2025-11-14T11:30:01-06:00 2024-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2024-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 MATTHEW SELLS PRESIDENT & CEO 7122461230 2025-11-13 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-11-11 2024 2025-03-06 01:10:19Z MATTHEW SELLS 300 PERSHING AVENUE SHENANDOAH IA 51601 70398933 0 X WWW.SMCHOSPITAL.COM X 1978 IA TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF SHENANDOAH. 9 8 443 152 0 0 2707562 2557287 56087519 63241256 624784 919247 266200 312165 59686065 67029955 0 0 0 0 29051655 33812924 0 0 0 24576292 28789568 53627947 62602492 6058118 4427463 79783296 85410832 41705627 41650730 38077669 43760102 TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. 0 0 54720757 63490032 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. DURING 2024 THE HOSPITAL PROVIDED 1,114 DAYS OF ACUTE CARE, 641 DAYS OF SKILLED CARE,157 NURSERY DAYS AND 219,263 OUTPATIENT OCCASIONS OF SERVICE. 54720757 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 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 62 0 1 443 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X KALEY NEAL CFO 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 HEATHER BABE MD DIRECTOR & CHIEF MEDICAL OFFICER 40.00 0.00 X 409828 0 17250 DENNIS GREBERT CHAIRMAN 3.00 1.00 X X 0 0 0 JON SKILLERN SECRETARY/TREASURER 3.00 0.00 X X 0 0 0 JOHN FINN VICE CHAIRMAN THRU OCT/24 3.00 0.00 X X 0 0 0 JILLIAN TRAVIS DIRECTOR 3.00 0.00 X 0 0 0 JAMES DOYLE DIRECTOR 3.00 0.00 X 0 0 0 NICK BOSLEY DIRECTOR 3.00 0.00 X 0 0 0 AMY MILLER DIRECTOR 3.00 0.00 X 0 0 0 CRAIG HOLMES DIRECTOR 3.00 0.00 X 0 0 0 SHANE MCHENRY DIRECTOR 3.00 0.00 X 0 0 0 BRUCE BALDWIN DIRECTOR THRU MAR/24 3.00 0.00 X 0 0 0 MATTHEW SELLS PRESIDENT & CEO 40.00 1.00 X 348604 0 40112 KALEY NEAL CFO 40.00 1.00 X 191657 0 9719 MOHAMED ABDI MD PHYSICIAN 40.00 0.00 X 713674 0 16605 REBECCA ROSE MD FACS PHYSICIAN 40.00 0.00 X 494427 0 17250 MARTEE MACLEOD-KOZAL MD PHYSICAN & CHIEF OF STAFF 40.00 0.00 X 488592 0 17250 CLYDE SULLIVAN MD PHYSICIAN 40.00 0.00 X 502631 0 0 CHASE BROWN DO PHYSICIAN 40.00 0.00 X 480819 0 17250 3630232 0 135436 56 0 1 0 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 100875068 CONTRACT LABOR 1976280 GRAHAM CONSTRUCTION CO INC 4601 N 252ND ST VALLEY NE 68064 CONSTRUCTION PROJECT 1400876 MD WEST ONE 8005 FARNAM DRIVE OMAHA NE 68114 PROVIDED ORTHO CONTRACT LABOR 668750 UNMC PHYSICIANS LAB REF S 42ND AND EMILE ST OMAHA NE 68198 MEDICAL LAB PROJECT 629021 ALTERA DIGITAL HEALTH 222 MERCHANDISE MART PLAZA CHICAGO IL 60654 SOFTWARE INSTALLATION AND SERVICE 391626 16 83914 2473373 2557287 PATIENT SERVICE REVENU 621110 59442844 59442844 PHARMACY REVENUE 456110 1999456 1999456 AMBULANCE SERVICES 621910 1203171 1203171 595785 595785 63241256 891345 891345 63389 0 63389 63389 63389 3352073 44807 3274522 94456 77551 -49649 27902 27902 CAFETERIA REVENUE 624200 248776 248776 248776 67029955 63490032 0 982636 X 1024862 430246 594616 89039 89039 26402369 23516861 2885508 679130 611747 67383 3851205 3361205 490000 1766319 1516302 250017 15274 15274 180001 180001 4836 4836 53733 53733 8260936 7279328 981608 1670004 279 1669725 2554119 2189976 364143 830130 813448 16682 161572 137242 24330 1037762 1006609 31153 3794936 3681016 113920 531574 515617 15957 MEDICAL SUPPLIES 9110689 9110689 FOOD 376230 350296 25934 LICENSES & FEES 138245 103361 34884 MEMBERSHIPS 69527 7496 62031 62602492 54720757 7881735 0 1705 2246 7632955 12832039 8079507 12229983 396216 1717417 1967581 421763 521881 81035317 42771729 39733264 38263588 10193130 10832721 223213 223213 11780342 8141364 79783296 85410832 8041973 8605618 33663654 32829182 0 215930 41705627 41650730 X 31532258 36370105 6545411 7389997 38077669 43760102 79783296 85410832 X 4427463 513518 741452 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 4836 4836 0 PART II-B, LINE 1: PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 438318 54525 492843 388820 49498 438318 440631 -51811 388820 404381 36250 440631 6023323 498337 54525 231663 6528608 0.64610 0.35390 0.00000 0 0 407142 407142 48251152 19687746 28563406 30705460 22115926 8589534 1671563 968057 703506 38263588 DUE - SHENANDOAH AMBULANCE SERVICE 840503 BENEFICIAL INTEREST-PERPETUAL TRST 6217549 PATIENT CUSTOMER CONTRACTS 262834 EST THIRD-PARTY PAYOR SETTLEMENTS 464194 EXECUTIVE REITREMENT PLAN 356284 8141364 FINANCE LEASE LIABILITY 215930 215930 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: 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, 2024 AND 2023, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART V, LINE 1A, COLUMN D: 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 19000 19000 0.00030 9816387 9816387 9835387 9816387 19000 0.00030 591792 591792 0.00950 17317978 10841926 6476052 0.10340 27816 27816 0.00040 17937586 10841926 7095660 0.11330 27772973 20658313 7114660 0.11360 1 4090278 539917 16958824 16980181 -21357 X 1 1 1 1 SHENANDOAH MEDICAL CENTER 300 PERSHING AVE SHENANDOAH IA 51601 WWW.SMCHOSPITAL.COM 730065H X X X X PROVIDER-BASED RURAL HEALTH CLINICS SHENANDOAH MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SMCHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 22 1 SMCHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 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 18, 2022 AT THE SHENANDOAH MEDICAL CENTER HARTMAN ROOM IN SHENANDOAH, IA. VINCE VANDEHAAR, MBA, FACILITATED THIS 1-1/2 HOUR SESSION WITH THIRTY (30) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. TO COMPLETE THE NEEDS ASSESSMENT WHICH WAS FINALIZED IN 2022. SMC PARTNERED WITH PAGE COUNTY PUBLIC HEALTH TO COMPLETE THE ASSESSMENT. ONGOING MEETINGS WITH CHNA STAKEHOLDERS WERE HELD THURSDAY, APRIL 4, 2022 AND MAY 22, 2022 AT SHENANDOAH MEDICAL CENTER IN SHENANDOAH, IA TO COMPOSE AN IMPLEMENTATION PLAN. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 6B: PAGE COUNTY PUBLIC HEALTH SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 11: NEEDS ADDRESSED IN THE MOST RECENT CHNA INCLUDE: MENTAL HEALTH, ECONOMIC DEVELOPMENT, SENIOR HEALTH, SUBSTANCE ABUSE, CANCER CARE, CHRONIC DISEASE MANAGEMENT, AND OBESITY.SHENANDOAH MEDICAL CENTER HAS WORKED TO EXPAND MENTAL HEALTH SERVICES IN PAGE COUNTY BY CONTINUING TO PARTNER WITH OTHER MENTAL HEALTH ORGANIZATIONS IN SHENANDOAH, AS WELL AS THROUGH THE RECRUITMENT OF ADDITIONAL BEHAVIORAL HEALTH ARNPS, LICENSED INDEPENDENT SOCIAL WORKER, AND A LICENSED MENTAL HEALTH COUNSELOR TO INCREASE ACCESS TO CARE. SMC HAS ALSO WORKED TO IMPLEMENT PEDIATRIC TELEHEALTH SERVICES THROUGH A PARTNERSHIP WITH CHILDREN'S HOSPITAL 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 THE EMERGENCY ROOM, 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'S CEO SERVES AS PRESIDENT OF THE SHENANDOAH CHAMBER AND INDUSTRY ASSOCIATION AND VISION SHENANDOAH BOARD OF DIRECTORS TO ADDRESS ECONOMIC DEVELOPMENT NEEDS, WHILE ALSO REPRESENTING SMC AS CHAIR OF THE COMMUNITY'S HOUSING COMMITTEE, ALTHOUGH THESE AREAS MAY NOT BE CONSIDERED MISSION CRITICAL TO SMC. SMC PARTNERS WITH SEVERAL LOCAL SENIOR LIVING PROVIDERS TO PROVIDE THE NECESSARY CARE FOR THE COMMUNITY'S SENIORS. SMC HAS DEVELOPED A ROBUST POPULATION HEALTH TEAM THAT INCLUDES FIVE HEALTH COACHES AND A COMMUNITY HEALTH WORKER WHO MANAGE THE CARE OF ACUTE DIABETIC PATIENTS AND OTHER CHRONIC DISEASES VIA PARTNERSHIP WITH IOWA MEDICAID AND PARTICIPATION IN MULTIPLE ACCOUNTABLE CARE ORGANIZATIONS TO IMPROVE CARE THROUGHOUT THE STATE OF IOWA. SMC ADDRESSED NEED OF CANCER CARE WITH A $13 MILLION DOLLAR INVESTMENT IN A REGIONAL CANCER CENTER THAT WILL PROVIDE BOTH MEDICAL AND RADIATION ONCOLOGY SERVICES. COMPLEX CHEMOTHERAPY AND RADIATION THERAPY ARE DELIVERED THROUGH THE ONBOARDING OF AN EMPLOYED MEDICAL ONCOLOGIST AND AN EMPLOYED RADIATION ONCOLOGIST. WHILE THESE ITEMS ARE SIGNIFICANT INVESTMENTS, SMC UNDERSTANDS THE IMPORTANCE OF PROVIDING CANCER CARE TO THIS REGION, AS CANCER PREVALENCE RATES ARE AMONG THE HIGHEST IN THE STATE OF IOWA IN SOUTHWEST IOWA. 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. AN UNINSURED DISCOUNT OF 35% IS GRANTED TO ALL PATIENTS WITH NO INSURANCE. FURTHER DISCOUNTING IS APPLIED BASED ON THE APPLICANT'S ABILITY TO MEET THE ELIGIBILITY CRITERIA. 1 2 - SHENANDOAH MEDICAL CENTER 2 JACK FOSTER DRIVE SHENANDOAH IA 51601 WELLNESS CENTER PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE ORGANIZATION ALSO USED ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, RESIDENCY AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT, LINE 7I, WERE REPORTED FROM THE GENERAL LEDGER. PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE MEDICAL CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 13.2% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED ON PAGES 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE TOTAL LOSS FROM MEDICARE SERVICES WOULD HAVE INCREASED BY $168,612.MEDICARE FEE SCHEDULE REVENUE $ 537,762MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS (709,374)NET (SHORTAGE) $ (168,612) 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 $57,752 AND $73,750 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2023, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $71,400. 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 7, REPORTS FILED WITH STATES IA X X X 0 0 0 0 0 0 0 1 0 MOHAMED ABDI MD PHYSICIAN 680486 0 32066 0 1122 0 16605 0 0 0 730279 0 0 0 REBECCA ROSE MD FACS PHYSICIAN 463538 0 26975 0 3914 0 17250 0 3168 0 514845 0 0 0 MARTEE MACLEOD-KOZAL MD PHYSICAN & CHIEF OF STAFF 451745 0 35725 0 1122 0 17250 0 3168 0 509010 0 0 0 CLYDE SULLIVAN MD PHYSICIAN 494336 0 7115 0 1180 0 0 0 0 0 502631 0 0 0 CHASE BROWN DO PHYSICIAN 358138 0 121608 0 1073 0 17250 0 3168 0 501237 0 0 0 HEATHER BABE MD DIRECTOR & CHIEF MEDICAL OFFICER 299159 0 108899 0 1770 0 17250 0 3168 0 430246 0 0 0 MATTHEW SELLS PRESIDENT & CEO 323531 0 24000 0 1073 0 16495 0 26411 0 391510 0 0 0 KALEY NEAL CFO 180881 0 10000 0 776 0 9719 0 1730 0 203106 0 0 0 PART I, LINE 7 PROVIDERS ARE PAID PRODUCTION BONUSES BASED ON THEIR PERFORMANCE/VOLUMES. THE FOLLOWING INDIVIDUALS RECEIVED PRODUCTION BONUSES DURING THE YEAR: HEATHER BABE MOHAMED ABDI CLYDE SULLIVAN REBECCA ROSE MARTEE MACLEOD-KOZAL CHASE BROWN HEATHER BABE DIRECTOR & CHIEF MEDICAL OFFICER SPLIT DOLLAR LIFE INSURANCE ARRANGEMENT X 90000 90923 0 1 1 KALEY NEAL CFO SPLIT DOLLAR LIFE INSURANCE ARRANGEMENT X 92500 93140 0 1 1 MATTHEW SELLS PRESIDENT & CEO SPLIT DOLLAR LIFE INSURANCE ARRANGEMENT X 210000 212153 0 1 1 396216 ALICIA SELLS EMPLOYEE OF ORGANIZATION AND WIFE OF MATTHEW SELLS, PRESIDENT & CEO 89039 EMPLOYEE'S COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. 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 15A 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. THE CFO COMPENSATION IS REVIEWED AND EVALUATED BY SMC'S NORMAL COMPENSATION PRACTICES. THESE PRACTICES TAKE INTO ACCOUNT THE LEVEL OF EXPERIENCE AND THE IHA COMPENSATION DATA RELEASED EACH OCTOBER THROUGH USE OF THEIR SALARY SURVEY. 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 172,591. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 172,591. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,401,325. MANAGEMENT AND GENERAL EXPENSES 124,490. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,525,815. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,496,821. MANAGEMENT AND GENERAL EXPENSES 542,328. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,039,149. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,189,091. MANAGEMENT AND GENERAL EXPENSES 314,790. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,503,881. CONSULTING FEES: PROGRAM SERVICE EXPENSES 19,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,500. FORM 990, PART XI, LINE 9: CHANGE IN PERPETUAL TRUST 741,452. 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 83914 GENERAL LEDGER