2018-02-09T11:22:10-06:00 2017-03-31 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-04-01 381369796 Sheridan Community Hospital SHER 9892913261 301 North Main Street Sheridan MI 48884 RANDOLPH FLECHSIG CEO 9892913261 2018-02-07 1 Terri Rexrode CPA MST P00096513 9206620016 2018-02-07 74.87.127.142 2018-02-07 10:34:23 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2016 2021-01-29 14:40:06Z Randolph Flechsig 301 North Main Street Sheridan MI 48884 15820382 0 X www.sheridanhospital.com X 1950 MI ACUTE CARE HOSPITAL and clinics 9 7 262 25 0 0 53523 39440 15388879 15485237 15752 13229 -10235 253320 15447919 15791226 0 0 0 0 10918032 10085595 0 0 0 4791339 4793678 15709371 14879273 -261452 911953 8408653 6055467 5401196 2136057 3007457 3919410 ABOVE ALL ELSE, WE ARE COMMITTED TO THE CARE AND IMPROVEMENT OF HUMAN LIFE. IN RECOGNITION OF THIS COMMITMENT, WE CONTINUE TO STRIVE TO DELIVER "ACCESSIBLE, PERSONALIZED, EFFICIENT, QUALITY HEALTHCARE BASED ON THE NEEDS OF THOSE WE SERVE." 0 0 11832815 15675531 SHERIDAN COMMUNITY HOSPITAL PROVIDED CARE TO 131 INPATIENTS AND 57 SWING BED PATIENTS WITH 1,008 DAYS OF CARE. WE ALSO PROVIDED 21,313 AMBULATORY VISITS WHICH INCLUDED 8,142 VISITS THROUGH OUR EMERGENCY ROOM. SHERIDAN COMMUNITY HOSPITAL PROVIDED $25,825 IN CHARITY CARE AND $1,588,668IN OTHER UNCOMPENSATED CARE DURING THE YEAR.SHERIDAN COMMUNITY HOSPITAL'S RURAL HEALTH CLINICS PROVIDED 9,842 AMBULATORY ENCOUNTERS TO PATIENTS IN THE SURROUNDING AREA. LARGELY THIS PATIENT POPULATION CONSISTS OF MEDICARE, MEDICAID AND UNINSURED INDIVIDUALS. 11832815 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 96 0 262 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Randolph Flechsig 9812913261 301 North Main Street Sheridan MI 48884 JAY TANS PRESIDENT 1.00 X X 0 0 0 DAVID STEERE TREASURER/SECRETARY 1.00 X X 0 0 0 DIANE BEACH Director 1.00 X 0 0 0 MAUREEN HOCKSTRA DIRECTOR 1.00 X 0 0 0 emily longnecker DIRECTOR 1.00 X 0 0 0 JAN WYCKOFF DIRECTOR 1.00 X 0 0 0 RONALD STEURY DO DIRECTOR/ER PHYSICIAN 40.00 X 184936 0 21689 RANDOLPH FLECHSIG CEO/HOSPITAL ADMINISTRATOR 40.00 X X 132165 0 27448 Esther COMBS DIRECTOR 1.00 X 0 0 0 RON SPRINGSTEEN DIRECTOR 1.00 X 0 0 0 MINDY BUFFMAN FORMER CFO 40.00 X 31312 0 3376 DENISE IDE CFO 40.00 X 0 0 0 Michael Cearlock Physician 40.00 X 290629 0 19169 STEPHEN FRY Physician 40.00 X 258198 0 13778 MONICA STEURY Physician 40.00 X 209389 0 50392 FRANKLIN WEST Physician 40.00 X 207814 0 20982 Monish Sharma physician 40.00 X 183690 0 23445 1498133 0 180279 9 0 1 0 J G Anesthesia Services Inc PO Box 923 Alma MI 48801 CRNA - Anesthesia 248219 WIPFLI LLP 11 SCOTT STREET WAUSAU WI 544028010 AUDIT SERVICES 117951 COVENANT MEDICAL CENTER 1447 N HARRISON SAGINAW MI 48602 PHARMACEUTICAL SUPPLIES/SERIVCES 115020 Hall Render Killian Heath & Lyman PC 39778 Treasury Center Chicago IL 60694 Legal Services 113982 ECLINICAL WORKS LLC 2 TECHNOLOGY DRIVE WESTBOROUGH MA 01581 EMR SOFTWARE/HARDWARE/SERVICE 103469 5 31387 8053 39440 PROGRAM SERVICE REVENUE 623990 14822343 14822343 QAAP Revenue 623990 581997 581997 Other revenue 909999 63305 63305 Medical office building 621110 16259 16259 CAFETERIA REVENUE 624200 1333 1333 15485237 11713 11713 29060 27544 1516 1516 1516 0 31387 1612 -1612 -1612 incentives/ehr 900099 254932 254932 254932 15791226 15675531 0 76255 400925 206625 194300 6904041 5758197 1145844 141843 117685 24158 2079453 1666546 412907 559333 458354 100979 57890 57890 14412 14412 1180 1180 1647905 1252867 395038 68046 68046 254997 213357 41640 45747 15853 29894 57962 48497 9465 524866 439157 85709 150150 150150 medical contracted serv 711617 711617 PROVISION FOR BAD DEBTS 645113 645113 repairs and maintenance 222796 205069 17727 collection expense 101673 101673 289324 34808 254516 14879273 11832815 3046458 0 425973 305405 1596141 79258 2726995 2417554 197264 243264 80402 82305 7270444 4360487 3381878 2909957 17724 8408653 6055467 3853437 1775184 1277410 267820 270349 93053 5401196 2136057 X 2964232 3888039 43225 31371 3007457 3919410 8408653 6055467 911953 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1187 1187 0 Part II-B, Line 1: A PORTION OF DUES PAID TO MHA (16.96%) ARE ALLOCATED TO LOBBYING EXPENSE. 410366 410366 3478693 2177762 1300931 3381385 2182725 1198660 2909957 COST REPORT SETTLEMENTS PAYABLE 93053 93053 15146113 -645113 -645113 15791226 0 15791226 14234160 0 14234160 645113 645113 14879273 Part XI, Line 2d - Other Adjustments: PROVISION FOR BAD DEBTS -645,113. Part XII, Line 4b - Other Adjustments: PROVISION FOR BAD DEBTS 645,113. TREE OF LIGHTS 11063 11063 1612 Auction 20324 20324 31387 31387 1612 1612 -1612 1 1 X 1 X 1 X 1 0 1 1 25825 25825 0.00180 3406212 1817544 1588668 0.11160 3432037 1817544 1614493 0.11340 2741 2741 0.00020 2741 2741 0.00020 3434778 1817544 1617234 0.11360 0 645113 212887 4667291 4756254 -88963 X 1 1 1 1 SHERIDAN COMMUNITY HOSPITAL 301 N MAIN STREET SHERIDAN MI 48884 WWW.SHERIDANHOSPITAL.COM 1060000119 X X X X SHERIDAN COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X 15 1 1 0 1 X https://sheridanhospital.com/documents/Montcalm_County_CHA_Updated_2015.pdf X 1 15 1 https://www.sheridanhospital.com 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X https://www.sheridanhospital.com/payments.asp X https://www.sheridanhospital.com/payments.asp X https://www.sheridanhospital.com/payments.asp X X X X X X 1 X 0 X X X X X 1 X 0 0 SHERIDAN COMMUNITY HOSPITAL Part V, Section B, Line 5: SHERIDAN used data from the local and regional behavioral risk factor surveillances, as well as from individuals and local service agencies in the surrounding community. COUNTY-SPECIFIC SECONDARY DATA FROM A VARIETY OF SOURCES WAS ALSO COLLECTED AND ANALYZED. SHERIDAN COMMUNITY HOSPITAL Part V, Section B, Line 6a: Sheridan Community Hospital conducted a community health needs assessment in conjunction with Spectrum United, Spectrum Kelsey, and Carson City Hospital - Healthy Montcalm. SHERIDAN COMMUNITY HOSPITAL Part V, Section B, Line 11: A Community Health Needs Assessment (CHNA) was performed in the fall of 2015 in collaboration with Healthy Montcalm, to determine the most prevalent health needs of the community served by Sheridan Community Hospital. Sheridan Community Hospital as a collaborative part of the Montcalm County Community Health Improvement Plan for 2016-2019 has incorporated and adopted pertinent elements of the Healthy Montcalm's Community Health Needs Assessment (CHNA) as its own assessment, to determine the most prevalent health needs of the community served by Sheridan Community Hospital.Information needed to identify and determine the community's significant health needs was obtained by gathering input selecting strategies from Montcalm Human Services Coalition. Implementation Plan Goals: Sheridan Community Hospital's Board of Directors, has determined that the following health needs identified in the CHNA, will be addressed through the implementation strategy noted for each such need as listed:Priority Health Issue: Access to HealthcareGoal: Increase access/utilization of primary and preventive health servicesObjective 1: Increase access by implementing and promoting the utilization of preventive health servicesObjective 2: Increase access to care by implementing telehealth services Baseline Measure: People who delayed health care: 15% (2018 Goal +12%)Population Served: All residents of Sheridan Community Hospital Service AreaA. Strategy: Increase the number of primary care providers, including midlevel, accepting Medicaid and Medicare with an eye toward manage population health.Action: Increase the number of primary care providers in Sheridan Community Hospital clinics including Allied Health Providers accepting all insurances including Medicare and Medicaid.Performance Measure: Increase in number of primary care providers accepting all insurances including Medicare and/or Medicaid above current staff:a. One provider by March 2017b. Two providers by March 2018c. Three providers by March 2018Action: Increase primary care provider availabilitya. Improve operational efficiency to optimize the number of appointments available per day, and hours for access.b. Ensure at least two open appointments available each day for Emergency Room/Walk in Clinic f/u appointments or need to be seen today appointments.c. Implementation of new clinic EMR to enhance provider productivity with documentation and integration of wellness metrics.Performance Measure: Increase number of patients seen by 10% by March 2017 Increase number of patients seen by 20% by March 2018 Increase number of patients seen by 30% by March 2019UPDATE: Full time physician assistant hired September 2016 for Sheridan Care. Full time in-house physician recruiter was hired December 2016 to assist with the searching of providers. At this time SCH has not hired a new physician.B. Strategy: Expand telemedicine communication technology (Use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status)Action: Use of technology to overcome transportation barriers by using telemedicine visits from provider to service location.a. Apply for grant fundingb. Initiate telemedicine program by March 2017 Performance Measure:Upon receipt of funding initiate program by March 2017Increase number of first year patients utilizing telemedicine by 10% by March 2018Increase number of patients utilizing telemedicine by 20% by March 2019 UPDATE: No action taken at this time to financial constraints.Other significant needs identified in the CHNA but not addressed in this plan: Each of the health needs listed are important and are being addressed by numerous programs and initiatives operated by neighboring healthcare system, and other community partners of Sheridan Community Hospital.However, Sheridan Community Hospital will not address the following significant health needs identified in the CHNA as part of this implementation plan due to limited resources and the need to allocate significant resources to the priority health needs identified above.Reduce the prevalence of obesity for adults and youth of Montcalm CountyNeeds are currently being addressed by the Great Start Collaborative of Montcalm County and existing programs through Spectrum Health United Life Styles. These programs address the overweight adult and children issues identified in needs assessment. Assist people with mental illness in leading more productive and autonomous lifestyles, and to promote mental health through advocacy and education. Needs are currently being addressed by Montcalm Center for Behavioral Health and Montcalm Human Services Coalition. These programs address the mental health and suicide issues identified in the needs assessment. Substance use and abuse to reduce tobacco, alcohol and other drug use. Needs are currently being addressed by Cherry Health Promotion Services, Spectrum Health United Lifestyles, You Think Coalition, Mid Michigan District Health Department and Great Start. These programs address alcohol/drug use, smoking, second-hand smoke, use of e-cigarettes, prescription drug abuse, and substance abuse treatment issues identified in the Community Health Needs Assessments.Strengthen early family development and support, especially as it relates to health for children and youth. Needs are being addressed by Great Start, Spectrum Health United Lifestyles through education to young families and the community about family development as well expanding opportunities for comprehensive heath activities in schools and other care settings. SHERIDAN COMMUNITY HOSPITAL Part V, Section B, Line 16j: We were not required to translate our FAP, FAP application form and plain language summary of the FAP into any other languages. SHERIDAN COMMUNITY HOSPITAL Part V, Section B, Line 20e: We let all self-pay individuals know at the time of admission and again at discharge. They are given contact information for our FAP coordinator. We also offer to anyone asking the same information if they have a high deductible. 2 1 - SHERIDAN CARE 303 CONGRESS SHERIDAN MI 48884 OUTPATIENT CLINIC 2 - STANTON FIRST CARE 620 WEST MAIN STANTON MI 48888 OUTPATIENT CLINIC Part I, Ln 7 Col(f): Bad debt expense of $645,113 included on Form 990, Part IX, Line 25 was excluded from the denominator per instructions when calculating the percent total expenses on schedule H. Part II, Community Building Activities: Sheridan Community Hospital offers a variety of health and wellness programs including education workshops, health screenings, community health fairs, blood pressure clinics, diabetes education, and support groups. These programs are open to everyone and are generally free of charge. Part III, Line 4: An allowance for uncollectible accounts is established on an aggregate basis by using historical write-off rate factors applies to upaid accounts based on aging. Loss rate factors are based on historical loss experience and adjusted for economic conditions and other trends affecting the hospital's ability to collect outstanding amounts. Uncollectible accounts are written off against the allowance for doubtful accounts in the period they are determined to be uncollectible. Part III, Line 8: COSTING METHODOLOGY IS A COST TO CHARGE RATIO AS DEFINED BY THE IRS 990 INSTRUCTIONS. THE ENTIRE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT DUE TO ITS REPRESENTATION OF COST TO PROVIDE SERVICES TO THE COMMUNITY WITHOUT PAYMENT. Part III, Line 9b: Patients fill out a financial application and also apply for medicaid for current services (past 90 days). If services are past 90 days, there is no application to medicaid. Medicaid will be billed if patient is deemed medicaid eligible. If the patient does not qualify for medicaid but is found eligible under the hospital's financial application guidelines, then the charges are written off to charity care. Part VI, Line 2: PARTICIPATING IN COMMUNITY INITIATIVES EVERY THREE YEARS. Part VI, Line 3: Related information is posted by the entrance doors to the hospital as well as on the wall next to ER. Part VI, Line 4: Sheridan Community Hospital serves a population of all ages but continues to see an increase in its aging population as well as quite a large migrant population. Over the past several years, thousands of jobs have been lost and unemployment has been on the rise in the communities SCH serves. There has been a large increase in foreclosures and healthcare reform impact. Part VI, Line 5: Sheridan Community Hospital and its hospital-owned family practices offer free or low-cost immunization clinics, free sports exams for students and provide a low cost lifeline program (Emergency Response System). Part VI, Line 7, Reports Filed With States MI X X 0 0 0 0 0 0 0 0 0 RONALD STEURY DO DIRECTOR/ER PHYSICIAN 184822 0 0 0 114 0 2000 0 19689 0 206625 0 0 0 RANDOLPH FLECHSIG CEO/HOSPITAL ADMINISTRATOR 131823 0 0 0 342 0 2000 0 25448 0 159613 0 0 0 Michael Cearlock Physician 290515 0 0 0 114 0 0 0 19169 0 309798 0 0 0 STEPHEN FRY Physician 258084 0 0 0 114 0 0 0 13778 0 271976 0 0 0 MONICA STEURY Physician 209275 0 0 0 114 0 2000 0 48392 0 259781 0 0 0 FRANKLIN WEST Physician 207472 0 0 0 342 0 2000 0 18982 0 228796 0 0 0 Monish Sharma physician 183576 0 0 0 114 0 0 0 23445 0 207135 0 0 0 Monica Steury Daughter of Ronald Steury board member 259781 Paid by Sheridan Community Hospital 0 Form 990, Part VI, Section B, line 11b All board members were provided a copy of the Form 990 before it was filed. The form 990 will be presented at a future board meeting. Form 990, Part VI, Section B, line 12c A CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED ANNUALLY BY THE BOARD OF DIRECTORS AND REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD. IF A CONFLICT DOES EXIST, IT IS UP TO THE EXECUTIVE COMMITTEE OF THE BOARD TO TAKE SUCH STEPS TO PROTECT THE HOSPITAL AS MAY BE REQUIRED OR APPROPRIATE. INDIVIDUALS INVOLVED WILL BE NOTIFIED TO TAKE CORRECTIVE ACTION BEFORE ANY PENALIZING AND REMEDIAL ACTION IS UNDERTAKEN BY THE HOSPITAL. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS COMPENSATION DATA PROVIDED BY MHA IN THE FORM OF EXECUTIVE COMPENSATION SURVEY. THE BOARD OF DIRECTORS APPROVES EXECUTIVE COMPENSATION AND DOCUMENTS CONCLUSIONS IN THE BOARD MINUTES. THE MOST RECENT YEAR THIS WAS UNDERTAKEN WAS FISCAL YEAR 2013. Form 990, Part VI, Section C, line 19 Any governing documents, conflict of interest policy and/or financial statements that are required to be open for public inspection, are available upon request. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR