2013-07-31T09:44:07-05:00 2012-12-31 421206169 Gronewold Bell Kyhnn & Co PC 1910 E 7th St Atlantic IA 50022 990 2012-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 KAREN COLE 7122461230 2013-07-31 1 Christopher J Nelson P00075202 7122431800 2012 2016-02-24 21:20:13Z KAREN COLE 300 PERSHING AVENUE SHENANDOAH IA 51601 28703599 0 X www.shenandoahmedcenter.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 10 331 50 6805 -3573 243254 205842 26805621 25789085 93695 462041 229026 182760 27371596 26639728 0 0 0 0 13802419 14828689 0 0 56768 12222591 10845918 26025010 25674607 1346586 965121 25598581 27500142 2662721 3500104 22935860 24000038 TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH & SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION 0 0 23822825 26427081 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. 23822825 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 0 0 0 0 1 22 0 1 331 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X SANDRA CHESSHIRE CFO 7122461230 300 PERSHING AVE SHENANDOAH IA 51601 DAVE LASHIER 3.00 X X 0 0 0 JON LEHNER 3.00 X X 0 0 0 KENNETH DEBAERE 3.00 X X 0 0 0 MARY JO CARRELL 3.00 X 0 0 0 GREG RITCHEY 3.00 X 0 0 0 DEB ISTAS 3.00 X 0 0 0 ALISSA MCGINNIS 3.00 X 0 0 0 TIM AUGUSTINE 3.00 X 0 0 0 FLOYD JONES DO 3.00 X 0 0 0 ED KLOBERDANZ 3.00 X 0 0 0 KAREN COLE 40.00 X 132430 0 12576 SANDRA CHESSHIRE 40.00 X 164777 0 29432 SUBIR RAY MD 40.00 X 746561 0 31801 SCOTT R KING 40.00 X 364450 0 23876 WAYNE JOHNSON 40.00 X 188903 0 6219 JOHN BOWERY MD 40.00 X 141663 0 18326 SANTOSH KUMAR 40.00 X 216151 0 10394 SUSAN MCGOUGH 0.00 X 128985 0 19795 2083920 0 152419 8 1 1 0 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 8 205842 205842 NET PATIENT SERVICE RE 621110 25789085 25789085 25789085 219633 219633 255051 73589 181462 181462 181462 2232190 500 1988540 1742 243650 -1242 242408 242408 CATERING OF MEALS 722320 6805 6805 SHENANDOAH AMBULANCE S 621910 -5507 -5507 1298 26639728 26427081 6805 0 297207 164777 132430 12071216 11399744 624188 47284 290994 272038 17801 1155 1343388 1259001 79547 4840 825884 736443 85952 3489 17832 17832 56767 56767 2110321 2089543 20778 1408404 1408404 SUPPLIES 6388326 5666382 721944 PURCHASED SERVICES 864268 826493 37775 25674607 23822825 1795014 56768 2270920 2232391 318384 319874 4643227 4495305 714538 832009 243250 211562 25818256 17379623 7970566 8438633 7578451 9734922 1859245 1235446 25598581 27500142 2017612 2014032 13109 0 632000 1486072 2662721 3500104 X 21806064 22778262 874110 954665 255686 267111 22935860 24000038 25598581 27500142 X 965121 102057 -3000 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7578451 2877629 565340 0 1286498 9734922 8688964 58208 1168721 7578451 8857784 601102 769922 8688964 6608058 1274933 974793 8857784 7318227 770144 -1480313 6608058 0.87450 0.02740 0.09810 0 0 92822 92822 11845815 8147407 3698408 12900230 8535164 4365066 979389 697052 282337 8438633 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1486072 1486072 26741785 102057 102057 26639728 0 26639728 25677607 3000 3000 25674607 0 25674607 Part XII, Line 2d - Other Adjustments: USE OF TEMP RESTRICTED FUNDS 1 1 X 1 X 1 X 1 1 1 0 1 1 374170 374170 0.01460 2323740 1921784 401956 0.01570 2697910 1921784 776126 0.03030 12 4026 382484 304936 77548 0.00300 1 0 13 26142 13220091 11174056 2046035 0.07970 4 9800 23900 23900 0.00090 30 39968 13626475 11478992 2147483 0.08360 30 39968 16324385 13400776 2923609 0.11390 1 146 107914 107914 0.00420 1 58 308 308 0.00000 2 204 108222 108222 0.00420 1 1235013 8826666 8955708 -129042 X 1 1 1 1 SHENANDOAH MEDICAL CENTER

300 PERSHING AVE SHENANDOAH IA 51601

X X X X SHENANDOAH MEDICAL CENTER 1 1 1 200.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X 1 X 1 X X 1 X 0 0 8 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 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. SHENANDOAH MEDICAL CENTER Part V, Section B, Line 20d: THE INDIVIDUALS WHO DID NOT HAVE INSURANCE ARE GIVEN A 15% UNINSURED DISCOUNT 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Shenandoah Medical Center's oversees the operating expenses of the Foundation. X 1 1 X 1 0 0 0 0 0 0 0 0 SANDRA CHESSHIRE 105727 0 59050 0 0 0 0 0 29432 0 194209 0 0 0 SUBIR RAY MD 629022 0 117539 0 0 0 0 0 31801 0 778362 0 0 0 SCOTT R KING 244099 0 120351 0 0 0 0 0 23876 0 388326 0 0 0 WAYNE JOHNSON 182603 0 6300 0 0 0 0 0 6219 0 195122 0 0 0 JOHN BOWERY MD 141663 0 0 0 0 0 0 0 18326 0 159989 0 0 0 SANTOSH KUMAR 201151 0 15000 0 0 0 0 0 10394 0 226545 0 0 0 SUSAN MCGOUGH 128985 0 0 0 0 0 0 0 19795 0 148780 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 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. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: USE OF TEMP RESTRICTED FUNDS -3000. Form 990, Part XII, Line 2c: PROCESS IS CONSISTENT WITH PRIOR YEAR.