2016-05-11T14:40:05-07:00 2015-09-30 990 2014-10-01 420710268 KEOKUK AREA HOSPITAL KEOK 3195247150 1600 MORGAN STREET KEOKUK IA 52632 Joseph Whiting Interim Chief Executive Officer 3195247150 2016-05-13 2014 2016-08-17 19:52:53Z JOSEPH WHITING 1600 MORGAN STREET KEOKUK IA 52632 19587091 0 X WWW.KEOKUKHEALTHSYSTEMS.ORG X 1975 IA IMPROVING COMMUNITY HEALTH AND ENSURING ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. 10 9 330 200 0 0 74206 110116 19961265 19197178 150446 731 1790868 279066 21976785 19587091 0 0 0 0 10504526 10103574 0 0 0 10975597 10279573 21480123 20383147 496662 -796056 13592057 12707741 12767913 12717872 824144 -10131 IMPROVING COMMUNITY HEALTH AND ENSURING ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. 0 0 19320942 0 19476975 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 serves 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. 0 0 0 19320942 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 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 1 330 1 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 ATTN Accounting 3195247150 1600 Morgan Street Keokuk IA 52632 Kiran Khanolkar MD Member, Board of Directors 3 40 X 1350 112605 5532 Walt Stephens Chairman, Board of Directors 3 1 X X 0 0 0 Kent Nixon Vice Chair, Board of Directors & Corporate Treasurer 1 1 X X 0 0 0 Wendy Swank Member, Board of Directors & Corporate Secretary 1 1 X X 0 0 0 Mike Maher Member, Board of Directors 1 1 X 0 0 0 Tom Marion Member, Board of Directors 1 1 X 0 0 0 Greg Miller Member, Board of Directors 1 1 X 0 0 0 Mike Klauser Member, Board of Directors 1 1 X 0 0 0 Ron Scott Member, Board of Directors 1 1 X 0 0 0 Neville Crenshaw DO Member, Board of Directors 1 1 X 0 0 0 Jagadamba Kantanmeni Anesthesiologist 40 0 X 307027 0 854 Elizabeth Davis Pharmacy Director 40 0 X 117412 0 10438 425789 112605 16824 2 0 1 0 Fitch Healthcare 123 W Front Street Suite 200 Wheaton IL 60187 Management Services 810316 Shared Medical Services 209 Limestone Cottage Grove WI 53527 MRI Services 198750 2 0 0 0 0 22087 88029 0 110116 Hospital Services 622000 19197178 19197178 0 0 0 0 0 0 19197178 731 731 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA/LAUNDRY/MISC 622000 211159 211159 0 0 WEIGHT LOSS PROGRAM 622000 33322 33322 0 0 EHR INCENTIVE PROGRAM 622000 34585 34585 0 0 0 0 0 0 279066 19587091 19476975 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8822079 8822079 0 0 0 0 0 0 660903 660903 0 0 620592 620592 0 0 809504 0 809504 0 97107 0 97107 0 92348 0 92348 0 60746 0 60746 0 0 0 2500 0 2500 0 2013141 2013141 0 0 47962 47962 0 0 0 0 0 239925 239925 0 0 0 0 0 0 495372 495372 0 0 40351 40351 0 0 0 0 0 0 0 0 0 0 507288 507288 0 0 0 0 0 0 1127173 1127173 0 0 115900 115900 0 0 MEDICAL SUPPLIES 3609062 3609062 0 0 REPAIRS/MINOR EQUIP/SERVICE 571789 571789 0 0 RECRUITMENT 38237 38237 0 0 IOWA PROVIDER TAX 228428 228428 0 0 182740 182740 0 0 20383147 19320942 1062205 0 1866925 1300895 813971 2310407 0 0 3909285 2695764 0 0 0 0 0 0 1078101 1039037 130000 98326 29166660 24012239 5569549 5154421 0 0 0 0 0 0 0 0 224226 108891 13592057 12707741 8360584 5182960 0 0 0 0 2662067 2646461 0 0 0 0 0 3989085 0 0 1745262 899366 12767913 12717872 X 766127 -885166 58017 875035 0 0 824144 -10131 13592057 12707741 X -796056 0 0 0 0 -38219 X 0 1 X 1 0 X 0 0 0 0 0 0 1 51468 0 1 9278 60746 0 Schedule C, Part II-B, Line 1 KEOKUK AREA HOSPITAL CONTRACTED WITH FIRMS PRIMARILY TO PROVIDE LOBBYING ACTIVITIES IN SUPPORT OF THE REACH ACT WHICH WAS INTRODUCED BY SENATOR GRASSLEY AND CO-SPONSORED BY SENATOR ERNST. 438675 0 438675 17134540 0 14336669 2797871 0 0 0 0 10996902 0 9207851 1789051 596543 0 467719 128824 5154421 0 CAPITAL LEASE OBLIGATIONS 786577 NOTES PAYABLE 112789 899366 19476244 0 0 0 0 0 19476244 0 110847 110847 19587091 20383147 0 0 0 0 0 20383147 0 0 0 20383147 Schedule D, Part XI, Line 4b INTEREST AND DIVIDEND INCOME ($731); UNRESTRICTED DONATIONS ($88,029); AND GRANT INCOME ($22,087). 1 1 1 X 1 X 1 1 0 1 1 285642 0 285642 0.13 241153 0 241153 0.11 46286 0 46286 0.02 0 0 573081 0 573081 0.26 25678 0 25678 0.01 43170 0 43170 0.02 1528586 0 1528586 0.71 0 0 0 0 10485 0 10485 0 0 0 1607919 0 1607919 0.74 0 0 2181000 0 2181000 1.00 0 0 0 0 1595 0 1595 0.1 3840 0 3840 0.25 0 0 0 0 0 0 0 0 2580 0 2580 0.17 1185 0 1185 0.08 4365 0 4365 0.28 1820 0 1820 0.12 0 0 15385 0 15385 1.00 1 693123 295473 8230839 9243264 -1012425 X 1 1 1 1 Keokuk Area Hospital 1600 Morgan Street Keokuk IA 52632 www.keokukhealthsystems.org 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 100 400 X X X X 1 1 X X X 1 X WWW.KEOKUKHEALTHSYSTEMS.ORG X WWW.KEOKUKHEALTHSYSTEMS.ORG X WWW.KEOKUKHEALTHSYSTEMS.ORG X X X X X 1 X 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Keokuk Area Hospital 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 OF 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. Schedule H, Part V, Section B, Line 6a-Keokuk Area Hospital KEOKUK AREA HOSPITAL'S CHNA WAS PERFORMED WITH FORT MADISON COMMUNITY HOSPITAL. Schedule H, Part V, Section B, Line 6b-Keokuk Area Hospital KEOKUK AREA HOSPITAL'S CHNA WAS PERFORMED WITH THE LEE COUNTY HEALTH DEPARTMENT. Schedule H, Part V, Section B, Line 7d-Keokuk Area Hospital A COPY OF THE CHNA IS AVAILABLE UPON REQUEST. Schedule H, Part V, Section B, Line 11-Keokuk Area Hospital 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 BICYLCE/WALKING TRAILS AND IMPROVED HEALTH DEPARTMENT FACILITIES WERE BEYOND ON THE SCOPE, EXPERTISE AND RESOURCES AVAILABLE AT KEOKUK AREA HOSPITAL. Schedule H, Part V, Section B, Line 18d-Keokuk Area Hospital 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. Schedule H, Part V, Section B, Line 22d-Keokuk Area Hospital THE HOSPITAL USES ITS CHARGE MASTER RATES LESS A 40% DISCOUNT. 1 TRI-STATE MEDICAL GROUP 1600 MORGAN STREET KEOKUK IA 52632 PRIMARY CARE CLINIC Schedule H, Part I, Line 6a KEOKUK AREA HOSPITAL PREPARES AND SUBMITS A COMMUNITY BENEFITS REPORT TO THE IOWA HOSPITAL ASSOCIATION EACH TAX YEAR. Schedule H, 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. Schedule H, Part I, Line 7, Column 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. Schedule H, Part I, Line 7g REPRESENTS THE SUBSIDY TO TRI-STATE MEDICAL GROUP, INC. TO COVER UNCOMPENSATED HEALTHCARE COSTS. Schedule H, Part II 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. Schedule H, Part III, Section A, Line 4 PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT WHEN DEEMED UNCOLLETABLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. Schedule H, Part III, Section B, Line 8 MEDICARE PAYS KEOKUK AREA HOSPITAL SUBSTANTIALLY 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 THE MEDICARE COST REPORT METHODOLOGY. Schedule H, Part III, Section C, Line 9b IF INFORMATION IS AVAILABLE TO CONFIRM ELIGIBILITY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS NOT PURSUED. Schedule H, 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. Schedule H, 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. Schedule H, 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. Schedule H, 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 MEDICAL 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. Schedule H, 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. Schedule H, Part VI, Line 7 IOWA 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 Schedule J, Part I, Line 3 PERMANENT CEO/EXECUTIVE SALARY IS APPROVED BY THE BOARD OF DIRECTORS AFTER REVIEW BY EXECUTIVE COMMITTEE USING VARIOUS BENCHMARK DATA INCLUDING 990 DATA OF SIMILIAR HOSPITALS, IOWA HOSPITAL ASSOCIATION SALARY SURVEYS AND EXPERIENCE LEVEL OF THE CANDIDATE. Form 990, Part VI, Section A, Line 3 THE ORGANIZATION DELEGATED CONTROL OVER MANANGEMENT DUTIES TO FITCH HEALTHCARE. Form 990, Part VI, Section A, Line 6 KEOKUK HEALTH SYSTEMS INC. 42-1237361 Form 990, Part VI, Section A, Line 7a KEOKUK HEALTH SYSTEMS INC BOARD OF DIRECTORS 42-1237361. 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 11b 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 WRITTING ANNUALLY THAT THEY HAVE DISCLOSED AND 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. Form 990, Part IX, Line 11g AMOUNT REPRESENTS CONTRACTED SERVICES IN THE ANCILLARY DEPARTMENTS AS WELL AS THE EMERGENCY ROOM. Form 990, Part XI, Line 9 ALLOWANCE RECORDED AGAINST AFFILIATE ADVANCES -$907,414; CONTRIBUTIONS FOR PROPERTY AND EQUIPMENT $45,002; RESTRICTED CONTRIBUTIONS $974,546; AND NET ASSETS RELEASED FROM RESTRICTIONS $150,353. Keokuk Health Systems Inc 1600 Morgan Street Keokuk IA 52632 421237361 Parent Company of Keokuk Area Hospital IA 501 c 3 exempt non profit N/A Tri State Medical Group 1600 Morgan Street Keokuk IA 52632 421435525 Medical Offices IA 501 c 3 exempt non profit Keokuk Health Systems Inc Keokuk Area Hospital Foundation 1600 Morgan Street Keokuk IA 52632 411202608 Fundraising IA 501 c 3 exempt non profit Keokuk Health Systems Inc Keokuk Area Medical Equipment Inc 1600 Morgan Street Keokuk IA 52632 421237312 DME Sales and Rentals IA Keokuk Health Systems Inc C 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 Tri State Medical Group b 907414 $907,414 REPRESENTS THE INCREAESE IN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS. ADVANCES WERE MADE TO TRI-STATE MEDICAL GROUP THROUGHOUT THE YEAR TO COVER STAFFING, SUPPLIES AND OTHER HEALTHCARE RELATED EXPENSES. Keokuk Area Medical Equipment Inc b 96314 ADVANCES TOTALING $96,314 WERE MADE TO KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY TO COVER EXPENSES. THE TOTAL WAS REPAID TO KEOKUK AREA HOSPITAL WITHIN THE SAME YEAR.