2015-05-05T12:54:10-07:00 2014-09-30 990 2013-10-01 420710268 KEOKUK AREA HOSPITAL KEOK 3195247150 1600 MORGAN STREET KEOKUK IA 52632 Joseph Whiting Interim Chief Executive Officer 3195247150 2015-05-15 2013 2016-02-25 16:41:14Z JOSEPH WHITING 1600 MORGAN STREET KEOKUK IA 52632 21976785 0 X WWW.KEOKUKHEALTHSYSTEMS.ORG X 1975 IA IMPROVING COMMUNITY HEALTH AND ENSURING ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. 12 11 327 200 0 0 64071 74206 19759572 19961265 110599 150446 2285001 1790868 22219243 21976785 0 0 0 0 12374704 10504526 0 0 0 10672584 10975597 23047288 21480123 -828045 496662 14267387 13592057 12432783 12767913 1834604 824144 IMPROVING COMMUNITY HEALTH AND ENSURING ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF ABILITY TO PAY. 0 0 20485681 0 21976785 Keokuk Area Hospital is a private 501 c 3 tax exempt acute care hospital with a mission of ensuring quality healthcare services are available to all residents of the community regardless of ability to pay. The hospital provides emergency care, inpatient and outpatient services to the Tri-State region. Approximately 65% of gross patient service revenue is derived under federal and state third-party reimbursement programs and another 5% is private pay. The hospital is undergoing a turnaround journey to create a financially stable organization that meets the needs of the community. This journey includes expense reduction initiatives as well as revenue growth opportunities. Surgery and Primary Care have been identified as centers of excellence. The hospital has increased its afterhours access to primary care through Keokuk Prompt Care. 0 0 0 20485681 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 39 0 1 327 1 0 0 0 0 0 0 X 12 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Keokuk Area Hospital ATTN Accounting 3195247150 1600 Morgan Street Keokuk IA 52632 Kiran Khanolkar MD Member, Board of Directors 1 40 X 0 282980 16585 Walt Stephens Chairman, Board of Directors 1 1 X X 0 0 0 Kent Nixon Vice Chair, Board of Directors & Corporate Treasurer 1 1 X X 0 0 0 Wendy Swank Member, Board of Directors & Corporate Secretary 1 1 X X 0 0 0 Mike Maher Member, Board of Directors 1 1 X 0 0 0 Tom Marion Member, Board of Directors 1 1 X 0 0 0 Greg Miller Member, Board of Directors 1 1 X 0 0 0 Mike Klauser Member, Board of Directors 1 1 X 0 0 0 Ron Scott Member, Board of Directors 1 1 X 0 0 0 David Waddell MD Member, Board of Directors 1 1 X 0 0 0 Dick Logsdon Member, Board of Directors 1 1 X 0 0 0 Neville Crenshaw DO Member, Board of Directors 1 1 X 0 0 0 Jagadamba Kantanmeni Anesthesiologist 40 0 X 314727 0 4835 Elizabeth Davis Pharmacy Director 40 0 X 115605 0 15558 430332 282980 36978 2 0 1 0 Fitch Healthcare 123 W Front Street Suite 200 Wheaton IL 60187 Management Services 752995 Shared Medical Services 209 Limestone Cottage Grove WI 53527 MRI Services 245250 McGladrey LLP 331 W Third Street Suite 200 Davenport IA 52801 Auditing/Accounting 112233 Mayo Collaborative Services 200 SW First Street Rochester MN 55905 Reference Lab 107438 4 0 0 0 0 17962 56244 0 74206 Hospital Services 622000 19961265 19961265 0 0 0 0 0 0 19961265 150446 150446 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria/Laundry/Misc 622000 211919 211919 0 0 Weight Loss Program 622000 49372 49372 0 0 EHR Incentive Program 622000 1529577 1529577 0 0 0 0 0 0 1790868 21976785 21902579 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8736586 8736586 0 0 12742 12742 0 0 1138530 1138530 0 0 616668 616668 0 0 796615 0 796615 0 28065 0 28065 0 61827 0 61827 0 105435 0 105435 0 0 0 2500 0 2500 0 2655242 2655242 0 0 10839 10839 0 0 0 0 0 0 216622 216622 0 0 0 0 0 0 516971 516971 0 0 45909 45909 0 0 0 0 0 0 0 0 0 0 329891 329891 0 0 0 0 0 0 1200359 1200359 0 0 110142 110142 0 0 MEDICAL SUPPLIES 3780784 3780784 0 0 REPAIRS AND MINOR EQPT 680051 680051 0 0 RECRUITMENT 4954 4954 0 0 PROVIDER TAX ASSESSMENT 228428 228428 0 0 200963 200963 0 0 21480123 20485681 994442 0 1115769 1866925 1512593 813971 0 3878350 3909285 0 0 173368 0 990032 1078101 92057 130000 29952954 24383405 6082854 5569549 0 0 0 0 422364 224226 14267387 13592057 7735484 8360584 0 0 2910968 2662067 0 0 0 0 1786331 1745262 12432783 12767913 X 1801321 766127 33283 58017 0 0 1834604 824144 14267387 13592057 X 496662 0 0 0 0 -1507122 X 0 1 X 1 0 X 0 0 0 0 0 0 1 30000 0 1 76000 106000 0 Schedule C, Part II-B, Line 1 KEOKUK AREA HOSPITAL CONTRACTED WITH FIRMS TO PROVIDE LOBBYING ACTIVITIES INCLUDING A FOCUS ON THE LEGAL ASPECTS OF SECURING FINANCIAL ASSISTANCE FROM THE STATE TO KEEP HEALTHCARE SERVICES IN KEOKUK AND TO PROVIDE WORKING CAPITAL FOR THE TURNAROUND EFFORTS. 0 438675 438675 0 500177 458740 41437 0 17047252 13938199 3109053 0 7603852 6595624 1008228 0 4362998 3390842 972156 5569549 0 Capital Lease Obligations 1175405 Notes Payable 569857 1745262 X 21752133 0 0 0 0 0 21752133 0 224652 224652 21976785 21480123 0 0 0 0 0 21480123 0 0 0 21480123 Schedule D, Part X, Line 2 TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF SEPTEMBER 30, 2014 AND 2013, THERE WERE NO UNCERTAIN TAX BENEFITS RELATED TO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. Schedule D, Part XI, Line 4b INTEREST AND DIVIDEND INCOME $178, GAIN ON SALE OF INVESTMENTS AND ASSETS LIMITED TO USE $115,772, CHANGE IN UNREALIZED GAINS ON TRADING INVESTMENTS $34,496, UNRESTRICTED DONATIONS $56,244 AND GRANT INCOME $17,962. 1 1 1 X 1 X 1 1 1 0 1 0 443819 443819 167245 167245 61634 61634 0 0 672698 0 672698 0 56757 56757 245430 245430 930309 930309 0 0 0 0 0 0 1232496 0 1232496 0 0 0 1905194 0 1905194 0 2400 0 2400 5480 0 5480 2850 0 2850 0 0 0 3392 0 3392 11400 0 11400 16165 0 16165 72356 0 72356 14455 0 14455 0 0 128498 0 128498 0 1 1926989 793031 9058020 10097804 -1039784 X 1 1 1 1 Keokuk Area Hospital 1600 Morgan Street Keokuk IA 52632 www.keokukhealthsystems.org X X X Keokuk Area Hospital 1 1 X X X X X X X X 13 1 1 1 X WWW.KEOKUKHEALTHSYSTEMS.ORG X LEECOUNTYHD.ORG X X X X X X 0 0 1 1 100 1 400 1 X X X X 1 1 X X 1 X 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Keokuk Area Hospital A LARGE NUMBER OF INDIVIDUALS REPRESENTING A BROAD SPECTRUM OF COMMUNITY MEMBERS WERE SENT INVITATIONS TO PARTICIPATE IN A TOWN HALL MEETING. AT THAT MEETING, TIME WAS SPENT REVIEWING DATA AND FINDINGS. AFTER MUCH DISCUSSION, THE GROUP VOTED ON THE HEALTHCARE PRIORITIES IN THE COMMUNITY. Schedule H, Part V, Section B, Line 4-Keokuk Area Hospital THE CHNA WAS PERFORMED WITH FORT MADISON COMMUNITY HOSPITAL IN FORT MADISON, IOWA. Schedule H, Part V, Section B, Line 7-Keokuk Area Hospital SOME OF THE HEALTH ISSUES IDENTIFIED THROUGH THE ASSESSMENT WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA BY THE LEE COUNTY HEALTH DEPARTMENT AND FORT MADISON COMMUNITY HOSPITAL. ADDITIONALLY, SOME COMMUNITY NEEDS SUCH AS INCREASED NUTRITION & FITNESS, IMPROVED BICYCLE/WALKING TRAILS AND IMPROVED HEALTH DEPARTMENT FACILITIES WERE BEYOND THE SCOPE, EXPERTISE AND RESOURCES AVAILABE AT KEOKUK AREA HOSPTIAL. Schedule H, Part V, Section B, Line 14-Keokuk Area Hospital THE FINANCIAL ASSISTANCE POLICY IS GIVEN TO ALL PRIVATE PAY PATIENTS UPON ADMISSION. IT IS ALSO AVAILABLE TO ANY PATIENT UPON REQUEST. Schedule H, Part V, Section B, Line 16-Keokuk Area Hospital PATIENTS FOLLOW THE HOSPTIAL'S BILLING AND COLLECTIONS POLICY UNLESS THEY APPLY AND QUALIFY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY REQUIRES PATIENTS TO AGREE AND ADHERE TO A PAYMENT SCHEUDULE TO OBTAIN THE COMPLETE DISCOUNT THEY QUALIFY FOR. Schedule H, Part V, Section B, Line 20-Keokuk Area Hospital THE HOSPTIAL USES ITS CHARGE MASTER RATES LESS A 40% DISCOUNT. 1 TRI-STATE MEDICAL GROUP 1600 MORGAN STREET KEOKUK IA 52632 CLINIC Schedule H, Part I, Line 6a KEOKUK HOSPITAL PREPARES AND SUBMITS A COMMUNITY BENEFITS REPORT TO THE IOWA HOSPITAL ASSOCIATION EACH TAX YEAR. Schedule H, Part I, Line 7 THE COST REPORT METHODOLOGY WAS USED TO CALCULATE 7A THROUGH 7D. THE COMMUNITY BENEFITS REPORT WAS USED TO CALCULATE 7E THROUGH 7K. Schedule H, Part I, Line 7, Column f BAD DEBT WAS NOT INCLUDED IN FORM 990 PART IX LINE 25 BUT RECORDED AS AN OFFSET TO GROSS REVENUE. IT WAS ALSO NOT INCLUDED IN THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. Schedule H, Part I, Line 7g REPRESENTS THE SUBSIDY TO TRI-STATE MEDICAL GROUP TO COVER UNCOMPENSATED HEALTHCARE COSTS. Schedule H, Part II KEOKUK AREA HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY THROUGH INCREASED EDUCATION AND TRAINING OF HEALTHCARE RELATED ISSUES AS WELL AS PROMOTING CAREER DEVELOPMENT IN HEALTHCARE FIELDS. Schedule H, Part III, Section A, Line 4 PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT WHEN DEEMED UNCOLLECTABLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. Schedule H, Part III, Section B, Line 8 MEDICARE PAYS KEOKUK AREA HOSPITAL SUBSTANTIALLY LESS THAN REASONABLE COST WHICH REPRESENTS UNCOMPENSATED CARE JUST LIKE PROVIDED TO INDIGENT PATIENTS WHO CANNOT PAY FOR THEIR SERVICES. THE COST OF THIS CARE IS CALCULATED PER THE MEDCIARE COST REPORT METHODOLOGY. Schedule H, Part III, Section C, Line 9b IF INFORMATION IS AVAILABLE TO CONFIRM ELIGIBILITY FOR CHARTY CARE, COLLECTION ACTIVITY IS NOT PURSUED. Schedule H, Part VI, Line 2 KEOKUK AREA HOSPTIAL PARTICIPATES WITH MANY HEALTH RELATED ORGANZIATIONS TO ASSESS HEALTHCARE NEEDS IN LEE COUNTY, IOWA AND SHARES THE RESULTS IN A WRITTEN COMMUNITY ASSESSMENT REPORT. Schedule H, Part VI, Line 3 BILLS AND STATEMENTS INCLUDE A WRITTEN NOTICE TO PATIENTS THAT FINANCIAL ASSISSTANCE IS AVAILABLE AND ENCOUARGES THEM TO EITHER CALL OR VISIT THE BUSINESS OFFICE FOR FURTHER INFORMATION. Schedule H, Part VI, Line 4 KEOKUK AREA HOSPITAL SERVES THE POPULATIONS OF SOUTHERN LEE COUNTY IN IOWA, WESTERN HANCOCK COUNTY IN ILLINOIS, AND NORTHERN CLARK COUNTY IN MISSOURI. APPROXIMATELY 22% OF THE KEOKUK POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. 70% OF ALL PATIENTS ARE MEDICARE, MEDICAID OR INDIGENT ALL OF WHICH REIMBURSE THE HOSPITAL LESS THAN COST AND 30% OF THE REMAINING INSURED POPULATION DOES NOT MAKE UP FOR THESE COST SHORTFALLS. Schedule H, Part VI, Line 5 KEOKUK AREA HOSPITAL HAS AN ALL VOLUNTEER BOARD OF DIRECTORS MADE UP OF LOCAL COMMUNITY MEMBERS WHO SERVE WITHOUT COMPENSATION. THE MEDICAL STAFF IS OPEN TO ALL INTERESTED MEDICAL PROVIDERS WHO ARE APPROPRIATELY CREDENTIALED. ALL FUNDS GENERATED BY THE HOSPTIAL ARE UTILIZED FOR PATIENT RELATED SERVICES AND TO ENSURE THAT ALL PATIENTS IN OUR MARKET HAVE ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. Schedule H, Part VI, Line 6 KEOKUK AREA HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. TRI-STATE MEDICAL GROUP PROVIDES MEDICAL OFFICES FOR ACCESS TO PRIMARY CARE FOR COMMUNITY HEALTH CENTER PATIENTS AND TO SPECIALITY CARE FOR TRI-STATE RESIDENTS. KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY PROVIDES DME AND PHARMACY SERVICES IN CLOSE PROXIMITY TO BOTH KEOKUK ARE HOSPITAL AND TRI-STATE MEDICAL GROUP. ALL SERVICES ARE COORDINATED TO HELP REDUCE LENGTH OF STAY IN THE HOSPTIAL AND ENSURE CONTINUITY OF CARE FROM ONE LEVEL TO ANOTHER. Schedule H, Part VI, Line 7 IOWA X X X X X 0 0 0 0 0 0 0 0 0 Kiran Khanolkar MD Member, Board of Directors 0 196659 0 86321 0 0 0 0 0 26583 0 309563 0 0 Jagadamba Kantanmeni Anesthesiologist 314726 0 0 0 0 0 0 0 8374 0 323100 0 0 0 Schedule J, Part I, Line 3 PERMANENT CEO/EXECUTIVE DIRECTOR SALARY IS APPROVED BY THE BOARD AFTER REVIEW BY EXECUTIVE COMMITTEE USING VARIOUS BENCHMARK DATA INCLUDING 990 DATA OF SIMILAR HOSPITALS, IOWA HOSPITAL ASSOCIATION SALARY SURVEYS AND EXPERIENCE LEVEL OF THE CANDIDATE. Form 990, Part VI, Section A, Line 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES TO FITCH HEALTHCARE. Form 990, Part VI, Section A, Line 6 KEOKUK HEALTH SYSTEMS INC 42-1237361 Form 990, Part VI, Section A, Line 7a KEOKUK HEALTH SYSTEMS INC BOARD OF DIRECTORS 42-1237361 Form 990, Part VI, Section A, Line 7b KEOKUK HEALTH SYSTEMS INC IS THE PARENT COMPANY OF KEOKUK AREA HOSPITAL AND SOLE MEMBER. Form 990, Part VI, Section B, Line 11b A DRAFT OF THE 990 IS REVIEWED BY TOP MANAGEMENT AND DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. Form 990, Part VI, Section B, Line 12c ALL BOARD MEMBERS AND EMPLOYEES ATTEST IN WRITING ANNUALLY THAT THEY HAVE DISCLOSED ANY POTENTIAL CONFLICTS OF INTEREST. Form 990, Part VI, Section B, Line 15 THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE REVIEWS AND ESTABLISHES ALL COMPENSATION ARRANGEMENTS WITH HIGHLY PAID EMPLOYEES UTILIZING BENCHMARK DATA FROM VARIOUS SOURCES INCLUDING THE IOWA HOSPITAL ASSOCIATION WAGE AND SALARY SURVEYS AND PHYSICIAN COMPENSATION SURVEYS. Form 990, Part VI, Section C, Line 19 ORGANIZATIONAL DOCUMENTS ARE AVAILABLE UPON REQUEST AND THE 990 IS PUBLISHED ON WWW.GUIDESTAR.COM. Form 990, Part IX, Line 11g AMOUNT REPRESENTS CONTRACTED SERVICES IN THE ANCILLARY DEPARTMENTS AS WELL AS THE EMERGENCY ROOM. Form 990, Part XI, Line 9 TRANSFER OF EQUITY TO TSMG TO SUBSIDIZE MEDICAL CARE -$388,660; ALLOWANCE RECORDED AGAINST AFFILIATE ADVANCES -$1,203,510; AND CONTRIBUTIONS FOR PROPERTY AND EQUIPMENT $85,048. Keokuk Health Systems Inc 1600 Morgan Street Keokuk IA 52632 421237361 Parent Company of Keokuk Area Hospital IA 501 c 3 exempt non profit N/A Tri State Medical Group 1600 Morgan Street Keokuk IA 52632 421435525 Medical Offices IA 501 c 3 exempt non profit Keokuk Health Systems Inc Keokuk Area Hospital Foundation 1600 Morgan Street Keokuk IA 52632 411202608 Fundraising IA 501 c 3 exempt non profit Keokuk Health Systems Inc Keokuk Area Medical Equipment Inc 1600 Morgan Street Keokuk IA 52632 421237312 DME and Rx Sales IA Keokuk Health Systems Inc C 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Schedule R, Part V, Line 1b KEOKUK AREA HOSPITAL SUBSIDIZIES CARE OF THE PATIENTS SEEN AT TSMG FOR PRIMARY CARE, AFFILIATED WITH THE COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, AND SPECIALTY CARE. THIS $388,660 SUBSIDY REPRESENTS THE COST OF EXPENDITURES UTILIZED BY TSMG TO CARE FOR PATIENTS THAT WERE NOT REIMBURSED BY THIRD PARTY PROGRAMS OR INDIVIDUALS.