2011-09-27T16:02:30-05:00 2010-12-31 Gronewold Bell Kyhnn & Co PC 1910 E 7th St Atlantic IA 50022 990 2010-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 SANDRA CHESSHIRE 7122461230 2011-09-28 1 Christopher J Nelson 7122431800 2010 2016-03-07 17:11:31Z SANDRA CHESSHIRE 300 PERSHING AVENUE SHENANDOAH IA 51601 24408430 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 9 9 290 40 13381 -49571 195372 304392 22891598 23169561 -135123 147338 393855 224620 23345702 23845911 0 0 0 0 11933155 12387739 0 0 55538 10272756 10229176 22205911 22616915 1139791 1228996 24854693 24175853 4879351 2534453 19975342 21641400 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 21426666 23528138 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 2010, THE HOSPITAL PROVIDED 1,280 DAYS OF ACUTE CARE, 858 DAYS OF SKILLED NURSING CARE, 181 NURSERY DAYS, AND 73,582 OUTPATIENT OCCASIONS OF SERVICE. THE NURSING FACILITY PROVIDED 2,450 ASSISTED LIVING DAYS AND 14,688 INTERMEDIATE CARE DAYS OF SERVICE. 21426666 1 1 0 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 14 0 1 290 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X SANDRA CHESSHIRE 7122461230 SHENANDOAH MEDICAL CENTER 300 SHENANDOAH IA 51601 GREG RITCHEY 3.00 X X 0 0 0 MARY JO CARRELL 3.00 X X 0 0 0 KENNETH DEBAERE 3.00 X X 0 0 0 TIM AUGUSTINE 3.00 X 0 0 0 GENE EATON 3.00 X 0 0 0 DEB ISTAS 3.00 X 0 0 0 DAVE LASHIER 3.00 X 0 0 0 JON LEHNER 3.00 X 0 0 0 PAM MCGARGILL 3.00 X 0 0 0 SUSAN MCGOUGH 40.00 X 200350 0 14493 SANDRA CHESSHIRE 40.00 X 130889 0 13778 DAVE LEIGHTON 40.00 X 113721 0 11946 JOHN BOWERY MD 40.00 X 149497 0 9770 VICTOR BYCROFT 40.00 X 118999 0 10660 WAYNE JOHNSON 40.00 X 181105 0 5655 SCOTT KING 40.00 X 329709 0 27212 SUBIR RAY 40.00 X 147571 0 3435 1371841 0 96949 8 0 1 0 STAFF CARE PO BOX 281923 ATLANTA GA 30384 PHYSICIAN'S SERVICES 522838 ACUTE CARE PO BOX 4130 DES MOINES IA 50533 ER WEEKEND PHYSICIANS 280900 UNMC PHYSICIANS PO BOX 30014 OMAHA NE 68103 LAB REFERENCE FEES 267347 DENNIS CUMMINGS 13951 W 115TH ST OLATHE KS 66062 CRNA SERVICES 215000 NISHNA VALLEY PHARMACY 1208 W NISHNA SHENANDOAH IA 51601 PHARMACY SERVICES 196533 8 138111 166281 304392 NET PATIENT SERVICE RE 621110 23169561 23169561 23169561 167061 167061 262809 62903 199906 199906 199906 472678 7215 471091 28525 1587 -21310 -19723 -19723 CATERING OF MEALS 722320 13381 13381 SHENANDOAH AMBULANCE S 621910 11333 11333 24714 23845911 23528138 13381 0 444960 244610 200350 9773703 9415185 312636 45882 272656 257687 13688 1281 1198177 1132982 60150 5045 698243 659991 35052 3200 10020 10020 48370 48370 1707131 1699576 7555 89316 89316 1241220 1241220 SUPPLIES 5256969 4835987 420852 130 BAD DEBTS 1478985 1478985 PURCHASED SERVICES 325727 299689 26038 SUPPORT SHEN HEALTHCARE 60858 60858 AMORTIZATION 10580 10580 22616915 21426666 1134711 55538 2182946 1846389 311612 315999 23035 3193039 3334085 550885 619421 171237 255007 23851383 15204303 8991289 8647080 8857784 8688964 595901 445873 24854693 24175853 1607987 1606834 14364 14619 2570000 840000 687000 73000 4879351 2534453 X 18939548 20512593 800829 878179 234965 250628 19975342 21641400 24854693 24175853 X 1228996 437062 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 234965 20892 5229 250628 197443 39900 2378 234965 277142 -71665 8034 197443 1.00000 0 0 92822 92822 11852331 7254316 4598015 10923226 7329055 3594171 983004 620932 362072 8647080 CASH AND EQUITY SECURITIES 8688964 F 8688964 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 73000 73000 23845911 22616915 1228996 440062 -3000 437062 1666058 24285973 440062 440062 23845911 0 23845911 22619915 3000 3000 22616915 0 22616915 Part XI, Line 8 - Other Adjustments: USE OF TEMP RESTRICTED FUNDS Part XIII, Line 2d - Other Adjustments: USE OF TEMP RESTRICTED FUNDS 1 1 1 X 1 X 1 1 1 0 1 1 305346 305346 0.01350 2854130 2249039 605091 0.02680 3159476 2249039 910437 0.04030 10 3620 36421 36421 0.00160 8 4170 2901711 1795077 1106634 0.04890 4 8685 27144 27144 0.00120 22 16475 2965276 1795077 1170199 0.05170 22 16475 6124752 4044116 2080636 0.09200 1697 1697 0.00010 3361 3361 0.00010 2 456 18436 18436 0.00080 499 499 0.00000 2 456 23993 23993 0.00100 1 863088 7757780 7835242 -77462 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 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 OR 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 19d: The individuals who did not have insurance are given a 15% uninsured discount. X 0 0 0 0 0 0 0 0 0 SUSAN MCGOUGH 161702 0 38648 0 0 0 10106 0 4387 0 214843 0 218513 0 JOHN BOWERY MD 149497 0 0 0 0 0 7922 0 1848 0 159267 0 152321 0 WAYNE JOHNSON 176105 0 5000 0 0 0 0 0 5655 0 186760 0 183048 0 SCOTT KING 236525 0 93184 0 0 0 16907 0 10305 0 356921 0 469050 0 SUBIR RAY 99268 0 48303 0 0 0 0 0 3435 0 151006 0 0 0 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 5: Net unrealized gains on investments: 440062. USE OF TEMP RESTRICTED FUNDS -3000. Total to Form 990, Part XI, Line 5: 437062.