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STEWART MEMORIAL COMMUNITY HOSPITAL: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
STEWART MEMORIAL COMMUNITY HOSPITAL (EIN 42-0860039)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-15
IRS object ID
201633209349302573
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-15T08:53:31-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN476097913PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SEIM JOHNSON LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT STREET SUITE 200AddressLine1Txt
CityOMAHACityNm
State AbbreviationNEStateAbbreviationCd
ZIP680224722ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN420860039EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STEWART MEMORIAL COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTEWBusinessNameControlTxt
Phone7124644200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 W MAINAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51449ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJIM HENKENIUSPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone7124644200PhoneNum
Signature2016-11-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWENDY R COOLEYPreparerPersonNm
PTINP01523804PTIN
Phone4023302660PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJIM HENKENIUSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 W MAINAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51449ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$30,984,135GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.STEWARTMEMORIAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1958FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionTO 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.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee295TotalEmployeeCnt
Total Volunteers125TotalVolunteersCnt
Total Gross UBI$5,080,328TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$917,433NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$53,713PYContributionsGrantsAmt
CY Contributions Grants$60,066CYContributionsGrantsAmt
PY Program Service Revenue$30,466,632PYProgramServiceRevenueAmt
CY Program Service Revenue$30,419,535CYProgramServiceRevenueAmt
PY Investment Income$459,202PYInvestmentIncomeAmt
CY Investment Income$117,522CYInvestmentIncomeAmt
PY Other Revenue$266,790PYOtherRevenueAmt
CY Other Revenue$271,496CYOtherRevenueAmt
PY Total Revenue$31,246,337PYTotalRevenueAmt
CY Total Revenue$30,868,619CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$15,352,287PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$15,615,339CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$16,534,276PYOtherExpensesAmt
CY Other Expenses$16,237,622CYOtherExpensesAmt
PY Total Expenses$31,886,563PYTotalExpensesAmt
CY Total Expenses$31,852,961CYTotalExpensesAmt
PY Revenues Less Expenses-$640,226PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$984,342CYRevenuesLessExpensesAmt
Total Assets BOY$18,021,265TotalAssetsBOYAmt
Total Assets EOY$16,694,795TotalAssetsEOYAmt
Total Liabilities BOY$8,332,082TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,117,476TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$9,689,183NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,577,319NetAssetsOrFundBalancesEOYAmt
MissionSTEWART MEMORIAL COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTHCARE WITH A PERSONAL TOUCH AND RESPONDING TO THE NEEDS OF THE COMMUNITIES AND PEOPLE WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$28,837,945ExpenseAmt
Revenue$25,339,207RevenueAmt
DescSTEWART MEMORIAL COMMUNITY HOSPITAL (SMCH) IS A COMPLETE RURAL HEALTH DELIVERY SYSTEM LOCATED IN LAKE CITY, IOWA. SERVICES PROVIDED INCLUDE INPATIENT, OUTPATIENT, PHYSICIAN CLINIC, HOMECARE, RETAIL PHARMACY, COMMUNITY WELLNESS, AND MANY OTHER RELATED HEALTHCARE PROGRAMS. SMCH IS ALSO AN APPROVED CRITICAL ACCESS HOSPITAL THAT PROVIDES EMERGENCY, OUTPATIENT AND SHORT-TERM INPATIENT SERVICES.Desc
Total Program Service Expenses$28,837,945TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document30IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee295EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JIM HENKENIUS CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7124644200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 W MAIN STREETAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51449ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
CHADRIC DIETRICH
BOARD CHAIR2.000.00Yes (X)Yes (X)$0$0$0
BRADLEY LANE
VICE CHAIR2.000.00Yes (X)Yes (X)$0$0$0
HEATHER MCCLUE
SECRETARY2.000.00Yes (X)Yes (X)$0$0$0
SCOTT NESBITT
TREASURER2.000.00Yes (X)Yes (X)$0$0$0
DEBRA LIGHTNER
DIRECTOR1.000.00Yes (X)$0$0$0
MARY WARNER
DIRECTOR1.000.00Yes (X)$0$0$0
LINDA BETTIN
DIRECTOR1.000.00Yes (X)$0$0$0
CHARLES SCHMITT
DIRECTOR1.000.00Yes (X)$0$0$0
DR ADAM SWISHER
MEDICAL COUNSEL40.000.00Yes (X)$397,648$0$30,781
HEATHER CAIN
CEO40.000.00Yes (X)$0$0$0
JIM HENKENIUS
CFO40.000.00Yes (X)$135,613$0$29,663
DEREK DUNCAN
D.O.40.000.00$668,162$0$27,104Yes (X)
DR DAVID FRATE
D.O.40.000.00$334,032$0$14,856Yes (X)
SUSAN HORNBACK
D.O.40.000.00$608,770$0$26,157Yes (X)
DANNIELE ANDERSON
PA40.000.00$315,208$0$25,427Yes (X)
MARK MORGENSEN
PA40.000.00$287,386$0$27,426Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,746,819TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$181,414TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K21IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
WESTERN IOWA SURGERY
311 S CLARK STREET SUITE 280CARROLLIA51401GENERAL SURGERY SERVICES$173,475
RTG MEDICAL
1005 E 23RD STREETFREMONTNE68025CONTRACTED NURSING SERVICES$153,103
LOCUM TENENSCOM LLC
PO BOX 405547ATLANTAGA30384ER PHYSICIAN LOCUM TENENS$152,398
HEALTHNET CONNECT
1776 WEST LAKES PARKWAY SUITE 400W DES MOINESIA50266IT CONTRACTED SERVICES$141,735
DES MOINES ORTHOPAEDIC SURGEONS
6001 WESTOWN PARKWAYW DES MOINESIA50266ORTHOPAEDIC SURGERY SERVICES$126,800
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Fundraising$41,048FundraisingAmt
All Other Contributions$19,018AllOtherContributionsAmt
Total Contributions$60,066TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
MEDICARE/MEDICAID REVENUE621400$13,241,486$13,241,486
PATIENT SERVICE REVENUE621400$9,788,824$9,788,824
RETAIL PHARMACY REVENUE446110$5,080,328$5,080,328
340B PROGRAM REVENUE621400$2,174,842$2,174,842

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$134,055TotalRevenueColumnAmt
Related Or Exempt Func Income$134,055RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$30,419,535TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$70,519TotalRevenueColumnAmt
Exclusion$70,519ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$98,820RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$23,989RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$74,831RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$74,831TotalRevenueColumnAmt
Exclusion$74,831ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$118,370SecuritiesAmt
Other$12,700OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$84,067SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$34,303SecuritiesAmt
Other$12,700OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$47,003TotalRevenueColumnAmt
Exclusion$47,003ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$4,685FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$41,048ContriRptFundraisingEventAmt
Fundraising Direct Expenses$7,460FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,775TotalRevenueColumnAmt
Exclusion-$2,775ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCAFETERIA SALESDesc
Business900099BusinessCd
Total Revenue Column$199,440TotalRevenueColumnAmt
Exclusion$199,440ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$199,440OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$30,868,619TotalRevenueColumnAmt
Related Or Exempt Func Income$25,339,207RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$5,080,328UnrelatedBusinessRevenueAmt
Exclusion$389,018ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$593,705TotalAmt
Program Services$428,429ProgramServicesAmt
Management And General$165,276ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,821,208TotalAmt
Program Services$10,755,635ProgramServicesAmt
Management And General$1,065,573ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$176,019TotalAmt
Program Services$162,104ProgramServicesAmt
Management And General$13,915ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,277,813TotalAmt
Program Services$2,009,405ProgramServicesAmt
Management And General$268,408ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$746,594TotalAmt
Program Services$674,311ProgramServicesAmt
Management And General$72,283ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$390,333TotalAmt
Management And General$390,333ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$16,817TotalAmt
Management And General$16,817ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$78,165TotalAmt
Management And General$78,165ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$18,559TotalAmt
Management And General$18,559ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,809,605TotalAmt
Program Services$2,597,257ProgramServicesAmt
Management And General$212,348ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$154,542TotalAmt
Program Services$104,254ProgramServicesAmt
Management And General$50,288ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,017,999TotalAmt
Program Services$895,404ProgramServicesAmt
Management And General$122,595ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$185,119TotalAmt
Management And General$185,119ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$335,695TotalAmt
Program Services$335,695ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$241,037TotalAmt
Program Services$137,849ProgramServicesAmt
Management And General$103,188ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$160,475TotalAmt
Program Services$160,475ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,415,400TotalAmt
Program Services$1,284,295ProgramServicesAmt
Management And General$131,105ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$162,161TotalAmt
Program Services$162,161ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
RETAIL PHARMACY EXPENSE$5,093,113$5,093,113
MEDICAL SUPPLIES$3,124,323$3,124,323
BAD DEBT$620,147$620,147
FOOD$191,224$191,224

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$222,908TotalAmt
Program Services$101,864ProgramServicesAmt
Management And General$121,044ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$31,852,961TotalAmt
Program Services$28,837,945ProgramServicesAmt
Management And General$3,015,016ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$72,585BOYAmt
EOY$346,198EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,153,669BOYAmt
EOY$1,163,427EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,947,596BOYAmt
EOY$3,050,093EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$43,093BOYAmt
EOY$68,380EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,496,427BOYAmt
EOY$1,480,950EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$80,038BOYAmt
EOY$35,573EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$29,946,197LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$21,461,991LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$8,484,469BOYAmt
EOY$8,484,206EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,069,922BOYAmt
EOY$1,894,771EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$673,466BOYAmt
EOY$171,197EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$18,021,265BOYAmt
EOY$16,694,795EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,637,274BOYAmt
EOY$3,118,768EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,765,000BOYAmt
EOY$2,425,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,929,808BOYAmt
EOY$2,339,814EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$233,894EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,332,082BOYAmt
EOY$8,117,476EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$9,689,183BOYAmt
EOY$8,577,319EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,689,183BOYAmt
EOY$8,577,319EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$18,021,265BOYAmt
EOY$16,694,795EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$984,342ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$127,522NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$171,513OtherCostOrOtherBasisAmt
Book Value$171,513BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,953,917OtherCostOrOtherBasisAmt
Depreciation$4,543,545DepreciationAmt
Book Value$1,410,372BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,523,010OtherCostOrOtherBasisAmt
Depreciation$16,001,302DepreciationAmt
Book Value$5,521,708BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,297,757OtherCostOrOtherBasisAmt
Depreciation$917,144DepreciationAmt
Book Value$1,380,613BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,484,206TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescESTIMATED THIRD-PARTY SETTLEMENTSDesc
Amt$233,894Amt
FieldValueIRS element (for citing)
Total Liability$233,894TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$30,152,399TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$127,522NetUnrealizedGainsInvstAmt
Other Revenue$31,449OtherRevenueAmt
Revenue Not Reported-$96,073RevenueNotReportedAmt
Revenue Subtotal$30,248,472RevenueSubtotalAmt
Other Revenues Not Included$620,147OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$620,147RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$30,868,619TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$31,264,263TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$31,449OtherExpensesIncludedAmt
Expenses Not Reported$31,449ExpensesNotReportedAmt
Expenses Subtotal$31,232,814ExpensesSubtotalAmt
Other Expenses Not Included$620,147OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$620,147ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$31,852,961TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND HAS RECEIVED A DETERMINATION LETTER THAT IT IS 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 HOSPITAL'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN 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, 2015 AND 2014, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 23,989. FUNDRASING EXPENSES 7,460.
PART XI, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR UNCOLLECTIBLE ACCOUNTS 620,147.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 23,989. FUNDRAISING EXPENSE 7,460.
PART XII, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR UNCOLLECTIBLE ACCOUNTS 620,147.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1TABLE A FAREEvent1Nm
Gross Receipts Event1$5,178GrossReceiptsEvent1Amt
Charitable Contri Event1$5,178CharitableContriEvent1Amt
Food And Beverage Event1$609FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$72OtherDirectExpensesEvent1Amt
Event2TRIVIA NIGHTEvent2Nm
Gross Receipts Event2$40,555GrossReceiptsEvent2Amt
Charitable Contri Event2$35,870CharitableContriEvent2Amt
Gross Revenue Event2$4,685GrossRevenueEvent2Amt
Cash Prizes Event2$226CashPrizesEvent2Amt
Rent Facility Costs Event2$50RentFacilityCostsEvent2Amt
Food And Beverage Event2$3,249FoodAndBeverageEvent2Amt
Entertainment Event2$400EntertainmentEvent2Amt
Other Direct Expenses Event2$2,854OtherDirectExpensesEvent2Amt
Gross Receipts Total$45,733GrossReceiptsTotalAmt
Charitable Contributions Tot$41,048CharitableContributionsTotAmt
Gross Revenue Total Events$4,685GrossRevenueTotalEventsAmt
Cash Prizes Total Events$226CashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$50RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$3,858FoodAndBeverageTotalEventsAmt
Entertainment Total Events$400EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$2,926OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$7,460DirectExpenseSummaryEventsAmt
Net Income Summary-$2,775NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other100.000000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically Indigent0FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served151PersonsServedCnt
Total Community Benefit Expns$63,658TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$63,658NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,612,854TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,958,130DirectOffsettingRevenueAmt
Net Community Benefit Expns$654,724NetCommunityBenefitExpnsAmt
Total Expense0.02100TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served151PersonsServedCnt
Total Community Benefit Expns$3,676,512TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,958,130DirectOffsettingRevenueAmt
Net Community Benefit Expns$718,382NetCommunityBenefitExpnsAmt
Total Expense0.02300TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs12ActivitiesOrProgramsCnt
Persons Served7394PersonsServedCnt
Total Community Benefit Expns$148,530TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$37,750DirectOffsettingRevenueAmt
Net Community Benefit Expns$110,780NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Persons Served16PersonsServedCnt
Total Community Benefit Expns$25,403TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$25,403NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs4ActivitiesOrProgramsCnt
Persons Served285PersonsServedCnt
Total Community Benefit Expns$21,736TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$21,736NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs19ActivitiesOrProgramsCnt
Persons Served7695PersonsServedCnt
Total Community Benefit Expns$195,669TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$37,750DirectOffsettingRevenueAmt
Net Community Benefit Expns$157,919NetCommunityBenefitExpnsAmt
Total Expense0.00500TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs19ActivitiesOrProgramsCnt
Persons Served7846PersonsServedCnt
Total Community Benefit Expns$3,872,181TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,995,880DirectOffsettingRevenueAmt
Net Community Benefit Expns$876,301NetCommunityBenefitExpnsAmt
Total Expense0.02800TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$918TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$918NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$1,655TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,655NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served360PersonsServedCnt
Total Community Benefit Expns$625TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$625NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Persons Served360PersonsServedCnt
Total Community Benefit Expns$3,198TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,198NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$620,147BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$9,758,232ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,036,402CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$278,170MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn0FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STEWART MEMORIAL COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 WEST MAIN STREETAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationIAStateAbbreviationCd
ZIP51449ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.STEWARTMEMORIAL.ORGWebsiteAddressTxt
State License130029HStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1STEWART MEMORIAL COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.STEWARTMEMORIAL.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care100.000000000000FPGFamilyIncmLmtDscntCarePct
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.STEWARTMEMORIAL.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.STEWARTMEMORIAL.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.STEWARTMEMORIAL.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
STEWART MEMORIAL COMMUNITY HOSPITALPART V, SECTION B, LINE 5: STEWART MEMORIAL COMMUNITY HOSPITAL (SMCH) CREATED A COMMUNITY NEEDS ASSESSMENT SURVEY. THE SURVEY 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. A COMMUNITY FORUM WAS HELD TO DISCUSS THE RESULTS OF THE ASSESSMENT AND TO DEVELOP A PLAN TO ADDRESS THE PRIORITIES IDENTIFIED. THOSE INVITED INCLUDED MEMBERS OF THE HOSPITAL, CALHOUN COUNTY PUBLIC HEALTH, OTHER HEALTH CARE PROVIDERS INCLUDING NURSING HOMES, OPTOMETRIST, DENTISTS AND ICF/ID PROVIDER, INSURANCE AGENTS, SCHOOL REPRESENTATIVES AND COMMUNITY MEMBERS.
STEWART MEMORIAL COMMUNITY HOSPITALPART V, SECTION B, LINE 11: THERE WERE 6 PRIORITY AREAS IDENTIFIED IN THE ASSESSMENT - 1) PROMOTE HEALTHY LIVING; 2) PREVENT INJURIES & VIOLENCE; 3) PROTECT AGAINST ENVIRONMENTAL HAZARDS; 4) PREVENT EPIDEMICS & THE SPREAD OF DISEASE; 5) PREPARE FOR, RESPOND TO, & RECOVER FROM PUBLIC HEALTH EMERGENCIES; 6) STRENGTHEN THE HEALTH INFRASTRUCTURE. THE 1ST PRIORITY, PROMOTE HEALTHY LIVING HAS 3 PRIORITIES OF ITS OWN AND 3 GOALS. THE PRIORITIES ARE CHRONIC DISEASE PREVENTION & SCREENING, ADDICTIVE BEHAVIORS IN ADULTS AND ADDICTIVE BEHAVIORS IN CHILDREN. THE GOALS ARE 1) REDUCE THE NUMBER OF NEWLY DIAGNOSED CASES OF DIABETES IN THE POPULATION; 2) REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO PRODUCTS AND SECOND-HAND SMOKE EXPOSURE; 3) REDUCE ALCOHOL ABUSE TO PROTECT THE HEALTH, SAFETY AND QUALITY OF LIFE FOR ALL, ESPECIALLY CHILDREN. THE 2ND PRIORITY, PREVENT INJURIES & VIOLENCE HAS 4 PRIORITIES LISTED IN THE CHNA. THE PRIORITIES ARE 1) UNINTENTIONAL INJURY RATES FOR ADULTS; 2) UNINTENTIONAL INJURY RATES FOR CHILDREN; 3) CHILD ABUSE & NEGLECT RATES; 4) BULLYING. THE GOAL IS TO PREVENT UNINTENTIONAL INJURIES, DEATHS AND VIOLENCE AND REDUCE THEIR CONSEQUENCES. THE 1ST OBJECTIVE IS TO REDUCE MOTOR VEHICLE CRASH DEATHS WITH ALCOHOL INVOLVEMENT, THE 2ND OBJECTIVE IS TO DECREASE THE LOCAL INJURY RATE, THE 3RD OBJECTIVE IS TO REDUCE CONFIRMED OR FOUNDED EVENTS OF CHILD ABUSE AND NEGLECT AND THE 4TH OBJECTIVE IS TO REDUCE THE PERCENT OF 6TH - 11TH GRADE STUDENTS WHO REPORT BEING BULLIED. THE 3RD PRIORITY, PROTECT AGAINST ENVIRONMENTAL HAZARDS HAS 3 PRIORITIES AND 2 GOALS UNDER IT. THE FIRST IS A HEALTHY LIVING ENVIRONMENT, 2ND IS SURFACE & GROUND WATER QUALITY AND 3RD IS FOOD SAFETY & HAZARDOUS WASTE DISPOSAL. THE GOALS ARE SAFE AND HEALTHY HOUSING FOR ALL AND SURFACE & GROUND WATER QUALITY. THE 4TH PRIORITY, PREVENT EPIDEMICS & THE SPREAD OF DISEASE HAS 2 MAIN PRIORITIES LISTED UNDER IT - 1) IMMUNIZATION RATES; 2) INFECTIOUS DISEASE. THE FIRST GOAL FOR IMMUNIZATION RATES IS TO ACHIEVE IMMUNIZATION COVERAGE FOR ALL UNIVERSALLY RECOMMENDED VACCINES BY INCREASING THE RECOMMENDED VACCINE LEVELS FOR CHILDREN AND ADULTS. THE SECOND GOAL IS TO REDUCE THE OUTBREAK RATES OF PREVENTABLE INFECTIOUS DISEASES. THE 2 OBJECTIVES ARE TO 1)DECREASE THE PROPORTION OF SEXUALLY ACTIVE PERSONS 24 YEARS AND YOUNGER DIAGNOSED WITH GENITAL CHLAMYDIA & GONORRHEA AND 2) REDUCE THE NUMBER OF IDSS CASES OF FOOD AND WATERBORNE DISEASES. THE 5TH PRIORITY, PREPARE FOR, RESPOND TO, & RECOVER FROM PUBLIC HEALTH EMERGENCIES IS BEING ADDRESSED UNDER 3 PRIORITIES - 1) HUMAN RESOURCE CAPACITY; 2) PLANNING; 3) TECHNICAL & COMMUNICATION CAPACITY. THE GOAL IS TO SUPPORT A SYSTEM OF PUBLIC & PRIVATE PARTNERS THAT PREPARE FOR, RESPOND TO AND RECOVER FROM EVENTS THAT EXCEED INDIVIDUAL CAPACITIES. THE OBJECTIVE IS TO MAINTAIN CURRENT RECORDS OF COMPLETED CERTIFICATES OF BASIC INCIDENT COMMAND SYSTEM TRAINING REQUIREMENTS. THE LAST AND 6TH PRIORITY, STRENGTHEN THE HEALTH INFRASTRUCTURE, HAS 3 PRIORITIES OF ITS OWN. THE 1ST PRIORITY IS ACCESS TO QUALITY HEALTH SERVICES AND SUPPORT, THE 2ND IS ACCREDITATION AND STANDARDIZATION OF HEALTH PROGRAMS & SERVICES AND THE 3RD IS POVERTY. 4 GOALS HAVE BEEN DEVELOPED UNDER THESE PRIORITIES AND THEY AS FOLLOWS - 1) IMPROVE ACCESS TO QUALITY HEALTH SERVICES AND SUPPORT. THE OBJECT IS TO REDUCE THE NUMBER OF PERSONS WHO ARE UNABLE TO OBTAIN OR DELAY OBTAINING NECESSARY MEDICAL CARE. GOAL 2 IS TO EXPAND DEVELOPMENT OF PATIENT-CENTERED MEDICAL HOME CONCEPT FOR ALL AGES WITH 3 OBJECTIVES - 1) INCREASE THE PROPORTION OF CHILDREN & YOUTH WHO HAVE A SPECIFIC SOURCE OF ON-GOING CARE THAT FOLLOWS MEDICAID EARLY & PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) RECOMMENDATIONS; 2) INCREASE THE PROPORTION OF ADULTS WHO HAVE A SPECIFIC SOURCE OF ON-GOING CARE THAT FOLLOWS THE COMMUNITY GUIDE/HEALTH INSURANCE COVERAGE WELLNESS SCREENING RECOMMENDATIONS; 3) INCREASE THE PROPORTION OF ADULTS WHO HAVE A SPECIFIC SOURCE OF ON-GOING CARE THAT FOLLOWS MEDICARE WELLNESS SCREENING RECOMMENDATIONS. THE 3RD GOAL IS TO ACHIEVE ACCREDITATION-LEVELS, STANDARDS DEVELOPMENT OR STRATEGIC PLANNING FOR PROGRAMS & SERVICES BY PURSUING PUBLIC HEALTH ACCREDITATION BOARD QUALITY INDICATORS FOR DOMAIN STANDARDS & PERFORMANCE MEASURES. THE LAST GOAL IS COMMUNITY-WIDE AWARENESS OF EMERGING STRATEGIES TO ADDRESS SOCIAL DETERMINANTS OF HEALTH THAT KEEP PEOPLE IN POVERTY. WE WILL ORGANIZE A COUNTY AND/OR REGIONAL "COALITION" DEDICATED TO COMPREHENSIVE STRATEGIES THAT WILL INCREASE UNDERSTANDING OF COLLABORATIVE ACTION TO ADDRESS INEQUITABLE SOCIAL DETERMINANTS OF HEALTH. THERE WAS 1 PRIORITY IDENTIFIED THAT WAS NOT ADDRESSED AND THAT WAS FOOD SAFETY AND HAZARDOUS WASTE DISPOSAL. AN EXISTING PROGRAM ALREADY EXISTS TO ADDRESS THE PROBLEM. BUENA VISTA COUNTY ASSUMED ALL FOOD INSPECTIONS FOR CALHOUN COUNTY IN 2015. CALHOUN COUNTY EH MAINTAINS A HOUSEHOLD HAZARDOUS WASTE SITE IN COLLABORATION WITH METRO WASTE AUTHORITY.
STEWART MEMORIAL COMMUNITY HOSPITALPART 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. THE NEW 501(R) REGULATIONS AND POLICIES THAT TAKE EFFECT JANUARY 1, 2016 WILL BE MADE AVAILABLE TO EVERY PATIENT AND ALSO MADE AVAILABLE ON OUR WEBSITE.
STEWART MEMORIAL COMMUNITY HOSPITALPART V, SECTION B, LINE 22D: IT IS THE POLICY OF THE HOSPITAL TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE PROGRAM AFTER CARE IS ADMINISTERED.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - MCCRARY-ROST CLINIC
1351 WEST MAIN STREETLAKE CITYIA51449HEALTH CLINIC
2 - GOWRIE CLINIC
1800 MAINGOWRIEIA50543HEALTH CLINIC
3 - LAKE VIEW CLINIC
1160 3RD STREETLAKE VIEWIA51540HEALTH CLINIC
4 - ROCKWELL CITY CLINIC
505 EAST LAKE STREETROCKWELL CITYIA50579HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:NOT APPLICABLE
PART I, LINE 6A:STEWART MEMORIAL COMMUNTIY HOSPITAL'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION.
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 I, LINE 7G:THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G.
PART I, LN 7 COL(F):THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $620,147.
PART II, COMMUNITY BUILDING ACTIVITIES: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 COO 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.
PART III, LINE 2:IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR 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 HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND ESTIMATES A PERCENTAGE OF THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON HISTORICAL ANALYSIS. THE ESTIMATED PERCENTAGE OF THOSE TRANSITION ACCOUNTS ARE ADDED TO 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 HOSPITAL 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 4:THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8 AND 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE, AND "CHARITY CARE."
PART III, LINE 8:NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. THE 2015 FILED MEDICARE COST REPORT WAS USED TO DETERMINE THE ALLOWABLE COSTS.
PART III, LINE 9B:COLLECTION POLICY:PATIENTS ARE ADMITTED INTO THE HOSPITAL COMPUTER SYSTEM WITH APPROPRIATE FINANCIAL INFORMATION INCLUDING INSURANCE INFORMATION AND ARE ASSIGNED A FINANCIAL CLASS (F/C) USED TO SEGREGATE ACCOUNTS IN ACCOUNTS RECEIVABLE (A/R) BY PAYER TYPE. PATIENTS WHO ARE MINORS ARE ADMITTED WITH THE PARENT WHO CARRIES THE INSURANCE COVERAGE AS THE RESPONSIBLE PARTY OR IF NO INSURANCE, THE PARENT WHO BROUGHT THE CHILD IN FOR CARE IS LISTED AS GUARANTOR.THE BUSINESS OFFICE WILL SEND AN ITEMIZED STATEMENT OF CHARGES TO ALL PATIENTS WHO REQUEST A COPY. INSURANCE COMPANIES ARE BILLED ELECTRONICALLY THROUGH THE USE OF EMDEON SOFTWARE WHENEVER POSSIBLE. ONCE THE INSURANCE COMPANY HAS PROCESSED THE CLAIM AND PAID ITS ENTIRE SHARE OR IF THE PATIENT DOESN'T HAVE INSURANCE, THEY WILL BE ASSIGNED A FINANCIAL CLASS OF SELF-PAY. SMCH ALLOWS PATIENTS TO SET UP PAYMENT ARRANGEMENTS FOLLOWING THIS SCHEDULE USING CHECK, MONEY ORDER, MASTERCARD OR VISA:BALANCE IS: MINIMUM PAYMENT:UNDER $250 $ 25.00 $251-$500 $ 50.00$501-$1000 $ 100.00$1001 - ABOVE $ 150.00THESE LIMITS ARE SET TO INSURE BALANCES ARE PAID IN FULL WITH 18 MONTHS IF AT ALL POSSIBLE. WHEN THE PATIENT IS ASSIGNED A FINANCIAL CLASS OF P, THE ACCOUNT IS SENT TO MED-PLAN FOR EARLY OUT PRE-COLLECT PROCESSING. THE FIRST STATEMENT FROM MED-PLAN IS MAILED OUT ON DAY 1 WHEN THEY RECEIVE THE ACCOUNT AND THEN AGAIN AT 30 DAYS. ACCOUNTS THAT DO NOT MAKE PAYMENT ARRANGEMENTS OR MAKE PAYMENTS FROM THE LETTER CAMPAIGN AFTER 45 DAYS ARE MOVED INTO A TELEPHONE CAMPAIGN. THE TELEPHONE CAMPAIGN MAKES 3 ATTEMPTS OVER 15 DAYS TO SECURE PAYMENT IN FULL OR A SCHEDULED PAYMENT PLAN. IF RESOLUTION ATTEMPTS FAIL AND MED-PLAN IS UNABLE TO RESOLVE AN ACCOUNT BECAUSE (1) IT IS IMPOSSIBLE TO REACH A PATIENT BY TELEPHONE, OR (2) THE PATIENT HAS FAILED TO COOPERATE IN ESTABLISHING A PAYMENT PLAN, OR (3) THE PATIENT HAS FAILED TO HONOR AN ESTABLISHED PLAN BY NOT MAKING SATISFACTORY PAYMENT WITHIN 60-90 DAYS, A FINAL NOTICE WILL BE SENT TO THE PATIENT. ACCOUNTS UNPAID OR ARRANGEMENTS NOT MADE AT THIS POINT IN THE BILLING PROCESS ARE DETERMINED UNCOLLECTIBLE. IF NO PAYMENT IN ALLOWABLE TIME IS RECEIVED, ACCOUNTS ARE ELECTRONICALLY SENT TO A COLLECTION AGENCY. IN THE EVENT OF PARTIAL PAYMENT, A DETERMINATION ON AN INDIVIDUAL BASIS IS MADE AS TO STOP OR PROCEED WITH THE COLLECTION AGENCY.
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 THAT 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: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 BOARD OF DIRECTORS ARE REPRESENTED BY THE VARIOUS COMMUNITIES THEY SERVE.
PART VI, LINE 6:THE HOSPITAL HAS 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 VI, LINE 7, REPORTS FILED WITH STATESIA

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR ADAM SWISHER
MEDICAL COUNSEL$385,186$0$12,318$0$144$0$7,077$0$23,704$0$428,429$0$0$0
JIM HENKENIUS
CFO$135,460$0$0$0$153$0$4,305$0$25,358$0$165,276$0$0$0
DEREK DUNCAN
D.O.$517,982$0$150,000$0$180$0$5,220$0$21,884$0$695,266$0$0$0
DR DAVID FRATE
D.O.$286,264$0$47,663$0$105$0$4,403$0$10,453$0$348,888$0$0$0
SUSAN HORNBACK
D.O.$518,500$0$90,000$0$270$0$7,063$0$19,094$0$634,927$0$0$0
DANNIELE ANDERSON
PA$305,161$0$0$0$10,047$0$7,525$0$17,902$0$340,635$0$0$0
MARK MORGENSEN
PA$277,224$0$0$0$10,162$0$3,944$0$23,482$0$314,812$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, PART VII, LINE 5:FormAndLineReferenceDesc
ExplanationHEATHER CAIN, CEO, RECEIVED COMPENSATION FROM TRINITY HEALTH SYSTEMS, AN UNRELATED ENTITY, WHICH PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS. MS. CAIN RECEIVED A BASE COMPENSATION OF $156,560 FOR HER SERVICES DURING THE CALENDAR YEAR 2015. HER COMPENSATION IS REPORTED IN PART IX, LINE 11A.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF LAKE CITY IOWABusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN426004850BondIssuerEIN
CUSIP508021AQ5CUSIPNum
Bond Issued2006-02-08BondIssuedDt
Issue Price$5,000,000IssuePriceAmt
PurposeCAPITAL IMPROVEMENTSPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$2,575,000RetiredAmt
Total Proceeds$5,142,886TotalProceedsAmt
In Reserve Fund$484,047InReserveFundAmt
Capital Expenditures$4,658,839CapitalExpendituresAmt
Substantial Completion2008SubstantialCompletionYr
Current Refunding0CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To RebateYes (1)ExceptionToRebateInd
No Rebate DueYes (1)NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART II, LINE 3:THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS.
PART IV, ARBITRAGE, LINE 2C:(A) ISSUER NAME: CITY OF LAKE CITY, IA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/31/2011
PART VSTEWART MEMORIAL COMMUNITY HOSPITAL IS IN THE PROCESS OF ADOPTING VCAP PROCEDURES.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3TRINITY HEALTH SYSTEMS AND STEWART MEMORIAL COMMUNITY HOSPITAL HAVE AN AGREEMENT FOR ADMINISTRATIVE SERVICES. TRINITY HEALTH SYSTEMS PROVIDED THE SERVICES OF HEATHER CAIN, CEO SINCE 01/01/14.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CEACH 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 15ATHE 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 19THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
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.