2014-03-04T11:25:51-06:00 2013-08-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2012-09-01 370512290 Shelby Memorial Hospital Association Inc % PHILIP MILLER SHEL 2177743961 200 South Cedar Street Suite Shelbyville IL 62565 PHILIP MILLER 2177743961 2014-02-28 true Donna J Larson 3142315544 2012 2015-11-30 17:44:51Z MARILYN SEARS 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 19814852 false X www.mysmh.org X 1916 IL ORGANIZATION'S UNIFIED MISSION IS TO MAINTAIN AND IMPROVE THE QUALITY OF LIFE OF THE PEOPLE IN THIS SERVICE AREA THROUGH THE PROVISION OF QUALITY HEALTH CARE PROGRAMS, SERVICES, EQUIPMENT AND PERSONAL CARE. 12 12 233 0 93704 -129997 479669 260553 16837398 14008447 599889 543400 218860 254831 18135816 15067231 0 0 0 0 8101588 9109038 0 0 0 9573475 9110718 17675063 18219756 460753 -3152525 38678995 36712554 11406938 11226849 27272057 25485705 X THE ASSOCIATION'S PURPOSE IS TO ESTABLISH AND MAINTAIN A FACILITY FOR THE CARE OF PERSONS SUFFERING FROM ILLNESS OR DISABILITIES, REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED; AND TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON SO AS TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. false false 15062624 0 14008447 OPERATION OF A 30 BED HOSPITAL FACILITY PROVIDING ALL ROUTINE AND ANCILLARY SERVICES. SERVICES INCLUDED 27,412 OUTPATIENT REGISTRATIONS, 7,741 RURAL HEALTH CLINIC VISITS, 2,662 INPATIENT DAYS & 5,668 EMERGENCY ROOM VISITS. 15062624 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 20 0 true 233 true true true false false false false false false false false false X 12 12 true false false false false false false true true false false false true true true true true true false false IL X PHILIP MILLER 2177743961 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 X RANDY BIEHLER 1.0 0.0 X 0 0 0 ELAINE BEERY 1.0 1.0 X 0 0 0 DR DAVID OLIGSCHLAEGER 1.0 0.0 X 0 0 0 SUSAN TYNAN 1.0 0.0 X X 0 0 0 BRIAN GREEN 1.0 0.0 X 0 0 0 DAVID KLEPZIG 1.0 0.0 X 0 0 0 MICHAEL KILEY 1.0 0.0 X X 0 0 0 DR JOHN BRIX 1.0 0.0 X 0 0 0 TAD MAYHALL 1.0 0.0 X X 0 0 0 LARRY DILLEY 1.0 0.0 X 0 0 0 ERIN CHAMBERS 1.0 0.0 X 0 0 0 DAVID CRUITT 1.0 0.0 X 0 0 0 MARILYN SEARS 40.0 1.0 X 185684 0 9205 PHILIP MILLER 40.0 1.0 X 131183 0 11468 REGINA CALVERT 40.0 0.0 X 104025 0 11370 DR ARNOLD AGAPITO 40.0 0.0 X 212522 0 9756 DR TRUMAN MARK VASKO 40.0 0.0 X 258338 0 10980 DR JAGAN BOKKA 40.0 0.0 X 179285 0 12249 1071037 0 65028 6 false true false CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT 938555 EMERGENCY STAFFING SOLUTIONS 17304 PRESTON ROAD SUITE 555 DALLAS TX 75252 ER PHYSICIANS 609720 SBLHC 1000 HEALTH CENTER DRIVE MATTOON IL 61938 LABORATORY SERVICES 101219 SPECIAL CARE HOSPITAL 12303 DEPAUL DRIVE 2ND FLOOR ST LOUIS MO 63045 DAY REHAB SERVICES 177415 4 76599 183954 260553 CHARGE FOR MEDICAL SRVC, ROOM, CARE & OT 621110 13194582 13194582 SHE ANCILLARY 446199 93704 93704 MISCELLANEOUS INCOME 900099 56074 56074 EHR INCENTIVE PAYMENT 900099 664087 664087 14008447 513217 513217 0 0 188700 0 188700 0 188700 188700 4777804 4747621 30183 30183 30183 0 0 0 CATERING INCOME 722320 1890 1890 CAFETERIA SALES 722100 64241 64241 66131 15067231 13914743 93704 798231 X 0 0 0 0 309371 309371 0 0 6591852 5875004 716848 0 237046 212387 24659 0 1496266 1292537 203729 0 474503 405557 68946 0 0 10076 10076 0 107885 107885 0 0 0 0 2202562 2202562 0 185318 185318 0 2001896 1522185 479711 0 0 0 292257 292257 0 59751 37923 21828 0 0 0 455244 455244 0 0 1303937 1173543 130394 0 276371 276371 0 BAD DEBT EXPENSE 1401223 1401223 0 IPA ASSESSMENT FEE 276358 276358 0 PHARMACY 108997 108997 0 COLLECTION & ADMINISTRATION 67172 67172 0 361671 76773 284898 18219756 15062624 3157132 0 66362 68417 6857 0 178325 0 4315608 3261933 0 0 0 0 432000 246004 164502 154670 254281 283267 31759269 20162480 12215816 11596789 20690473 20676298 4356 4356 21719 20000 0 0 328696 400820 38678995 36712554 1365610 1770845 0 0 0 0 8700000 8400000 0 0 0 0 0 0 0 500000 1341328 556004 11406938 11226849 X 27172057 25385705 60000 60000 40000 40000 27272057 25485705 38678995 36712554 -3152525 1366173 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 8972 false false false 8972 false GRANTS TO OTHER ORGANIZATIONS PART II-B, LINE 1F THE AMOUNT REPRESENTS THE PORTION OF DUES PAID TO PROFESSIONAL HOSPITAL ASSOCIATIONS THAT WAS ALLOCATED TO LOBBYING ACTIVITIES. 401490 133039 534529 399597 1893 401490 1358320 56 958779 399597 1348180 9900 240 1358320 1324418 22970 792 1348180 0.60960 0.11220 0.27820 false true true 473600 473600 15211092 8139444 7071648 245904 104148 141756 4767373 3521716 1245657 11061300 8397172 2664128 11596789 0 EST. THIRD PARTY SETTLEMENTS 310000 PROFESSIONAL LIABILITY RESERVE 246004 556004 USE OF ENDOWMENT FUNDS PART V, LINE 4 THE FUNDS ARE TO BE USED FOR BOND RESERVE FUND, A LETTER OF CREDIT AGREEMENT, OPERATIONS, AND MAINTENANCE OF ASSOCIATION. FIN 48 DISCLOSURE PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true true X true X true true false false 463334 463334 0.02750 2259325 1093717 1165608 0.06930 2722659 1093717 1628942 0.09680 33028 33028 0.00200 33028 33028 0.00200 2755687 1093717 1661970 0.09880 true 1401223 0 6436415 6192130 244285 X false 1 1 SHELBY MEMORIAL HOSPITAL ASSOCIATION

200 SOUTH CEDAR STREET SHELBYVILLE IL 62565

X X X SHELBY MEMORIAL HOSPITAL ASSOCIATION true X X X X X X X X 12 true false true X X X X X X true false true true 200. true 400. true X true true X X X X X X true false X X X X true X false false 2 SHELBY HOME EQUIPMENT

200 SOUTH CEDAR STREET SHELBYVILLE IL 62565

DURABLE MEDICAL EQUIPMENT SHELBY MEMORIAL HOME HEALTH

200 SOUTH CEDAR STREET SHELBYVILLE IL 62565

HOME HEALTH AGENCY CHARITY CARE & COMMUNITY BENEFITS AT COST PART I, LINE 7 THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. CHARITY CARE & COMMUNITY BENEFITS AT COST PERCENT OF TOTAL EXPENSE PART I, LINE 7, COLUMN F THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,401,223 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. BAD DEBT EXPENSE PART III, LINE 4 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION 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 UNCOLLECTIBLE ACCOUNTS. 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 ASSOCIATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY BALANCES (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 ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. MEDICARE COSTS PART III, LINE 8 THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT. NEEDS ASSESSMENT PART VI, LINE 2 SHELBY MEMORIAL HOSPITAL HAS CONDUCTED JOINT COMMUNITY HEALTH ASSESSMENTS THROUGH A LOCAL COMMUNITY HEALTH COMMITTEE. THE COMMITTEE CONSISTS OF EXECUTIVES OF SHELBY MEMORIAL HOSPITAL, PHYSICIAN REPRESENTATION FROM THE SHELBY COUNTY BOARD OF HEALTH, A REPRESENTATIVE FROM THE SHELBY COUNTY COMMUNITY SERVICES, A REPRESENTATIVE OF THE LOCAL COMMUNITY, AND LOCAL HEALTH DEPARTMENT OFFICIALS. DATA FROM DIFFERENT GROUPINGS WAS COLLECTED AND ANALYZED TO HELP ESTABLISH PRIORITIES. GROUPINGS INCLUDED DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, GENERAL HEALTH AND ACCESS TO CARE, MATERNAL AND CHILD HEALTH CARE, CHRONIC DISEASE, INFECTIOUS DISEASE, AND ENVIRONMENTAL/OCCUPATIONAL HEALTH AND INJURY CONTROL. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 MULTIPLE AVENUES OF EDUCATION ARE UTILIZED TO INSURE ELIGIBLE INDIVIDUALS ARE AWARE OF AVAILABILITY OF ASSISTANCE THROUGH GOVERNMENTAL AND HOSPITAL BASED PROGRAMS. PATIENTS ARE PROVIDED WITH A PACKET OF INFORMATION THAT DETAILS THE AVAILABILITY OF UNINSURED DISCOUNTS AND CHARITY CARE PROGRAMS. ALL STATEMENTS WITH PATIENT DUE BALANCES HAVE WORDING INCLUDED TO SHOW THE AVAILABILITY OF SUCH ASSISTANCE. PRINTED MATERIALS CLEARLY IDENTIFY THE AVAILABILITY OF PROGRAMS. THE HOSPITAL WEB SITE ALSO HAS PROMINENT LANGUAGE ON ALL PAGES CONCERNING AVAILABILITY OF ASSISTANCE. COMMUNITY INFORMATION PART VI, LINE 4 SHELBY MEMORIAL HOSPITAL PRIMARILY SERVES THE RESIDENTS OF SHELBY COUNTY, ILLINOIS. TOTAL POPULATION IS 21,874 ACCORDING TO THE 2008 CENSUS ESTIMATES AVAILABLE ON FACTFINDER.CENSUS.GOV. 22% OF RESIDENTS ARE UNDER THE AGE OF 18; 18.6% ARE 65 AND OLDER. 10.4% OF ALL PEOPLE ARE IDENTIFIED AS BEING AT OR BELOW POVERTY LEVEL. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 SINCE 1918, SHELBY MEMORIAL HOSPITAL HAS PROVIDED FOR THE HEALTH CARE NEEDS OF SHELBY COUNTY AND OTHER SURROUNDING COMMUNITIES. SMH IS LOCATED IN CENTRAL ILLINOIS, IT IS THE ONLY HOSPITAL IN SHELBY COUNTY. SMH IS COMMITTED TO THE HEALTH AND WELFARE OF THE PEOPLE IT SERVES. OVER THE LAST 90+ YEARS, SMH HAS PROVIDED EMERGENT AND NON-EMERGENT CARE REGARDLESS OF A PERSON'S ABILITY TO PAY. SMH WORKS CLOSELY WITH OTHER AGENCIES IN THE AREA TO PROVIDE FOR THOSE NEEDS BEYOND THE SCOPE OF THE HOSPITAL, SUCH AS TRANSPORTATION, PRESCRIPTION ASSISTANCE, SOCIAL WELFARE AND DAILY LIVING NEEDS. SMH PROVIDES THE RESOURCES TO RECRUIT HEALTHCARE WORKERS, PHYSICIAN ASSISTANTS, AND PHYSICIANS TO THE AREA. SMH HAS ESTABLISHED A RURAL HEALTH CARE CENTER TO HELP COMBAT THE PHYSICIAN SHORTAGE IN RURAL AMERICA AND PROVIDE FOR THOSE UNABLE TO PAY FOR SUCH CARE. MEMBERS OF THE SMH TEAM ARE ACTIVE MEMBERS IN THE ECONOMIC DEVELOPMENT COMMITTEE OF SHELBY COUNTY, THE CHAMBER OF COMMERCE, THE MID-ILLINOIS CHAPTER OF THE AMERICAN RED CROSS AND OTHER CIVIC AND NOT FOR PROFIT ORGANIZATIONS DEDICATED TO THE BETTERMENT OF LIVING STANDARDS FOR THE RESIDENTS OF THE AREA. THE BOARD OF DIRECTORS AND MANAGEMENT OF SMH ARE COMMITTED TO PROVIDING THE BEST IN CARE AND EQUIPMENT TO THE COMMUNITY AS IS DEMONSTRATED IN OUR MOST RECENT PURCHASE OF DIGITAL MAMMOGRAPHY EQUIPMENT, LAPAROSCOPIC SURGERY EQUIPMENT AND NEW CARDIAC MONITORING SYSTEMS IN THE PAST TWO YEARS. ADDITIONALLY, SMH HAS SPENT MONIES AND TIME IN MEETING MEANINGFUL USE FOR THE COMPUTERIZED MEDICAL RECORD. SMH'S COMMITMENT TO ELECTRONIC MEDICAL RECORDS MAKES US ONE OF THE FEW SMALL RURAL HOSPITALS IN THE NATION APPLYING TO THE FEDERAL GOVERNMENT FOR THE FUNDS AS OF JANUARY 2011 UNDER THE AMERICAN RECOVERY ACT OF 2009. ALL FUNDS ARE RETAINED BY THE CORPORATION AND REINVESTED IN THE HEALTHCARE NEEDS OF THE COMMUNITY PRESENT OR FUTURE. AFFILIATED HEALTH CARE SYSTEM NOT APPLICABLE STATE OF FILING OF COMMUNITY BENEFIT REPORT NOT APPLICABLE BAD DEBT METHODOLOGY PART III, LINE 2 IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION 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 UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY PART V, SECTION B, LINE 3 THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK. POSSIBLE AVENUES FOR GATHERING PRIMARY DATA WERE REVIEWED AND IT WAS DETERMINED TO PROCEED WITH THREE FOCUS GROUPS COMPRISED OF AREA HEALTH CARE PROFESSIONALS/PARTNERS, COMMUNITY OFFICIALS AND COMMUNITY LEADERS AND GROUPS. THIS ASSESSMENT HAS EXPLORED THE NEEDS OF THOSE WHO MAY BE IMPACTED BY ISOLATED LOCAL ACCESS ISSUES BY SEEKING INPUT FROM PERSONS EXPECTED TO HAVE KNOWLEDGE OF POTENTIAL SPECIFIC ISSUES FACING AREA COMMUNITIES. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS, INCLUDING SCHOOL OFFICIALS DEALING DAILY WITH YOUTH AND FAMILIES. HOW THE CHNA WAS MADE WIDELY AVAILABLE TO THE PUBLIC PART V, SECTION B, LINE 5C THE CHNA WAS ALSO MADE WIDELY AVAILABLE THROUGH NOTICES IN LOCAL PRINT AND ONLINE PUBLICATIONS. DIRECT WEBSITE URL PART V, SECTION B, LINE 5A THE DIRECT WEBSITE URL IS: WWW.MYSMH.ORG/FILES/SHELBYMEMORIAL_HOSPIITAL_2012_1.PDF CHNA IMPLEMENTATION STRATEGY 1. MENTAL HEALTH SERVICES, INCLUDING SUBSTANCE ABUSE PREVENTION AND TREATMENT SECURE OUTSIDE COMPANY RESOURCE ASSISTANCE IN HELPING TO DETERMINE NEEDS AND POTENTIAL SOLUTIONS FROM AN OBJECTIVE SOURCE. INVOLVE COMMUNITY STAKEHOLDERS IN PROCESS TO DETERMINE PRACTICAL ABILITY TO ASSIST WITH LOCAL MENTAL HEALTH SERVICES AS WELL AS ABUSE PREVENTION AND TREATMENT. TIMELINE TO DATE: NOVEMBER, 2012 - CONTACTED SIGNET HEALTH CORPORATION AND HORIZON HEALTH, BOTH COMPANIES PRESENTED, THE ONLY SOLUTIONS THEY COULD DETERMINE THAT WOULD BE FINANCIALLY FEASIBLE WOULD BE IP GERIATRIC PSYCHE. JANUARY - MARCH, 2013 - PHYSICAL ASSESSMENT OF CURRENT FACILITIES THAT COULD BE USED FOR A IP GERIATRIC PSYCHE UNIT CONDUCTED. MURRAY AND COMPANY DEVELOPED RENOVATION COST ESTIMATES ALONG WITH PRELIMINARY PLAN. COST EXCEEDED 10 YEAR ROI FOR PAYOFF WITH ESTIMATED 100% OCCUPANCY OF UNIT. APRIL, 2013 - PLANS TO PURSUE IP GERIATRIC PSYCHE UNIT DISCARDED. OCTOBER, 2013 - CONTACTED PSYCHIATRIC RESOURCE PARTNERS TO EXPLORE OTHER ELEMENTS OF POTENTIAL MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION AND TREATMENT. FEBRUARY, 2014 - SET UP MEETING WITH PRP, SMH AND COMMUNITY STAKEHOLDERS TO DISCUSS POTENTIAL SOLUTIONS TO OP MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. 2. EDUCATION SHELBY MEMORIAL HOSPITAL IS CONTINUING TO PROVIDE EDUCATIONAL OPPORTUNITIES, E.G. GIRLS NIGHT OUT AIMED AT WOMEN'S HEALTH, FOR THE COMMUNITY. ADDITIONAL PROGRAMS ARE UNDER CONSIDERATION CONTINUALLY. 3. PLANNING FOR CONTINUED LOCAL AVAILABILITY OF PHYSICIANS AND MEDICAL SPECIALISTS SHELBY MEMORIAL HOSPITAL IS CONTINUALLY RECRUITING PHYSICIANS AND MID-LEVEL PROVIDERS TO THE COMMUNITY. FROM THE TIME OF THE CHNA UNTIL FEBRUARY, 2014 TWO ADDITIONAL MID-LEVEL PROVIDERS HAVE BEEN ADDED TO THE COMMUNITY HEALTHCARE FORCE AND AN ADDITIONAL CARDIOLOGIST AND ORTHOPEDIC SURGEON HAVE BEEN ADDED TO THE SPECIALTY CLINIC, WHERE OUT OF TOWN PHYSICIANS COME TO SEE PATIENTS IN THE SMH FACILITY. 4. ACCESS TO BASIC SERVICES FOR ALL RESIDENTS SHELBY MEMORIAL HOSPITAL CONTINUES TO OFFER SERVICES TO AREA RESIDENTS REGARDLESS OF ABILITY TO PAY. WE CONTINUALLY ADVERTISE THIS AVAILABILITY THROUGH OUR WEB PAGE, COMMUNITY ADVERTISING AND GENERAL COMMUNITY INVOLVEMENT OPPORTUNITIES. SPECIFIC IDEAS IDENTIFIED IN THIS PRIORITY SUCH AS EXPANDED SURGICAL OPPORTUNITIES, EXPANDED DIAGNOSTIC EQUIPMENT AND DELIVERY OF BABIES WERE DEEMED FINANCIALLY UNFEASIBLE. X X X X false false false false false false false false false MARILYN SEARS 163004 0 22680 0 0 0 7427 0 1777 0 194888 0 0 0 DR ARNOLD AGAPITO 162522 0 50000 0 0 0 8501 0 1255 0 222278 0 0 0 DR TRUMAN MARK VASKO 258338 0 0 0 0 0 10334 0 646 0 269318 0 0 0 DR JAGAN BOKKA 179285 0 0 0 0 0 7171 0 5077 0 191533 0 0 0 A CITY OF SHELBYVILLE 421741646 2010-12-30 9000000 CONSTRUCTION/RETIRMENT OF BONDS false false false A 0 0 9000000 0 0 7165000 0 0 0 1835000 0 0 2012 true false false true A false false false false 0.00000 0.00000 0.00000 false false false true A false false false false false false 0 false 0 false false A false FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 2 MICHAEL KILEY HAS A FAMILY RELATIONSHIP WITH DAVID CRUITT. REVIEW PROCESS FORM 990, PART VI, SECTION A, LINE 11 THE 990 IS REVIEWED BY THE CFO FOR ACCURACY. NO REVIEW WAS OR WILL BE CONDUCTED BY THE ORGANIZATION'S GOVERNING BODY. COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE ORGANIZATION ALSO HOLDS QUARTERLY MEETINGS WITH EMPLOYEES. THE HOSPITAL'S CEO, CFO, AND CNE ARE RESPONSIBLE FOR DETERMINING AND REVIEWING ANY CONFLICTS OF INTEREST. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINE 15A WAGE SCALE IS PREPARED USING COMPARISON INFO FROM OTHER HOSPITALS. IT IS PREPARED BY THE HUMAN RESOURCE DIRECTOR AND ENFORCED BY THE HUMAN RESOURCE DIRECTOR AND THE CFO. THE COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE GOVERNING BODY. PROCESS FOR MAKING DOCUMENTS AVAILABLE TO PUBLIC FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES - EMERGENCY ROOM 731,753 PROFESSIONAL FEES - OTHER MEDICAL 200,904 PURCHASED SERVICES - PHARMACY 849,821 PURCHASED SERVICES - OTHER MEDICAL 420,084 ------------------------------------------------ TOTAL 2,202,562 PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINE 15B WAGE SCALE IS PREPARED USING COMPARISON INFO FROM OTHER HOSPITALS. IT IS PREPARED BY THE HUMAN RESOURCE DIRECTOR AND ENFORCED BY THE HUMAN RESOURCE DIRECTOR AND THE CFO. SHELBY MEMORIAL HOSPITAL FOUNDATIONINC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371294401 FUNDRAISING IL 501(C)(3) 11 - I SMHA true false false true false false false false false false false false false true true false false false true SHELBY MEMORIAL HOSPITAL FOUNDATION INC C 76599 CASH