2011-05-13T13:06:39-05:00 2010-06-30 Eide Bailly LLP 5601 Green Valley Drive Ste 700 Minneapolis MN 554371145 990 2009-07-01 201347269 Renown Skilled Nursing RENO 7759824404 1155 Mill Street C/O Tax Treasury Z-5 Reno NV 89502 Dawn D Ahner 7759824404 2011-05-10 1 Kim Hunwardsen CPA 9529446166 2011-05-10 2009 2016-02-24 21:20:13Z Dawn D Ahner 1155 Mill Street C/O Tax Treasury Z-5 Reno NV 89502 12895072 0 X www.renown.org X 2004 NV A 160 bed long-term acute care nursing facility specializing in rehabilitative care. 3 0 0 10 0 0 3224655 2785248 10542985 10107284 0 0 6092 2540 13773732 12895072 0 0 0 0 8541197 8880056 0 0 0 5644220 5427085 14185417 14307141 -411685 -1412069 1924085 2190530 8019335 9697851 -6095250 -7507321 Our purpose is to make a genuine difference for the many lives we touch by optimizing our patients' healthcare experience. 0 0 11150200 10109824 See schedule ORenown Skilled Nursing is a 160-bed nursing facility designed to serve the healthcare needs of long- and short-term, acute-care patients. Services include physical, occupational and speech rehabilitation and restorative therapy programs. This valuable facility serves a need that otherwise would be unmet in northern Nevada. By accepting the long-term, acute-care patients for rehabilitative services, other hospital beds in the health network are available for higher-acuity, shorter-term care. Renown Skilled Nursing provided 51,492 patient care days for patients transferred from other hospital beds in the health network because they required a level of care delivered most appropriately in a skilled nursing facility. The facility also provided another 1,206 days of long-term care services that were not funded and were designated for patients awaiting Medicaid qualification.Our patients at Renown Skilled Nursing have access to transportation, laundry, a barber and beauty shop, on-site dental and podiatry services, financial advice, and spiritual support - in short, everything patients need to enjoy the best possible quality of life. In an effort to provide patients with the opportunity for social interaction, Renown Skilled Nursing also offered musical performances and pet therapy visits. The facility is proud to have been chosen to be a focus center for the Centers for Medicare & Medicaid Services' Nursing Home Quality Initiative. 11150200 1 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN D AHNER 7759824404 1155 MILL STREET Z-6 RENO NV 89502 X James Miller 1.00 X X 0 787242 311466 Dawn Ahner 1.00 X X 0 396440 84338 Ellen Kelly 60.00 X 0 108385 11452 Barbara Coruna 60.00 X 0 118696 20944 0 1410763 428200 0 0 1 0 0 2785248 2785248 PATIENT SERVICE REVENU 623000 10107284 10107284 10107284 OTHER REVENUE 900099 2540 2540 2540 12895072 10109824 0 0 7383247 6416299 966948 1496809 1296503 200306 412453 412453 7875 7875 495273 290344 204929 1755153 1710995 44158 1245484 183021 1062463 3792 2863 929 1552 1552 200123 107296 92827 93967 93967 Hospital Provider Tax 1035762 1035762 Bad Debt Expense 106321 106321 Other Expenses 68825 796 68029 Business Meals/Entertai 505 505 14307141 11150200 3156941 0 51176 62132 1187751 1014659 25728 28047 23375 107986 3771657 2793951 636055 977706 1924085 2190530 572020 639093 50444 36925 7396871 9021833 8019335 9697851 X -6095250 -7507321 -6095250 -7507321 1924085 2190530 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 1355014 867336 487678 2413204 1926615 486589 3439 3439 977706 Due to Affliates 9021833 9021833 Part IV, Line 2b: The organization acts as custodian for the funds of the residents of the skilled nursing facility. These funds are included in cash and custodial liability in the financial statements. Part X: Description of Uncertain Tax Positions Under FIN 48: The consolidated financial statements did not contain a footnote to report the organization's liability for uncertain tax positions under FIN 48 as there were no uncertain tax positions to be reported. X X X X 0 1 0 0 0 0 0 0 0 James Miller 0 774390 0 0 0 12852 0 296565 0 16558 0 1100365 0 0 Dawn Ahner 0 396440 0 0 0 0 0 65679 0 18658 0 480777 0 0 Part I, Line 4a Dawn Ahner is party to a supplemental nonqualified retirement plan. Contribution of $55,879 to Dawn Ahner was included in Schedule J, Part II, Column (C). Supplemental Information Part III Part I, Line 3: Renown Skilled Nursing relies on Renown Health, a related organization, to establish compensation for officers and other key employees. Renown Health uses the identified methods to establish compensation. See Schedule O, Form 990, Part VI, Section B, Line 15 for a description of the process utilized by Renown Health. Form 990, Part VI, Section A, line 6 Renown Health is the sole corporate member of Renown Skilled Nursing. Form 990, Part VI, Section A, line 7a Renown Health, acting through its Board of Directors, appoints the members of the Board of Governors of Renown Skilled Nursing. Form 990, Part VI, Section A, line 7b Renown Health must approve any merger, consolidation or dissolution of Renown Skilled Nursing, any borrowing in excess of $1 million in any fiscal year, and encumbrances of assets and certain other actions not in the ordinary course of business. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by the organization's tax department with support from a certified tax preparer. The form is reviewed by the organization's Chief Accounting Officer and the Chief Financial Officer prior to the final Form 990 being sent to the board. The IRS Form 990, as filed with the IRS, is sent to each voting member of the Renown Health Board prior to filing. Along with the forms, the Renown Health board is provided with a narrative that explains the various parts of the Form and their content. Form 990, Part VI, Section B, line 12c On an annual basis at or prior to the first regular meeting following the election of new board members, the members of the Renown Skilled Nursing Board are given an Annual Disclosure Statement. They are expected to perform a reasonable investigation into their business, financial, family or significant personal relationships to disclose any actual or potential conflicts of interest. If, in connection with a proposed transaction or arrangement involving a Renown Health entity, a board member discovers that an actual or possible conflict of interest has arisen that was not disclosed on the Annual Statement, then the board member must disclose the existence and nature of his or her financial interests to the remaining directors that are considering the proposed transaction or arrangement in a timely manner. If a board member discloses an actual or possible conflict of interest, the board member shall leave the board or committee meeting while the remaining board members discuss the financial interest. The remaining board members shall vote upon and decide whether a conflict of interest actually exists. If the remaining board members determine that a conflict does exist, then appropriate measures are taken to ensure the issue is addressed. Form 990, Part VI, Section B, line 15 Renown Health's executive compensation is set by the Renown Health Compensation Committee. Members of this committee review and approve various employee pay practices and parameters, as well as compensation for the CEO and certain executives. The Compensation Committee is comprised of independent members of the Renown Health Board of Directors unrelated to and not subject to the control or undue influence of executives, with no material financial interest in transactions of the Company or any other perceived or actual conflicts of interest. The Compensation Committee members are appointed by the Chairman of the Renown Health Board of Directors. The Compensation Committee meets approximately five times per year. Meeting minutes are kept documenting the deliberations and decisions regarding the compensation arrangements. Total cash compensation for the organization's executives are targeted at competitive compensation levels, relative to market surveys of comparable healthcare organizations, based upon the level of performance required to achieve the targeted compensation levels. Base compensation and total cash compensation is reviewed at a minimum of every two years in comparison to the surveys for comparable businesses and responsibilities and adjusted as to maintain equity with the survey information. The Compensation Committee undertook the process outlined above for the fiscal year 2010 executive compensation. Form 990, Part VI, Section C, line 19 Renown Skilled Nursing does not make its governing documents, conflict of interest policy, or financial statements available to the general public. Form 990, Part VII, Column B Average hours per week Jim Miller, President & CEO, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. Dawn Ahner, CFO, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. Form 990, Part XI, Line 2b Audit Committee Renown Health, the sole member of this entity, has an audit committee that assumes responsibility for the consolidated audit and selection of the independent accountant. Form 990, Part V, Line 2a Number of employees on W-3 Renown Skilled Nursing has its own employees, however, Renown Health, the parent organization, pays all compensation and employee benefit amounts under a common paymaster arrangement. The actual compensation of each employee is directly charged to their assigned entity. Salaries are reported on line 7 of Part IX. Form 990, Part X Balance Sheet Reclassification Reclassifications were made to beginning of year amounts in order to provide consistent reporting with end of year amounts. Renown Health 1155 Mill Street Z-5 Reno NV 89502 942972845 Health Care NV 501 (c) (3) III-Fi N/A Renown Health Foundation 1155 Mill Street Z-5 Reno NV 89502 942972749 Foundation NV 501 (c) (3) 7 N/A Renown Regional Medical Center 1155 Mill Street Z-5 Reno NV 89502 880213754 Hospital NV 501 (c) (3) 3 N/A Renown South Meadows Medical Center 1155 Mill Street Z-5 Reno NV 89502 460517825 Hospital NV 501 (c) (3) 3 N/A Hometown Health Plan 1155 Mill Street Z-5 Reno NV 89502 880231433 HMO NV 501 (c) (4) N/A Renown Network Services 1155 Mill Street Z-5 Reno NV 89502 880231828 Outpatient Imaging and Pregnancy Center NV 501 (c) (3) 3 N/A Routt Dialysis LLC 1155 Mill St Z-5 Reno NV 89502 263558729 Kidney Dialysis NV N/A Renown Businesses 1155 Mill St Z-5 Reno NV 89502 880228030 Health Care NV N/A C Hometown Health Managment Company 1155 Mill St Z-5 Reno NV 89502 880236758 Management Services NV N/A C The Provider Network Inc 1155 Mill St Z-5 Reno NV 89502 880376369 Health Care NV N/A C Remittance Assistance Corporation 1155 Mill St Z-5 Reno NV 89502 880277761 Collections NV N/A C Hometown Health Providers Insurance Co 1155 Mill St Z-5 Reno NV 89502 880177026 Insurance NV N/A C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 Hometown Health Plan Inc L 414560