2018-02-13T12:30:23-06:00 2017-03-31 390758449 Wipfli LLP 7601 France Avenue South Suite 400 Minneapolis MN 55435 990 2016-04-01 880256932 South Lyon Health Center dba South Lyon Medical Center SOUT 7754632301 PO BOX 940 Yerington NV 89447 Toni Inserra Chief Executive Officer 7754632301 2018-02-08 1 Tim A Ritter CPA P00732856 9525483400 2018-02-08 50.249.107.123 2018-02-08 13:43:02 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BB3069DA9F6047B5836CE2952E0AE234800C2778 2016 2021-01-29 14:40:06Z Toni Inserra PO BOX 940 Yerington NV 89447 12347589 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 5 236 9 0 0 34726 33312 11252402 12112640 0 5006 436356 196631 11723484 12347589 0 0 0 0 7669845 7303224 0 0 0 4581850 4794314 12251695 12097538 -528211 250051 4168817 4209720 1382530 1173382 2786287 3036338 The mission of South Lyon Medical Center is to provide access to quality health care services needed by the community. 0 0 6156407 0 7289344 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 assistance available for completing applications. The hospital provides the standard influenza vaccine at a nominal cost. 2705043 0 3202840 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. 1492780 0 1767490 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. 10354230 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 30 0 1 236 1 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 1.00 X 0 0 0 Robert Rowley Director 1.00 X 0 0 0 Ted Rudolph Director (Thru Jan) 1.00 X 0 0 0 Dale Theiss Director 1.00 X 0 0 0 Robin L Titus Director/Chief of Staff (Thru Jan) 40.00 X 191454 0 24105 Jeffrey Westin Director/Chief of Staff 40.00 X 0 0 0 Matt Christenson President 1.00 X X 0 0 0 John Diekmann Vice President 1.00 X X 0 0 0 David Bezard CFO 40.00 X 93432 0 21322 Toni Inserra CEO 40.00 X 115100 0 11267 Thomas Ard IT Director 40.00 X 110497 0 11175 Thomas Cliften Physical Therapist 40.00 X 138792 0 23052 Patricia Wise Physician Assistant 40.00 X 100100 0 10967 749375 0 101888 5 0 1 0 Jeffrey Westin MD 2851 Friar Rock Court Sparks NV 89436 Physican Services 527475 Robert T Floyd MD LLC 180 Ox-Yoke Lane Reno NV 89521 Physican Services 411850 RN Network PO Box 974088 Dallas TX 75397 Nursing Locums Services 158238 NV Rural Hospital Partners 4600 Kietzke Lane Reno NV 89502 MRI and Technical Services 112772 4 33312 33312 Program Service Revenue-Related 621400 9911720 9911720 Hospital District Reimbursement 621400 846229 846229 District Tax Subsidy 900099 738184 738184 UPL Revenue 621400 589441 589441 Patient Lab Testing 621400 26000 26000 1066 1066 12112640 5200 0 5200 5200 5200 5006 0 5006 5006 5006 EHR Incentive 900099 147034 147034 Employee Meals 900099 8685 8685 35712 35712 191431 12347589 12259674 0 54603 X 453666 275729 177937 5761960 5019205 742755 84006 73160 10846 476838 421523 55315 526754 447319 79435 98087 98087 2482695 2319618 163077 2127 2127 349318 155596 193722 171813 171813 270695 270350 345 19601 4144 15457 63902 58405 5497 6600 6600 27682 27682 125138 121696 3442 Medical Supplies 863382 863382 PROVISION FOR BAD DEBTS 289012 289012 Dues and Subscriptions 24049 7200 16849 213 209 4 12097538 10354230 1743308 0 1554779 1676923 17563 18223 2378886 2126202 130271 115415 45021 96563 280812 104418 42297 176394 4168817 4209720 1052255 843107 330275 330275 1382530 1173382 X 2786287 3036338 2786287 3036338 4168817 4209720 250051 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 95 95 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 of the healthcare delivery systems and the health status of Nevada's Population. 90670 54665 36005 190142 49753 140389 176394 11320393 0 11320393 1027196 1027196 12347589 11808526 0 11808526 289012 289012 12097538 Part XI, Line 4b - Other Adjustments: Provision for bad debts 289,012. Nonoperating Gains - District Tax Subsidy 738,184. Part XII, Line 4b - Other Adjustments: Provision for bad debts 289,012. 1 1 0 1 X 1 0 0 31525 31525 0.00270 1717105 705083 1012022 0.08570 1748630 705083 1043547 0.08840 1748630 705083 1043547 0.08840 0 184043 61348 3143031 2939521 203510 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 15 1 0 0 1 X See Supplemental Information X X 1 15 1 See Supplemental Information 0 1 X 0.000000000000 250.000000000000 X X X 1 1 X X X 1 X See Part V, Page 7 X See Part V, Page 7 X See Part V, Page 7 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: 1,750 surveys were distributed to local community businesses and groups, including Yerington and Smith Valley Schools. 480 Spanish surveys were provided to Yerington Elementary school in an attempt to reach out to nonEnglish speaking community members. 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. 302 completed paper surveys were returned to Nevada State Office of Rural Health (8 in Spanish) and 52 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 2016 and has begun addressing the following identified needs: 1)Access to Healthcare - Wellness Wednesdays are held weekly to provide reduced cost screenings, Telemedicine education is being provided to our clinic providers to increase utilization for specialists, coordinate mobile screening vans providing mammography and diabetic retinopathy and working to integrate reporting from EHR to state health registries. Due to the lack of available services in the area, South Lyon Medical Center added a staff Behavioral Health provider in 2017. This individual helps primary care providers and patients bridge the gaps to ensure care is provided. South Lyon Medical Center also extended the hours and days its walk-in clinic is available. We have added Telepsych and Telestroke to our ER which will provide Emergent Psychiatric and stroke evaluations. We also have access to a website for our Spanish speaking community members to get free help with diabetes, smoking cessation and other health improving strategies.2)Quality of Care - We have moved forward with the Dialysis project, added 4 Emergency room doctors Certified in ER care, we have added 3 new clinic practitioners, we have begun to accept VA patients in our Long Term care facility and are moving forward with developing and implementing a community wellness program with the main focus on diabetes. We now have a Certified Diabetes Educator and offer public courses every quarter. South Lyon Medical Center participates in the CMS Quality Reporting for hospital compare and has a very vigorous quality assurance committee. 3) Cost of Care - The facility has added a cash clinic offering patients with no insurance an option to see a physician for a reduced fee at all three clinics, a prompt pay discount was instituted which allows patients a 30% discount on outpatient and inpatient services, we have revised our sliding fee discounts to be more generous and less restrictive and a certified enrollment counselor position was created to help individuals obtain coverage through the Insurance Exchange. We now have a representative from The American Cancer Society that comes twice a month to meet with the public and help them navigate the available resources at no charge.4) More Specialty Services Needed - We are educating all our providers on the availability of telemedicine services for specialty providers, we increased the advertising for our current visiting providers including a better internet presence/social media and we hope to increase the types of specialties offered. We have added Surgeons from CVMC that also provide wound care and added a Podiatrist who comes out monthly. Part V, Section B, Line 16 (a-c): https://slmcnv.org/wp-content/uploads/2017/04/FAP-CHARITY-CARE-LOW-INCOME-UNINSURED-web-2017.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 $ 289,012. 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 1 0 X X X 0 0 0 0 0 0 0 0 0 Robin L Titus Director/Chief of Staff (Thru Jan) 191454 0 0 0 0 0 3829 0 20276 0 215559 0 0 0 Thomas Cliften Physical Therapist 138792 0 0 0 0 0 2776 0 20276 0 161844 0 0 0 Rebecca Inserra Employee of hospital 35071 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 42 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 of 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 sharing with the board of directors. The Form is then submited 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 303,423. Management and general expenses 50,181. Fundraising expenses 0. Total expenses 353,604. Laboratory Services: Program service expenses 165,669. Management and general expenses 0. Fundraising expenses 0. Total expenses 165,669. MRI Services: Program service expenses 158,628. Management and general expenses 0. Fundraising expenses 0. Total expenses 158,628. Business Office Purchase Services: Program service expenses 0. Management and general expenses 112,896. Fundraising expenses 0. Total expenses 112,896. Med/Surg Services: Program service expenses 302,536. Management and general expenses 0. Fundraising expenses 0. Total expenses 302,536. LTC Services: Program service expenses 125,544. Management and general expenses 0. Fundraising expenses 0. Total expenses 125,544. ER Services: Program service expenses 1,263,818. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,263,818.