2014-11-13T16:28:51-06:00 2013-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2013-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 KAREN COLE CEO 7122461230 2014-11-13 1 BARBARA J FAJEN P00400874 4023302660 2013 2015-11-30 17:44:51Z KAREN COLE 300 PERSHING AVENUE SHENANDOAH IA 51601 31453446 0 X WWW.SMCHOSPITAL.COM X 1978 IA TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH & SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION. 10 10 370 44 1100 0 205842 210849 25789085 30567549 462041 349658 182760 320602 26639728 31448658 0 137168 0 0 14828689 17520092 0 0 0 10845918 14608339 25674607 32265599 965121 -816941 27500142 31599910 3500104 3177450 24000038 28422460 TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. 0 0 28155779 137168 30567549 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. 28155779 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 28 0 1 370 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MATTHEW SELLS CFO 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 DAVE LASHIER CHAIRMAN 3.00 0.00 X X 0 0 0 ED KLOBERDANZ VICE CHAIRMAN 3.00 0.00 X X 0 0 0 GREG RITCHEY SECRETARY/TREASURER 3.00 0.00 X X 0 0 0 TIM AUGUSTINE DIRECTOR 3.00 0.00 X 0 0 0 MARY JO CARRELL DIRECTOR 3.00 0.00 X 0 0 0 DEB ISTAS DIRECTOR 3.00 0.00 X 0 0 0 FLOYD JONES DO DIRECTOR 3.00 0.00 X 0 0 0 ROGER JONES DIRECTOR 3.00 0.00 X 0 0 0 ALISSA MCGINNIS DIRECTOR 3.00 0.00 X 0 0 0 LINDA LAUGHLIN DIRECTOR 3.00 0.00 X 0 0 0 KAREN COLE CEO 40.00 0.00 X 238447 0 23135 SANDRA CHESSHIRE CFO THRU 4/22/13 40.00 0.00 X 146807 0 7366 MATTHEW SELLS CFO 40.00 0.00 X 47415 0 5950 SCOTT R KING OB-GYN 40.00 0.00 X 368262 0 32678 SANTOSH KUMAR HOSPITALIST 40.00 0.00 X 269922 0 30768 SUBIR RAY MD PHYSICIAN 40.00 0.00 X 468267 0 28998 SATYA THIPPAREDDI PHYSICIAN 40.00 0.00 X 269467 0 9424 SUZANNE ALT PHYSICIAN 40.00 0.00 X 266032 0 2212 2074619 0 140531 19 0 1 0 STAFF CARE PO BOX 281923 ATLANTA GA 30384 ER PHYSICIAN COVERAGE 333397 ACUTE CARE INC 1609 N ANKENY BLVD STE 200 ANKENY IA 50023 ER PHYSICIAN COVERAGE 272608 UNMC PHYSICIANS LAB REF PO BOX 30014-1114 OMAHA NE 68103 LAB REFERENCE FEES 272130 FOCUSONE SOLUTIONS PO BOX 3037 OMAHA NE 68103 CONTRACT LABOR 241141 DENNIS CUMMINGS 13951 W 115TH STREET OLATHE KS 66062 CRNA 227700 9 210849 210849 NET PATIENT SERVICE REVENUE 624100 14903792 14903792 MEDICARE/MEDICAID PAYMENTS 624100 14358175 14358175 AMBULANCE SERVICES 621910 516228 516228 MEANINGFUL USE INCENTIVE PAYMENTS 624100 462396 462396 340B REVENUE 624100 196215 196215 130743 130743 30567549 350823 350823 152689 0 152689 152689 152689 3623 3500 1288 -3500 2335 -1165 -1165 CAFETERIA REVENUE 624200 166813 166813 CATERING 722320 1100 1100 167913 31448658 30567549 1100 669160 X 137168 137168 469120 469120 14383700 12821202 1562498 326352 290039 36313 1336983 1181790 155193 1003937 859284 144653 61518 61518 70972 70972 3635238 2847592 787646 164093 164093 1294197 988829 305368 423066 392594 30472 161175 120606 40569 1889800 1753683 136117 295805 274499 21306 MEDICAL SUPPLIES 3222206 3222206 BAD DEBT EXPENSE 2821725 2821725 EMPLOYEE RECRUITMENT 291948 216488 75460 LICENSES & FEES 214210 43056 171154 62386 20925 41461 32265599 28155779 4109820 0 2232391 914990 319874 2850924 4495305 5160961 832009 834190 211562 216890 28059552 19155292 8438633 8904260 9734922 7117116 211704 327523 1023742 5273056 27500142 31599910 2014032 2637414 0 540036 1486072 0 3500104 3177450 X 22778262 22336832 954665 1077663 267111 5007965 24000038 28422460 27500142 31599910 X -816941 394031 4679423 165909 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6700 6700 0 PART II-B, LINE 1: 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. 9734922 30006 498003 989586 9273345 7578451 2877629 565340 1286498 9734922 8688964 58208 1168721 7578451 8857784 601102 769922 8688964 6608058 1274933 974793 8857784 0.85380 0.03000 0.11620 0 0 92822 92822 12378169 10742020 1636149 14499766 7679579 6820187 1088795 733693 355102 8904260 INVESTMENT IN HOSPITAL LLC 1742 DUE FROM SHENANDOAH AMBULANCE SERVICE 47696 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 494105 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 4729513 5273056 X 29189873 394031 168909 562940 28626933 2821725 2821725 31448658 29443874 0 29443874 2821725 2821725 32265599 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. 1 1 1 X 1 X 1 1 1 0 1 1 362496 5568 356928 0.01210 4156140 4064210 91930 0.00310 4518636 4069778 448858 0.01520 11 2865 334023 245543 88480 0.00300 1 400 2861 0 2861 0.00010 19 41420 15730607 13694617 2035990 0.06910 4 4900 25315 0 25315 0.00090 35 49585 16092806 13940160 2152646 0.07310 35 49585 20611442 18009938 2601504 0.08830 1 105 60011 60011 0.00200 1 130 1461 1461 0.00000 2 235 61472 61472 0.00200 1 2821725 0 9762142 9892926 -130784 X 1 1 1 1 SHENANDOAH MEDICAL CENTER 300 PERSHING AVE SHENANDOAH IA 51601 WWW.SMCHOSPITAL.COM 730065H X X X X SHENANDOAH MEDICAL CENTER 1 1 X X X X X X X X X X 13 1 0 1 X WWW.SMCHOSPITAL.COM X X X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X 1 X 1 X X 1 X X 0 0 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. 5 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 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. 1 SHENANDOAH HEALTH CARE FOUNDATION 300 PARK AVENUE SHENANDOAH IA 51601 421471184 501(C)(3) 137168 0 GENERAL SUPPORT 1 0 PART I, LINE 2: SHENANDOAH MEDICAL CENTER OVERSEES THE OPERATING EXPENSES OF THE FOUNDATION, THEREFORE, IT DIRECTLY MONITORS THE USE OF THE GRANT FUNDS. X 1 1 X 1 0 0 1 0 0 0 0 0 KAREN COLE CEO 199940 0 37800 0 707 0 6809 0 16326 0 261582 0 0 0 SANDRA CHESSHIRE CFO THRU 4/22/13 146637 0 0 0 170 0 1990 0 5376 0 154173 0 0 0 SCOTT R KING OB-GYN 240555 0 126988 0 719 0 9706 0 22972 0 400940 0 0 0 SANTOSH KUMAR HOSPITALIST 259256 0 10000 0 666 0 9722 0 21046 0 300690 0 0 0 SUBIR RAY MD PHYSICIAN 467542 0 0 0 725 0 12094 0 16904 0 497265 0 0 0 SATYA THIPPAREDDI PHYSICIAN 248836 0 20000 0 631 0 5056 0 4368 0 278891 0 0 0 SUZANNE ALT PHYSICIAN 240962 0 25000 0 70 0 0 0 2212 0 268244 0 0 0 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. 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.