STEWART MEMORIAL COMMUNITY HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- STEWART MEMORIAL COMMUNITY HOSPITAL (EIN 42-0860039)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201413189349301426
- Schema version
- 2013v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-14T08:31:36-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420860039 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEWART MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STEW | BusinessNameControlTxt |
| Phone | 7124644200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 W MAIN | AddressLine1 |
| City | LAKE CITY | City |
| State | IA | State |
| ZIP Code | 51449 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM HENKENIUS | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 7124644200 | PhoneNum |
| Signature | 2014-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BARBARA J FAJEN | PreparerPersonNm |
| PTIN | P00400874 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JIM HENKENIUS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 W MAIN | AddressLine1 |
| City | LAKE CITY | City |
| State | IA | State |
| ZIP Code | 51449 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,603,228 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STEWARTMEMORIAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1958 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO 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 Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 310 | TotalEmployeeCnt |
| Total Volunteers | 82 | TotalVolunteersCnt |
| Total Gross UBI | $4,313,349 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$194,230 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $64,405 | PYContributionsGrantsAmt |
| CY Contributions Grants | $127,567 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,027,896 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,599,247 | CYProgramServiceRevenueAmt |
| PY Investment Income | $274,881 | PYInvestmentIncomeAmt |
| CY Investment Income | $292,906 | CYInvestmentIncomeAmt |
| PY Other Revenue | $521,268 | PYOtherRevenueAmt |
| CY Other Revenue | $241,360 | CYOtherRevenueAmt |
| PY Total Revenue | $30,888,450 | PYTotalRevenueAmt |
| CY Total Revenue | $30,261,080 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,815,237 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,195,756 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,179,446 | PYOtherExpensesAmt |
| CY Other Expenses | $15,968,973 | CYOtherExpensesAmt |
| PY Total Expenses | $30,994,683 | PYTotalExpensesAmt |
| CY Total Expenses | $31,164,729 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$106,233 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$903,649 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,479,737 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,006,154 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,177,226 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,413,580 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,302,511 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,592,574 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | STEWART 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,276,560 | ExpenseAmt |
| Revenue | $1,813,167 | RevenueAmt |
| Desc | PHYSICIAN CLINIC SERVICES | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,911,116 | ExpenseAmt |
| Revenue | $2,045,990 | RevenueAmt |
| Desc | MEDICAL AND SURGICAL SERVICES | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,587,299 | ExpenseAmt |
| Revenue | $2,990,105 | RevenueAmt |
| Desc | RADIOLOGY SERVICES | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $19,321,963 | ExpenseAmt |
| Revenue | $18,436,636 | RevenueAmt |
| Desc | OTHER MEDICAL SERVICES | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $19,321,963 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $18,436,636 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $29,096,938 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 310 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JIM HENKENIUS CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7124644200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 W MAIN STREET | AddressLine1 |
| City | LAKE CITY | City |
| State | IA | State |
| ZIP Code | 51449 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CHARLES SCHMITT | ||||||||
| BOARD CHAIR | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARY WARNER | ||||||||
| VICE CHAIR | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HEATHER MCCLUE | ||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRADLEY LANE | ||||||||
| TREASURER | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DEBRA LIGHTNER | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SCOTT NESBITT | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA BETTIN | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CHADRIC DIETRICH | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN HORNBACK | ||||||||
| MEDICAL COUNSEL | 40.00 | 0.00 | Yes (X) | $484,156 | $0 | $22,663 | ||
| LEAH GLASGO | ||||||||
| CEO THRU 6/25/13 | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CINDY CARSTENS | ||||||||
| INTERIM CEO AS OF 06/26/13 | 40.00 | 0.00 | Yes (X) | $118,092 | $0 | $21,313 | ||
| JIM HENKENIUS | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $140,330 | $0 | $25,465 | ||
| DEREK DUNCAN | ||||||||
| D.O. | 40.00 | 0.00 | $440,676 | $0 | $25,273 | Yes (X) | ||
| ADAM SWISHER | ||||||||
| D.O. | 40.00 | 0.00 | $384,162 | $0 | $25,334 | Yes (X) | ||
| PABLO AMADOR | ||||||||
| M.D. | 40.00 | 0.00 | $325,144 | $0 | $27,668 | Yes (X) | ||
| DAVID FRATE | ||||||||
| D.O. | 40.00 | 0.00 | $331,824 | $0 | $19,712 | Yes (X) | ||
| PERRY HENELY | ||||||||
| CRNA | 40.00 | 0.00 | $206,089 | $0 | $20,526 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,430,473 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $187,954 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 25 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LEE D HIEB MD | |||||
| 524 W 4TH STREET | LOGAN | IA | 51546 | ORTHOPAEDIC SERVICES | $340,000 |
| DIAGNOSTIC IMAGING ASSOC | |||||
| 1111 SIXTH AVENUE | DES MOINES | IA | 50314 | RADIOLOGY SERVICES | $256,163 |
| RTG MEDICAL | |||||
| 1005 E 23RD STREET | FREMONT | NE | 68025 | NURSING/OR LOCUM TENENS | $241,222 |
| WESTERN IOWA SURGERY | |||||
| 311 S CLARK STREET | CARROLL | IA | 51401 | GENERAL SURGERY SERVICES | $182,700 |
| ICE TECHNOLOGIES | |||||
| 411 SE 9TH ST | PELLA | IA | 50219 | IT CONTRACTED SERVICES | $165,797 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $9,300 | FundraisingAmt |
| Government Grants | $50,000 | GovernmentGrantsAmt |
| All Other Contributions | $68,267 | AllOtherContributionsAmt |
| Total Contributions | $127,567 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| MEDICARE/MEDICAID REVENUE | 621400 | $12,695,096 | $12,695,096 | |
| PATIENT SERVICE REVENUE | 621400 | $11,987,356 | $11,987,356 | |
| RETAIL PHARMACY REVENUE | 446110 | $4,313,349 | $4,313,349 | |
| 340B PROGRAM REVENUE | 621400 | $361,354 | $361,354 | |
| EHR INCENTIVE PAYMENT | 621400 | $42,948 | $42,948 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $199,144 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $199,144 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,599,247 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $94,687 | TotalRevenueColumnAmt |
| Exclusion | $94,687 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $102,626 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $51,369 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $51,257 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,257 | TotalRevenueColumnAmt |
| Exclusion | $51,257 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $446,576 | SecuritiesAmt |
| Other | $38,319 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $275,479 | SecuritiesAmt |
| Other | $11,197 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $171,097 | SecuritiesAmt |
| Other | $27,122 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $198,219 | TotalRevenueColumnAmt |
| Exclusion | $198,219 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $6,875 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $9,300 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $4,103 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,772 | TotalRevenueColumnAmt |
| Exclusion | $2,772 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA SALES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $187,331 | TotalRevenueColumnAmt |
| Exclusion | $187,331 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $187,331 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,261,080 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $25,285,898 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,313,349 | UnrelatedBusinessRevenueAmt |
| Exclusion | $534,266 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $812,019 | TotalAmt |
| Program Services | $506,819 | ProgramServicesAmt |
| Management And General | $305,200 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,446,144 | TotalAmt |
| Program Services | $10,976,136 | ProgramServicesAmt |
| Management And General | $470,008 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,626 | TotalAmt |
| Program Services | $242,127 | ProgramServicesAmt |
| Management And General | $7,499 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,929,950 | TotalAmt |
| Program Services | $1,849,820 | ProgramServicesAmt |
| Management And General | $80,130 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $758,017 | TotalAmt |
| Program Services | $726,809 | ProgramServicesAmt |
| Management And General | $31,208 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,072 | TotalAmt |
| Management And General | $273,072 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,401 | TotalAmt |
| Management And General | $18,401 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,109 | TotalAmt |
| Management And General | $93,109 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,653 | TotalAmt |
| Management And General | $27,653 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,875,763 | TotalAmt |
| Program Services | $3,717,604 | ProgramServicesAmt |
| Management And General | $158,159 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,236 | TotalAmt |
| Program Services | $141,221 | ProgramServicesAmt |
| Management And General | $1,015 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $806,879 | TotalAmt |
| Program Services | $695,173 | ProgramServicesAmt |
| Management And General | $111,706 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,248 | TotalAmt |
| Program Services | $316,248 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,897 | TotalAmt |
| Program Services | $211,320 | ProgramServicesAmt |
| Management And General | $43,577 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,017 | TotalAmt |
| Program Services | $192,017 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,283,668 | TotalAmt |
| Program Services | $961,776 | ProgramServicesAmt |
| Management And General | $321,892 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,109 | TotalAmt |
| Program Services | $166,109 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| RETAIL PHARMACY EXPENSE | $4,046,904 | $4,046,904 |
| MEDICAL SUPPLIES | $2,919,306 | $2,919,306 |
| BAD DEBT | $1,067,489 | $1,067,489 |
| LICENSES AND TAXES | $48,690 | $48,690 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,532 | TotalAmt |
| Program Services | $311,370 | ProgramServicesAmt |
| Management And General | $125,162 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,164,729 | TotalAmt |
| Program Services | $29,096,938 | ProgramServicesAmt |
| Management And General | $2,067,791 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,705 | BOYAmt |
| EOY | $409,772 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $705,727 | BOYAmt |
| EOY | $950,211 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,405,291 | BOYAmt |
| EOY | $4,321,756 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $43,093 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,386,104 | BOYAmt |
| EOY | $1,488,549 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,303 | BOYAmt |
| EOY | $86,439 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,730,368 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,308,970 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,975,949 | BOYAmt |
| EOY | $8,421,398 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,901,498 | BOYAmt |
| EOY | $3,029,841 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,030,160 | BOYAmt |
| EOY | $255,095 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,479,737 | BOYAmt |
| EOY | $19,006,154 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,236,237 | BOYAmt |
| EOY | $3,591,373 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,400,000 | BOYAmt |
| EOY | $3,090,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,540,989 | BOYAmt |
| EOY | $1,350,772 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $381,435 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,177,226 | BOYAmt |
| EOY | $8,413,580 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,302,511 | BOYAmt |
| EOY | $10,592,574 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,302,511 | BOYAmt |
| EOY | $10,592,574 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,479,737 | BOYAmt |
| EOY | $19,006,154 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$903,649 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $193,712 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $171,513 | OtherCostOrOtherBasisAmt |
| Book Value | $171,513 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,868,759 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,322,317 | DepreciationAmt |
| Book Value | $1,546,442 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,472,987 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,224,557 | DepreciationAmt |
| Book Value | $6,248,430 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,217,109 | OtherCostOrOtherBasisAmt |
| Depreciation | $762,096 | DepreciationAmt |
| Book Value | $455,013 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,421,398 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | Desc |
| Amt | $381,435 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $381,435 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $29,442,775 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $193,712 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $55,472 | OtherRevenueAmt |
| Revenue Not Reported | $249,184 | RevenueNotReportedAmt |
| Revenue Subtotal | $29,193,591 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,067,489 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,067,489 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,261,080 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $30,152,712 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $55,472 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $55,472 | ExpensesNotReportedAmt |
| Expenses Subtotal | $30,097,240 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,067,489 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,067,489 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $31,164,729 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2013 AND 2012, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2010. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 51,369. FUNDRASING EXPENSES 4,103. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,067,489. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 51,369. FUNDRAISING EXPENSE 4,103. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,067,489. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | DINNER | NameOfEvent1Amt |
| Gross Receipts Event1 | $16,175 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $9,300 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,875 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $50 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $899 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $500 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $2,654 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $16,175 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $9,300 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $6,875 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $50 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $899 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $500 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,654 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $4,103 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $2,772 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 111 | PersonsServedCnt |
| Total Community Benefit Expns | $195,944 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $195,944 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,646,020 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,138,444 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $507,576 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01690 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 111 | PersonsServedCnt |
| Total Community Benefit Expns | $2,841,964 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,138,444 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $703,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02340 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 13 | ActivitiesOrProgramsCnt |
| Persons Served | 8148 | PersonsServedCnt |
| Total Community Benefit Expns | $152,289 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $51,353 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $100,936 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 25 | PersonsServedCnt |
| Total Community Benefit Expns | $29,947 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,947 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 38 | PersonsServedCnt |
| Total Community Benefit Expns | $17,864 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Persons Served | 8211 | PersonsServedCnt |
| Total Community Benefit Expns | $200,100 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $51,353 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $148,747 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Persons Served | 8322 | PersonsServedCnt |
| Total Community Benefit Expns | $3,042,064 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,189,797 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $852,267 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02840 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,565 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,565 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,565 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,565 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,067,489 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,283,686 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,484,044 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$200,358 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEWART MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 WEST MAIN STREET | AddressLine1 |
| City | LAKE CITY | City |
| State | IA | State |
| ZIP Code | 51449 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.STEWARTMEMORIAL.ORG | WebsiteAddressTxt |
| State License | 130029H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEWART MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.STEWARTMEMORIAL.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | 0 | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 3: STEWART MEMORIAL COMMUNITY HOSPITAL (SMCH) CREATED A COMMUNITY NEEDS ASSESSMENT AND MADE IT AVAILABLE TO STAFF, COMMUNITY MEMBERS, MEMBERS OF OUR COUNTY PUBLIC HEALTH DEPARTMENT, LOCAL SCHOOLS AND OTHER ORGANIZATIONS. THE SURVEY WAS CREATED ONLINE AND ALLOWED FOR TABULATION OF RESPONSES AND IDENTIFIED NEEDS. THE SURVEY WAS PROMOTED VIA SMCH'S WEBSITE, EMAIL CAMPAIGN AND PAPER FLIERS. SMCH ALSO PARTNERED WITH AND USED INPUT FROM THE COUNTY PUBLIC HEALTH DEPARTMENT AS THEY HAD PREVIOUSLY CONDUCTED A COMMUNITY HEALTH NEEDS SURVEY IN 2011. |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 7: THE SURVEY WAS COMPLETED IN THE 4TH QUARTER OF 2012. SMCH STARTED, WITHIN THE ORGANIZATION, TO ADDRESS THE GREATEST CONCERNS AND THOSE THAT CAN HAVE A DIRECT IMPACT. |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 18E: THE HOSPITAL MADE NO SUCH EFFORTS. |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 20D: IT IS THE POLICY OF THE HOSPITAL TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE PROGRAM AFTER CARE IS ADMINSTERED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| MCCRARY-ROST CLINIC | ||||
| 1351 WEST MAIN STREET | LAKE CITY | IA | 51449 | HEALTH CLINIC |
| GOWRIE CLINIC | ||||
| 1800 MAIN | GOWRIE | IA | 50543 | HEALTH CLINIC |
| LAKE VIEW CLINIC | ||||
| 1160 3RD STREET | LAKE VIEW | IA | 51540 | HEALTH CLINIC |
| ROCKWELL CITY CLINIC | ||||
| 505 EAST LAKE STREET | ROCKWELL CITY | IA | 50579 | HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $1,067,489. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | OUR CEO IS A VOLUNTEER MEMBER OF THE COUNTY ECONOMIC DEVELOPMENT ORGANIZATION AND 2 MEMBERS OF OUR ORGANIZATION ALSO ARE ON OUR LOCAL BETTERMENT ORGANIZATION. AT THESE MONTHLY MEETINGS, THEY USE THEIR TIME TO PROMOTE THE SERVICES AND WELLNESS ACTIVITIES OUR HOSPITAL PROVIDES. CURRENT BUSINESSES AND PROSPECTIVE BUSINESSES UNDERSTAND THE VARIOUS HEALTH SERVICES THAT ARE MADE AVAILABLE TO THEM AND THEIR EMPLOYEES. OUR CEO AND AN EMPLOYED PHYSICIAN ARE MEMBERS OF THE CALHOUN COUNTY BOARD OF HEALTH. |
| 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 PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER 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 3: | NOT APPLICABLE |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE," AND "CHARITY CARE." PATIENT RECEIVABLES, NET:THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER 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.PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN EXTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON OUTSTANDING BALANCES OWED.NET PATIENT SERVICE REVENUE:THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, RESIDENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.CHARITY CARE:TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE.THE HOSPITAL IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE HOSPITAL PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST.THE BAD DEBT EXPENSE DOES NOT INCLUDE ANY PATIENTS ELIGIBLE UNDER OUR CHARITY CARE POLICY SINCE THEY ARE LISTED SEPARATELY IN THE GENERAL LEDGER. BAD DEBT EXPENSE IS NOT LISTED IN OUR COMMUNITY BENEFITS. |
| PART III, LINE 8: | NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. THE 2013 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 CAREMEDICS 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 P. 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: | WE COLLABORATE WITH THE COUNTY HEALTH DEPARTMENT IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNIITES WE SERVE. WE ALSO EVALUATE USAGE DATA THROUGH THE IOWA HOSPITAL ASSOCIATION TO SEE THE PRIMARY MEDICAL DIAGNOSIS IN OUR COMMUNITIES. |
| PART VI, LINE 3: | WE HAVE 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: | OUR SERVICE AREA IS A 35 MILE RADIUS SURROUNDING OUR COMMUNITY. THIS AREA CONSISTS OF MANY SMALL, RURAL COMMUNITIES THAT ARE AGRICULTURAL BASED. OUR PATIENT BASE CONSISTS OF A LARGE MEDICARE POPULATION. |
| PART VI, LINE 5: | WE PROVIDE THE COMMUNITIES WITH LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS ON PROMOTING HEALTHY LIFESTYLES. WE PROVIDE CARE TO THE INDIGENT REGARDLESS OF THEIR ABILITY TO PAY. OUR BOARD OF DIRECTORS ARE REPRESENTED BY THE VARIOUS COMMUNITIES WE SERVE. |
| PART VI, LINE 6: | OUR 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. WE PROVIDE MONTHLY LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS BI-MONTHLY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN HORNBACK | ||||||||||||||
| MEDICAL COUNSEL | $273,147 | $0 | $90,000 | $0 | $121,009 | $0 | $7,658 | $0 | $15,005 | $0 | $506,819 | $0 | $0 | $0 |
| JIM HENKENIUS | ||||||||||||||
| CFO | $129,789 | $0 | $10,395 | $0 | $146 | $0 | $4,499 | $0 | $20,966 | $0 | $165,795 | $0 | $0 | $0 |
| DEREK DUNCAN | ||||||||||||||
| D.O. | $223,359 | $0 | $121,205 | $0 | $96,112 | $0 | $5,911 | $0 | $19,362 | $0 | $465,949 | $0 | $0 | $0 |
| ADAM SWISHER | ||||||||||||||
| D.O. | $238,441 | $0 | $48,899 | $0 | $96,822 | $0 | $8,349 | $0 | $16,985 | $0 | $409,496 | $0 | $0 | $0 |
| PABLO AMADOR | ||||||||||||||
| M.D. | $208,024 | $0 | $0 | $0 | $117,120 | $0 | $8,374 | $0 | $19,294 | $0 | $352,812 | $0 | $0 | $0 |
| DAVID FRATE | ||||||||||||||
| D.O. | $229,620 | $0 | $7,607 | $0 | $94,597 | $0 | $7,668 | $0 | $12,044 | $0 | $351,536 | $0 | $0 | $0 |
| PERRY HENELY | ||||||||||||||
| CRNA | $205,683 | $0 | $0 | $0 | $406 | $0 | $6,381 | $0 | $14,145 | $0 | $226,615 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII, LINE 5: | FormAndLineReferenceDesc |
| Explanation | LEAH GLASGOW, CEO THRU 06/25/13, RECEIVED COMPENSATION FROM TRINITY HEALTH SYSTEMS, AN UNRELATED ENTITY, WHICH PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS. LEAH RECEIVED A BASE COMPENSATION OF $85,854 FOR HER SERVICES DURING THE CALENDAR YEAR 2013. HER COMPENSATION IS REPORTED IN PART IX, LINE 11A. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF LAKE CITY IOWA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 426004850 | BondIssuerEIN |
| CUSIP | 508021AQ5 | CUSIPNum |
| Bond Issued | 2006-02-08 | BondIssuedDt |
| Issue Price | $5,000,000 | IssuePriceAmt |
| Purpose | CAPITAL IMPROVEMENTS | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,910,000 | RetiredAmt |
| Total Proceeds | $5,147,856 | TotalProceedsAmt |
| In Reserve Fund | $489,017 | InReserveFundAmt |
| Capital Expenditures | $4,658,839 | CapitalExpendituresAmt |
| Substantial Completion | 2008 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 V | STEWART MEMORIAL COMMUNITY HOSPITAL IS IN THE PROCESS OF ADOPTING VCAP PROCEDURES. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | TRINITY HEALTH SYSTEMS AND STEWART MEMORIAL COMMUNITY HOSPITAL HAVE AN AGREEMENT FOR ADMINISTRATIVE SERVICES. TRINITY HEALTH SYSTEMS PROVIDED THE SERVICES OF LEAH GLASGOW, CEO THRU 06/25/13. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE REVIEWED BY THE CEO AND CFO PRIOR TO SUBMISSION. THE FORM 990 WILL BE REVIEWED BY MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS AFTER SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH 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 15A | THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS MEETS 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 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | ONCOLOGY FEES: PROGRAM SERVICE EXPENSES 387,672. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 387,672. RADIOLOGIST FEES: PROGRAM SERVICE EXPENSES 256,163. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 256,163. NUCLEAR MEDICINE FEES: PROGRAM SERVICE EXPENSES 133,714. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,714. TRINITY MOBILE FEES: PROGRAM SERVICE EXPENSES 155,452. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 155,452. MRI FEES: PROGRAM SERVICE EXPENSES 114,850. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,850. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 2,669,753. MANAGEMENT AND GENERAL EXPENSES 158,159. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,827,912. |
| 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. |