SHENANDOAH MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SHENANDOAH MEDICAL CENTER (EIN 42-1101835)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-07-31
- IRS object ID
- 201312129349300711
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-07-31T09:44:07-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421206169 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gronewold Bell Kyhnn & Co PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1910 E 7th St | AddressLine1 |
| City | Atlantic | City |
| State | IA | State |
| ZIP Code | 50022 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421101835 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHENANDOAH MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SHEN | NameControl |
| Phone | 7122461230 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KAREN COLE | Name |
| Title | CEO | Title |
| Phone | 7122461230 | Phone |
| Date Signed | 2013-07-31 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Christopher J Nelson | Name |
| PTIN | P00075202 | PTIN |
| Phone | 7122431800 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KAREN COLE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 28703599 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.shenandoahmedcenter.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1978 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH & SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 331 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 6805 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -3573 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 243254 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 205842 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26805621 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 25789085 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 93695 | InvestmentIncomePriorYear |
| Investment Income Current Year | 462041 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 229026 | OtherRevenuePriorYear |
| Other Revenue Current Year | 182760 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27371596 | TotalRevenuePriorYear |
| Total Revenue Current Year | 26639728 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 13802419 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 14828689 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 56768 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12222591 | OtherExpensePriorYear |
| Other Expenses Current Year | 10845918 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 26025010 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25674607 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1346586 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 965121 | RevenuesLessExpensesCY |
| Total Assets BOY | 25598581 | TotalAssetsBOY |
| Total Assets EOY | 27500142 | TotalAssetsEOY |
| Total Liabilities BOY | 2662721 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3500104 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 22935860 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 24000038 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH & SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23822825 | Expense |
| Revenue | 26427081 | Revenue |
| Description | 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 2012, THE HOSPITAL PROVIDED 1,520 DAYS OF ACUTE CARE, 751 DAYS OF SKILLED NURSING CARE, 218 NURSERY DAYS, AND 77,506 OUTPATIENT OCCASIONS OF SERVICE. THE NURSING FACILITY PROVIDED 1,943 ASSISTED LIVING DAYS AND 14,763 INTERMEDIATE CARE DAYS OF SERVICE. | Description |
| Total Program Service Expense | 23822825 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 22 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 331 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANDRA CHESSHIRE CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7122461230 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 PERSHING AVE | AddressLine1 |
| City | SHENANDOAH | City |
| State | IA | State |
| ZIP Code | 51601 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| DAVE LASHIER | ||||||||
| CHAIRMAN | 3.00 | X | X | 0 | 0 | 0 | ||
| JON LEHNER | ||||||||
| VICE CHAIRMAN | 3.00 | X | X | 0 | 0 | 0 | ||
| KENNETH DEBAERE | ||||||||
| SECRETARY/TREASURER | 3.00 | X | X | 0 | 0 | 0 | ||
| MARY JO CARRELL | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| GREG RITCHEY | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| DEB ISTAS | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| ALISSA MCGINNIS | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| TIM AUGUSTINE | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| FLOYD JONES DO | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| ED KLOBERDANZ | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| KAREN COLE | ||||||||
| CEO | 40.00 | X | 132430 | 0 | 12576 | |||
| SANDRA CHESSHIRE | ||||||||
| CFO | 40.00 | X | 164777 | 0 | 29432 | |||
| SUBIR RAY MD | ||||||||
| PHYSICIAN | 40.00 | 746561 | 0 | 31801 | X | |||
| SCOTT R KING | ||||||||
| OB-GYN | 40.00 | 364450 | 0 | 23876 | X | |||
| WAYNE JOHNSON | ||||||||
| CRNA | 40.00 | 188903 | 0 | 6219 | X | |||
| JOHN BOWERY MD | ||||||||
| PHYSICIAN | 40.00 | 141663 | 0 | 18326 | X | |||
| SANTOSH KUMAR | ||||||||
| HOSPITALIST | 40.00 | 216151 | 0 | 10394 | X | |||
| SUSAN MCGOUGH | ||||||||
| FORMER CEO | 0.00 | 128985 | 0 | 19795 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2083920 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 152419 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ACUTE CARE | |||||
| 1609 N ANKENY BLVD | ANKENY | IA | 50023 | ER PHYSICIAN STAFFING | 978542 |
| JE DUNN CONSTRUCTION | |||||
| 1001 LOCUST STREET | KANSAS CITY | MO | 64106 | RENOVATION | 410997 |
| GRAPETREE MEDICAL | |||||
| 703 16TH STREET | SPIRIT LAKE | IA | 51360 | STAFFING | 318014 |
| STAFF CARE | |||||
| PO BOX 281923 | ATLANTA | GA | 30384 | PHYSICIAN STAFFING | 259132 |
| UNMC PHYSICIANS | |||||
| PO BOX 30014 | OMAHA | NE | 68103 | LAB REFERENCE FEES | 248595 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| All Other Contributions | 205842 | AllOtherContributions |
| Total Contributions | 205842 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 25789085 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25789085 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 25789085 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 219633 | TotalRevenueColumn |
| Related Or Exempt Function Income | 219633 | RelatedOrExemptFunctionIncome |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 255051 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 73589 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 181462 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 181462 | TotalRevenueColumn |
| Related Or Exempt Function Income | 181462 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2232190 | Securities |
| Other | 500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1988540 | Securities |
| Other | 1742 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 243650 | Securities |
| Other | -1242 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 242408 | TotalRevenueColumn |
| Related Or Exempt Function Income | 242408 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CATERING OF MEALS | 722320 | 6805 | 6805 | |
| SHENANDOAH AMBULANCE S | 621910 | -5507 | -5507 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1298 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26639728 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26427081 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 6805 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 297207 | Total |
| Program Services | 164777 | ProgramServices |
| Management And General | 132430 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12071216 | Total |
| Program Services | 11399744 | ProgramServices |
| Management And General | 624188 | ManagementAndGeneral |
| Fundraising | 47284 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 290994 | Total |
| Program Services | 272038 | ProgramServices |
| Management And General | 17801 | ManagementAndGeneral |
| Fundraising | 1155 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1343388 | Total |
| Program Services | 1259001 | ProgramServices |
| Management And General | 79547 | ManagementAndGeneral |
| Fundraising | 4840 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 825884 | Total |
| Program Services | 736443 | ProgramServices |
| Management And General | 85952 | ManagementAndGeneral |
| Fundraising | 3489 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17832 | Total |
| Management And General | 17832 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56767 | Total |
| Management And General | 56767 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2110321 | Total |
| Program Services | 2089543 | ProgramServices |
| Management And General | 20778 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1408404 | Total |
| Program Services | 1408404 | ProgramServices |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 6388326 | 5666382 | 721944 |
| PURCHASED SERVICES | 864268 | 826493 | 37775 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25674607 | Total |
| Program Services | 23822825 | ProgramServices |
| Management And General | 1795014 | ManagementAndGeneral |
| Fundraising | 56768 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2270920 | BOY |
| EOY | 2232391 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 318384 | BOY |
| EOY | 319874 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4643227 | BOY |
| EOY | 4495305 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 714538 | BOY |
| EOY | 832009 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 243250 | BOY |
| EOY | 211562 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25818256 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17379623 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7970566 | BOY |
| EOY | 8438633 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7578451 | BOY |
| EOY | 9734922 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1859245 | BOY |
| EOY | 1235446 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25598581 | BOY |
| EOY | 27500142 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2017612 | BOY |
| EOY | 2014032 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13109 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 632000 | BOY |
| EOY | 1486072 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2662721 | BOY |
| EOY | 3500104 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21806064 | BOY |
| EOY | 22778262 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 874110 | BOY |
| EOY | 954665 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 255686 | BOY |
| EOY | 267111 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22935860 | BOY |
| EOY | 24000038 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25598581 | BOY |
| EOY | 27500142 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 965121 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 102057 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -3000 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7578451 | BeginningOfYearBalance |
| Contributions | 2877629 | Contributions |
| Investment Earnings Or Losses | 565340 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 1286498 | OtherExpenditures |
| End Of Year Balance | 9734922 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8688964 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 58208 | InvestmentEarningsOrLosses |
| Other Expenditures | 1168721 | OtherExpenditures |
| End Of Year Balance | 7578451 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8857784 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 601102 | InvestmentEarningsOrLosses |
| Other Expenditures | 769922 | OtherExpenditures |
| End Of Year Balance | 8688964 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6608058 | BeginningOfYearBalance |
| Contributions | 1274933 | Contributions |
| Investment Earnings Or Losses | 974793 | InvestmentEarningsOrLosses |
| End Of Year Balance | 8857784 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7318227 | BeginningOfYearBalance |
| Contributions | 770144 | Contributions |
| Investment Earnings Or Losses | -1480313 | InvestmentEarningsOrLosses |
| End Of Year Balance | 6608058 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.87450 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.02740 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.09810 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 92822 | InvestmentCostOrOtherBasis |
| Book Value | 92822 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 11845815 | InvestmentCostOrOtherBasis |
| Depreciation | 8147407 | Depreciation |
| Book Value | 3698408 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 12900230 | InvestmentCostOrOtherBasis |
| Depreciation | 8535164 | Depreciation |
| Book Value | 4365066 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 979389 | InvestmentCostOrOtherBasis |
| Depreciation | 697052 | Depreciation |
| Book Value | 282337 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8438633 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | Description |
| Amount | $1,486,072 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1486072 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 26741785 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 102057 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 102057 | RevenueNotRptdF990 |
| Revenue Subtotal | 26639728 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 26639728 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 25677607 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 3000 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 3000 | ExpensesNotRptdF990 |
| Expenses Subtotal | 25674607 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 25674607 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part XII, Line 2d - Other Adjustments: | Identifier |
| Explanation | USE OF TEMP RESTRICTED FUNDS | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 374170 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 374170 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01460 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2323740 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1921784 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 401956 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01570 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2697910 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1921784 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 776126 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03030 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 12 | NumberOfActivitiesOrPrograms |
| Persons Served | 4026 | PersonsServed |
| Total Community Benefit Expense | 382484 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 304936 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 77548 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 13 | NumberOfActivitiesOrPrograms |
| Persons Served | 26142 | PersonsServed |
| Total Community Benefit Expense | 13220091 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11174056 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2046035 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07970 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 9800 | PersonsServed |
| Total Community Benefit Expense | 23900 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 23900 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 30 | NumberOfActivitiesOrPrograms |
| Persons Served | 39968 | PersonsServed |
| Total Community Benefit Expense | 13626475 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11478992 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2147483 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08360 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 30 | NumberOfActivitiesOrPrograms |
| Persons Served | 39968 | PersonsServed |
| Total Community Benefit Expense | 16324385 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13400776 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2923609 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11390 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 146 | PersonsServed |
| Total Community Building Expense | 107914 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 107914 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 58 | PersonsServed |
| Total Community Building Expense | 308 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 308 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 204 | PersonsServed |
| Total Community Building Expense | 108222 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 108222 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,235,013 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 8826666 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8955708 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -129042 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHENANDOAH MEDICAL CENTER | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHENANDOAH MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 8 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| ELM HEIGHTS CARE CENTER | ||||
| 1204 SOUTH ELM | SHENANDOAH | IA | 51601 | NURSING HOME |
| SHENANDOAH MEDICAL CENTER | ||||
| 300 PARK AVE | SHENANDOAH | IA | 51601 | MEDICAL CLINIC |
| SHENANDOAH MEDICAL CENTER | ||||
| 315 PERSHING | SHENANDOAH | IA | 51601 | RENTAL FOR CRNA |
| FREMONT COUNTY MEDICAL CENTER | ||||
| 802 ILLINOIS ST | FREMONT | IA | 52561 | SIDNEY CLINIC |
| FREMONT COUNTY MEDICAL CENTER | ||||
| 804 ILLINOIS ST | FREMONT | IA | 52561 | DENTAL OFFICE RENTAL |
| SHENANDOAH MEDICAL CENTER | ||||
| 2 JACK FOSTER DR | SHENANDOAH | IA | 51601 | WELLNESS CENTER |
| SHENANDOAH MEDICAL CENTER | ||||
| 317 PERSHING AVE | SHENANDOAH | IA | 51601 | RENTAL HOME |
| ALEGENT HEALTH CLINIC | ||||
| 527 IOWA AVE | ESSEX | IA | 51638 | ESSEX CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (4 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, L7 Col(f): NONE. BAD DEBTS ARE REPORTED AS DEDUCTIONS FROM REVENUE, NOT AS OPERATING EXPENSES. | |
| Part III, Line 4: PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT ITS ESTIMATED NET REALIZABLE VALUE. THE CHANGE IN THE ESTIMATED ALLOWANCE FOR BAD DEBTS PLUS THE BAD DEBT ACCOUNTS WRITTEN OFF LESS RECOVERIES OF BAD DEBTS EQUALS THE BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST WAS ESTIMATED BASED ON THE HOSPITAL'S OVERALL COST COMPARED TO GROSS REVENUES. | |
| 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 V, Section B, Line 20d: THE INDIVIDUALS WHO DID NOT HAVE INSURANCE ARE GIVEN A 15% UNINSURED DISCOUNT | SHENANDOAH MEDICAL CENTER |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Shenandoah Medical Center's oversees the operating expenses of the Foundation. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SANDRA CHESSHIRE | ||||||||||||||
| CFO | 105727 | 0 | 59050 | 0 | 0 | 0 | 0 | 0 | 29432 | 0 | 194209 | 0 | 0 | 0 |
| SUBIR RAY MD | ||||||||||||||
| PHYSICIAN | 629022 | 0 | 117539 | 0 | 0 | 0 | 0 | 0 | 31801 | 0 | 778362 | 0 | 0 | 0 |
| SCOTT R KING | ||||||||||||||
| OB-GYN | 244099 | 0 | 120351 | 0 | 0 | 0 | 0 | 0 | 23876 | 0 | 388326 | 0 | 0 | 0 |
| WAYNE JOHNSON | ||||||||||||||
| CRNA | 182603 | 0 | 6300 | 0 | 0 | 0 | 0 | 0 | 6219 | 0 | 195122 | 0 | 0 | 0 |
| JOHN BOWERY MD | ||||||||||||||
| PHYSICIAN | 141663 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18326 | 0 | 159989 | 0 | 0 | 0 |
| SANTOSH KUMAR | ||||||||||||||
| HOSPITALIST | 201151 | 0 | 15000 | 0 | 0 | 0 | 0 | 0 | 10394 | 0 | 226545 | 0 | 0 | 0 |
| SUSAN MCGOUGH | ||||||||||||||
| FORMER CEO | 128985 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 19795 | 0 | 148780 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 AND WAYNE JOHNSON DURING 2012, FOR WHICH THE FAIR VALUE OF THE HOUSING PROVIDED WAS TREATED AS TAXABLE INCOME TO THEM. |
| Part I, Line 4a | Susan McGough, former CEO, received severance compensation of $147,490 during 2012. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | REVIEWED BY CEO, CFO, AND GOVERNING BOARD. | |
| Form 990, Part VI, Section B, line 12c | ENFORCED BY CEO AND COMPLIANCE OFFICER. | |
| Form 990, Part VI, Section B, line 15 | BOARD OF DIRECTORS AUTHORIZATION. | |
| 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 OF THE ORGANIZATION. | |
| Form 990, Part XI, line 9: | USE OF TEMP RESTRICTED FUNDS -3000. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2c: | PROCESS IS CONSISTENT WITH PRIOR YEAR. |