SHENANDOAH MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- SHENANDOAH MEDICAL CENTER (EIN 42-1101835)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-13
- IRS object ID
- 201423179349306212
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-13T16:28:51-06:00 | 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 | 421101835 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHENANDOAH MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHEN | BusinessNameControlTxt |
| Phone | 7122461230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 PERSHING AVENUE | AddressLine1 |
| City | SHENANDOAH | City |
| State | IA | State |
| ZIP Code | 51601 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAREN COLE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7122461230 | PhoneNum |
| Signature | 2014-11-13 | 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 | KAREN COLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 PERSHING AVENUE | AddressLine1 |
| City | SHENANDOAH | City |
| State | IA | State |
| ZIP Code | 51601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,453,446 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SMCHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH & SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 370 | TotalEmployeeCnt |
| Total Volunteers | 44 | TotalVolunteersCnt |
| Total Gross UBI | $1,100 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $205,842 | PYContributionsGrantsAmt |
| CY Contributions Grants | $210,849 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,789,085 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,567,549 | CYProgramServiceRevenueAmt |
| PY Investment Income | $462,041 | PYInvestmentIncomeAmt |
| CY Investment Income | $349,658 | CYInvestmentIncomeAmt |
| PY Other Revenue | $182,760 | PYOtherRevenueAmt |
| CY Other Revenue | $320,602 | CYOtherRevenueAmt |
| PY Total Revenue | $26,639,728 | PYTotalRevenueAmt |
| CY Total Revenue | $31,448,658 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $137,168 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,828,689 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,520,092 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,845,918 | PYOtherExpensesAmt |
| CY Other Expenses | $14,608,339 | CYOtherExpensesAmt |
| PY Total Expenses | $25,674,607 | PYTotalExpensesAmt |
| CY Total Expenses | $32,265,599 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $965,121 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$816,941 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $27,500,142 | TotalAssetsBOYAmt |
| Total Assets EOY | $31,599,910 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,500,104 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,177,450 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,000,038 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $28,422,460 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $28,155,779 | ExpenseAmt |
| Grant | $137,168 | GrantAmt |
| Revenue | $30,567,549 | RevenueAmt |
| Desc | SHENANDOAH MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS AND A 61 BED ASSISTED LIVING AND INTERMEDIATE CARE NURSING FACILITY. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN AN INPATIENT AND OUTPATIENT SETTING. IN ADDITION, THE HOSPITAL PROVIDES RENTAL SPACE FOR A PHYSICIAN CLINIC AND A CANCER AND DIALYSIS TREATMENT CENTER. DURING 2013, THE HOSPITAL PROVIDED 1,214 DAYS OF ACUTE CARE, 884 DAYS OF SKILLED NURSING CARE, 232 NURSERY DAYS, AND 97,026 OUTPATIENT OCCASIONS OF SERVICE. THE NURSING FACILITY PROVIDED 1,955 ASSISTED LIVING DAYS AND 14,553 INTERMEDIATE CARE DAYS OF SERVICE. | Desc |
| Total Program Service Expenses | $28,155,779 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 370 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | 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 | MATTHEW SELLS CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7122461230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 PERSHING AVENUE | AddressLine1 |
| City | SHENANDOAH | City |
| State | IA | State |
| ZIP Code | 51601 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 |
|---|---|---|---|---|---|---|---|---|
| DAVE LASHIER | ||||||||
| CHAIRMAN | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ED KLOBERDANZ | ||||||||
| VICE CHAIRMAN | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GREG RITCHEY | ||||||||
| SECRETARY/TREASURER | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TIM AUGUSTINE | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY JO CARRELL | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DEB ISTAS | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| FLOYD JONES DO | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ROGER JONES | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ALISSA MCGINNIS | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA LAUGHLIN | ||||||||
| DIRECTOR | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KAREN COLE | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $238,447 | $0 | $23,135 | ||
| SANDRA CHESSHIRE | ||||||||
| CFO THRU 4/22/13 | 40.00 | 0.00 | Yes (X) | $146,807 | $0 | $7,366 | ||
| MATTHEW SELLS | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $47,415 | $0 | $5,950 | ||
| SCOTT R KING | ||||||||
| OB-GYN | 40.00 | 0.00 | $368,262 | $0 | $32,678 | Yes (X) | ||
| SANTOSH KUMAR | ||||||||
| HOSPITALIST | 40.00 | 0.00 | $269,922 | $0 | $30,768 | Yes (X) | ||
| SUBIR RAY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $468,267 | $0 | $28,998 | Yes (X) | ||
| SATYA THIPPAREDDI | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $269,467 | $0 | $9,424 | Yes (X) | ||
| SUZANNE ALT | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $266,032 | $0 | $2,212 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,074,619 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $140,531 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| STAFF CARE | |||||
| PO BOX 281923 | ATLANTA | GA | 30384 | ER PHYSICIAN COVERAGE | $333,397 |
| ACUTE CARE INC | |||||
| 1609 N ANKENY BLVD STE 200 | ANKENY | IA | 50023 | ER PHYSICIAN COVERAGE | $272,608 |
| UNMC PHYSICIANS LAB REF | |||||
| PO BOX 30014-1114 | OMAHA | NE | 68103 | LAB REFERENCE FEES | $272,130 |
| FOCUSONE SOLUTIONS | |||||
| PO BOX 3037 | OMAHA | NE | 68103 | CONTRACT LABOR | $241,141 |
| DENNIS CUMMINGS | |||||
| 13951 W 115TH STREET | OLATHE | KS | 66062 | CRNA | $227,700 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $210,849 | AllOtherContributionsAmt |
| Total Contributions | $210,849 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 624100 | $14,903,792 | $14,903,792 |
| MEDICARE/MEDICAID PAYMENTS | 624100 | $14,358,175 | $14,358,175 |
| AMBULANCE SERVICES | 621910 | $516,228 | $516,228 |
| MEANINGFUL USE INCENTIVE PAYMENTS | 624100 | $462,396 | $462,396 |
| 340B REVENUE | 624100 | $196,215 | $196,215 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $130,743 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $130,743 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,567,549 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $350,823 | TotalRevenueColumnAmt |
| Exclusion | $350,823 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $152,689 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $152,689 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $152,689 | TotalRevenueColumnAmt |
| Exclusion | $152,689 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,623 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,500 | SecuritiesAmt |
| Other | $1,288 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$3,500 | SecuritiesAmt |
| Other | $2,335 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,165 | TotalRevenueColumnAmt |
| Exclusion | -$1,165 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 624200 | $166,813 | $166,813 | |
| CATERING | 722320 | $1,100 | $1,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $167,913 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,448,658 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,567,549 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,100 | UnrelatedBusinessRevenueAmt |
| Exclusion | $669,160 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,168 | TotalAmt |
| Program Services | $137,168 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,120 | TotalAmt |
| Management And General | $469,120 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,383,700 | TotalAmt |
| Program Services | $12,821,202 | ProgramServicesAmt |
| Management And General | $1,562,498 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $326,352 | TotalAmt |
| Program Services | $290,039 | ProgramServicesAmt |
| Management And General | $36,313 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,336,983 | TotalAmt |
| Program Services | $1,181,790 | ProgramServicesAmt |
| Management And General | $155,193 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,003,937 | TotalAmt |
| Program Services | $859,284 | ProgramServicesAmt |
| Management And General | $144,653 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,518 | TotalAmt |
| Management And General | $61,518 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,972 | TotalAmt |
| Management And General | $70,972 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,635,238 | TotalAmt |
| Program Services | $2,847,592 | ProgramServicesAmt |
| Management And General | $787,646 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,093 | TotalAmt |
| Program Services | $164,093 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,294,197 | TotalAmt |
| Program Services | $988,829 | ProgramServicesAmt |
| Management And General | $305,368 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $423,066 | TotalAmt |
| Program Services | $392,594 | ProgramServicesAmt |
| Management And General | $30,472 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,175 | TotalAmt |
| Program Services | $120,606 | ProgramServicesAmt |
| Management And General | $40,569 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,889,800 | TotalAmt |
| Program Services | $1,753,683 | ProgramServicesAmt |
| Management And General | $136,117 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,805 | TotalAmt |
| Program Services | $274,499 | ProgramServicesAmt |
| Management And General | $21,306 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,222,206 | $3,222,206 | |
| BAD DEBT EXPENSE | $2,821,725 | $2,821,725 | |
| EMPLOYEE RECRUITMENT | $291,948 | $216,488 | $75,460 |
| LICENSES & FEES | $214,210 | $43,056 | $171,154 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,386 | TotalAmt |
| Program Services | $20,925 | ProgramServicesAmt |
| Management And General | $41,461 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,265,599 | TotalAmt |
| Program Services | $28,155,779 | ProgramServicesAmt |
| Management And General | $4,109,820 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,232,391 | BOYAmt |
| EOY | $914,990 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $319,874 | BOYAmt |
| EOY | $2,850,924 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,495,305 | BOYAmt |
| EOY | $5,160,961 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $832,009 | BOYAmt |
| EOY | $834,190 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,562 | BOYAmt |
| EOY | $216,890 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $28,059,552 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,155,292 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,438,633 | BOYAmt |
| EOY | $8,904,260 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,734,922 | BOYAmt |
| EOY | $7,117,116 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,704 | BOYAmt |
| EOY | $327,523 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,023,742 | BOYAmt |
| EOY | $5,273,056 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,500,142 | BOYAmt |
| EOY | $31,599,910 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,014,032 | BOYAmt |
| EOY | $2,637,414 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $540,036 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,486,072 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,500,104 | BOYAmt |
| EOY | $3,177,450 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,778,262 | BOYAmt |
| EOY | $22,336,832 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $954,665 | BOYAmt |
| EOY | $1,077,663 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,111 | BOYAmt |
| EOY | $5,007,965 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,000,038 | BOYAmt |
| EOY | $28,422,460 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,500,142 | BOYAmt |
| EOY | $31,599,910 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$816,941 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $394,031 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $4,679,423 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $165,909 | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $6,700 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,700 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PORTION OF DUES PAID TO THE AMERICAN ACADEMY OF FAMILY PHYSICIANS, THE AMERICAN MEDICAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCATION ARE ALLOCABLE TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,734,922 | BeginningYearBalanceAmt |
| Contributions | $30,006 | ContributionsAmt |
| Investment Earnings Or Losses | $498,003 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $989,586 | OtherExpendituresAmt |
| End Year Balance | $9,273,345 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,578,451 | BeginningYearBalanceAmt |
| Contributions | $2,877,629 | ContributionsAmt |
| Investment Earnings Or Losses | $565,340 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,286,498 | OtherExpendituresAmt |
| End Year Balance | $9,734,922 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,688,964 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $58,208 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,168,721 | OtherExpendituresAmt |
| End Year Balance | $7,578,451 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,857,784 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $601,102 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $769,922 | OtherExpendituresAmt |
| End Year Balance | $8,688,964 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,608,058 | BeginningYearBalanceAmt |
| Contributions | $1,274,933 | ContributionsAmt |
| Investment Earnings Or Losses | $974,793 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $8,857,784 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.85380 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.03000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.11620 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $92,822 | OtherCostOrOtherBasisAmt |
| Book Value | $92,822 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,378,169 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,742,020 | DepreciationAmt |
| Book Value | $1,636,149 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,499,766 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,679,579 | DepreciationAmt |
| Book Value | $6,820,187 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,088,795 | OtherCostOrOtherBasisAmt |
| Depreciation | $733,693 | DepreciationAmt |
| Book Value | $355,102 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,904,260 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INVESTMENT IN HOSPITAL LLC | $1,742 |
| DUE FROM SHENANDOAH AMBULANCE SERVICE | $47,696 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $494,105 |
| BENEFICIAL INTEREST IN PERPETUAL TRUSTS | $4,729,513 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,273,056 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $29,189,873 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $394,031 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $168,909 | OtherRevenueAmt |
| Revenue Not Reported | $562,940 | RevenueNotReportedAmt |
| Revenue Subtotal | $28,626,933 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,821,725 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,821,725 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $31,448,658 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $29,443,874 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $29,443,874 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,821,725 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,821,725 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $32,265,599 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS WERE DESIGNATED AS SUCH BY THE SHENANDOAH MEDICAL CENTER BOARD OF DIRECTORS AND ARE MEANT TO BE HELD BY THE HOSPITAL IN PERPETUITY. THE INCOME IS TYPICALLY REINVESTED IN THE ENDOWMENT FUNDS ON AN ANNUAL BASIS, BUT THE BOARD OF DIRECTORS HAS THE ABILITY TO DETERMINE THAT THE INCOME COULD BE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES. |
| PART X, LINE 2: | THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE MEDICAL CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE MEDICAL CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE MEDICAL CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE MEDICAL CENTER 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 MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. THE MEDICAL CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS ENDED PRIOR TO DECEMBER 31, 2010. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST 165,034. GAIN ON EQUITY IN SHENANDOAH AMBULANCE SERVICE 875. NET ASSETS RELEASED FROM OPERATIONS 3,000. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 2,821,725. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 2,821,725. |
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 |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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) |
|---|---|---|
| Total Community Benefit Expns | $362,496 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,568 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $356,928 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,156,140 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,064,210 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $91,930 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,518,636 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,069,778 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $448,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 2865 | PersonsServedCnt |
| Total Community Benefit Expns | $334,023 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $245,543 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $88,480 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 400 | PersonsServedCnt |
| Total Community Benefit Expns | $2,861 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,861 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 41420 | PersonsServedCnt |
| Total Community Benefit Expns | $15,730,607 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,694,617 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,035,990 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06910 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 4900 | PersonsServedCnt |
| Total Community Benefit Expns | $25,315 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $25,315 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 35 | ActivitiesOrProgramsCnt |
| Persons Served | 49585 | PersonsServedCnt |
| Total Community Benefit Expns | $16,092,806 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,940,160 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,152,646 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07310 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 35 | ActivitiesOrProgramsCnt |
| Persons Served | 49585 | PersonsServedCnt |
| Total Community Benefit Expns | $20,611,442 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,009,938 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,601,504 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08830 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 105 | PersonsServedCnt |
| Total Community Benefit Expns | $60,011 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $60,011 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 130 | PersonsServedCnt |
| Total Community Benefit Expns | $1,461 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,461 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 235 | PersonsServedCnt |
| Total Community Benefit Expns | $61,472 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $61,472 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,821,725 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,762,142 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,892,926 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$130,784 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | SHENANDOAH MEDICAL CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 PERSHING AVE | AddressLine1 |
| City | SHENANDOAH | City |
| State | IA | State |
| ZIP Code | 51601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SMCHOSPITAL.COM | WebsiteAddressTxt |
| State License | 730065H | 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 | SHENANDOAH MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | 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.SMCHOSPITAL.COM | OwnWebsiteURLTxt |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| 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 | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SHENANDOAH MEDICAL CENTER | PART V, SECTION B, LINE 1J: THE NEEDS ASSESSMENT INDICATED THAT AREAS FOR IMPROVEMENT WERE AS FOLLOWS: CHILD AND INFANT IMMUNIZATION, TRANSPORTATION, INTERNET/TELECOMMUNICATIONS INFRASTRUCTURE, UNINSURED/UNDERINSURED, TELEMEDICINE, EYE CARE FOR VETERANS, CARDIOVASCULAR ACCESS, MEDICAL TECHNOLOGY, CATASTROPHIC PLANNING, MEDICARE FRAUD, MAMMOGRAPHY, PRIMARY CARE ACCESS IN FREMONT COUNTY, DRUG ASSISTANCE, ECONOMIC DEVELOPMENT, SENIOR CARE, SUICIDE PREVENTION IN SCHOOL, PHYSICIAN RETENTION, NURSES, PARAMEDICS, DOMESTIC AND SEXUAL ABUSE, EDUCATION OF EXISTING SERVICES, LAYOUT OF SMC, PSYCHIATRIST, PEDIATRICIAN, COLLABORATION BETWEEN SMC AND CLARINDA REGIONAL MEDICAL CENTER, EDUCATION OF EXISTING FACILITIES, OBESITY, TEEN PREGNANCY, SIDEWALKS AROUND SCHOOLS, SAFE WALKING AND BIKING PATH, AND HEALTHY FOOD. |
| SHENANDOAH MEDICAL CENTER | PART V, SECTION B, LINE 3: PAGE COUNTY'S TOWN HALL WAS HELD OVER DINNER ON THURSDAY SEPT 6, 2012 AT THE SHENANDOAH CHAMBER AND INDUSTRY, 100 S MAPLE STREET, SHENANDOAH, IA. EXTERNAL CONSULTANTS FACILITATED THIS HOUR AND A HALF SESSION WITH FORTY THREE (43) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. FOR THIS NEEDS ASSESSMENT. |
| SHENANDOAH MEDICAL CENTER | PART V, SECTION B, LINE 6I: AFTER COLLABORATING WITH COMMUNITY STAKEHOLDERS REGARDING THE HEALTH NEEDS OF ITS COMMUNITY, SHENANDOAH MEDICAL CENTER (SMC) GATHERED WITH REPRESENTATIVES FROM MANY OTHER ORGANIZATIONS THAT HAD ORIGINALLY WORKED ON THE CHNA TO EVALUATE THE FINDINGS AND COMPOSE AN IMPLEMENTATION STRATEGY. THERE WERE ITEMS CONTAINED WITHIN THE REPORT THAT WERE PRIORITIZED FOR COMPLETION BY SMC, WHICH INCLUDED BUDGETING CASH OUTLAYS TO ADDRESS THE PRIORITIES, WHICH ARE DESCRIBED BELOW. WHILE THERE WERE ITEMS THAT SMC AND OTHER STAKEHOLDERS FELT COULD NOT BE IMPACTED BY THE FACILITY, PLANS WERE DEVELOPED BY OTHER ORGANIZATIONS TO COLLABORATE IN MEETING THOSE NEEDS. OTHER ITEMS, WHICH WERE DETERMINED TO BE OF A LOWER PRIORITY WERE PLANNED TO BE ADDRESSED IN FUTURE YEARS. THE IMPLEMENTATION STRATEGY WAS COLLECTIVELY AGREED UPON AND HAS CONTINUED TO BE MONITORED BY THE ORGANIZATIONS MOVING FORWARD. SMC ASSISTED IN EDUCATING ITS COMMUNITY ON HEALTH REFORM LAW INSURANCE OPTIONS BY UTILIZING ITS FINANCIAL ASSISTANCE COUNSELOR AND SOCIAL SERVICES DIRECTOR TO PROVIDE INSURANCE INFORMATION TO PATIENTS AND ASSIST THEM IN ENROLLMENT IN MEDICAID AND MEDICARE IN ORDER TO LOWER THE UNINSURED AND UNDERINSURED POPULATION. ADDITIONALLY, THE FACILITY INVESTED IN A CONNECTION WITH THE IHIN, WHICH ALLOWS PATIENTS TO ACCESS THEIR MEDICAL INFORMATION FROM NUMEROUS FACILITIES IN IOWA. FURTHERMORE, AN INVESTMENT IN A PATIENT PORTAL THAT IS COMPATIBLE WITH SMC'S ELECTRONIC MEDICAL RECORD SYSTEM ALSO OCCURRED IN ORDER TO ASSIST WITH THE BUILDING OF THE HEALTH INTERNET INFRASTRUCTURE. ANOTHER ITEM OF IMPORTANCE IDENTIFIED BY THE ASSESSMENT WAS THE NEED TO IMPROVE CHILDREN'S ACCESS TO IMMUNIZATIONS. SMC NOW PARTICIPATES IN A PROGRAM TO PROVIDE FREE AND REDUCED PRICE VACCINATIONS FOR CHILDREN AND INFANTS. IN ORDER TO RETAIN AND RECRUIT PROVIDERS, SMC HAS INVESTED NUMEROUS DOLLARS TO ADD THREE ADDITIONAL PHYSICIANS AND ONE ADVANCED REGISTERED NURSE PRACTITIONER DURING 2013. IN ORDER TO SUPPORT VETERAN CARE DELIVERY, THE FACILITY BECAME A PREFERRED PROVIDER TO CONDUCT VETERANS' DISABILITY EXAMS AND ALSO EXPANDED ITS HOME HEALTH AND HOSPICE COVERAGE TO VETERANS THROUGH THE "WE HONOR VETERANS" PROGRAM. ADDITIONAL EDUCATION IN WORKING WITH MENTAL HEALTH PATIENTS HAS BEEN PROVIDED TO STAFF MEMBERS IN THE EMERGENCY ROOM AND PRIMARY CARE CLINICS TO HELP EXPAND THE MENTAL HEALTH DELIVERY IN PAGE AND FREMONT COUNTIES. TO HELP FIGHT DRUG ABUSE, NUMEROUS EDUCATIONAL SESSIONS ON THE APPROPRIATE MAINTENANCE OF PATIENTS WITH OPIATES PRESCRIPTIONS WERE HELD WITH PROVIDERS. |
| SHENANDOAH MEDICAL CENTER | PART V, SECTION B, LINE 7: NEEDS THAT DID NOT GET DIRECTLY ADDRESSED INCLUDE SUPPORTING COMMUNITY ECONOMIC DEVELOPMENT OUTSIDE OF THE NUMBER OF JOBS ADDED AT SHENANDOAH MEDICAL CENTER IN 2013. ADDITIONALLY, SMC DID NOT WORK ON BUILDING A SAFE WALKING/BIKING PATH IN THE COMMUNITY OR REDUCING TEEN PREGNANCY IN OUR SERVICE AREA. OTHER ITEMS THAT DID NOT GET ADDRESSED BY SMC THIS YEAR WERE THE BUILDING OF A SCHOOL SUICIDE PREVENTION PROGRAM AND FIGHTING DOMESTIC AND SEXUAL ABUSE. ALL ITEMS NOT ADDRESSED WERE CONSIDERED NOT RELATED TO THE FACILITY'S MISSION CRITICAL OPERATIONS. AS A RESULT, SMC WILL CONTINUE TO HELP SUPPORT COMMUNITY PARTNERS TO ADDRESS THOSE NEEDS. |
| SHENANDOAH MEDICAL CENTER | PART V, SECTION B, LINE 20D: THE INDIVIDUALS WHO DID NOT HAVE INSURANCE ARE GIVEN A 30% UNINSURED DISCOUNT. ANY INDIVIDUAL COMPLETING THE FINANCIAL ASSISTANCE APPLICATION ALSO RECEIVED AN AUTOMATIC ADDITIONAL 20% DISCOUNT TO ENSURE THAT THE HOSPITAL WAS CHARGING NO MORE THAN THE AVERAGE OF ITS THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| ELM HEIGHTS CARE CENTER | ||||
| 1204 SOUTH ELM STREET | SHENANDOAH | IA | 51601 | NURSING HOME |
| SHENANDOAH MEDICAL CENTER | ||||
| 300 PARK AVENUE | SHENANDOAH | IA | 51601 | MEDICAL CLINIC |
| FREMONT COUNTY MEDICAL CENTER | ||||
| 802 ILLINOIS STREET | FREMONT | IA | 52561 | SIDNEY CLINIC |
| SHENANDOAH MEDICAL CENTER | ||||
| 2 JACK FOSTER DRIVE | SHENANDOAH | IA | 51601 | WELLNESS CENTER |
| ESSEX HEALTH CENTER | ||||
| 527 IOWA AVENUE | ESSEX | IA | 51638 | ESSEX CLINIC |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NOT APPLICABLE |
| PART I, LINE 6A: | THE ANNUAL COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED ORGANIZATION. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,821,725. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | SHENANDOAH MEDICAL CENTER PROVIDES JOB SHADOWING TO STUDENTS OF SHENANDOAH, PHLEBOTOMY STUDENT ROTATIONS, CLARKSON/METHODIST STUDENTS JOB SHADOWING, CNA CLASSES FOR SHENANDOAH HIGH SCHOOL STUDENTS, MENTORING OF STUDENTS BY SMC STAFF, AND IS INVOLVED IN THE FREMONT/PAGE COUNTY PREVENT CHILD ABUSE GROUP AND BREAST CANCER AWARENESS. THESE ACTIVITIES HELP TO FURTHER THE EDUCATION OF THE COMMUNITY ON HEALTH IMPROVEMENT AND MAINTENANCE AND ALSO ASSIST IN THE DEVELOPMENT OF LOCAL INDIVIDUALS IN BECOMING HEALTH CARE PROFESSIONALS. |
| PART III, LINE 2: | IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER 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 MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR 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 MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE," "NET PATIENT SERVICE REVENUE," AND "CHARITY CARE":PATIENT ACCOUNTS RECEIVABLE:THE MEDICAL CENTER 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 MEDICAL CENTER 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 MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR 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 MEDICAL CENTER 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.NET PATIENT SERVICE REVENUE:THE MEDICAL CENTER HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE MEDICAL CENTER 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, 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 SETTLEMENT ARE DETERMINED.CHARITY CARE:THE MEDICAL CENTER 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 MEDICAL CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE MEDICAL CENTER IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE MEDICAL CENTER PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST. |
| PART III, LINE 8: | THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE IT REPRESENTS UNCOMPENSATED CARE PROVIDED TO INDIVIDUALS IN THE SHENANDOAH AND SURROUNDING COMMUNITIES. IT HAS BEEN DETERMINED BASED ON THE OVERALL MEDICARE ALLOWABLE COST AS A PERCENT OF TOTAL CHARGES, APPLIED TO THE TOTAL MEDICARE CHARGES. |
| PART III, LINE 9B: | ONCE A PATIENT HAS BEEN DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT IS UPDATED WITH THE APPROPRIATE AMOUNT OF FINANCIAL ASSISTANCE. IF A PATIENT HAS HAD ALL ACCOUNTS GRANTED FULL FINANCIAL ASSISTANCE, THE PATIENT RECEIVES NOTICE THAT ALL OBLIGATIONS HAVE BEEN SATISFIED. IF THERE IS A REMAINING PATIENT BALANCE, SMC'S FINANCIAL COUNSELOR WORKS CLOSELY WITH THE PATIENT TO AGREE UPON A PAYMENT PLAN THAT IS FINANCIALLY FEASIBLE FOR THE PATIENT. |
| PART VI, LINE 2: | THE ORGANIZATION'S LEADERSHIP INFORMALLY MEETS WITH LEADERS IN THE COMMUNITY TO DISCUSS COMMUNITY ISSUES, AS WELL AS ATTEMPTS TO IDENTIFY AREAS WHERE SMC CAN BE OF SERVICE TO THE EMPLOYERS IN THE COMMUNITY. |
| PART VI, LINE 3: | THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO ALL PATIENTS ON THE WEBSITE. ADDITIONALLY, OUR THIRD PARTY SELF-PAY ORGANIZATION MAILS APPLICATIONS TO THOSE PATIENTS WHO INDICATE THAT THEY DO NOT HAVE THE MEANS TO PAY THEIR ACCOUNTS. UPON CONTACT AT SMC, OUR SOCIAL SERVICES REPRESENTATIVE AND PATIENT ACCOUNT COUNSELOR DISCUSS OPTIONS WITH PATIENTS AND ALSO ASSIST IN THE COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATIONS, MEDICARE AND MEDICAID APPLICATIONS IF APPLICABLE, AND MAKING ANY OTHER ARRANGEMENTS NECESSARY TO ASSIST PATIENTS IN FINANCIALLY SATISFYING THEIR OBLIGATIONS. |
| PART VI, LINE 4: | THE MEDIAN HOUSEHOLD INCOME WAS $40,778 AND $47,225 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2010, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $48,872. AS A BYPRODUCT OF THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA, SHENANDOAH MEDICAL CENTER TREATS A SIGNIFICANT NUMBER OF MEDICAID, UNINSURED, AND UNDERINSURED PATIENTS. THE AREA POPULATION IS PREDOMINATELY WHITE, NON-HISPANIC. |
| PART VI, LINE 5: | IN ADDITION TO ITS EFFORTS TO ADDRESS THE NEEDS IDENTIFIED BY ITS COMMUNITY HEALTH NEEDS ASSESSMENT, THE FACILITY ALSO HAS AN ACTIVE INTERNAL WELLNESS PROGRAM THAT IT IS ATTEMPTING TO ROLL-OUT IN ITS COMMUNITY. ADDITIONALLY, THE HOSPITAL OPERATES A WELLNESS CENTER THAT PROVIDES VERY AFFORDABLE MEMBERSHIP RATES AND PERSONAL TRAINING OPTIONS TO HELP PROMOTE WELLNESS IN THE COMMUNITY. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHENANDOAH HEALTH CARE FOUNDATION | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 PARK AVENUE | AddressLine1 |
| City | SHENANDOAH | City |
| State | IA | State |
| ZIP Code | 51601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 421471184 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $137,168 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | SHENANDOAH MEDICAL CENTER OVERSEES THE OPERATING EXPENSES OF THE FOUNDATION, THEREFORE, IT DIRECTLY MONITORS THE USE OF THE GRANT FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KAREN COLE | ||||||||||||||
| CEO | $199,940 | $0 | $37,800 | $0 | $707 | $0 | $6,809 | $0 | $16,326 | $0 | $261,582 | $0 | $0 | $0 |
| SANDRA CHESSHIRE | ||||||||||||||
| CFO THRU 4/22/13 | $146,637 | $0 | $0 | $0 | $170 | $0 | $1,990 | $0 | $5,376 | $0 | $154,173 | $0 | $0 | $0 |
| SCOTT R KING | ||||||||||||||
| OB-GYN | $240,555 | $0 | $126,988 | $0 | $719 | $0 | $9,706 | $0 | $22,972 | $0 | $400,940 | $0 | $0 | $0 |
| SANTOSH KUMAR | ||||||||||||||
| HOSPITALIST | $259,256 | $0 | $10,000 | $0 | $666 | $0 | $9,722 | $0 | $21,046 | $0 | $300,690 | $0 | $0 | $0 |
| SUBIR RAY MD | ||||||||||||||
| PHYSICIAN | $467,542 | $0 | $0 | $0 | $725 | $0 | $12,094 | $0 | $16,904 | $0 | $497,265 | $0 | $0 | $0 |
| SATYA THIPPAREDDI | ||||||||||||||
| PHYSICIAN | $248,836 | $0 | $20,000 | $0 | $631 | $0 | $5,056 | $0 | $4,368 | $0 | $278,891 | $0 | $0 | $0 |
| SUZANNE ALT | ||||||||||||||
| PHYSICIAN | $240,962 | $0 | $25,000 | $0 | $70 | $0 | $0 | $0 | $2,212 | $0 | $268,244 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE MEDICAL CENTER OFFERS TEMPORARY HOUSING TO CERTAIN NEW EMPLOYEES TO ASSIST THEM IN RELOCATING TO SHENANDOAH WHILE THEY FIND SUITABLE HOUSING. THE TEMPORARY HOUSING WAS USED BY DR. SUBIR RAY, DENNIS CUMMINGS, AND WAYNE JOHNSON DURING 2013. THE FAIR VALUE OF THE HOUSING PROVIDED WAS TREATED AS TAXABLE INCOME TO THEM. |
| PART I, LINE 4A | SANDY CHESHIRE, CFO THRU 4/22/13, RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $74,987. |
| PART I, LINE 5 | DR. SCOTT KING RECEIVED A BONUS BASED ON REVENUES. THE FORMULA FOR CALCULATING DR. KING'S BONUS IS: GROSS CHARGES X .317 LESS COMPENSATION, BENEFITS AND CONTINUING MEDICAL EDUCATION EXPENSES. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION SHALL HAVE TWO CLASSES OF MEMBERS, DESIGNATED CLASS A MEMBERS AND CLASS B MEMBERS. THE CLASS A MEMBERS SHALL BE ALL OF THOSE INDIVIDUALS THEN SERVING AS DULY ELECTED MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION, EXCEPT FOR THAT PERSON NOMINATED TO THE BOARD OF DIRECTORS BY THE CLASS B MEMBER. THE CLASS B MEMBER SHALL BE SHENANDOAH/NHS REGIONAL VENTURES, LLC, AN IOWA LIMITED LIABILITY COMPANY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CLASS B MEMBER SHALL HAVE THE RIGHT TO NOMINATE ONE PERSON TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. THE PERSON SO NOMINATED SHALL BE A PHYSICIAN HAVING ACTIVE STAFF PRIVILEGES AT THE CORPORATION'S HOSPITAL, WHO RESIDES IN MILLS, PAGE, FREMONT, MONTGOMERY OR TAYLOR COUNTIES, IOWA, OR ATHISON OR HOLT COUNTIES, MISSOURI. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS REVIEWED BY THE CEO, CFO, AND GOVERNING BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS ENFORCED BY THE CEO AND COMPLIANCE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE ORGANIZATION'S CEO WAS REVIEWED AND AUTHORIZED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | LAB FEES: PROGRAM SERVICE EXPENSES 305,861. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 305,861. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,502,474. MANAGEMENT AND GENERAL EXPENSES 24,986. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,527,460. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 488,716. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 488,716. CONSULTING FEES: PROGRAM SERVICE EXPENSES 56,835. MANAGEMENT AND GENERAL EXPENSES 67,133. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,968. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 493,706. MANAGEMENT AND GENERAL EXPENSES 695,527. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,189,233. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST 165,034. GAIN ON EQUITY IN SHENANDOAH AMBULANCE SERVICE 875. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF SMC'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |