2013-02-12T07:44:48-07:00 2012-09-30 990 2011-10-01 420710268 KEOKUK AREA HOSPITAL KEOK 3195247150 1600 Morgan Street Keokuk IA 52632 walter winkler 3195268661 2013-02-08 2011 2016-02-25 16:41:14Z walter winkler 1600 morgan street keokuk IA 52632 24850748 0 X keokukhealthsystems.org X 1975 IA Improving Community Health/assuring access to quality healthcare services regardless of ability to pay. 11 11 430 200 0 0 55870 40056 28422996 23853868 204709 -43500 699437 1000324 29383012 24850748 0 0 0 0 17040400 14783615 0 0 0 13994352 10961151 31034752 25744766 -1651740 -894018 16487269 15808372 11751250 12373410 4736019 3434962 Improving Community Health assuring access to quality healthcare services regardless of ability to pay. 0 0 25258028 55768664 Keokuk Area Hospital is a private 501 c 3 tax exempt charitable community primary care acute hospital with a mission of ensuring quality healthcare services are available to all residents of our community regardless of their ability to pay. The hospital provides emergency are, outpatient, and inpatient services to about 45,000 patients each year. About 75% of these patients are either Medicare, Medicaid, or indigent, and result in more than $6,000,000 of uncompensated cost of care each year. KAH struggles to continue providing this uncompensated care due to growing Medicare and Medicaid cost shortfalls as the hospital receives only about 75% of the cost of caring for these patients. To date, efforts by KAH have been highly successful as demonstrated by the wide scope of services available for a community hospital and the relatively low cost when compared with other facilities of KAH's size locally, regionally, or nationally (as evidenced by the Iowa Hospital Association Databank and other benchmarking entities). However, continued payment below cost has resulted in KAH closing our psychiatric unit, inpatient rehab unit, and skilled nursing facility, and is impacting the ability of the hospital to continue delivering services and recruiting physicians to the area. The Governing Board is made up of local concerned residents from various business and professional backgrounds who serve without compensation. In addition to a total of over $6,000,000 of uncompensated cost, which includes subsidies for mental health services, obstetrics, swing bed services, emergency room services, and many other hospital services and several hundred thousand dollars of subsidies to the local Community Health Center of Southeast Iowa, KAH services and community benefit include: 1. Recruitment and retention of physicians to the hospital community 2. Stop smoking clinics, radon clinics, advanced directive clinics and I can Cope programs 3. Community Health Education of mny types 4. Support groups for many chronic and acute illnesses 5. Self Help programs 6. Health Screening services 7. Immunization clinics and support 8. Counseling for a variety of topics 9. In home services 10. Transportation services 11. Physician referral service - The hospital aids any patients presenting themselves for medical treatment in finding a physician if they do not have one 12. Baby Hot Line 0 A 24 hour hotline is available to the hospital OB department for expectant mothers to call with concerns of questions about their pregnancies or care of infants. 13. The hospital provides appropriate telecommunication devices for the hearing impaired, as well as policies that ensure that persons handicapped in any manner can be cared for. 14. Hospital Social Services assist patients in applying for Medicare and Medicaid benefits, finding long term care services for those who need them, and supporting both the patient and families during their hospital stay and any time after 15. The hospital's business office provides hundreds of hours of insurance counseling and assistance to patients in getting properly reimbursed through their insuring agent 16. The hospital provides various other telephone information programs through the hospital Psychiatric Department, as well as the Emergency Department 17. The hospital also provides a variety of assistance to local organizations and people seeking health care services and/or information, and participates with all local health care related organizations in coordinating services and referrals 18. The hospital has a formal improvement program with participation by all levels of employees. The PI efforts are aimed at continually improving care and increasing productivity and cost effectiveness 19. As a demonstration of the ongoing support of the community, more than 200 volunteers continue to provide thousands of hours of time and service to patients and visitors at the hospital, and also raise significant funds towards the purchase of needed hospital equipment. The Board is committed to providing services in our community only if they can be provided in a quality manner and at a cost that is no greater than can be provided elsewhere. The hospital has also been operated without any tax support from the community and the hospital board is committed to operating the facility in such a manner that it does not become a burden to the community. The Board is also committed to charging for services in an equitable manner, and distributing costs of providing services across the broadest segment of payers possible The greater Keokuk area includes Lee County Iowa, Hancock County Illinois, and Clark County Missouri. Each of these areas are rural and this entire market area continues to experience some of the highest unemployment rates in their respective states, caused by plant closings and cutbacks. As a result of the demographics of our area and reimbursement characteristics of Medicare and Medicaid programs (which do not pay the cost of care in rural Iowa) less than 25% of patients' third party payers must bear the burden of government shortfalls and indigent care. These third party payers do not always make up the deficit created by government and indigent patients which has resulted in losses for Keokuk Area Hospital in six of the past ten years despite KAH being a low cost hospital by any benchmarking information available. 2012 resulted in a large loss of $890k despite a reduction of expenses of over $3 Million. Keokuk Area hospital cost shortfalls from Medicare alone have exceeded $27,5,000,000 over the past 14 years, making it difficult to purchase needed technology, new facilities, and equipment as well as impacting Keokuk Area Hospital's ability to provide competitive wages and benefits in our labor market. Keokuk Area Hospital employees have not had a wage increase for 3 years and contributions to the employee's 401k pension plan have been suspended to help over come government reimbursement shortfalls. Many rural Iowa hospitals have the same issues, however, most have been able to take advantage of the federal government's Critical Access Hospital program which increases Medicare payment to 101% of costs, and which once achieved brings higher payment from both Medicaid and some commercial payers such as Wellmark. Keokuk Area Hospital's census has diminished to the point where it is now operating as a Critical Access Hospital and meets all of the requirements of being a Critical Access Hospital, however, it cannot be designated as such because it is less than 35 miles from the nearest hospital, despite the fact that there is a critical access hospital within 17 miles of Keokuk, and despite the fact that Keokuk Area Hospital has been designated as a "necessary hospital" by the State of Iowa. As was the case with other hospitals prior to the Critical Access Hospital legislation being enacted, Keokuk Area Hospital is struggling to survive financially due to the failure of Medicare and Medicaid to pay the cost of caring for their enrollees. The Keokuk Community is being discriminated against simply because our Hospital was not smaller at an earlier date. The mission of caring for all Keokuk Area Residents regardless of their ability to pay creates a huge Community Benefit, however, this benefit is in jeopardy due to CMS policy of paying other hospitals in similar Communities higher rates while denying the Keokuk Community the same reimbursement. 0 0 0 25258028 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 34 0 1 430 1 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Walter H Winkler 3195268661 1600 Morgan Street Keokuk IA 52632 Jim Bowles 1 X 0 0 0 Walt Stephens 1 X X 0 0 0 Jeff Allerman 1 X 0 0 0 Anne Schock 1 X 0 0 0 Kiran Khanolkar MD 1 X 0 263430 0 Neville Crenshaw DO 1 X 0 0 0 Kent Nixon 1 X X 0 0 0 Allan Zastrow 1 X X 168256 0 13750 Mike Maher 1 X 0 0 0 Wendy Swank 1 X 0 0 0 Tom Marion 1 X 0 0 0 Walter H Winkler 40 X X X 116515 0 13750 Susan Pankey 40 X X X 108286 0 11853 Elizabeth Allen 40 X 121782 0 11853 Jagadamba Kantanmeni 40 X 323771 0 8202 John J Miller 40 X 111733 0 5926 950343 263430 65334 6 0 1 1 PT Services Rehabilitation Inc Box 833 Tiffin OH 44883 Physical Therapy 327940 Kirk Green 2020 Meadow Lane Keokuk IA 52632 Orthopedic Surgeon 400000 Blessing Physician Services Box 5007 Quincy IL 61232 Emergency Room Physician Coverage 1684682 Pathology Services 2916 S Brentwood Blvd St Louis MO 63144 Pathologist Services 140000 Shared Medical Services Box 330 Cottage Grove WI 53527 MRI 292500 6 0 0 0 0 14241 25815 0 40056 Hospital Services 622000 23853868 23853868 0 0 0 0 0 0 23853868 -43500 -43500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria/laundry/rent/etc. 622000 358811 358811 0 0 Weight Loss Program 622000 230280 230280 0 0 Miscellaneous 622000 411233 411233 0 0 0 0 0 0 1000324 24850748 24810692 0 0 393057 393057 11545209 11545209 0 130915 126605 4310 1880694 1818773 61921 833740 806290 27450 2913433 2913433 115817 115817 487925 487925 86511 86511 399091 399091 1255771 1255771 114514 114514 Supplies 3751401 3751401 0 0 Repairs and Minor Equip 715953 715953 0 0 Recruitment and Physician Support 590441 590441 0 0 Miscellaneous 530294 530294 0 0 25744766 25258028 486738 0 579662 553965 1400818 1468715 4375104 4957833 886697 307973 1015249 991376 79273 152478 28623565 22123960 6785676 6499605 1364790 876427 16487269 15808372 5546519 6517545 0 0 3889446 3305608 0 0 0 0 2315285 2550257 11751250 12373410 X 4690725 3409735 45294 25227 0 0 4736019 3434962 16487269 15808372 X -894018 -407039 X 0 1 1 0 X 0 438675 438675 0 505333 0 505333 0 17069484 13653640 3415844 0 6654755 5323045 1331710 0 3955318 3147275 808043 6499605 Advance to affiliates 839005 Deferred Financing Costs 37422 876427 0 Capital lease obligations 1749400 Notes 613481 Line of Credit 187376 2550257 24850748 25744766 -894018 0 0 0 0 0 0 -894018 24850748 0 0 0 0 0 24850748 0 0 0 24850748 25744766 0 0 0 0 0 25744766 0 0 0 25744766 1 1 1 X 1 X 1 1 1 0 1 1 430320 430320 1195534 1195534 68322 68322 0 0 1694176 0 1694176 0 3240 58827 58827 52 460061 460061 839604 839604 0 3292 1358492 0 1358492 0 0 3292 3052668 0 3052668 0 1080 1080 3000 3000 4970 4970 3128 3128 13652 13652 5200 5200 86886 86886 117916 117916 0 0 235832 0 235832 0 1 2750322 1269645 9829251 12083280 -2254029 X 1 1 1 1 Keokuk Area Hospital

1600 Morgan Street Keokuk IA 52632

X X X Keokuk Area Hospital 1 1 X X X X X X X X X 12 1 1 1 X X X X X 1 SchH_P01_S00_L06a Schedule H, Part I, Line 6a Keokuk Area Hospital submitted data to the Iowa Hospital Association which prepares Community Benefit Reports for Iowa Hospitals IHA is not a related organization SchH_P01_S00_L07 Schedule H, Part I, Line 7 Ratio of cost to charges is applied to gross charges SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f 0 (zero) SchH_P01_S00_L07g Schedule H, Part I, Line 7g All of the $839604 is attributable to the hospital providing subsidized services to patients of Tri State Medical Group a related organization TSMG is affiliated with the Community Health Centers of Southeast Iowa and Keokuk Area Hospital provides this subsidy to ensure CHC patients have access to primary medical care SchH_P02_S00_L00 Schedule H, Part II Involving hospital staff in outside organizations and working with them to provide health education and assessment provides a forum to keep the Hospital aware of Community needs, while building coalitions to address these needs. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by third-party payors and less an estimated allowance for doubtful receivables based on a review of all outstanding amounts on a monthly basis. Management determines the allowance for doubtful accounts by identifying troubled accounts by historical experience applied to an aging of accounts and by considering the patients' financial history, credit history and current economic conditions. The Hospital does not charge interest on patient receivables. Patient receivables are written off as bad debt when deemed uncollectible. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received....For uninsured patients that do not qualify for charity care the Hospital recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates if negotiated or provided by policy) On the basis of historical experience a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Medicare pays Keokuk Area Hospital substantially less than reasonable cost which represents uncompensated care just like care provided to indigent patients who cannot pay for their services. The cost of this care is calculated per the Medicare cost report methodology. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b If information is available to confirm a patient is eligible for charity care collection services are not pursued. SchH_P05_S0B_L04 Schedule H, Part V, Section B, Line 4 Keokuk Area Hospital participated in the Community Wide Needs Assessment along with many other healthcare and civic organizations in Lee County Iowa SchH_P06_S00_L02 Schedule H, Part VI, Line 2 KAH participates with as many health related organizations as possible to assess healthcare needs in Lee County Iowa and shares the results in a written Community Assessment SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Bills and statements include a written notice to patients that financial assistance is available and encourages patients to either call or visit the Business Office if they are interested SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Keokuk Area Hospital serves the populations of southern Lee County in Iowa, Western Hancock County in Illinois, and Northern Clark County in Missouri all of which are economically depressed. More than 23% of the Keokuk population is below the federal poverty level. 75% of all patients are either Medicaid, Medicare, or Indigent, all of which reimburse Keokuk Area Hospital less than cost and the 25% remaining insured population does not make up for these cost shortfalls SchH_P06_S00_L05 Schedule H, Part VI, Line 5 Keokuk Area Hospital has an all volunteer Board of Directors made up of local Community members who serve without compensation. The Medical Staff is open to all interested medical practitioners who are appropriately credentialled. All funds generated by the Hospital are utilized for patient related services and ensuring that all patients of our market have access to quality medical services regardless of their ability to pay. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Keokuk Area Hospital provides inpatient and outpatient health care services Tri State Medical Group provides medical offices and access to medical care for Community Health Center patients, and Keokuk Area Medical Equipment provides DME and pharmacy services including MAP services which help indigent patient obtain drugs at no cost from the manufacturer All services are coordinated to help reduce lengths of stay in the hospital and ensure that care is provided in the appropriate setting and that there is continuity of care from one level to another SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Iowa X X X X 0 0 0 0 0 0 0 1 0 Kiran Khanolkar MD 0 140233 0 113768 0 0 0 0 0 21281 0 275282 0 0 Allan Zastrow 154949 0 0 0 5200 0 0 0 21857 0 182006 0 0 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 All highly paid individuals' wages are reviewed and established by the Board of Directors using benchmark data from numerous sources including the Iowa Hospital Association salary surveys, physician compensation surveys, etc. SchJ_P01_S00_L07 Schedule J, Part I, Line 7 Part of the physician Board Member's compensation from a related organization is subject to RVU production. (Relative Value Units) F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Keokuk Health Systems, Inc XXX-XX-XXXX F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Keokuk Health Systems, Inc XXX-XX-XXXX F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Keokuk Health Systems, Inc XXX-XX-XXXX is the parent company of Keokuk Area Hospital and sole member F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Distributed to Board Executive Committee prior to filing and to all Board Members after filing F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c All employees, officers, and directors are required to disclose any conflict of interests at the point they arise and to sign a conflict of interest statement annually attesting that they have disclosed any conflicts of interest F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Board of Directors Executive committee reviews and establishes all compensation arrangements with highly paid employs utilizing benchmark data from various sources including the Iowa Hospital Association wage and salary surveys and physician compensation surveys F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Yes documents are available upon request and the 990 is published at guidestar.com F990_P11_S00_L05 Form 990, Part XI, Line 5 Transfer of equity to TSMG to subsidize medical care at Community Health Center -$840000 Return of equity from KAH ODS dissolved insurance plan $357816 Contributions of equipment $75145 Keokuk Health Systems Inc 1600 Morgan Street Keokuk IA 52632 421237361 Parent Company of Keokuk Area Hospital IA 501 c 3 exempt non profit N/A Tri State Medical Group 1600 Morgan Street Keokuk IA 52632 421435525 Medical Offices IA 501 c 3 exempt non profit Keokuk Health Systems Inc Keokuk Area Hospital Foundation 1600 Morgan Street Keokuk IA 52632 411202608 Fundraising IA 501 c 3 exempt non profit Keokuk Health Systems Inc Keokuk Area Hospital Organized Delivery System 1600 Morgan Street Keokuk IA 52632 421474799 Non Profit Indemnity Health Insurance IA Keokuk Health Systems Inc C 1 Keokuk Area Medical Equipment Inc 1600 Morgan Street Keokuk IA 52632 421237312 Durable Medical Equipment and Pharmacy Sales IA Keokuk Health Systems Inc C 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Tri State Medical Group b 840000 Keokuk Area Hospital subsidized care of patients seen at TSMG through an affiliation with the Community Health Centers of Southeast Iowa. This subsidy basically represents the cost of expenditures utilized by TSMG to care for these patients that were not reimbursed by third party programs or individuals. Keokuk Health Systems Inc c 357816 Keokuk Area Hospital provided equity to the Keokuk Area Hospital Organized Delivery System through Keokuk Health Systems. The KAH ODS has been non operational for the past two years and this $356816 is a return of equity to Keokuk Area Hospital through Keokuk Health Systems, Inc.