2016-04-06T13:04:16-05:00 2015-08-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2014-09-01 370512290 Shelby Memorial Hospital Association Inc % MARILYN SEARS SHEL 2177743961 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 MARILYN SEARS President/CEO 2177743961 2016-04-06 true Donna J Larson P00043751 3142315544 2014 2016-08-17 19:52:53Z MARILYN SEARS 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 21023547 false X WWW.MYSMH.ORG X 1916 IL SEE SCHEDULE O. 12 12 210 12 249324 -32770 83211 40678 14732467 13569374 3629351 2406881 299520 323714 18744549 16340647 0 0 0 0 8453813 8672443 0 0 0 9594932 9258041 18048745 17930484 695804 -1589837 34787432 29975636 9519035 9041511 25268397 20934125 X THE ASSOCIATION'S PURPOSE IS TO ESTABLISH AND MAINTAIN A FACILITY FOR THE CARE OF PERSONS SUFFERING FROM ILLNESS OR DISABILITIES, REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED; AND TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON SO AS TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. false false 14573470 13569374 OPERATION OF A 30 BED HOSPITAL FACILITY PROVIDING ALL ROUTINE AND ANCILLARY SERVICES. SERVICES INCLUDED 26,543 OUTPATIENT REGISTRATIONS, 7,080 RURAL HEALTH CLINIC VISITS, 1,954 INPATIENT DAYS AND 5,086 EMERGENCY ROOM VISITS. 14573470 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 20 0 true 210 true true true false false false false false false false false false X 12 12 true false false false false false false true true false false false true true true true true true false false IL X MARILYN SEARS 2177743961 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 X BRIAN GREEN BOARD MEMBER 1.0 0.0 X 0 0 0 BRUCE STEINKE BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID CRUITT BOARD MEMBER 1.0 0.0 X 0 0 0 DENISE BENCE BOARD MEMBER 1.0 0.0 X 0 0 0 DR DAVID OLIGSCHLAEGER BOARD MEMBER 1.0 0.0 X 0 0 0 ERIN CHAMBERS SECRETARY 1.0 0.0 X X 0 0 0 JOHN BRIX BOARD MEMBER 1.0 0.0 X 0 0 0 JOSH SHALLENBERGER BOARD MEMBER 1.0 0.0 X 0 0 0 MATTHEW BEYERS BOARD MEMBER 1.0 0.0 X 0 0 0 MIKE KILEY PRESIDENT 1.0 0.0 X X 0 0 0 RANDY BIEHLER VICE-CHAIR 1.0 0.0 X X 0 0 0 SUSAN LEACH BOARD MEMBER 1.0 0.0 X 0 0 0 MARILYN SEARS CEO 40.0 1.0 X 163886 0 12788 PHILLIP MILLER CFO 40.0 1.0 X 121387 0 14574 DR ARNOLD AGAPITO PHYSICIAN 40.0 0.0 X 237061 0 9652 DR JAGAN BOKKA PHYSICIAN 40.0 0.0 X 131516 0 1799 REGINA CALVERT CNE 40.0 0.0 X 104793 0 10798 DR TRUMAN MARK VASKO PHYSICIAN 40.0 0.0 X 299497 0 16663 1058140 0 66274 6 false true false CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT 850710 EMERGENCY STAFFING SOLUTIONS 17304 PRESTON ROAD DALLAS TX 75252 ER PHYSICIANS 784920 EVIDENT PO BOX 850309 MOBILE AL 36685 COMPUTER SYSTEMS 312107 SPECIAL CARE HOSPITAL 175 W JACKSON BLVD STE 1750 CHICAGO IL 60604 SUBST ABUSE SERVICES 177415 BKD LLP ONE METRO SQUARE ST LOUIS MO 63102 AUDITING 207452 14 31747 8931 40678 CHARGE FOR MEDICAL SRVC, ROOM, CARE & OT 621110 13281775 13281775 SHE ANCILLARY 446199 249324 249324 MISCELLANEOUS INCOME 900099 38275 38275 EHR INCENTIVE PAYMENT 900099 13569374 614604 614604 0 0 251049 20031 231018 0 231018 231018 6451037 4109 4662869 1788168 4109 1792277 1792277 0 0 0 CATERING INCOME 722320 9945 9945 CAFETERIA SALES 721000 64843 64843 WELLNESS PROGRAM 621990 17908 17908 92696 16340647 13320050 249324 2730595 X 0 0 0 0 297747 297747 0 6653681 5889281 764400 0 192054 172556 19498 1037585 896067 141518 491376 417910 73466 0 43732 43732 136686 136686 0 0 0 2305131 2303381 1750 59198 59198 2060063 1544159 515904 0 0 310343 310343 51224 36160 15064 0 0 363118 363118 0 1364479 1228031 136448 288986 288986 BAD DEBT EXPENSE 1096049 1096049 IPA ASSESSMENT FEE 385701 385701 DUES & FEES 426643 90933 335710 COLLECTION & ADMINISTRATION 176634 176634 190054 143701 46353 17930484 14573470 3357014 0 290604 65262 0 0 0 0 3020040 2414335 0 0 0 0 100968 210000 195342 185386 238951 241492 32214022 22762283 10609402 9451739 18889416 15977420 4356 4356 39921 29757 0 0 1398432 1395889 34787432 29975636 928033 1031511 0 0 0 0 8100000 7800000 0 0 0 0 0 0 0 0 491002 210000 9519035 9041511 X 25168397 20834125 60000 60000 40000 40000 25268397 20934125 34787432 29975636 -1589837 -2744435 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 34164 false false false 34164 false SCHEDULE C, PART II-B, LINE 1F GRANTS TO OTHER ORGANIZATIONS: THE AMOUNT REPRESENTS THE PORTION OF DUES PAID TO PROFESSIONAL HOSPITAL ASSOCIATIONS THAT WAS ALLOCATED TO LOBBYING ACTIVITIES. 1494769 36899 58187 89733 1500122 534529 960240 1494769 401490 133039 534529 399597 1893 401490 1358320 56 958779 399597 0.88420 0.04000 0.07580 false true true 473600 473600 15214332 9674146 5540186 280987 126542 154445 4833910 3792278 1041632 11411193 9169317 2241876 9451739 0 PROFESSIONAL LIABILITY RESERVE 210000 210000 SCHEDULE D, PART V, LINE 4 USE OF ENDOWMENT FUNDS: THE FUNDS ARE TO BE USED FOR BOND RESERVE FUND, OPERATIONS, AND MAINTENANCE OF ASSOCIATION. SCHEDULE D, PART X, LINE 2 FIN 48 DISCLOSURE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true true X true X true true false false 154638 154638 0.00900 2780426 1365333 1415093 0.07900 2935064 1365333 1569731 0.08800 28812 28812 0.00200 28812 28812 0.00200 2963876 1365333 1598543 0.09000 true 1096049 111704 4155961 6780618 -2624657 X false 1 1 SHELBY MEMORIAL HOSPITAL ASSOCIATION 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 WWW.MYSMH.ORG 0002154 X X X SHELBY MEMORIAL HOSPITAL ASSOCIATION false false true X X X X X X X X X 12 true false false true X SEE PART V, SECTION C X true 12 false true false true X 200. 400. X X X true true X X X X true X SEE PART V, SECTION C X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK. POSSIBLE AVENUES FOR GATHERING PRIMARY DATA WERE REVIEWED AND IT WAS DET ERMINED TO PROCEED WITH THREE FOCUS GROUPS COMPRISED OF AREA HEALTH CARE PROFESSIONALS/PARTNERS, COMMUNITY OFFICIALS AND COMMUNITY LEADERS AND GROUPS. THIS ASSESSMENT EXPLORED THE NEEDS OF THOSE WHO MAY BE IM PACTED BY ISOLATED LOCAL ACCESS ISSUES BY SEEKING INPUT FROM PERSONS EXPECTED TO HAVE KNOWLEDGE OF POTENTIAL SPECIFIC ISSUES FACING AREA COMMUNITIES. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS INCLUDING SCHOOL OFFICIALS DEALING DAILY WITH YOUTH AND FAMILIES SCHEDULE H, PART V, SECTION B, LINE 7A DIRECT WEBSITE URL: HTTP://MYSMH.ORG/WP-CONTENT/UPLOADS/2016/02/SHELBY-MEMORIAL-HOSPITAL-2 012.PDF SCHEDULE H, PART V, SECTION B, LINE 11 SIGNIFICANT NEEDS IDENTIFIED IN CHNA: SMH IS CONSIDERING THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH OUR STRATEGIC PLANNING PROCESS BY DECIDING HOW BEST TO MEET THE NEEDS IDENTIFIED. THE ASSISTANCE OF AN OUTSIDE CONSULTANT HAS BEEN USED IN DEVELOPING OUR STRATEGIC PLAN, ENSURING PROPER ATTENTION IS GIVEN TO THE CHNA. SCHEDULE H, PART V, LINE 16A URL TO FAP: HTTP://MYSMH.ORG/WP-CONTENT/UPLOADS/2015/11/FINANCIAL-ASSISTANCE-POLICY.PD F CHNA IMPLEMENTATION STRATEGY 1. MENTAL HEALTH SERVICES, INCLUDING SUBSTANCE ABUSE PREVENTION AND TREATMENT SECURE OUTSIDE COMPANY RESOURCE ASSISTANCE IN HELPING TO DETERMINE NEEDS AND POTENTIAL SOLUTIONS FROM AN OBJECTIVE SOURCE. INVOLVE COMMUNITY STAKEHOLDERS IN PROCESS TO DETERMINE PRACTICAL ABILITY TO ASSIST WITH LOCAL MENTAL HEALTH SERVICES AS WELL AS ABUSE PREVENTION AND TREATMENT. TIMELINE TO DATE: NOVEMBER, 2012 - CONTACTED SIGNET HEALTH CORPORATION AND HORIZON HEALTH, BOTH COMPANIES PRESENTED, THE ONLY SOLUTIONS THEY COULD DETERMINE THAT WOULD BE FINANCIALLY FEASIBLE WOULD BE IP GERIATRIC PSYCHE. JANUARY - MARCH, 2013 - PHYSICAL ASSESSMENT OF CURRENT FACILITIES THAT COULD BE USED FOR A IP GERIATRIC PSYCHE UNIT CONDUCTED. MURRAY AND COMPANY DEVELOPED RENOVATION COST ESTIMATES ALONG WITH PRELIMINARY PLAN. COST EXCEEDED 10 YEAR ROI FOR PAYOFF WITH ESTIMATED 100% OCCUPANCY OF UNIT. APRIL, 2013 - PLANS TO PURSUE IP GERIATRIC PSYCHE UNIT DISCARDED. OCTOBER, 2013 - CONTACTED PSYCHIATRIC RESOURCE PARTNERS TO EXPLORE OTHER ELEMENTS OF POTENTIAL MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION AND TREATMENT. FEBRUARY, 2014 - SET UP MEETING WITH PRP, SMH AND COMMUNITY STAKEHOLDERS TO DISCUSS POTENTIAL SOLUTIONS TO OP MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. 2. EDUCATION SHELBY MEMORIAL HOSPITAL IS CONTINUING TO PROVIDE EDUCATIONAL OPPORTUNITIES, E.G. GIRLS NIGHT OUT AIMED AT WOMEN'S HEALTH, FOR THE COMMUNITY. ADDITIONAL PROGRAMS ARE UNDER CONSIDERATION CONTINUALLY. 3. PLANNING FOR CONTINUED LOCAL AVAILABILITY OF PHYSICIANS AND MEDICAL SPECIALISTS SHELBY MEMORIAL HOSPITAL IS CONTINUALLY RECRUITING PHYSICIANS AND MID-LEVEL PROVIDERS TO THE COMMUNITY. FROM THE TIME OF THE CHNA UNTIL FEBRUARY, 2014 TWO ADDITIONAL MID-LEVEL PROVIDERS HAVE BEEN ADDED TO THE COMMUNITY HEALTHCARE FORCE AND AN ADDITIONAL CARDIOLOGIST AND ORTHOPEDIC SURGEON HAVE BEEN ADDED TO THE SPECIALTY CLINIC, WHERE OUT OF TOWN PHYSICIANS COME TO SEE PATIENTS IN THE SMH FACILITY. 4. ACCESS TO BASIC SERVICES FOR ALL RESIDENTS SHELBY MEMORIAL HOSPITAL CONTINUES TO OFFER SERVICES TO AREA RESIDENTS REGARDLESS OF ABILITY TO PAY. WE CONTINUALLY ADVERTISE THIS AVAILABILITY THROUGH OUR WEB PAGE, COMMUNITY ADVERTISING AND GENERAL COMMUNITY INVOLVEMENT OPPORTUNITIES. SPECIFIC IDEAS IDENTIFIED IN THIS PRIORITY SUCH AS EXPANDED SURGICAL OPPORTUNITIES, EXPANDED DIAGNOSTIC EQUIPMENT AND DELIVERY OF BABIES WERE DEEMED FINANCIALLY UNFEASIBLE. 3 SHELBY HOME EQUIPMENT 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 DURABLE MEDICAL EQUIPMENT SHELBY MEMORIAL HOME HEALTH 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 HOME HEALTH AGENCY SMH FAMILY HEALTH CLINIC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7 CHARITY CARE & COMMUNITY BENEFITS AT COST: THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY AS USED FOR ALL PATIENT SEGMENTS. SCHEDULE H, PART I, LINE 7, COLUMN F CHARITY CARE & COMMUNITY BENEFITS AT COST PERCENT OF TOTAL EXPENSE: THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,096,049 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSE OF CALCULATING THE PERCENTAGE IN THIS COLUMN. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT METHODOLOGY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION 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 UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THIS PORTION OF BAD DEBT SHOULD BE INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT DUE TO THE FACT THAT IF SUFFICIENT INFORMATION HAD BEEN PROVIDED TO DETERMINE ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY, THE AMOUNT WOULD HAVE BEEN CLASSIFIED AS FINANCIAL ASSISTANCE REPORTABLE IN PART I, LINE 7A. SCHEDULE H, PART III, SECTION A, LINE 3 METHODOLOGY TO ESTIMATE COMMUNITY BENEFIT PORTION OF BAD DEBT: THE U.S. CENSUS BUREAU'S PERCENTAGE FOR PERSONS BELOW THE FEDERAL POVERTY LEVEL WAS USED TO MAKE ESTIMATES FOR SHELBY COUNTY. SCHEDULE H, PART III, SECTION B, LINE 4 BAD DEBT EXPENSE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION 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 UNCOLLECTIBLE ACCOUNTS. 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 ASSOCIATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE (UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY BALANCES (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 ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 SHORTFALL AND MEDICARE COSTS: THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT. THE MEDICARE COST REPORT IS FILED FOLLOWING THE COST REPORT GUIDELINES. MEDICARE PAYMENT SHORTFALLS SHOULD BE REFLECTED AS COMMUNITY BENEFIT AS THE FEDERAL GOVERNMENT PROSPECTIVELY SETS THE HOSPITAL PAYMENT RATES; THE RATES ARE NOT NEGOTIABLE AND CONSEQUENTLY, NO LONGER COVER THE HOSPITAL'S COST TO PROVIDE SERVICES TO MEDICARE BENEFICIARIES. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: SHELBY MEMORIAL HOSPITAL HAS CONDUCTED JOINT COMMUNITY HEALTH ASSESSMENTS THROUGH A LOCAL COMMUNITY HEALTH COMMITTEE. THE COMMITTEE CONSISTS OF EXECUTIVES OF SHELBY MEMORIAL HOSPITAL, PHYSICIAN REPRESENTATION FROM THE SHELBY COUNTY BOARD OF HEALTH, A REPRESENTATIVE FROM THE SHELBY COUNTY COMMUNITY SERVICES, A REPRESENTATIVE OF THE LOCAL COMMUNITY, AND LOCAL HEALTH DEPARTMENT OFFICIALS. DATA FROM DIFFERENT GROUPINGS WAS COLLECTED AND ANALYZED TO HELP ESTABLISH PRIORITIES. GROUPINGS INCLUDED DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, GENERAL HEALTH AND ACCESS TO CARE, MATERNAL AND CHILD HEALTH CARE, CHRONIC DISEASE, INFECTIOUS DISEASE, AND ENVIRONMENTAL/OCCUPATIONAL HEALTH AND INJURY CONTROL. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: MULTIPLE AVENUES OF EDUCATION ARE UTILIZED TO INSURE ELIGIBLE INDIVIDUALS ARE AWARE OF AVAILABILITY OF ASSISTANCE THROUGH GOVERNMENTAL AND HOSPITAL BASED PROGRAMS. PATIENTS ARE PROVIDED WITH A PACKET OF INFORMATION THAT DETAILS THE AVAILABILITY OF UNINSURED DISCOUNTS AND CHARITY CARE PROGRAMS. ALL STATEMENTS WITH PATIENT DUE BALANCES HAVE WORDING INCLUDED TO SHOW THE AVAILABILITY OF SUCH ASSISTANCE. PRINTED MATERIALS CLEARLY IDENTIFY THE AVAILABILITY OF PROGRAMS. THE HOSPITAL WEB SITE ALSO HAS PROMINENT LANGUAGE ON ALL PAGES CONCERNING AVAILABILITY OF ASSISTANCE. TO SHOW THE AVAILABILITY OF SUCH ASSISTANCE. PRINTED MATERIALS CLEARLY IDENTIFY THE AVAILABILITY OF PROGRAMS. THE HOSPITAL WEB SITE ALSO HAS PROMINENT LANGUAGE ON ALL PAGES CONCERNING AVAILABILITY OF ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SHELBY MEMORIAL HOSPITAL PRIMARILY SERVES THE RESIDENTS OF SHELBY COUNTY, ILLINOIS. TOTAL POPULATION IS 21,874 ACCORDING TO THE 2008 CENSUS AVAILABLE ON FACTFINDER.CENSUS.GOV. 22% OF RESIDENTS ARE UNDER THE AGE OF 18; 18.6% ARE 65 AND OLDER. 10.4% OF ALL PEOPLE ARE IDENTIFIED AS BEING AT OR BELOW THE POVERTY LEVEL. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: SINCE 1918, SHELBY MEMORIAL HOSPITAL HAS PROVIDED FOR THE HEALTH CARE NEEDS OF SHELBY COUNTY AND OTHER SURROUNDING COMMUNITIES. SMH IS LOCATED IN CENTRAL ILLINOIS, IT IS THE ONLY HOSPITAL IN SHELBY COUNTY. SMH IS COMMITTED TO THE HEALTH AND WELFARE OF THE PEOPLE IT SERVES. OVER THE LAST 90+ YEARS, SMH HAS PROVIDED EMERGENCY AND NONEMERGENT CARE REGARDLESS OF A PERSON'S ABILITY TO PAY. SMH WORKS CLOSELY WITH OTHER AGENCIES IN THE AREA TO PROVIDE FOR THOSE NEEDS BEYOND THE SCOPE OF THE HOSPITAL, SUCH AS TRANSPORTATION, PRESCRIPTION ASSISTANCE, SOCIAL WELFARE AND DAILY LIVING NEEDS. SMH PROVIDES THE RESOURCES TO RECRUIT HEALTHCARE WORKERS, PHYSICIAN ASSISTANTS, AND PHYSICIANS TO THE AREA. SMH HAS ESTABLISHED A RURAL HEALTH CARE CENTER TO HELP COMBAT THE PHYSICIAN SHORTAGE IN RURAL AMERICA AND PROVIDE FOR THOSE UNABLE TO PAY FOR SUCH CARE. MEMBERS OF THE SMH TEAM ARE ACTIVE MEMBERS IN THE ECONOMIC DEVELOPMENT COMMITTEE OF SHELBY COUNTY, THE CHAMBER OF COMMERCE AND OTHER CIVIC AND NOT FOR PROFIT ORGANIZATIONS DEDICATED TO THE BETTERMENT OF LIVING STANDARDS FOR THE RESIDENTS OF THE AREA. THE BOARD OF DIRECTORS AND MANAGEMENT OF SMH ARE COMMITTED TO PROVIDING THE BEST IN CARE AND EQUIPMENT TO THE COMMUNITY AS IS DEMONSTRATED IN OUR MOST RECENT PURCHASE OF DIGITAL MAMMOGRAPHY EQUIPMENT, LAPAROSCOPIC SURGERY EQUIPMENT AND NEW CARDIAC MONITORING SYSTEMS IN THE PAST FEW YEARS. ADDITIONALLY, SMH HAS SPENT MONIES AND TIME IN MEETING MEANINGFUL USE FOR THE COMPUTERIZED MEDICAL RECORD. NEW CARDIAC MONITORING SYSTEMS IN THE PAST FEW YEARS. ADDITIONALLY, SMH HAS SPENT MONIES AND TIME IN MEETING MEANINGFUL USE FOR THE COMPUTERIZED MEDICAL RECORD. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: NOT APPLICABLE SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NOT APPLICABLE SCHEDULE H, PART I, LINE 3C SEE PART V, LINE 13 FOR ADDITIONAL CRITERIA USED TO DETERMINE ELIGIBILITY. X X X X false false false false false false false false false MARILYN SEARS CEO 163886 0 0 0 0 0 6555 0 6233 0 176674 0 0 0 DR ARNOLD AGAPITO PHYSICIAN 237061 0 0 0 0 0 7140 0 2512 0 246713 0 0 0 DR TRUMAN MARK VASKO PHYSICIAN 299497 0 0 0 0 0 9977 0 6686 0 316160 0 0 0 A CITY OF SHELBYVILLE 421741646 2010-12-30 9000000 CONSTRUCTION/RETIRMENT OF BONDS false false false A 1200000 0 9000000 0 0 7165000 0 0 0 1835000 0 0 2012 true false false true A false false false false 0 false false false true A false false false false false false 0 false 0 false false A false FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: ORGANIZATION'S UNIFIED MISSION IS TO MAINTAIN AND IMPROVE THE QUALITY OF LIFE OF THE PEOPLE IN THIS SERVICE AREA THROUGH THE PROVISION OF QUALITY HEALTH CARE PROGRAMS, SERVICES, EQUIPMENT AND PERSONAL CARE. FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIPS: MICHAEL KILEY HAS A FAMILY RELATIONSHIP WITH DAVID CRUITT. JOSH SHALLENBERGER HAS A FAMILY RELATIONSHIP WITH ERIN CHAMBERS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS: THE 990 IS REVIEWED BY THE INTERIM CFO FOR ACCURACY. NO REVIEW WAS OR WILL BE CONDUCTED BY THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH CONFLICT OF INTEREST POLICY: OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE ORGANIZATION ALSO HOLDS QUARTERLY MEETINGS WITH EMPLOYEES. THE HOSPITAL'S CEO, ACTING CFO, AND CNE ARE RESPONSIBLE FOR DETERMINING AND REVIEWING ANY CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A/B PROCESS OF DETERMINING COMPENSATION: WAGE SCALE IS PREPARED USING COMPARISON INFO FROM OTHER HOSPITALS. IT IS PREPARED BY THE HUMAN RESOURCE DIRECTOR AND ENFORCED BY THE HUMAN RESOURCE DIRECTOR AND THE CEO. THE COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE GOVERNING BODY. THE LAST SUCH REVIEW WAS DONE IN 2010 AND WAS CONDUCTED BY THE CEO, CFO AND HR DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 PROCESS FOR MAKING DOCUMENTS AVAILABLE TO PUBLIC: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, UPON REQUEST. FORM 990 PART IX LINE 11G DESCRIPTION:PROF. FEES-EMERGENCY ROOM TOTAL FEES:784920 FORM 990 PART IX LINE 11G DESCRIPTION:PROF. FEES-OTHER MEDICAL TOTAL FEES:215346 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-PHARMACY TOTAL FEES:839055 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-OTHER MEDIC TOTAL FEES:464060 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-IT TOTAL FEES:1750 SHELBY MEMORIAL HOSPITAL FOUNDATIONINC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371294401 FUNDRAISING IL 501(C)(3) 11 - I SMHA true false false true false false false false false false false false false false true true false false false true