2015-05-15T12:56:19-05:00 2014-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-07-01 201347269 Renown Skilled Nursing RENO 7759824780 1155 Mill Street C/O Tax Treasury Z-4 Reno NV 89502 Janette Townsend VP & Corporate CFO 7759824780 2015-05-15 1 Kim Hunwardsen CPA P00484560 6122536500 2015-05-13 2013 2016-03-07 17:11:31Z Janette Townsend 1155 Mill Street C/O Tax Treasury Z-4 Reno NV 89502 10084409 0 X www.renown.org X 2004 NV A 160 bed long-term acute care nursing facility specializing in rehabilitative care. 4 0 0 12 0 0 2738244 2713441 8298522 7370968 -2670 0 587 0 11034683 10084409 0 0 0 0 8688802 8819242 0 0 0 4910086 4498193 13598888 13317435 -2564205 -3233026 2329181 5055017 16371959 22330821 -14042778 -17275804 X Renown Health makes a genuine difference in the health and well-being of the people and communities we serve. 0 0 10354755 0 7370968 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 33,223 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 88 days of long-term care services that were not funded and were designated for patients awaiting Medicaid qualification. It also includes 763 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, 2014, Renown Skilled Nursing, along with its parent, Renown Health and its subsidiaries, provided nearly $94 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. 10354755 1 1 0 0 0 0 0 0 1 0 1 0 0 1 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 0 0 X 4 0 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Janette Townsend 7759824780 1155 Mill St Z-4 Reno NV 89502 David Line President 3.00 18.00 X X 0 28497 0 Dawn Ahner Secretary/Treasurer/CFO 1.00 59.00 X X 0 742858 106396 Ellen Kelly Director/Administrator 60.00 0.00 X 122308 0 10506 Janette Townsend Director/CAO 1.00 59.00 X 0 242881 23869 Donald Sibery Interim CEO 1.00 59.00 X 0 0 0 Samantha Moore Director of Nursing 60.00 0.00 X 103617 0 1336 James I Miller Former President/CEO 0.00 0.00 X 0 943638 351308 225925 1957874 493415 2 1 1 0 Talent Framework 5596 Longley Ln Ste A Reno NV 89502 Temp Labor 435466 Core Medical Group 2 Keewaydin Dr Salem NH 03079 Temp Labor 273355 Innovative Employee Solutions 9665 Granite Ridge Dr 420 San Diego CA 92123 Temp Labor 192022 3 2713441 2713441 Patient Service Revenue 623000 7370369 7370369 Other Revenue 900099 599 599 7370968 10084409 7370968 0 0 130807 130807 7235722 6108252 1127470 1452713 1195807 256906 4438 4438 881022 414309 466713 597900 544437 53463 836764 153516 683248 12712 2305 10407 1786 1361 425 214669 152922 61747 32128 32128 Medical Supplies 1106899 1106899 0 Provider Tax 763595 763595 0 Licenses & Property Tax 69072 0 69072 Overhead Allocation 39455 0 39455 -62247 -88648 26401 13317435 10354755 2962680 0 -14471 9915 1152196 667655 23309 18013 6202 6809 4087768 2616473 1161945 1471295 0 2881330 2329181 5055017 901917 825864 13877 8915 15456165 21496042 16371959 22330821 X -14042778 -17275804 -14042778 -17275804 2329181 5055017 -3233026 0 X X 0 1 X 1 0 X 2785248 2779730 2825316 2738244 2713441 13841979 10107284 8795487 7689721 8298522 7370968 42261982 12892532 11575217 10515037 11036766 10084409 56103961 0 0 0 56103961 2540 1475 1763 587 6365 12895072 11576692 10516800 11037353 10084409 56110326 0.99990 0.99990 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1714481 1082189 632292 2286770 1534284 752486 86517 86517 1471295 Due from Affiliates 2881330 2881330 Due to Affliates 21496042 21496042 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. Renown Skilled Nursing's Federal Form 990 filings are no longer subject to federal tax examinations by tax authorities for years before 2011. X X X X X 1 1 0 0 0 0 0 0 0 Dawn Ahner Secretary/Treasurer/CFO 0 501030 0 237526 0 4302 0 86072 0 20323 0 849253 0 0 Janette Townsend Director/CAO 0 203783 0 35640 0 3458 0 4671 0 19468 0 267020 0 0 James I Miller Former President/CEO 0 563084 0 0 0 380554 0 335873 0 15435 0 1294946 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 received a severance payment. A payment of $363,048 to James Miller included in Schedule J, Part II, Column (B)(iii). Dawn Ahner is party to a supplemental nonqualified retirement plan. Contribution of $76,072 to Dawn Ahner was 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 Janette Townsend, Dawn Ahner, Donald Sibery, and David Line have a business relationship. Form 990, Part VI, Section A, line 3 Renown Health paid Decisive Consulting Solutions, LLC for Donald Sibery's services as the Interim CEO for all the Renown entities. Renown Health paid $970,982 for fiscal year ending June 30, 2014 for the Interim CEO services and reimbursed travel and business expenses. 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 VP & Corporate CFO 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 2014 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. 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 Network Services 1155 Mill Street Z-4 Reno NV 89502 880231828 Outpatient Imaging and 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 Nevada Heart Institute Clinic LLC 1155 Mill St Z-4 Reno NV 89502 453571779 Cardiology 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 Nevada Heart Institute 1155 Mill St Z-4 Reno NV 89502 880247743 Cardiology NV N/A C 0 NHI-1 Inc 1155 Mill St Z-4 Reno NV 89502 880303924 Cardiology NV N/A C 0 Elko Heart Insititute 1155 Mill St Z-4 Reno NV 89502 452152594 Cardiology 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 914717 General Ledger