2020-02-05T16:27:22-06:00 2019-03-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-04-01 880256932 SOUTH LYON HEALTH CENTER INC DBA SOUTH LYON MEDICAL CENTER SOUT 7754632301 PO BOX 940 YERINGTON NV 89447 TONI INSERRA CHIEF EXECUTIVE OFFICER 7754632301 2020-02-01 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-02-01 216.54.158.12 2020-02-01 10:00:35 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 05365E77D662BDC17E2AAA2C6021CC7EC3235B8D 2018 2020-09-23 17:36:50Z TONI INSERRA PO BOX 940 YERINGTON NV 89447 14202712 0 X WWW.SLMCNV.ORG X 1990 NV PROVIDE HEALTHCARE FOR THE RESIDENTS AND VISITORS TO THE CITY OF YERINGTON AND LYON COUNTY, NEVADA. 6 5 222 9 0 0 27504 32260 13874350 14112264 0 0 54130 58188 13955984 14202712 0 0 0 0 8171935 8177183 0 0 0 5137365 5879036 13309300 14056219 646684 146493 4838556 5109984 1155534 1280469 3683022 3829515 TO PROVIDE ACCESS TO QUALITY HEALTH CARE SERVICES NEEDED BY THE COMMUNITY. 0 0 7651246 0 9047283 THE HOSPITAL IS A 14-BED ACUTE HOSPITAL WITH 24 HOUR EMERGENCY ROOM, FULL SERVICE LAB, AND X-RAY DEPARTMENTS. THE E/R SEES APPROXIMATELY 300 PATIENTS A MONTH. CLOSE COMMUNICATIONS WITH LARGER FACILITIES AND SPECIALISTS IN MANY DISCIPLINES ALLOW BOTH HELICOPTER AND AIR AMBULANCE SERVICES TO TAKE PATIENTS TO THOSE HOSPITALS WITHIN A SHORT AMOUNT OF TIME. HOSPITAL HAS A SLIDING FEE SCALE AND FINANCIAL ASSISTANCE AVAILABLE FOR PATIENTS COMPLETING APPLICATIONS. THE HOSPITAL PROVIDES THE STANDARD INFLUENZA VACCINE AT A NOMINAL COST. 2878987 0 3404283 THE LONG-TERM CARE PROGRAM IS A MEDICARE APPROVED 49-BED SKILLED NURSING AND LONG-TERM CARE FACILITY WITH IN-HOUSE PHYSICAL THERAPY AVAILABLE. STAFF TO PATIENT RATIO IS ABOVE REQUIRED. A SOCIAL WORKER/RESIDENT ADVOCATE AND AN ENTHUSIASTIC ACTIVITIES PROGRAM MAKE OUR LTC ONE OF THE FINEST ANYWHERE. 1410830 0 1668248 THE CLINICS PROGRAM CONSISTS OF THREE RURAL HEALTH CLINICS. WE HAVE PHYSICIANS, PHYSICIANS ASSISTANTS, AND NURSE PRACTITIONERS THAT WORK OUT OF OUR CLINICS TO SERVE THE NEEDS OF THE COMMUNITY. ONE OF OUR CLINICS IS A WALK-IN CLINIC AVAILABLE AT CONVENIENT HOURS FOR OUR PATIENTS WHO NEED TO SEE A PROVIDER IMMEDIATELY OR WHO DO NOT HAVE A REGULAR DOCTOR. ALL CLINICS OFFER SERVICES AT A REDUCED FEE FOR THOSE WHO NEED IT. A FINANCIAL COUNSELOR IS AVAILABLE FOR ASSISTANCE AT ALL TIMES. 11941063 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 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 0 0 0 0 1 32 0 222 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID BEZARD 7754636402 213 SOUTH WHITACRE STREET YERINGTON NV 89447 MYRTLE MCDOWELL DIRECTOR (THRU MAY) 1.00 X 0 0 0 ALYCE REESE DIRECTOR 1.00 X 0 0 0 ROBERT ROWLEY DIRECTOR 1.00 X 0 0 0 DALE THEISS DIRECTOR 1.00 X 0 0 0 JEFFREY WESTIN DIRECTOR/CHIEF OF STAFF 40.00 X 538578 0 0 MATT CHRISTENSON PRESIDENT 1.00 X X 0 0 0 JOHN DIEKMANN VICE PRESIDENT 1.00 X X 0 0 0 TONI INSERRA CEO 40.00 X 115100 0 11304 DAVID BEZARD CFO 40.00 X 99252 0 21568 TOM J WALSH PHYSICIAN 40.00 X 239195 0 25118 LOREN SIMPSON PHYSICIAN 40.00 X 207650 0 23774 ROBIN TITUS PHYSICIAN 40.00 X 200100 0 24336 THOMAS CLIFTEN PHYSICAL THERAPIST 40.00 X 142812 0 23218 ELLEN MAMOLEN PHYSICIAN ASSISTANT 40.00 X 131439 0 9384 1674126 0 138702 11 0 1 0 RN NETWORK PO BOX 974088 DALLAS TX 75397 NURSING LOCUMS SERVICES 381156 SHARON MALOTTE 35 RESERVATION ROAD RENO NV 89447 PHYSICAN SERVICES 313988 MEDICAL SOLUTIONS PO BOX 310737 DES MOINES IA 80331 NURSING LOCUMS SERVICES 232193 NV RURAL HOSPITAL PARTNERS 4600 KIETZKE LANE RENO NV 89502 MRI AND TECHNICAL SERVICES 171540 TITAN MEDICAL HOLDINGS INC 2110 S 169 PLAZA 100 OMAHA NE 68130 NURSING LOCUMS SERVICES 121849 5 32260 32260 PROGRAM SERVICE REVENUE-RELATED 621400 11883211 11883211 UPL REVENUE 621400 895730 895730 DISTRICT TAX SUBSIDY 900099 764475 764475 HOSPITAL DISTRICT REIMBURSEMENT 621400 529318 529318 PATIENT LAB TESTING 621400 26000 26000 13530 13530 14112264 6350 0 6350 6350 6350 EMPLOYEE MEALS 900099 20317 20317 EHR INCENTIVE 900099 7550 7550 23971 23971 51838 14202712 14119814 0 50638 X 782273 538400 243873 6282585 5789413 493172 103707 51347 52360 499743 250491 249252 508875 242884 265991 79600 79600 2942207 2776552 165655 5235 5235 267260 120310 146950 320796 320796 289436 284851 4585 28200 14085 14115 36699 30389 6310 10408 9292 1116 134249 119855 14394 122913 117888 5025 MEDICAL SUPPLIES 861031 861031 PROVISION FOR BAD DEBTS 727040 727040 TAXES AND LICENSES 31944 31944 DUES AND SUBSCRIPTIONS 21773 7000 14773 245 235 10 14056219 11941063 2115156 0 2156328 1400 19911 2293292 2073680 1913771 116544 121898 112621 202948 878978 302303 359472 576675 4838556 5109984 1007107 1034778 148427 245691 1155534 1280469 X 3683022 3829515 3683022 3829515 4838556 5109984 146493 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 67 67 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF NEVADA HOSPITAL ASSOCIATION. A PORTION OF MEMBERSHIP DUES TO NEVADA HOSPITAL ASSOCIATION IS USED FOR LOBBYING. THE NEVADA HOSPITAL ASSOCIATION ADVOCATES ON BEHALF OF ITS MEMBERS FOR IMPROVING EFFICIENCY AND ACCESSIBILITY TO THE HEALTHCARE DELIVERY SYSTEMS AND THE HEALTH STATUS OF NEVADA'S POPULATION. 146918 61928 84990 727516 240375 487141 4544 4544 576675 12711197 0 12711197 1491515 1491515 14202712 13329179 0 13329179 727040 727040 14056219 PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 727,040. NONOPERATING GAINS - DISTRICT TAX SUBSIDY 764,475. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 727,040. 1 1 X 1 X 1 X 1 0 0 117582 117582 0.00880 1813645 1137908 675737 0.05070 1931227 1137908 793319 0.05950 1931227 1137908 793319 0.05950 0 595167 198389 3760511 3685357 75154 X 1 1 1 1 SOUTH LYON MEDICAL CENTER PO BOX 940 YERINGTON NV 89447 WWW.SLMCNV.ORG 660RUH-19 X X X RURAL SOUTH LYON MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION X X 1 18 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 5: 240 SURVEYS WERE DISTRIBUTED TO LOCAL COMMUNITY BUSINESSES AND GROUPS BY HAND DELIVERY AND BY USPS. AN ONLINE VERSION OF THE SURVEY WITH IDENTICAL QUESTIONS WAS MADE AVAILABLE ON THE SOUTH LYON MEDICAL CENTER WEBSITE AND FACEBOOK PAGE USING SURVEY MONKEY. 42 COMPLETED PAPER SURVEYS WERE RETURNED TO NEVADA STATE OFFICE OF RURAL HEALTH AND 103 ADDITIONAL SURVEYS WERE COMPLETED ONLINE. THE UNIVERSITY OF NEVADA INSTITUTIONAL REVIEW BOARD DID NOT REQUIRE APPROVAL OF THIS PILOT PROJECT BECAUSE THE INFORMATION WAS COLLECTED FOR A COMMUNITY HEALTH NEEDS ASSESSMENT RATHER THAN RESEARCH PURPOSES. SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 7D: HTTPS://SLMCNV.ORG/COMMUNITY-NEEDS-ASSESSMENT/ SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 11: SOUTH LYON MEDICAL CENTER (SLMC) COMPLETED THE MOST RECENT CHNA IN MARCH 2018 AND HAS BEGUN ADDRESSING THE FOLLOWING IDENTIFIED NEEDS: 1)CUSTOMER SERVICE - THE SLMC ADMINISTRATIVE TEAM RECOGNIZED THE NEED TO CONTINUE TO IMPROVE CUSTOMER SERVICE FACILITY WIDE. IMPROVING COMMUNITY CONFIDENCE IN THE FACILITY WHICH INCLUDES IMPROVED CUSTOMER SERVICE WILL HELP WITH OUTMIGRATION. MEMBERS OF THE ADMINISTRATIVE STAFF WILL BE IMPLEMENTING NEW DISCIPLINES TO PROMOTE CUSTOMER SERVICE FACILITY WIDE THAT WILL INCLUDE MANDATORY TELEPHONE SCRIPTING AND IN-SERVICE TRAINING.2) MORE SPECIALTY SERVICES NEEDED - SOUTH LYON MEDICAL CENTER HAS AND WILL CONTINUE TO WORK DILIGENTLY TO BRING OTHER SERVICES TO OUR RURAL COMMUNITY. WE CURRENTLY OFFER TELEMEDICINE FOR OVER 20 SPECIALTY SERVICES. THIS HAS HELPED TO PROVIDE GREATER ACCESS TO MEDICAL SPECIALISTS FOR OUR PATIENTS. WE ALSO HAVE SOME PROVIDERS THAT COME ONSITE REGULARLY TO SEE PATIENTS IN OUR SPECIALTY CLINIC; INCLUDING AN OBGYN WHO IS NOW BRINGING A (MEDICAL STUDENT OR MEDICAL RESIDENT FROM THE UNIVERSITY OF NEVADA RENO SCHOOL OF MEDICINE) THAT IS DOING WELL BABY CHECKS. THIS SERVICE IS BEING PROMOTED ON SOCIAL MEDIA, OUR LOCAL RADIO STATION AND LOCAL VIDEO SIGN. RENOWN HEALTH WORKS WITH OUR PRIMARY CARE PROVIDERS TO INCREASE UTILIZATION OF SPECIALTY SERVICES. WE WILL BE PARTNERING WITH RENOWN TO UPGRADE OUR TELEMEDICINE EQUIPMENT AND IMPROVING THE PATIENT EXPERIENCE AS WELL.3)AFFORDABILITY OF CARE - SOUTH LYON MEDICAL CENTER HAS ADDED AN ADDITIONAL FULLTIME BILINGUAL FINANCIAL COUNSELOR TO ASSIST SPANISH SPEAKING PATIENTS IN ACCESSING SLIDING FEE AND OTHER DISCOUNTS. THE FACILITY HAS SIMPLIFIED THE FINANCIAL ASSISTANCE APPLICATION. WE HAVE WORKED ON BUILDING POSITIVE RELATIONSHIPS WITH LOCAL BUSINESSES TO ENSURE THEIR INSURANCE PRODUCT IS IN NETWORK. SLMC IS ALSO WORKING WITH THE TWO LARGEST EMPLOYERS WHO HAVE RECENTLY CONVERTED TO A SELF-INSURED PRODUCT. THE FACILITY CONTINUES TO OFFER CASH CLINIC AND PROMPT PAY DISCOUNTS. SEVERAL YEARS AGO, WE ADDED AN ANNUAL TAX SEASON DISCOUNTS ON AGED PRIVATE PAY BALANCES. PART V, SECTION B, LINE 16 (A-C): HTTPS://SLMCNV.ORG/WP-CONTENT/UPLOADS/2019/10/2019-FAAP-ENGLISH-POLICY.PDF 4 1 - LONG TERM CARE 213 S WHITACRE STREET YERINGTON NV 89447 LONG TERM CARE 2 - PHYSICIAN'S CLINIC 311 SURPRISE STREET YERINGTON NV 89447 RURAL HEALTH CLINIC 3 - BARNETT CLINIC 213 S WHITACRE STREET YERINGTON NV 89447 RURAL HEALTH CLINIC 4 - SMITH VALLEY CLINIC 445 STATE HWY 338 WELLINGTON NV 89444 RURAL HEALTH CLINIC PART I, LINE 7: THE COSTING METHODOLOGY IS THE COST TO CHARGES RATIO. THE COST-TO-CHARGES RATIO IS USED FOR ALL PATIENT SEGMENT LINE INPATIENT, OUTPATIENT, AND EMERGENCY ROOM. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 727,040. PART II, COMMUNITY BUILDING ACTIVITIES: THERE ARE A VARIETY OF ACTIVITIES THAT SLMC DOES TO SUPPORT AND PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS WEDNESDAY (OFFERING REDUCED COST FOR SERVICES), PROVIDING SPACE FOR SPECIALISTS FOR LOCAL VISITS, PROVIDING FREE MEETING ACCESS TO COMMUNITY SUPPORT ORGANIZATIONS, PROVIDING DIABETIC EDUCATION TO PATIENTS, THEIR FAMILIES AND THE COMMUNITY. SLMC ALSO PROVIDES TRAVELING FLU VACCINATION CLINICS TO AREA BUSINESSES. MANY OF THESE PROGRAMS ARE NOT EASY OR COST EFFECTIVE TO TRACK IN OUR ACCOUNTING SYSTEM AND THEREFORE ARE NOT REPORTED. PART III, LINE 2: THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY IS DETERMINED BY THE ORGANIZATION USING INFORMATION AVAILABLE TO MAKE AN EDUCATED ESTIMATE. PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOOTNOTE INCLUDED HERE IS THE PATIENT RECEIVABLES AND CREDIT POLICY NOTE.PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT AND RESIDENT ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORTED IN THE MEDICARE COST REPORT IS THE COST TO CHARGE RATIO. PART III, LINE 9B: EMERGENCY ROOM PATIENTS WITHOUT A PAYMENT SOURCE MAY BE CLASSIFIED AS CHARITY IF THEY DO NOT HAVE A JOB, MAILING ADDRESS, RESIDENCE, OR INSURANCE. CONSIDERATION MUST ALSO BE GIVEN TO CLASSIFYING EMERGENCY ROOM ONLY PATIENTS WHO DO NOT PROVIDE ADEQUATE INFORMATION AS TO THEIR FINANCIAL STATUS. IN MANY INSTANCES, THESE PATIENTS ARE HOMELESS AND HAVE FEW RESOURCES TO COVER THE COST OF THEIR CARE.IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE HOSPITAL'S CHARITY CARE ELIGIBILITY CRITERIA, THEIR PATIENT ACCOUNT MAY BE CONSIDERED CHARITY CARE, EVEN IF THEY WERE ORIGINALLY CLASSIFIED AS A BAD DEBT. COLLECTION AGENCY PATIENT ACCOUNTS MEETING CHARITY CARE CRITERIA SHOULD BE RETURNED TO THE HOSPITAL BILLING OFFICE AND REVIEWED FOR CHARITY CARE ELIGIBILITY. PART VI, LINE 2: SOUTH LYON MEDICAL CENTER (SLMC) CONDUCTS WELLNESS WEDNESDAY WEEKLY OFFERING REDUCED LAB TESTING TO ACCESS PATIENT HEALTH. SLMC WILL MEET WITH LOCAL ORGANIZATIONS (I.E. ROTARY, SOROPTOMISTS, ETC.) UPON REQUEST. SLMC IS ALSO DEVELOPING A COMMUNITY WELLNESS PROGRAM WITH A FOCUS ON DIABETES IN ENGLISH AND SPANISH. THE ORGANIZATION PROVIDES COMMENT BOXES, HCAPHS SURVEYS AND PATIENT COMPLAINT/CONCERNS SURVEYS TO GATHER INFORMATION ON COMMUNITY NEEDS. PART VI, LINE 3: PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE THROUGH THE CHARITY CARE POLICY ARE MADE THROUGH EACH OF THE FOLLOWING MEANS:1. POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMITTING OFFICES, AND HOSPITAL OUTPATIENT SERVICE SETTINGS.2. INCLUDING INFORMATION IN THE BILLS SENT TO UNINSURED PATIENTS STATEMENTS INDICATING:A) IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS, THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR FOR FINANCIAL ASSISTANCE FROM THE HOSPITAL.B) A HOSPITAL PHONE NUMBER THAT PATIENTS MAY CALL FOR FURTHER INFORMATION.3. POSTING NOTICE OF THE AVAILABILITY OF ASSISTANCE AND A CONTACT PHONE NUMBER ON THE SLMC WEB SITE.4. PROVIDING UNINSURED PATIENTS INFORMATION OUTLINING THE TYPES OF FINANCIAL ASSISTANCE AVAILABLE.POSTED NOTICES (AS LISTED ABOVE) SHALL BE IN THE PRIMARY LANGUAGE(S) OF SLMC'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. POSTED NOTICES SHALL CONTAIN THE FOLLOWING INFORMATION:1. A STATEMENT INDICATING THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS WHO MAY NOT BE ABLE TO PAY THEIR BILL AND THAT THIS POLICY PROVIDES FOR FULL OR PARTIAL CHARITY CARE WRITE-OFF.2. IDENTIFICATION OF A HOSPITAL CONTACT PHONE NUMBER THAT THE PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND ABOUT HOW TO APPLY FOR ASSISTANCE. PART VI, LINE 4: THE PRIMARY MEDICAL SERVICE AREA FOR SOUTH LYON MEDICAL CENTER CONSISTS OF THREE ZIP CODE TABULATION AREAS: 89430 (SMITH VALLEY), 89444 (WELLINGTON) AND 89447 (YERINGTON). THIS IS A LARGE RURAL AREA CONSISTING 1,098 SQUARE MILES IN SIZE AND HAS A POPULATION OF 11,098 ACCORDING TO THE CENSUS 2010 DATA. 25 PERCENT OF THE POPULATION (OR 2,750 INDIVIDUALS) ARE AGE 65 YEARS AND OLDER WHICH IS ABOUT TWICE THE PERCENTAGE OF THIS AGE GROUP IN THE NATIONAL OR STATE POPULATION. THE HISPANIC POPULATION IS 17% AND IS MUCH YOUNGER ON AVERAGE THAN THE NON-HISPANIC POPULATION. PART VI, LINE 5: SOUTH LYON MEDICAL CENTER HAS A COMMUNITY BASED BOARD OF DIRECTORS; AN OPEN MEDICAL STAFF AND USES SURPLUS FUNDS TO PAY FOR COMMUNITY SERVICES SUCH AS HEALTH FAIRS, SPACE FOR MEDICAL SPECIALISTS FOR LOCAL VISITS. SLMC PROVIDES ACCESS TO MEDICAL INFORMATION VIA THE CARES COTTAGE, PROVIDING DIABETIC EDUCATION TO COMMUNITY MEMBERS AND VIA OUTREACH PROGRAMS WITH THE LOCAL SCHOOLS. X X X 0 0 0 0 0 0 0 0 0 JEFFREY WESTIN DIRECTOR/CHIEF OF STAFF 538578 0 0 0 0 0 0 0 0 0 538578 0 0 0 TOM J WALSH PHYSICIAN 239195 0 0 0 0 0 4784 0 20334 0 264313 0 0 0 LOREN SIMPSON PHYSICIAN 207650 0 0 0 0 0 4153 0 19621 0 231424 0 0 0 ROBIN TITUS PHYSICIAN 200100 0 0 0 0 0 4002 0 20334 0 224436 0 0 0 THOMAS CLIFTEN PHYSICAL THERAPIST 142812 0 0 0 0 0 2884 0 20334 0 166030 0 0 0 REBECCA INSERRA EMPLOYEE OF HOSPITAL 32759 REBECCA INSERRA IS A FAMILY MEMBER OF TONI INSERRA AND IS AN EMPLOYEE OF THE HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS 25 MEMBERS. THERE IS ONLY ONE CLASS OF MEMBERS, ALL MEMBERS ARE VOTING MEMBERS. MEMBERSHIP IS LIMITED TO RESIDENTS OF THE SOUTH LYON HOSPITAL DISTRICT. MEMBERS ARE ACCEPTED ANNUALLY UPON COMPLETION OF AN APPLICATION AND PAYMENT OF ANNUAL DUES. MEMBERS MAY HAVE A MOTION CONSIDERED BY THE BOARD OF DIRECTORS. ANY WRITTEN MOTION THAT IS SECONDED WILL BE PRESENTED TO THE BOARD AND THERE WILL BE A DETERMINATION WITHIN 90 DAYS. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS HAVE UNLIMITED TERMS AND ARE ACCEPTED UPON YEARLY COMPLETION OF THE CORPORATION APPLICATION AND PAYMENT DUES. THE MEMBERS ARE REQUIRED TO MEET ANNUALLY AND MUST BE RESIDENTS OF THE SOUTH LYON HOSPITAL DISTRICT. MEMBERSHIP IS NOT TRANSFERABLE OR ASSIGNABLE. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE AUDIT FIRM BASED ON THE INFORMATION PROVIDED BY THE CFO OF THE ORGANIZATION. THE 990 IS THEN REVIEWED AND APPROVED BY THE CEO PRIOR TO PRESENTING TO THE BOARD OF DIRECTORS. THE FORM IS THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, MEMBERS OF THE ADMINISTRATIVE STAFF, AND OTHER PERSONS EMPLOYED BY THE ORGANIZATION. COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. ADMINISTRATION AND RISK MANAGEMENT REVIEW FILES FOR SIGNATURES AND DISCLOSURES. IF A CONFLICT OF INTEREST DOES OCCUR IT IS ANNOUNCED TO THE ENTIRE BOARD PRESENT. IF NECESSARY, THE BOARD ASKS FOR STAFF INPUT AND LEGAL OPINION TO DETERMINE IF A CONFLICT EXISTS IF THE BOARD CANNOT DO SO INDEPENDENTLY. THE INTERESTED BOARD MEMBER WILL ABSTAIN FROM VOTING ON ITEMS THAT HAVE BEEN IDENTIFIED AS A POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO, TOP MANAGEMENT AND OFFICERS OF THE ORGANIZATION IS DETERMINED BY USING SURVEYS FROM THE NEVADA HOSPITAL ASSOCIATION, NEVADA RURAL HOSPITAL PARTNERS, MGMA, MERRITT HAWKINS AND OTHER PROFESSIONAL SURVEY INSTRUMENTS. THE CEO'S COMPENSATION IS THEN APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AND ANNOUNCES SUCH AT BOARD MEETINGS AND THE ANNUAL SOUTH LYON HOSPITAL DISTRICT CORPORATION MEETING. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 335,765. MANAGEMENT AND GENERAL EXPENSES 56,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 392,647. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 172,021. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 172,021. MRI SERVICES: PROGRAM SERVICE EXPENSES 156,737. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,737. BUSINESS OFFICE PURCHASE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 108,773. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,773. MED/SURG SERVICES: PROGRAM SERVICE EXPENSES 441,878. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 441,878. LTC SERVICES: PROGRAM SERVICE EXPENSES 402,163. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 402,163. ER SERVICES: PROGRAM SERVICE EXPENSES 1,267,988. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,267,988.