0 0 0 WENDY SWANK BOARD SECRETARY 1.00 1.00 X X 0 0 0 ELIZABETH DAVIS PHARMACY DIRECTOR 40.00 0.00 X 117412 0 18453 JAGADAMBA KANTANMENI ANESTHESIOLOGIST 40.00 0.00 X 307027 0 1349 425789 112605 28669 2 0 1 0 FITCH HEALTHCARE 123 W FRONT STREET WHEATON IL 60187 MANAGEMENT SERVICES 810316 SHARED MEDICAL SERVICES 209 LIMESTONE COTTAGE GROVE WI 53527 MRI SERVICES 198750 2 80460 11334 51112 142906 NET PATIENT REVENUE 900099 18086564 18086564 MISCELLANEOUS REVENUE 900099 927281 927281 RENTAL REVENUE 532000 53353 53353 LABORATORY SERVICES 621500 18015 18015 19085213 502 502 85498 41375 44123 44123 44123 CAFETERIA/LAUNDRY/MISC 900099 80924 80924 OTHER HEALTHCARE SERVICES 900099 43327 43327 MISCELLANEOUS REVENUE 900099 22846 22846 147097 19419841 19232310 0 44625 1350 1350 8490692 8490692 1385767 1385767 596899 596899 820903 820903 29771 29771 22480 22480 60000 60000 2500 2500 2070595 1960435 110160 48918 48918 224546 224546 534124 534124 33417 33417 491351 491351 1049907 1049907 107582 107582 MEDICAL SUPPLIES 3664528 3664528 MISCELLANEOUS EXPENSE 1251403 1251403 MEDICAID PROVIDER ASSES 228428 228428 INCOME TAXES 4338 4338 21119499 20073685 1045814 0 1300895 587419 2310407 1157768 2695764 2717521 120069 1039037 955897 98326 138476 29255823 24986827 5154421 4268996 108891 109773 12707741 10055919 5182960 3994449 2646461 2417366 3989085 5153893 899366 200000 12717872 11765708 X -885166 -2376826 875035 667037 -10131 -1709789 12707741 10055919 -1699658 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 60000 0 0 60000 0 PART II-B, LINE 1: KEOKUK AREA HOSPITAL CONTRACTED WITH FIRM PRIMARILY TO PROVIDE LOBBYING ACTIVITIES IN SUPPORT OF THE RURAL EMERGENCY ACUTE CARE HOSPITAL ACT. 438675 438675 17143849 14720774 2423075 11068730 9786563 1282167 604569 479490 125079 4268996 MISCELLANEOUS LIABILITY 200000 200000 X 19504876 207998 207998 19296878 122963 122963 19419841 20345039 0 20345039 774460 774460 21119499 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. KEOKUK AREA HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. FORMS 990 FILED BY KEOKUK AREA HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE ("IRS") UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 FILED BY KEOKUK AREA HOSPITAL ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED SEPTEMBER 30, 2012 AND PRIOR. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUES IN TEMPORARILY RESTRICTED FUND BALANCE 207,998. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUES IN UNRESTRICTED FUND BALANCE 76,927. EXPENSES NETTED IN REVENUES 46,036. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN UNRESTRICTED FUND BALANCE 728,424. EXPENSES NETTED IN REVENUES 46,036. 1 1 1 X 1 X 1 1 0 1 1 280057 280057 0.01330 267966 267966 0.01270 32262 32262 0.00150 580285 580285 0.02750 28360 28360 0.00130 191955 191955 0.00910 846642 846642 0.04010 20648 20648 0.00100 1087605 1087605 0.05150 1667890 1667890 0.07900 1000 1000 0.00000 2060 2060 0.00010 5980 5980 0.00030 3580 3580 0.00020 19643 19643 0.00090 32263 32263 0.00150 1 1064834 472985 8960255 8114524 845731 X 1 1 1 1 KEOKUK AREA HOSPITAL 1600 MORGAN STREET KEOKUK IA 52632 WWW.KEOKUKHEALTHSYSTEMS.ORG 560054H X X X KEOKUK AREA HOSPITAL 1 0 0 1 X X X X X X X X 13 1 1 1 1 X WWW.KEOKUKHEALTHSYSTEMS.ORG X LEECOUNTYHD.ORG X 1 13 1 WWW.KEOKUKHEALTHSYSTEMS.ORG 0 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X 1 X WWW.KEOKUKHEALTHSYSTEM.ORG X WWW.KEOKUKHEALTHSYSTEM.ORG X WWW.KEOKUKHEALTHSYSTEM.ORG X X X X X 1 X 0 X X X 1 X 0 0 KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 5: KEOKUK AREA HOSPITAL, FORT MADISON COMMUNITY HOSPITAL AND THE LEE COUNTY HEALTH DEPARTMENT ALL COME TOGETHER TO HOST A COMMUNITY STAKEHOLDER'S MEETING WHICH CONSISTS OF MEMBERS OF EACH ORGANIZATION AS WELL AS INTERESTED COMMUNITY MEMBERS. DURING THIS MEETING, ALL MEMBERS ARE DIVIDED INTO SMALL GROUPS AND PROVIDED WITH A LEE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT DATA PROFILE. EACH GROUP IS ASKED TO REVIEW THE DATA AND COME UP WITH A LIST OF TOP HEALTH NEEDS TO LEE COUNTY. EACH GROUP PRESENTS THEIR FINDINGS AND THEN AS AN ENTIRE GROUP, VOTE ON THE TOP 3-5 HEALTH NEEDS TO FOCUS ON OVER THE NEXT 3-5 YEARS. TASKFORCES ARE THEN DEVELOPED FOR EACH HEALTH NEED AND MEETINGS OF THOSE TASKFORCES ARE HELD EVERY FEW MONTHS. KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 6A: KEOKUK AREA HOSPITAL'S CHNA WAS PERFORMED WITH FORT MADISON COMMUNITY HOSPITAL. KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 6B: KEOKUK AREA HOSPITAL'S CHNA WAS PERFORMED WITH THE LEE COUNTY HEALTH DEPARTMENT. KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 7D: A COPY OF THE CHNA IS AVAILABLE UPON REQUEST. KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 11: SOME OF THE HEALTH NEEDS IDENTIFIED THROUGH THE ASSESSMENT WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA BY THE LEE COUNTY HEALTH DEPARTMENT AND FORT MADISON COMMUNITY HOSPITAL. ADDITIONALLY, SOME COMMUNITY HEALTH NEEDS SUCH AS INCREASED NUTRITION & FITNESS, IMPROVED BICYCLE/WALKING TRAILS AND IMPROVED HEALTH DEPARTMENT FACILITIES WERE BEYOND ON THE SCOPE, EXPERTISE AND RESOURCES AVAILABLE AT KEOKUK AREA HOSPITAL. KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 18D: PATIENTS FOLLOW THE HOSPITAL'S COLLECTIONS POLICY UNLESS THEY APPLY AND QUALIFY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY REQUIRES PATIENTS TO AGREE AND ADHERE TO A PAYMENT PLAN ONCE APPROVED FOR DISCOUNTED CARE. KEOKUK AREA HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL USES ITS CHARGE MASTER RATES LESS A 40% DISCOUNT. 1 1 - TRI-STATE MEDICAL GROUP 1600 MORGAN STREET KEOKUK IA 52632 PRIMARY CARE CLINIC PART I, LINE 6A: KEOKUK AREA HOSPITAL PREPARES AND SUBMITS A COMMUNITY BENEFITS REPORT TO THE IOWA HOSPITAL ASSOCIATION EACH TAX YEAR. PART I, LINE 7: THE COST REPORT METHODOLOGY WAS USED TO CALCULATE 7A THROUGH 7D. THE COMMUNITY BENEFITS REPORT WAS USED TO CALCULATE 7E THROUGH 7I. PART I, LINE 7G: REPRESENTS THE SUBSIDY TO TRI-STATE MEDICAL GROUP, INC. TO COVER UNCOMPENSATED HEALTHCARE COSTS. PART I, LN 7 COL(F): BAD DEBT WAS NOT INCLUDED IN FORM 990 PART IX LINE 25 BUT RECORDED AS AN OFFSET TO GROSS REVENUE. IT WAS ALSO NOT INCLUDED IN THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. PART II, COMMUNITY BUILDING ACTIVITIES: KEOKUK AREA HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY THROUGH INCREASED EDUCATION AND TRAINING OF HEALTHCARE RELATED ISSUES AS WELL AS PROMOTING CAREER DEVELOPMENT IN THE HEALTHCARE FIELD. PART III, LINE 4: PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT WHEN DEEMED UNCOLLECTABLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: MEDICARE PAYS KEOKUK AREA HOSPITAL SUBSTANIALLY LESS THAN REASONABLE COST WHICH REPRESENTS UNCOMPENSATED CARE JUST LIKE PROVIDED TO INDIGENT PATIENTS WHO CANNOT PAY FOR THEIR SERVICES. THE COST OF THIS CARE IS CALCULATED PER MEDICARE COST REPORT METHODOLOGY. PART III, LINE 9B: IF INFORMATION IS AVAILABLE TO CONFIRM ELIGIBILITY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS NOT PURSUED. PART VI, LINE 2: KEOKUK AREA HOSPITAL PARTICIPATES WITH MANY HEALTH RELATED ORGANIZATIONS TO ASSESS HEALTHCARE NEEDS IN LEE COUNTY, IOWA AND SHARES THE RESULTS IN A WRITTEN COMMUNITY HEALTH NEEDS ASSESSMENT WHICH IS AVAILABLE ON THE WEBSITE OR BY REQUEST. PART VI, LINE 3: PATIENT STATEMENTS INCLUDE A WRITTEN NOTICE TO PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND ENCOURAGES THEM TO EITHER CALL OR VISIT THE BUSINESS OFFICE FOR FURTHER INFORMATION. FINANCIAL ASSISTANCE IS ALSO DISCUSSED WITH ALL PRIVATE PAY PATIENTS DURING REGISTRATION AND SIGNS ARE POSTED BY THE BUSINESS OFFICE AND OUTPATIENT REGISTRATION AREAS. PART VI, LINE 4: KEOKUK AREA HOSPITAL MAINLY SERVES THE COMMUNITIES OF SOUTHERN LEE COUNTY IN IOWA, WESTERN HANCOCK COUNTY IN ILLINOIS, AND NORTHERN CLARK COUNTY IN MISSOURI. PART VI, LINE 5: KEOKUK AREA HOSPITAL HAS AN ALL VOLUNTEER BOARD OF DIRECTORS MADE UP OF LOCAL COMMUNITY MEMBERS WHO SERVE WITHOUT COMPENSATION. THE MEDICAL STAFF IS OPEN TO ALL INTERESTED PROVIDERS WHO ARE APPROPRIATELY CREDENTIALED. ALL FUNDS GENERATED BY THE HOSPITAL ARE UTILIZED FOR PATIENT RELATED SERVICES AND TO ENSURE THAT ALL PATIENTS IN THE MARKET HAVE ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. PART VI, LINE 6: KEOKUK AREA HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES. TRI-STATE MEDICAL GROUP PROVIDES PRIMARY CARE, PROMPT CARE, OCCUPATIONAL HEALTH AND SPECIALTY CARE SERVICES. KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY SELLS AND DELIVERS DURABLE MEDICAL EQUIPMENT WITHIN A 75 MILE RADIUS. ALL ENTITIES ARE IN CLOSE PROXIMITY TO ONE ANOTHER AND WORK TOGETHER TO REDUCE LENGTH OF STAY IN THE HOSPITAL AND ENSURE CONTINUITY OF CARE FROM ONE LEVEL TO ANOTHER. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X X 0 0 0 0 0 0 0 0 0 JAGADAMBA KANTANMENI ANESTHESIOLOGIST 307027 0 0 0 0 0 0 0 1349 0 308376 0 0 0 PART I, LINE 3 CEO/EXECUTIVE SALARY IS APPROVED BY THE BOARD OF DIRECTORS AFTER REVIEW BY EXECUTIVE COMMITTEE USING VARIOUS BENCHMARK DATA, INCLUDING 990 DATA OF SIMILAR HOSPITALS, IOWA HOSPITAL ASSOCIATION SALARY SURVEYS AND EXPERIENCE LEVEL OF CANDIDATE. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES TO FITCH HEALTHCARE. FORM 990, PART VI, SECTION A, LINE 6 KEOKUK HEALTH SYSTEMS INC., A TAX-EXEMPT IOWA NONPROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A KEOKUK HEALTH SYSTEMS INC.'S BOARD OF DIRECTORS, KEOKUK AREA HOSPITAL FOUNDATION'S CURRENT PRESIDENT AND KEOKUK AREA HOSPITAL'S CURRENT CHIEF OF STAFF HAVE SEATS ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B KEOKUK HEALTH SYSTEMS INC. IS THE PARENT COMPANY OF KEOKUK AREA HOSPITAL AND SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE 990 IS REVIEWED BY TOP MANAGEMENT AND DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND EMPLOYEES ATTEST IN WRITING ANNUALLY THAT THEY HAVE DISCLOSED ANY POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEWS ALL COMPENSATION ARRANGEMENTS WITH HIGHLY PAID EMPLOYEES UTILIZING BENCHMARK DATA FROM VARIOUS SOURCES INCLUDING THE IOWA HOSPITAL ASSOCIATION WAGE AND SALARY SURVEYS AND PHYSICIAN COMPENSATION SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATIONAL DOCUMENTS ARE AVAILABLE UPON REQUEST AND THE 990 IS PUBLISHED ON WWW.GUIDESTAR.COM KEOKUK AREA HOSPITAL FOUNDATION 1600 MORGAN STREET KEOKUK IA 52632 421202608 CHARITABLE FUNDRAISING IA 501(C)(3) 509(A)(3), TYPE II KEOKUK HEALTH SYSTEMS INC 0 KEOKUK HEALTH SYSTEMS INC 1600 MORGAN STREET KEOKUK IA 52632 421237361 SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II 0 TRI-STATE MEDICAL GROUP INC 1600 MORGAN STREET KEOKUK IA 52632 421435525 MEDICAL OFFICES IA 501(C)(3) 170(B)(1) (A)(III) KEOKUK HEALTH SYSTEMS INC 0 KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY INC 1600 MORGAN STREET KEOKUK IA 52632 421237312 DME SALES AND RENTALS IA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 KEOKUK AREA MEDICAL EQUIPMENT INC S 4400 BASED ON GAAP, CASH AND/OR FMV. TRI-STATE MEDICAL GROUP INC R 772424 BASED ON GAAP, CASH AND/OR FMV.