2016-11-15T08:53:31-06:00 2015-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2015-01-01 421101835 SHENANDOAH MEDICAL CENTER SHEN 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 MATTHEW SELLS CFO 7122461230 2016-11-14 1 WENDY R COOLEY P01523804 4023302660 2015 2017-02-10 21:41:12Z KAREN COLE 300 PERSHING AVENUE SHENANDOAH IA 51601 42141371 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. 10 9 441 50 50 0 145231 209245 35895816 40939000 590492 481617 320432 321617 36951971 41951479 69130 0 0 0 19351591 21586785 0 0 0 15832576 19349247 35253297 40936032 1698674 1015447 36601106 67750733 6608413 37478759 29992693 30271974 TO MAKE A DIFFERENCE BY PROVIDING EXCEPTIONAL PATIENT CARE. 0 0 32892495 40939000 SHENANDOAH MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS AND A 50 BED INTERMEDIATE CARE NURSING FACILITY. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN AN INPATIENT AND OUTPATIENT SETTING. IN ADDITION, THE HOSPITAL PROVIDES RENTAL SPACE FOR A CANCER AND DIALYSIS TREATMENT CENTER. DURING 2015, THE HOSPITAL PROVIDED 1,309 DAYS OF ACUTE CARE, 768 DAYS OF SKILLED NURSING CARE, 203 NURSERY DAYS, AND 103,629 OUTPATIENT OCCASIONS OF SERVICE. THE NURSING FACILITY PROVIDED 15,074 INTERMEDIATE CARE DAYS AND 553 SKILLED NURSING CARE DAYS OF SERVICE. 32892495 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 24 0 1 441 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MATTHEW SELLS CFO 7122461230 300 PERSHING AVENUE SHENANDOAH IA 51601 ED KLOBERDANZ CHAIRMAN 3.00 0.00 X X 0 0 0 ALISSA MCGINNIS VICE CHAIRMAN 3.00 0.00 X X 0 0 0 GREG RITCHEY SECRETARY/TREASURER 3.00 0.00 X X 0 0 0 TIM AUGUSTINE DIRECTOR 3.00 0.00 X 0 0 0 MARY JO CARRELL DIRECTOR 3.00 0.00 X 0 0 0 DEB ISTAS DIRECTOR 3.00 0.00 X 0 0 0 FLOYD JONES DO DIRECTOR 3.00 0.00 X 0 0 0 ROGER JONES DIRECTOR 3.00 0.00 X 0 0 0 DAVE LASHIER DIRECTOR 3.00 1.00 X 0 0 0 LINDA LAUGHLIN DIRECTOR 3.00 0.00 X 0 0 0 KAREN COLE CEO 40.00 1.00 X 309740 0 29811 MATTHEW SELLS CFO 40.00 0.00 X 132308 0 27877 REBECCA ROSE PHYSICIAN 40.00 0.00 X 494563 0 21657 SCOTT R KING PHYSICIAN 40.00 0.00 X 433860 0 28188 SANTOSH KUMAR PHYSICIAN 40.00 0.00 X 366203 0 36785 MICHAEL WOODS PHYSICIAN 40.00 0.00 X 322030 0 38511 SATYA THIPPAREDDI PHYSICIAN 40.00 0.00 X 195539 0 14471 2254243 0 197300 23 0 1 0 ALTUS ARCHITECTURAL STUDIOS 12925 WEST DODGE RD OMAHA NE 68154 CONSULTING 723566 GRAHAM CONSTRUCTION 421 GRAND AVENUE DES MOINES IA 51601 CONSTRUCTION ON NEW ADDITION 474864 UNMC PHYSICIANS LAB REF PO BOX 30014-1114 OMAHA NE 68103 LAB REFERENCE FEES 452352 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 10087 COVERAGE FOR OB, MED SURG,LAB AND SURGER 370900 DENNIS CUMMINGS DEPARTMENT 300 KANSAS CITY MO 64121 ANESTHESIOLOGIST 139209 7 78797 12318 118130 209245 MEDICARE/MEDICAID PAYM 624100 18780574 18780574 NET PATIENT SERVICE RE 624100 17757284 17757284 340B REVENUE 624100 2035882 2035882 MEANINGFUL USE INCENTI 624100 1650919 1650919 AMBULANCE SERVICES 621910 559062 559062 155279 155279 40939000 423566 423566 152387 0 152387 152387 152387 235803 12140 189892 0 45911 12140 58051 58051 CAFETERIA REVENUE 624200 169180 169180 CATERING 722320 50 50 169230 41951479 40939000 50 803184 X 499736 499736 92871 92871 17625714 14190843 3434871 390821 321173 69648 1799560 1446791 352769 1178083 990189 187894 58228 58228 85186 85186 5173212 3229052 1944160 185625 27055 158570 1257114 864349 392765 399999 364741 35258 171192 121965 49227 108308 108308 2575224 2348234 226990 198607 181101 17506 MEDICAL SUPPLIES 4998244 4998244 BAD DEBT EXPENSE 3248531 3248531 FOOD 300240 300240 EMPLOYEE RECRUITMENT 277474 50513 226961 312063 116603 195460 40936032 32892495 8043537 0 2028593 1382 1875107 23831263 7016049 10206784 801328 1040538 215346 262578 38225705 22555728 11173093 15669977 7852376 7364792 339146 378181 5300068 8995238 36601106 67750733 3449688 6067824 331071 1910399 25350000 2305914 4150536 521740 0 6608413 37478759 X 23779747 24578643 1118564 1023321 5094382 4670010 29992693 30271974 36601106 67750733 X 1015447 -580642 -155524 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 6068 6068 0 PART II-B, LINE 1: PORTION OF DUES PAID TO THE AMERICAN ACADEMY OF FAMILY PHYSICIANS, THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCATION ARE ALLOCABLE TO LOBBYING ACTIVITIES. 9342606 5632 -1413381 184503 7750354 9273345 36330 147606 114675 9342606 9734922 30006 498003 989586 9273345 7578451 2877629 565340 1286498 9734922 8688964 58208 1168721 7578451 0.86130 0.00670 0.13200 0 0 92822 92822 12435940 9310084 3125856 20725309 12430374 8294935 4971634 815270 4156364 15669977 INVESTMENT IN HOSPITAL LLC 1742 DUE FROM SHENANDOAH AMBULANCE SERVICE 53019 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 4618010 DUE FROM SHENANDOAH MEDICAL CENTER FOUNDATION 73309 OTHER RECEIVABLES 3840288 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 408870 8995238 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: SHENANDOAH MEDICAL CENTER(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, 2015 AND 2014, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 1 X 1 X 1 1 0 1 1 419690 419690 0.01110 5466857 4440702 1026155 0.02720 5886547 4440702 1445845 0.03830 13332 13332 0.00040 442683 126812 315871 0.00840 9858818 7572025 2286793 0.06070 23294 23294 0.00060 10338127 7698837 2639290 0.07010 16224674 12139539 4085135 0.10840 58883 58883 0.00160 748 748 0.00000 59631 59631 0.00160 1 3248531 0 10959184 11522417 -563233 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 X 13 1 0 0 1 X WWW.SMCHOSPITAL.COM X 1 14 0 1 0 1 X 200.000000000000 200.000000000000 X X X X X X 1 1 X X X 1 X WWW.SMCHOSPITAL.COM X X X X 1 X 0 X X X X 1 X X 0 0 SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 3J: THE NEEDS ASSESSMENT INDICATED THAT AREAS FOR IMPROVEMENT WERE AS FOLLOWS: CHILD AND INFANT IMMUNIZATION, TRANSPORTATION, INTERNET/TELECOMMUNICATIONS INFRASTRUCTURE, UNINSURED/UNDERINSURED, TELEMEDICINE, EYE CARE FOR VETERANS, CARDIOVASCULAR ACCESS, MEDICAL TECHNOLOGY, CATASTROPHIC PLANNING, MEDICARE FRAUD, MAMMOGRAPHY, PRIMARY CARE ACCESS IN FREMONT COUNTY, DRUG ASSISTANCE, ECONOMIC DEVELOPMENT, SENIOR CARE, SUICIDE PREVENTION IN SCHOOL, PHYSICIAN RETENTION, NURSES, PARAMEDICS, DOMESTIC AND SEXUAL ABUSE, EDUCATION OF EXISTING SERVICES, LAYOUT OF SMC, PSYCHIATRIST, PEDIATRICIAN, COLLABORATION BETWEEN SMC AND CLARINDA REGIONAL MEDICAL CENTER, EDUCATION OF EXISTING FACILITIES, OBESITY, TEEN PREGNANCY, SIDEWALKS AROUND SCHOOLS, SAFE WALKING AND BIKING PATH, AND HEALTHY FOOD. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 5: PAGE COUNTY'S TOWN HALL WAS HELD OVER DINNER ON THURSDAY SEPT 6, 2012 AT THE SHENANDOAH CHAMBER AND INDUSTRY, 100 S MAPLE STREET, SHENANDOAH, IA. EXTERNAL CONSULTANTS FACILITATED THIS HOUR AND A HALF SESSION WITH FORTY THREE (43) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. FOR THIS NEEDS ASSESSMENT. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 11: SHENANDOAH MEDICAL CENTER ASSISTED IN EDUCATING ITS COMMUNITY ON HEALTH REFORM LAW INSURANCE OPTIONS BY UTILIZING ITS PATIENT FINANCIAL COUNSELOR AND MEMBERS OF ITS SOCIAL SERVICES DEPARTMENT TO PROVIDE INSURANCE INFORMATION TO PATIENTS AND ASSIST THEM IN ENROLLMENT IN MEDICAID AND MEDICARE IN ORDER TO THE LOWER UNINSURED AND UNDERINSURED POPULATION. ADDITIONALLY, THE FACILITY INVESTED IN A CONNECTION WITH THE IHIN, WHICH ALLOWS PATIENTS TO ACCESS THEIR MEDICAL INFORMATION TO NUMEROUS FACILITIES IN IOWA. FURTHERMORE, AN INVESTMENT IN A PATIENT PORTAL THAT IS COMPATIBLE WITH SMC'S ELECTRONIC MEDICAL RECORD SYSTEM ALSO OCCURRED IN ORDER TO FURTHER ALONG THE BUILDING OF THE HEALTH INTERNET INFRASTRUCTURE. ANOTHER ITEM OF IMPORTANCE IDENTIFIED WITHIN THE ASSESSMENT WAS THE NEED TO IMPROVE CHILDREN'S ACCESS TO IMMUNIZATIONS. SMC NOW PARTICIPATES IN THE PROGRAM TO PROVIDE FREE AND REDUCED PRICE VACCINATIONS FOR CHILDREN AND INFANTS. IN ORDER TO RETAIN AND RECRUIT PROVIDERS, SMC HAS INVESTED NUMEROUS DOLLARS TO ADD AN ORTHOPEDIC SURGEON AND FOUR ADVANCED REGISTERED NURSE PRACTITIONERS DURING 2015. IN ORDER TO SUPPORT VETERAN CARE DELIVERY, THE FACILITY CONTINUES TO BE A PREFERRED PROVIDER TO CONDUCT VETERAN'S DISABILITY EXAMS AND ALSO EXPANDED ITS HOME HEALTH AND HOSPICE COVERAGE TO VETERANS THROUGH THE WE HONOR VETERANS PROGRAM. ADDITIONAL EDUCATION IN WORKING WITH MENTAL HEALTH PATIENTS HAS BEEN PROVIDED TO STAFF MEMBERS IN THE EMERGENCY ROOM AND PRIMARY CARE CLINICS IN ORDER TO HELP EXPAND THE MENTAL HEALTH DELIVERY IN PAGE AND FREMONT COUNTIES. IN ORDER TO FIGHT DRUG ABUSE, NUMEROUS EDUCATIONAL SESSIONS WERE HELD WITH PROVIDERS IN THE APPROPRIATE MAINTENANCE OF PATIENTS WITH OPIATES PRESCRIPTIONS. THE HOSPITAL ALSO FACILITATED EXPANDED TESTING OF SEXUALLY TRANSMITTED DISEASES FOR TEENAGERS IN THE AREA.NEEDS THAT DID NOT GET DIRECTLY ADDRESSED INCLUDE SUPPORTING COMMUNITY ECONOMIC DEVELOPMENT OUTSIDE OF THE NUMBER OF JOBS ADDED AT SHENANDOAH MEDICAL CENTER IN 2015. ADDITIONALLY, SMC DID NOT WORK ON BUILDING A SAFE WALKING/BIKING PATH IN THE COMMUNITY OR REDUCING TEEN PREGNANCY IN OUR SERVICE AREA. OTHER ITEMS THAT DID NOT GET ADDRESSED BY SMC THIS YEAR WAS THE BUILDING OF A SCHOOL SUICIDE PREVENTION PROGRAM AND FIGHTING DOMESTIC AND SEXUAL ABUSE. ALL ITEMS NOT ADDRESSED WERE 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 REVENUE CYCLE DIRECTOR. 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 POVERTY LEVELS AFTER APPLYING ALL OTHER RESOURCES. CHARITY CARE IS BASED ON 200% OF POVERTY LEVEL. AN UNINSURED DISCOUNT OF 30% 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. SHENANDOAH MEDICAL CENTER PART V, SECTION B, LINE 22D: THE INDIVIDUALS WHO DID NOT HAVE INSURANCE ARE GIVEN A 30% UNINSURED DISCOUNT. ANY INDIVIDUAL COMPLETING THE FINANCIAL ASSISTANCE APPLICATION ALSO RECEIVED AN AUTOMATIC ADDITIONAL 20% DISCOUNT TO ENSURE THAT THE HOSPITAL WAS CHARGING NO MORE THAN THE AVERAGE OF ITS THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. 5 1 - ELM HEIGHTS CARE CENTER 1204 SOUTH ELM STREET SHENANDOAH IA 51601 SKILLED NURSING 2 - SHENANDOAH MEDICAL CENTER 300 PARK AVENUE SHENANDOAH IA 51601 MEDICAL CLINIC 3 - SHENANDOAH PHYSICIANS CLINIC - SIDNEY 802 ILLINOIS STREET FREMONT IA 52561 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 PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED ORGANIZATION. 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 $3,248,531. PART II, COMMUNITY BUILDING ACTIVITIES: SHENANDOAH MEDICAL CENTER PROVIDES JOB SHADOWING TO STUDENTS OF SHENANDOAH, PHLEBOTOMY STUDENT ROTATIONS, CLARKSON/METHODIST STUDENTS JOB SHADOWING, CNA CLASSES FOR SHENANDOAH HIGH SCHOOL STUDENTS, MENTORING OF STUDENTS BY SMC STAFF, AND IS INVOLVED IN THE FREMONT/PAGE COUNTY PREVENT CHILD ABUSE GROUP AND BREAST CANCER AWARENESS. 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. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: THE MEDICAL CENTER PROVIDES CHARITY CARE 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 CHARITY CARE. ACCORDINGLY, THE MEDICAL CENTER DOES NOT REPORT THESE AMOUNTS IN NET PATIENT SERVICE REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE," "NET PATIENT SERVICE REVENUE, AND "CHARITY CARE" CAN BE FOUND ON PAGES 8, 10 AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE 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 ACCOUNT 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 $44,786 AND $52,221 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2014, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $53,712. 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 ATTEMPTING TO ROLL-OUT IN ITS 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 0 0 0 0 0 0 0 0 0 KAREN COLE CEO 219132 0 82355 0 8253 0 13250 0 16561 0 339551 0 0 0 MATTHEW SELLS CFO 117189 0 15000 0 119 0 4319 0 23558 0 160185 0 0 0 REBECCA ROSE PHYSICIAN 462418 0 30060 0 2085 0 7207 0 14450 0 516220 0 0 0 SCOTT R KING PHYSICIAN 375832 0 55561 0 2467 0 13250 0 14938 0 462048 0 0 0 SANTOSH KUMAR PHYSICIAN 303799 0 62100 0 304 0 13250 0 23535 0 402988 0 0 0 MICHAEL WOODS PHYSICIAN 320212 0 0 0 1818 0 9465 0 29046 0 360541 0 0 0 SATYA THIPPAREDDI PHYSICIAN 182851 0 12000 0 688 0 11054 0 3417 0 210010 0 0 0 A IOWA FINANCE AUTHORITY 521699886 46246NHT6 2015-12-08 25350000 CONSTRUCT AND REMODEL HOSPITAL AND CLINIC 0 0 0 A 25350000 1096354 294375 2728090 22621910 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 ALICIA SELLS EMPLOYEE OF ORGANIZATION AND WIFE OF MATTHEW SELLS, CFO 66356 EMPLOYEE'S COMPENSATION 0 CODY AUGUSTINE EMPLOYEE OF ORGANIZATION AND SON OF TIM AUGUSTINE, BOARD MEMBER 26515 EMPLOYEE'S COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE TWO CLASSES OF MEMBERS, DESIGNATED CLASS A MEMBERS AND CLASS B MEMBERS. THE CLASS A MEMBERS SHALL BE ALL OF THOSE INDIVIDUALS THEN SERVING AS DULY ELECTED MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION, EXCEPT FOR THAT PERSON NOMINATED TO THE BOARD OF DIRECTORS BY THE CLASS B MEMBER. THE CLASS B MEMBER SHALL BE SHENANDOAH/NHS REGIONAL VENTURES, LLC, AN IOWA LIMITED LIABILITY COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE CLASS B MEMBER SHALL HAVE THE RIGHT TO NOMINATE ONE PERSON TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 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 370,507. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 370,507. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,195,658. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,195,658. CONSULTING FEES: PROGRAM SERVICE EXPENSES 56,460. MANAGEMENT AND GENERAL EXPENSES 160,352. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,812. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,606,427. MANAGEMENT AND GENERAL EXPENSES 1,783,808. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,390,235. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST -194,559. GAIN ON EQUITY IN SHENANDOAH AMBULANCE SERVICE 39,035. 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 11A, I SHENANDOAH MEDICAL CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 SHENANDOAH MEDICAL CENTER FOUNDATION C 78797 FAIR MARKET VALUE