2022-11-14T08:11:39-06:00 2021-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2021-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 MATTHEW SELLS CEO 7122461230 2022-11-11 1 MATTHEW SELLS 999009999 MEGAN L KOZIOL CPA P01544037 4023302660 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MATTHEW SELLS 300 PERSHING AVENUE SHENANDOAH IA 51601 56353126 0 X WWW.SMCHOSPITAL.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 9 406 174 0 0 5674956 5511286 43418116 46670412 201402 757443 234414 815559 49528888 53754700 0 0 0 0 25072518 25887261 0 0 0 20231481 22680982 45303999 48568243 4224889 5186457 64157556 66279280 39268355 35500164 24889201 30779116 TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. 0 0 42715612 46670412 SHENANDOAH MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN AN INPATIENT AND OUTPATIENT SETTING. IN JUNE OF 2020 THE SHENANDOAH MEDICAL CENTER ASSUMED RESPONSIBILITY FOR THE CANCER TREATMENT CENTER. IN 2021 THE CANCER CENTER PROVIDED 1,024 VISITS. SHENANDOAH MEDICAL CENTER CONTINUES TO LEASE SPACE TO THE DIALYSIS TREATMENT CENTER. DURING 2021 THE HOSPITAL PROVIDED 1,113 DAYS OF ACUTE CARE, 804 DAYS OF SKILLED CARE, 157 NURSERY DAYS AND 201,882 OUTPATIENT OCCASIONS OF SERVICE. 42715612 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 41 0 1 406 1 0 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 X KALEY NEAL CFO 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 BRIAN ROWAN PHYSICIAN 40.00 0.00 X 581531 0 38320 REBECCA ROSE PHYSICIAN 40.00 0.00 X 499386 0 35569 MARTEE MACLEOD-KOZAL PHYSICIAN 40.00 0.00 X 447359 0 39123 MICHAEL WOODS PHYSICIAN 40.00 0.00 X 397314 0 35496 CHASE BROWN PHYSICIAN 40.00 0.00 X 368620 0 32783 MATTHEW SELLS CEO 40.00 1.00 X 291176 0 27446 KALEY NEAL CFO 40.00 1.00 X 151164 0 7983 DENNIS GREBERT CHAIRMAN 3.00 1.00 X X 0 0 0 STEPHEN RUZEK VICE CHAIRMAN 3.00 0.00 X X 0 0 0 ROGER JONES SECRETARY/TREASURER 3.00 0.00 X X 0 0 0 ALISSA MCGINNIS DIRECTOR 3.00 0.00 X 0 0 0 ED KLOBERDANZ DIRECTOR 3.00 1.00 X 0 0 0 HEATHER BABE MD DIRECTOR 3.00 0.00 X 0 0 0 BRUCE BALDWIN DIRECTOR 3.00 0.00 X 0 0 0 JON SKILLERN DIRECTOR 3.00 0.00 X 0 0 0 BRIANNA SORENSEN DIRECTOR 3.00 0.00 X 0 0 0 2736550 0 216720 37 0 1 0 UNMC PHYSICIANS LAB REF PO BOX 30014-1114 OMAHA NE 68103 LAB FEES 558526 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 100875068 CONTRACT LABOR 534617 NEBRASKA MEDICINE 988140 NEBRASKA MEDICAL CENTER OMAHA NE 68198 PHYSICIST SERVICES & PHARMACY COVERAGE 269393 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI AND PET SCANS 244210 CLARKSON HEART CENTER 4239 FARNAM STREET OMAHA NE 68131 CARDIOLOGY 180090 9 177209 5038133 295944 5511286 MEDICARE/MEDICAID PAYM 624100 30873788 30873788 NET PATIENT SERVICE RE 624100 12615854 12615854 340B REVENUE 624100 2140729 2140729 AMBULANCE SERVICES 621910 808943 808943 231098 231098 46670412 425122 425122 382757 0 382757 382757 382757 2930747 2570767 27659 359980 -27659 332321 332321 INSURANCE PROCEEDS 900099 307268 307268 CAFETERIA REVENUE 624200 125534 125534 432802 53754700 46670412 0 1573002 X 488643 488643 67222 67222 20753288 17744503 3008785 653436 564910 88526 2530846 2140057 390789 1393826 1170153 223673 16769 16769 102717 102717 24572 24572 5296293 4567787 728506 280620 280620 894121 670972 223149 608158 604742 3416 91267 81195 10072 846106 819619 26487 2355855 2286413 69442 423476 410994 12482 MEDICAL SUPPLIES 7386501 7386501 BAD DEBT EXPENSE 3676826 3676826 FOOD 304866 301438 3428 LICENSES & FEES 282284 208375 73909 90551 13905 76646 48568243 42715612 5852631 0 1309 1619 17954120 13860097 5324971 4722234 1100271 1301569 163112 343811 66282847 37644234 27685629 28638613 5535951 10875866 223212 223212 6168981 6312259 64157556 66279280 4070027 5479801 6707106 4575630 24932322 24749646 3558900 0 0 695087 39268355 35500164 X 18325105 23859394 6564096 6919722 24889201 30779116 64157556 66279280 X 5186457 254498 448960 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6162 6162 0 PART II-B, LINE 1: PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION ARE ALLOCABLE TO LOBBYING ACTIVITIES. 404381 36250 440631 6023323 498337 238611 231663 6528608 5970820 133351 151032 231880 6023323 6073766 73697 52315 228958 5970820 7780348 19127 200711 1926420 6073766 0.72330 0.27670 0.00000 0 1 1 76025 76025 37631339 15125043 22506296 26083438 21613847 4469591 2492045 905344 1586701 28638613 DUE FROM SHENANDOAH AMBULANCE SERVICE 120349 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 5583619 OTHER RECEIVABLES 331819 PATIENT CUSTOMER CONTRACTS 276472 6312259 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 695087 695087 X PART V, LINE 4: THE ENDOWMENT FUNDS WERE DESIGNATED AS SUCH BY THE SHENANDOAH MEDICAL CENTER BOARD OF DIRECTORS AND ARE MEANT TO BE HELD BY THE HOSPITAL. THE INCOME IS TYPICALLY REINVESTED IN THE ENDOWMENT FUNDS ON AN ANNUAL BASIS, BUT THE BOARD OF DIRECTORS HAS THE ABILITY TO DETERMINE THAT THE INCOME COULD BE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES. PART X, LINE 2: SMC AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE MEDICAL CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE MEDICAL CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE MEDICAL CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2021 AND 2020, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART V, LINE 1A, COLUMN A: THE BEGINNING BALANCE HAS BEEN ADJUSTED TO REMOVE FUNDS THAT WERE DETERMINED TO NOT BE CONSIDERED ENDOWMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 51893 51893 0.00120 7160917 5795534 1365383 0.03040 7212810 5795534 1417276 0.03160 486 11314 11314 0.00030 405 1331 1331 0.00000 13701 13701 0.00030 891 26346 26346 0.00060 891 7239156 5795534 1443622 0.03220 5880 1141074 1141074 0.02540 5880 1141074 1141074 0.02540 1 3676826 0 17045157 16838885 206272 X 1 1 1 1 SHENANDOAH MEDICAL CENTER 300 PERSHING AVE SHENANDOAH IA 51601 WWW.SMCHOSPITAL.COM 730065H X X X X SHENANDOAH MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SMCHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 19 1 SMCHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 200.000000000000 200.000000000000 X X X X X X 1 1 X X X 1 X SMCHOSPITAL.COM/INSURANCE-FINANCIAL-ASSISTANCE/ X SMCHOSPITAL.COM/INSURANCE-FINANCIAL-ASSISTANCE/ X SMCHOSPITAL.COM/INSURANCE-FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 5: THE CHNA TOWN HALL WAS HELD OVER LUNCH ON WEDNESDAY, FEBRUARY 13, 2019 AT THE THE HISTORICAL SOCIETY IN SHENANDOAH, IA. VINCE VANDEHAAR, MBA, AND ALEXA BACKMAN FACILITATED THIS 1-1/2 HOUR SESSION WITH THIRTY SIX (36) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. TO COMPLETE THE NEEDS ASSESSMENT WHICH WAS FINALIZED IN 2019. SMC PARTNERED WITH PAGE COUNTY PUBLIC HEALTH AND CLARINDA REGIONAL HEALTH CENTER IN CLARINDA, IA TO COMPLETE THE ASSESSMENT. ONGOING MEETINGS WITH CHNA STAKEHOLDERS WERE HELD THURSDAY, APRIL 4, 2019 AT SHENANDOAH MEDICAL CENTER IN SHENANDOAH, IA. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 6A: CLARINDA REGIONAL HEALTH CENTER IN CLARINDA, IA SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 6B: PAGE COUNTY PUBLIC HEALTH SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 11: SHENANDOAH MEDICAL CENTER HAS WORKED TO EXPAND MENTAL HEALTH SERVICES IN PAGE COUNTY BY CONTINUING TO PARTNER WITH OTHER MENTAL HEALTH ORGANIZATIONS IN SHENANDOAH TO INCREASE ACCESS TO CARE. SMC HAS ALSO WORKED TO IMPLEMENT TELEHEALTH SERVICES THROUGH A PARTNERSHIP WITH THE UNIVERSITY OF IOWA HOSPITAL AND HEALTH CLINICS IN AN EFFORT TO GAIN ACCESS TO PSYCHIATRIC TELEHEALTH SERVICES FOR CHILDREN. ADDITIONALLY, TELEHEALTH PARTNERSHIPS WERE DEVELOPED TO GAIN ACCESS TO BEHAVIORAL HEALTH CARE IN BOTH THE EMERGENCY ROOM AND THE ELM HEIGHTS CARE CENTER, WHICH HAS PROVIDED MUCH IMPROVED ACCESS TO CARE. SMC FIGHTS DRUG ABUSE THROUGH USE OF SPECIFIC PAIN CONTRACTS ENTERED INTO BETWEEN PROVIDERS AND PATIENTS WITH DRUG ABUSE HISTORY. SMC ALSO PARTNERS WITH SEVERAL ORGANIZATIONS SUCH AS ZION RECOVERY SERVICES TO INCREASE THE ACCESS TO TREATMENT FOR DRUG ABUSE PATIENTS. SMC HAS AN ACCREDITED PATIENT CENTERED MEDICAL HOME THAT INCLUDES TWO HEALTH COACHES THAT MANAGE THE CARE OF ACUTE DIABETIC PATIENTS VIA PARTNERSHIP WITH IOWA MEDICAID. SMC CONTINUES TO WORK CLOSELY WITH SHENANDOAH COMMUNITY SCHOOLS TO PROVIDE EDUCATION ON SEXUALLY TRANSMITTED INFECTIONS AND PROVIDES A GREAT DEAL OF PATIENT COUNSELING VIA ITS THREE OB-GYN PHYSICIANS. SMC CONTINUES TO ADVOCATE FOR OUR PATIENTS TO ASSIST WITH THE RISING COSTS OF HEALTHCARE THROUGH THE IOWA HOSPITAL ASSOCIATION. SMC HAS DEVELOPED WELLNESS PARTNERSHIPS WITH SEVERAL LOCAL EMPLOYERS THAT INCLUDE BLOOD DRAWS WITH WELLNESS LAB TESTING, A REVIEW OF LAB RESULTS WITH OUR OCCUPATIONAL HEALTH NURSE, A FORMULATION OF AN INDIVIDUALIZED WELLNESS PLAN, AND MEMBERSHIP TO OUR WELLNESS CENTER. THE IMPLEMENTATION OF THESE SERVICES HAS A GOAL OF LOWERING INSURANCE CLAIMS EXPERIENCE FOR LOCAL EMPLOYERS TO ENSURE MORE AFFORDABLE HEALTH INSURANCE. A NEED THAT DID NOT GET DIRECTLY ADDRESSED BY SMC WAS THE IMPROVEMENT OF ACCESS TO DENTAL SERVICES FOR OUR MEDICAID PATIENTS. THIS ITEM WAS NOT CONSIDERED RELATED TO THE FACILITY'S MISSION CRITICAL OPERATIONS. AS A RESULT, SMC WILL CONTINUE TO HELP SUPPORT COMMUNITY PARTNERS IN ORDER TO ADDRESS THOSE NEEDS. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 13H: THE ELIGIBILITY OF EACH APPLICANT FOR FINANCIAL ASSISTANCE IS DETERMINED ON A CASE BY CASE BASIS THROUGH COORDINATION OF THE PATIENT FINANCIAL COUNSELOR, BUSINESS OFFICE MANAGER, AND CHIEF FINANICAL OFFICER. ELIGIBILITY IS BASED ON A REVIEW AND VERIFICATION OF INCOME OF AN INDIVIDUAL OR FAMILY, INCLUDING THE SIZE OF THE FAMILY. VERIFICATION INCLUDES BUT IS NOT LIMITED TO: TAX RETURNS, PAY STUBS, SOCIAL SECURITY CHECKS, DISABILITY CHECKS OR BANK STATEMENTS. DETERMINATION IS BASED UPON INCOME DATA DIRECTLY RELATED TO FEDERAL POVERY LEVEL AFTER APPLYING ALL OTHER RESOURCES. CHARITY CARE IS BASED ON 200% OF POVERTY LEVEL. AN UNINSURED DISCOUNT OF 35% IS GRANTED TO ALL PATIENTS WITH NO INSURANCE. AN ADDITIONAL 20% DISCOUNT IS AUTOMATICALLY GRANTED TO THESE INDIVIDUALS ONCE THEY COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. FURTHER DISCOUNTING IS APPLIED BASED ON THE APPLICANT'S ABILITY TO MEET THE ELIGIBILITY CRITERIA. 5 1 - ELM HEIGHTS CARE CENTER 1203 SOUTH ELM STREET SHENANDOAH IA 51601 SKILLED NURSING 3 - SHENANDOAH PHYSICIANS CLINIC - SIDNEY 802 ILLINOIS STREET SIDNEY IA 51652 SIDNEY CLINIC 4 - SHENANDOAH MEDICAL CENTER 2 JACK FOSTER DRIVE SHENANDOAH IA 51601 WELLNESS CENTER 5 - SHENANDOAH PHYSICIANS CLINIC - ESSEX 527 IOWA AVENUE ESSEX IA 51638 ESSEX CLINIC 6 - SHENANDOAH PHYSICIANS CLINIC - TABOR 713 MAIN STREET TABOR IA 51653 TABOR CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: THE ORGANIZATION UTILIZED AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. PART I, LINE 7G: THERE WERE NO SUBSIDIZED HEALTH SERVICES DURING THE YEAR. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,676,826. PART II, COMMUNITY BUILDING ACTIVITIES: SHENANDOAH MEDICAL CENTER PROVIDES JOB SHADOWING OPPORTUNITIES TO HIGH SCHOOL STUDENTS OF SHENANDOAH, AND PROFESSIONAL STUDENT ROTATIONS FOR PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, PHLEBOTOMY, RADIOLOGY TECHNOLOGIST, MEDICAL TECHNOLOGIST, ANESTHESIA, REHABILITATION, NURSING, AND MEDICAL STUDENTS. THESE ACTIVITIES HELP TO FURTHER THE EDUCATION OF THE COMMUNITY ON HEALTH IMPROVEMENT AND MAINTENANCE AND ALSO ASSIST IN THE DEVELOPMENT OF LOCAL INDIVIDUALS IN BECOMING HEALTH CARE PROFESSIONALS. SMC ALSO PROVIDES AN ANNUAL "SCRUBS CAMP" TO GRADE SCHOOL AND MIDDLE SCHOOL STUDENTS TO PROVIDE THEM WITH EXPOSURE TO HEALTHCARE RELATED FIELDS. COVID-19 HAD A DRAMATIC IMPACT ON PARTICIPATION IN THESE PROGRAMS. PART III, LINE 2: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE MEDICAL CENTER PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE MEDICAL CENTER ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE.FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENTS ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. PART III, LINE 3: THE MEDICAL CENTER PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE MEDICAL CENTER NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE MEDICAL CENTER DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE MEDICAL CENTER DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEAR ENDED DECEMBER 31, 2021 AND 2020 WAS APPROXIMATELY $115,000 AND $66,000, RESPECTIVELY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE" CAN BE FOUND ON PAGES 8, 11, AND 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THERE IS NO MEDICARE SHORTFALL IN THE CURRENT YEAR. ANY 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 III, LINE 9B: ONCE A PATIENT HAS BEEN DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT IS UPDATED WITH THE APPROPRIATE AMOUNT OF FINANCIAL ASSISTANCE. IF A PATIENT HAS HAD ALL ACCOUNTS GRANTED FULL FINANCIAL ASSISTANCE, THE PATIENT RECEIVES NOTICE THAT ALL OBLIGATIONS HAVE BEEN SATISFIED. IF THERE IS A REMAINING PATIENT BALANCE, SMC'S FINANCIAL COUNSELOR WORKS CLOSELY WITH THE PATIENT TO AGREE UPON A PAYMENT PLAN THAT IS FINANCIALLY FEASIBLE FOR THE PATIENT. PART VI, LINE 2: THE ORGANIZATION'S LEADERSHIP INFORMALLY MEETS WITH LEADERS IN THE COMMUNITY TO DISCUSS COMMUNITY ISSUES, AS WELL AS ATTEMPTS TO IDENTIFY AREAS WHERE SMC CAN BE OF SERVICE TO THE EMPLOYERS IN THE COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO ALL PATIENTS ON THE WEBSITE. ADDITIONALLY, OUR THIRD PARTY SELF-PAY ORGANIZATION MAILS APPLICATIONS TO THOSE PATIENTS WHO INDICATE THAT THEY DO NOT HAVE THE MEANS TO PAY THEIR ACCOUNTS. UPON CONTACT AT SMC, OUR SOCIAL SERVICES REPRESENTATIVE AND PATIENT FINANCIAL COUNSELOR DISCUSS OPTIONS WITH PATIENTS AND ALSO ASSIST IN THE COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATIONS, MEDICARE AND MEDICAID APPLICATIONS IF APPLICABLE, AND MAKING ANY OTHER ARRANGEMENTS NECESSARY TO ASSIST PATIENTS IN FINANCIALLY SATISFYING THEIR OBLIGATIONS. PATIENTS ARE ALSO NOTIFIED OF THE FINANCIAL ASSISTANCE POLICY AT ADMISSION AND DISCHARGE. PART VI, LINE 4: THE MEDIAN HOUSEHOLD INCOME WAS $51,867 AND $56,750 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2019, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $60,523. AS A BYPRODUCT OF THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA, SHENANDOAH MEDICAL CENTER TREATS A SIGNIFICANT NUMBER OF MEDICAID, UNINSURED, AND UNDERINSURED PATIENTS. THE AREA POPULATION IS PREDOMINATELY WHITE, NON-HISPANIC. PART VI, LINE 5: IN ADDITION TO ITS EFFORTS TO ADDRESS THE NEEDS IDENTIFIED BY ITS COMMUNITY HEALTH NEEDS ASSESSMENT, THE FACILITY ALSO HAS AN ACTIVE INTERNAL WELLNESS PROGRAM THAT IT IS CURRENTLY ROLLING OUT TO THE COMMUNITY. ADDITIONALLY, THE HOSPITAL OPERATES A WELLNESS CENTER THAT PROVIDES VERY AFFORDABLE MEMBERSHIP RATES AND PERSONAL TRAINING OPTIONS TO HELP PROMOTE WELLNESS IN THE COMMUNITY. PART VI, LINE 6: SMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X X X 0 0 0 0 0 0 0 0 0 BRIAN ROWAN PHYSICIAN 574867 0 3100 0 3564 0 14500 0 23820 0 619851 0 0 0 REBECCA ROSE PHYSICIAN 462822 0 33000 0 3564 0 14500 0 21069 0 534955 0 0 0 MARTEE MACLEOD-KOZAL PHYSICIAN 407072 0 39747 0 540 0 14500 0 24623 0 486482 0 0 0 MICHAEL WOODS PHYSICIAN 383650 0 10100 0 3564 0 9906 0 25590 0 432810 0 0 0 CHASE BROWN PHYSICIAN 336034 0 32100 0 486 0 8160 0 24623 0 401403 0 0 0 MATTHEW SELLS CEO 224654 0 66100 0 422 0 14500 0 12946 0 318622 0 0 0 KALEY NEAL CFO 138824 0 12100 0 240 0 7686 0 297 0 159147 0 0 0 ALICIA SELLS EMPLOYEE OF ORGANIZATION AND WIFE OF MATTHEW SELLS, CEO 67222 EMPLOYEE'S COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO, CFO, AND GOVERNING BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS ENFORCED BY THE CEO AND COMPLIANCE OFFICER. ALL BOARD MEMBERS AND EXECUTIVES ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST THAT ARE PRESENTED. ON AN ANNUAL BASIS, A SUMMARY OF ALL CONFLICTS IDENTIFIED DURING THE YEAR ARE PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AS PART OF THE ANNUAL COMPLIANCE SUMMARY. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL POSSESSING THE CONFLICT IS NOT ALLOWED TO PROVIDE INPUT ON THE SUBJECT AND IS REQUIRED TO ABSTAIN FROM ANY RELATED VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CEO WAS REVIEWED AND AUTHORIZED BY THE BOARD OF DIRECTORS. SMC ALSO UTILITIZES THE IOWA HOSPITAL ASSOCIATION SALARY SURVEY DATA TO APPROPRIATELY SET COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES. ADDITIONALLY, SALARY SURVEY DATA OBTAINED FROM MGMA AND MERRITT HAWKINS IS USED TO EVALUATE THE COMPENSATION OF ALL PROVIDERS. 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. FORM 990, PART IX, LINE 11G LAB FEES: PROGRAM SERVICE EXPENSES 591,309. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 591,309. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 534,617. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 534,617. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 3,441,861. MANAGEMENT AND GENERAL EXPENSES 544,724. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,986,585. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 183,782. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 183,782. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST 448,960. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF SMC'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SHENANDOAH MEDICAL CENTER FOUNDATION 300 PERSHING AVENUE SHENANDOAH IA 51601 421471184 SUPPORT SHENANDOAH MEDICAL CENTER IA 501(C)(3) LINE 12A, I SHENANDOAH MEDICAL CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 SHENANDOAH MEDICAL CENTER FOUNDATION C 177209 FMV