2014-09-12T15:58:13-05:00 2013-10-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2012-11-01 420948420 MARSHALLTOWN MEDICAL & SURGICAL CENTER % MARY K PFANTZ MARS 6417545126 3 SOUTH 4TH AVE Suite MARSHALLTOWN IA 50158 JOHN C HUGHES 6417545126 2014-09-15 true ELIZABETH S HOGAN 3162652811 2012 2015-11-30 17:44:51Z JOHN C HUGHES 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 60486947 false X HTTP://WWW.MARSHMED.COM X 1969 IA TO CREATE AND CONTINUALLY IMPROVE SERVICES THAT RESPOND TO HEALTHCARE NEEDS IN OUR COMMUNITY. 13 11 759 225 0 219381 37572 56883836 56274300 115095 65773 3737250 2866349 60955562 59243994 0 0 0 0 36704754 36874169 0 0 0 24089158 26153695 60793912 63027864 161650 -3783870 67090928 62868693 6873754 6448529 60217174 56420164 TO CREATE AND CONTINUALLY IMPROVE SERVICES THAT RESPOND TO HEALTHCARE NEEDS IN OUR COMMUNITY. false false 46220533 56274300 TO PROVIDE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY AND SURROUNDING COMMUNITIES REGARDLESS OF ABILITY TO PAY. CARE INCLUDES PREVENTION, DIAGNOSIS, TREATMENT, REHABILITATION AND OTHER SERVICES. MARSHALLTOWN MEDICAL & SURGICAL CENTER EXPERIENCED APPROXIMATELY 191,000 OUTPATIENT VISITS; 2,699 INPATIENT ADMISSIONS; 531 BIRTHS; 8,736 PATIENT DAYS; 4,230 SURGICAL PROCEDURES AND 19,238 EMERGENCY ROOM VISITS. 46220533 true true false true false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 103 0 true 759 true false false false false false false false false false false X 13 11 false false false false true true false true true false false true true true true true true true true false X MARY K PFANTZ 6417545126 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 BRIAN BURNSIDE 40.0 X X 297898 0 38960 JOHN HUGHES 40.0 X X 124850 26474 T L BRIGGS 2.0 X X 0 0 MIKE MASON 2.0 X X 0 0 JIM LOWRANCE 2.0 X X 0 0 CAROL HIBBS 2.0 X X 0 0 CHRIS DUREE 1.0 X 0 0 POLLY HINEMAN 40.0 X 169562 9778 KEVIN SWARTZ 1.0 X 0 0 STEPHEN VANBUREN 1.0 X 0 0 SUE MARTIN 1.0 X 0 0 SHARON GREER 1.0 X 0 0 KIMBERLE SCHRYVER 1.0 X 0 0 BRUCE WIRIN 1.0 X 0 0 ROBERT L DOWNEY 40.0 X 197318 27366 MARY SCHREURS 40.0 X 172741 22935 JOHN MCCUNE 40.0 X 397253 44071 RONALD TERRILL 40.0 X 369576 35861 NARASIMHA PALAGUMMI 40.0 X 313549 32061 LARRY BEATY 40.0 X 289098 35373 KATHLEEN GRAUERHOLZ 40.0 X 242221 28377 2574066 0 301256 30 false true false MCFARLAND CLINIC PC PHYSICIAN SERVICES 2324968 ARAMARK CORP ENG SERVICES 1388377 ICE TECHNOLOGIES IT SERVICES 398632 SALAHUDDIN SYED MD PC PATHOLOGY SERVICES 366000 IOWA HEART CENTER PC CARDIOLOGY SERVICES 318460 14 11050 26522 37572 NET PATIENT SERVICE REVENUE 621400 56274300 56274300 56274300 114010 114010 0 0 1966526 1128842 837684 0 837684 837684 31438 34436 32000 82111 -562 -47675 -48237 -48237 0 0 0 ELECTRONIC HEALTH RECORD REVENUE 900099 1173710 1173710 CAFETERIA INCOME 722514 457088 457088 HOME HEALTH SUPPORT SERVICES 621610 265638 265638 132229 132229 2028665 59243994 56274300 2932122 0 0 0 0 832685 832685 0 28003713 22342538 5661175 1263843 1008546 255297 4796297 3827445 968852 1977631 1578150 399481 1175471 269683 905788 59891 59891 31700 31700 0 0 0 7626811 5412053 2214758 321159 321159 690307 690307 0 0 873224 571612 301612 144073 111777 32296 0 0 0 0 3006515 2216090 790425 544373 81093 463280 MEDICAL SUPPLIES 6896552 6896552 NURSING SERVICES EXPENSES 1023809 1023809 ADMINISTRATIVE EXPENSES 619299 619299 DUES & SUBSCRIPTIONS 99362 99362 3041149 881185 2159964 63027864 46220533 16807331 0 14075 13109 20487045 13233141 45725 38755 9415517 10819367 0 0 0 0 418547 297352 1626943 1657226 454295 547119 99040516 65172139 34035186 33868377 213085 204771 0 0 0 0 0 0 380510 2189476 67090928 62868693 6117601 6448529 0 0 0 0 0 0 0 0 0 0 0 0 0 0 756153 0 6873754 6448529 X 59979884 56183767 237290 236397 0 0 60217174 56420164 67090928 62868693 -3783870 -13140 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 14721 false false false 14721 false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1F MARSHALLTOWN MEDICAL & SURGICAL HAS PAID MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE IOWA HOSPITAL ASSOCIATION. THESE ORGANIZATIONS HAVE PROVIDED AN ESTIMATED PERCENTAGE OF DUES USED FOR LOBBYING ACTIVITIES. 767397 3392947 4160344 18392983 41073120 36314689 23151414 363074 33108424 27741265 5730233 1942571 1116185 826386 33868377 0 0 X 59248994 59248994 -5000 -5000 59243994 63032864 5000 5000 63027864 63027864 UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 AS REQUIRED BY THE INCOME TAXES TOPIC OF THE FASB ACCOUNTING STANDARDS CODIFICATION, THE HOSPITAL HAS EVALUATED THEIR MATERIAL TAX POSITIONS AND DETERMINED NO INCOME TAX EFFECTS WITH RESPECT TO THE FINANCIAL STATEMENTS. THE HOSPITAL'S FEDERAL INCOME TAX RETURNS SINCE 2009 OPEN BY STATUTE ARE SUBJECT TO EXAMINATION BY THE TAX AUTHORITIES. THE HOSPITAL HAS NOT BEEN NOTIFIED OF ANY IMPENDING EXAMINATIONS BY AUTHORITIES, AND NO EXAMINATIONS ARE IN PROCESS. RECONCILIATION OF REVENUE SCHEDULE D, PART XI, LINE 4B RENT EXPENSE (5,000) RECONCILIATION OF EXPENSES SCHEDULE D, PART XII, LINE 2D RENT EXPENSE 5,000 true true true X true X true true true false true true 1819952 0 1819952 0.02890 7239377 5237081 2002296 0.03180 9059329 5237081 3822248 0.06070 434773 39768 395005 0.00630 3058908 2574923 483985 0.00770 78384 0 78384 0.00120 3572065 2614691 957374 0.01520 12631394 7851772 4779622 0.07590 81748 81748 0.00130 81748 81748 0.00130 true 4199937 125998 18891171 20179005 -1287834 X true true 1 1 MARSHALLTOWN MEDICAL & SURGICAL CTR

3 SOUTH 4TH AVE MARSHALLTOWN IA 50158

WWW.MARSHMED.COM X X X MARSHALLTOWN MEDICAL & SURGICAL CTR true X X X X X X X X X 13 true false true X X X X X X true false true true 100 true 200. true X X X X true true X true false X X X X true X false false 4 MMSC CLINIC - STATE CENTER

503 3RD AVENUE SW STATE CENTER IA 50247

PHYSICIAN CLINIC MMSC CLINIC - TAMATOLEDO

1307 S BROADWAY TOLEDO IA 52342

PHYSICIAN CLINIC MMSC CLINIC - CONRAD

105 NORTH CHURCH ST CONRAD IA 50621

PHYSICIAN CLINIC MMSC CLINIC - MARSHALLTOWN

405 EAST MAIN ST MARSHALLTOWN IA 50158

PHYSICIAN CLINIC COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A COMMUNITY BENEFIT REPORT IS PREPARED ANNUALLY IN A COLLABORATIVE EFFORT WITH THE IOWA HOSPITAL ASSOCIATION. THIS INFORMATION IS SHARED IN TOTAL FOR THE ENTIRE STATE THROUGH PRESS RELEASES AND FOR OUR INDIVIDUAL HOSPITAL BY INCLUDING THIS INFORMATION IN OUR ANNUAL CORPORATE REPORT, ON OUR WEBSITE AND A LOCAL PRESS RELEASE. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 AMOUNTS REPORTED IN THIS TABLE WERE CALCULATED BASED ON IRS WORKSHEETS 1-8, USING ENTITY SPECIFIC COST TO CHARGE RATIOS. SUBSIDIZED HEALTH SERVICES SCHEDULE H, PART I, LINE 7G THE AMOUNT REPORTED ON THIS LINE INCLUDES SUBSIDIZED HEALTH SERVICES AT 3 PHYSICIAN CLINICS LOCATED IN 3 SMALL RURAL COMMUNITIES IN OUR GEOGRAPHIC SERVICE AREA. PHYSICIAN CLINICS ARE PROVIDED IN THE SMALL RURAL COMMUNITIES OF STATE CENTER, TAMA/TOLEDO, AND CONRAD, IOWA TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY REDUCING GEOGRAPHIC AND FINANCIAL BARRIERS. THESE COMMUNITIES WOULD BE MEDICALLY UNDERSERVED IF THESE SERVICES WERE NOT PROVIDED. WORKFORCE DEVELOPMENT SCHEDULE H, PART II, LINE 8 THE COMMUNITY BUILDING ACTIVITIES EXPENSE INCURRED BY MARSHALLTOWN MEDICAL & SURGICAL CENTER ARE EXPENSES INCURRED TO RECRUIT PHYSICIANS WHO WOULD NOT OTHERWISE COME TO THIS MEDICALLY UNDERSERVED AREA AND TO RETAIN PHYSICIANS IN THIS MEDICALLY UNDERSERVED AREA. BAD DEBT EXPENSE METHODOLOGY SCHEDULE H, PART III, LINE 2 THE ORGANIZATIONS BAD DEBT EXPENSE (AT COST) IS DETERMINED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO. BAD DEBT EXPENSE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS SCHEDULE H, PART III, LINE 3 THE AMOUNT ON LINE 3 IS AN ESTIMATE BASED UPON THE NUMBER OF FINANCAL ASSISTANCE APPLICATIONS NOT RETURNED AND THE NUMBER OF FINANCIAL ASSISTANCE APPLICATIONS RETURNED WITH INSUFFICIENT DOCUMENTATION. EVERY EFFORT IS MADE TO COLLECT FINANCIAL ASSISTANCE APPLICATIONS AND TO COLLECT ADEQUATE INFORMATION TO MAKE A DETERMINATION OF FINANCIAL ASSISTANCE. BAD DEBT EXPENSE FOOTNOTE SCHEDULE H, PART III, LINE 4 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE FOOTNOTE DISCLOSURES REGARDING BAD DEBT, RECEIVABLES OR ALLOWANCES. THIS HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. THE HOSPITAL BILLS THIRD PARTY PAYERS DIRECTLY AND BILLS THE PATIENT ONLY WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENTS ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD BASED ON INDIVIDUAL CREDIT EVALUATION, LACK OF PAYMENTS, AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. EVERY EFFORT IS MADE TO MAKE PATIENTS AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. A STATEMENT IS INCLUDED IN THE FIRST BILLING TO PATIENTS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND SIGNS ARE POSTED IN THE REGISTRATION AREAS. COSTING METHODOLOGY SCHEDULE H, PART III, LINE 8 COSTS WERE DERIVED USING THE MEDICARE COST REPORT. THE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: 1) MANY MEDICARE RECIPIENTS ARE LOW-INCOME INDIVIDUALS AND IF NOT FOR MEDICARE, WOULD QUALIFY FOR CHARITY CARE OR OTHER MEANS TESTED GOVERNMENT PROGRAMS. 2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUAL THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. 3) IRS REV RULING 69-545 ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR HOSPITALS, WHICH INDICATES, THAT IF A HOSPITAL SERVES PATIENTS COVERED BY GOVERNMENTAL HEALTH BENEFITS (INCLUDING MEDICARE), THEN THIS INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9B AFTER A PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS EITHER PARTIALLY OR ENTIRELY WRITTEN-OFF. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. INPUT FROM COMMUNITY REPRESENTATIVES SCHEDULE H, PART V, SECTION B, LINE 3 MARSHALLTOWN MEDICAL & SURGICAL CENTER UTILIZED MANY METHODS IN ORDER TO ENSURE THAT INPUT WAS RECEIVED FROM THE ENTIRE COMMUNITY, INCLUDING REPRESENTATIVES OF THE COMMUNITY WITH PUBLIC HEALTH KNOWLEDGE, THOSE WITH SPECIALIZED HEALTH KNOWLEDGE, AS WELL AS THOSE SERVED BY THE HOSPITAL. THIS WAS DONE BY HOSTING THREE COMMUNITY MEETINGS, CONDUCTING A DIRECT MAIL SURVEY OF HOUSEHOLDS IN THE SERVICE AREA, AND FORMING FOCUS GROUPS ATTENDED BY BUSINESS LEADERS, CITY AND COUNTY LEADERS, HEALTH CARE PROFESSIONALS, RELIGIOUS LEADERS, NOT-FOR-PROFIT ORGANIZATIONS AND CONSUMERS. CHNA, IMPLEMENTATION STRATEGY AVAILABILITY SCHEDULE H, PART V, SECTION B, LINES 5A,6A http://www.marshmed.com/file.cfm/media/news/REVISED_CHNA_and_Implementatio n_Pla_20F769AA66DD7.pdf MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE PATIENTS SCHEDULE H, PART V, SECTION B, LINE 20 THE HOSPITAL FACILITY USES THE RATES PAID BY COMMERCIAL INSURANCE PAYORS TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO INDIVIDUALS ELIGIBLE UNDER THE HOSPITALS FINANCIAL ASSISTANCE POLICY. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 MARSHALLTOWN MEDICAL & SURGICAL CENTER AND THE MARSHALL COUNTY BOARD OF HEALTH AND THE PIONEERING HEALTHIER COMMUNITY COALITION PARTNERED TO COMPLETE A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013. THROUGH THESE EFFORTS PRIORITIES AND STRATEGIES HAVE BEEN DEVELOPED. REPRESENTATIVES OF MARSHALLTOWN MEDICAL & SURGICAL CENTER ARE INVOLVED IN THE ABOVE MENTIONED GROUPS AND THE LARGER COALITION. THE HEALTH NEEDS OF THE COMMUNITY ARE ASSESSED THROUGH A COMMUNITY NEEDS ASSESSMENT PROCESS EVERY THREE YEARS. A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY, AND TO ASSIST OUR COMMUNITY PARTNERS IN FOCUSING ON OUR COMMUNITIES FURTURE HEALTH NEEDS. THIS ASSESSMENT SERVES AS THE BASIS FOR MARSHALL COUNTY PUBLIC HEALTH, PIONEERING HEALTHIER COMMUNITIES, AND OUR OVERALL HEALTHCARE COMMUNITY TO DEVELOP ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES. THIS COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO: - GAIN INSIGHT INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY - ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS -PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNING MARSHALLTOWN MEDICAL & SURGICAL CENTER ACTIVELY CONTRIBUTES TO THE COMMUNITY NEEDS ASSESSMENT AND ENGAGES IN THE PRIORITIES THAT MATCH ITS VISION AND MISSION. MEASUREMENT AND EVALUATION TOOLS ARE COLLECTED AND MONITORED BY THE LARGER COMMUNITY COALITION ENGAGED IN THE VARIOUS EFFORTS. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS, MARSHALLTOWN MEDICAL & SURGICAL CENTER MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND RESOURCES AVAILABLE. INDIVIDUAL DEPARTMENTS ALSO WORK TO IDENTIFY COMMUNITY NEEDS AS RELATED TO THEIR SERVICES AND THE POPULATION SERVED. SERVED. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 SIGNS STATING THAT FINANCIAL ASSISTANCE AND FREE CARE ARE AVAILABLE AND ARE POSTED IN THE HOSPITAL REGISTRATION AND CASHIER AREAS. REGISTRATION STAFF HAVE EDUCATIONAL MATERIAL AND APPLICATION FORMS THAT ARE MADE AVAILABLE TO PATIENTS WANTING INFORMATION OR AN APPLICATION FOR OUR COMMUNITY ASSITANCE PROGRAM. PATIENT FINANCIAL SERVICE REPS CONSULT AND ADVISE SELF PAY PATIENTS ON THEIR OPTIONS FOR GOVERNMENT SPONSORED FINANCIAL ASSISTANCE AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ADDITIONALLY, AN OUTSIDE VENDOR CONTACTS ADMITTED SELF PAY PATIENTS AND DISCUSSES OPTIONS FOR GOVERNMENT SPONSORED FINANCIAL ASSISTANCE AND PROVIDES ASSISTANCE TO PATIENTS APPLYING FOR A SPECIFIC PROGRAM. OUR OUTSIDE VENDOR DIRECTS PATIENTS THAT DO NOT QUALIFY FOR A GOVERNMENT SPONSORED PROGRAM TO A HOSPITAL FINANCIAL SERVICE REPRESENTATIVE TO FOLLOW UP WITH AN APPLICATION FOR COMMUNITY ASSISTANCE. WE FURTHER USE AN "EARLY OUT" SELF PAY VENDOR THAT PROVIDES INFORMATION ON GOVERNMENT PROGRAMS AND THE HOSPITAL'S COMMUNITY ASSISTANCE PROGRAM. OUR SELF PAY VENDOR PROVIDES COMMUNITY ASSISTANCE APPLICATIONS TO PATIENTS WHEN AN APPLICATION IS REQUESTED AND MAXES REFERRALS FOR POSSIBLE APPLICATION TO GOVERNMENT SPONSORED ASSISTANCE PROGRAMS. ALSO, A STATEMENT IS INCLUDED IN THE FIRST BILLING TO PATIENTS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 MARSHALL COUNTY, POPULATION 40,648, IS COMPRISED OF 13 INCORPORATED COMMUNITIES AND THEIR SURROUNDING AREAS. THE POPULATION IS SOMEWHAT CONCENTRATED IN THE CENTRAL CITY OF MARSHALLTOWN WHERE ABOUT 66% OF COUNTY RESIDENTS LIVE. THE COUNTY'S POPULATION HAS REMAINED STABLE OVER THE PAST 50 YEARS; HOWEVER, THE DEMOGRAPHICS OF THE POPULATION HAVE SHIFTED DRAMATICALLY IN THE PAST 15 YEARS. NEW IMMIGRANTS RECRUITED TO THE COMMUNITY BY THE MEAT PACKING INDUSTRY HAVE DRIVEN THESE CHANGES. LARGE NUMBERS OF HISPANIC IMMIGRANTS HAVE LEFT THE SUB-MINIMUM WAGE EXISTENCE IN CENTRAL MEXICO TO TRAVEL TO THE AMERICAN MIDWEST FOR JOBS IN MEAT PACKING. THIS INDUSTRY IS THE LARGEST PRIVATE EMPLOYER IN MARSHALL COUNTY WITH PAY RANGING FROM $9-13 PER HOUR. THESE CHANGES RAVE RESULTED IN AN INCREASE IN THE NUMBER OF PEOPLE LIVING IN POVERTY AND AN UPSURGE IN THE NUMBER OF UNINSURED OR UNDERINSURED RESIDENTS. MARSHALL COUNTY IS DESIGNATED AS A HEALTH PROVIDER SHORTAGE AREA (HPSA). FURTHER, THE COUNTY HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVED COMMUNITY (MUC) AND THE IMMIGRANT POPULATION HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVED POPULATION (MUP) DUE TO LANGUAGE AND CULTURAL BARRIERS IN ACCESSING HEALTH CARE SERVICES. ACCORDING TO THE 2013 U.S. CENSUS DATA: 19.4% OF THE MARSHALL COUNTY'S POPULATION IS OF HISPANIC OR LANTIO ORIGIN COMPARED TO 5.0% IN THE STATE OF IOWA; 17.5% MARSHALL COUNTY'S POPULATION (AGE 5+) SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME COMPARED TO 7.2% IN THE STATE OF IOWA; 84.5% OF MARSHALL COUNTY RESIDENTS ARE HIGH SCHOOL GRADUATES COMPARED TO 90.7% IN IOWA (2010); 18.7% OF MARSHALL COUNTY POPULATION HAD A BACHELOR'S DEGREE OR HIGHER COMPARED TO 24.5% IN IOWA (2000); THE MEDIAN HOUSEHOLD INCOME IN 2008-2012 IN MARSHALL COUNTY WAS $49,259 COMPARED TO $51,129 IN IOWA; PERSONS LIVING BELOW POVERTY IN MARSHALL COUNTY WAS 12.9% COMPARED TO 12.2% IN IOWA. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 MARSHALLTOVN MEDICAL & SURGICAL CENTER IS A SOLE COMMUNITY HOSPITAL AND A RURAL REFERRAL CENTER BY CMS'S DEFINITIONS. THE HOSPITAL IS LOCATED IN A RURAL, MEDICALLY UNIDERSERVED AREA AND IS THE ONLY HOSPITAL WITHIN A 30 MILE RADIUS. THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES AND CONTINUALLY IMPROVING SERVICES TO RESPOND TO HEALTH CARE NEEDS. THE HOSPITAL PROVIDES A 24 HOUR EMERGENCY DEPARTMENT, INCLUDING AMBULANCE COVERAGE, AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES, NOR CONTRACTORS, NOR FAMILY MEMBERS THEREOF AND ARE A BROAD CROSS SECTION OF COMMUNITY LEADERS. THE ORGANIZATION PROVIDES AN OPEN MEDICAL STAFF TO ALL QUALIFIED PHYSICIANS, SUBJECT TO THE NORMAL, EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, EMERGENCY DEPARTMENT, AND HEART CATHETERIZATION LAB. THE EXCLUSIVE CONTRACTS ARE NECESSARY TO ASSURE THAT THESE MUCH NEEDED SERVICES ARE PROVIDED IN THIS RURAL MEDICALLY UNDERSERVED COMMUNITY. ALL SURPLUS FUNDS ARE USED TO MEET AND TO RESPOND TO THE HEALTHCARE NEEDS OF THE COMMUNITIES THIS ORGANIZATION SERVES. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A FACILITY REPORTING GROUP(S) SCHEDULE H, PART VI, LINE 8 N/A X X X X true false false false false false false false false BRIAN BURNSIDE 293738 0 0 0 4160 0 15208 0 23752 0 336858 0 0 0 JOHN HUGHES 124557 293 6385 0 20089 0 151324 0 0 0 POLLY HINEMAN 169000 562 8450 0 1328 0 179340 0 0 0 ROBERT L DOWNEY 195335 1983 10110 0 17256 0 224684 0 0 0 MARY SCHREURS 124691 48050 7827 0 15108 0 195676 0 0 0 JOHN MCCUNE 394780 2473 20124 0 23947 0 441324 0 0 0 RONALD TERRILL 364852 4724 18681 0 17180 0 405437 0 0 0 NARASIMHA PALAGUMMI 281836 31713 15842 0 16219 0 345610 0 0 0 LARRY BEATY 285288 3810 14816 0 20557 0 324471 0 0 0 KATHLEEN GRAUERHOLZ 235931 6290 12277 0 16100 0 270598 0 0 0 SEVERANCE PAYMENT SCHEDULE J, PART II, LINE 5 MARY SCHREUERS RECEIVED A $16,200 SEVERANCE PAYMENT. MEMBERS FORM 990, PART VI, SECTION A, LINE 6 MEMBERS IN THIS ENTITY SHALL BE BONA FIDE CITIZENS OF THE AREA SERVED BY THIS HOSPITAL WHO ARE AT LEAST 18 YEARS OF AGE AND WHO HAVE PAID THEIR ANNUAL DUES. MEMBERS MAY ELECT GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A AN ANNUAL MEETING IS HELD IN WHICH THE AGENDA INCLUDES ELECTION OF TRUSTEES. PROXY VOTES MAY BE CAST BY ELIGIBLE MEMBERS WHO ARE UNABLE TO ATTEND THE MEETING. THE BOARD MEMBERSHIP SHALL INCLUDE MEMBERS FROM THE COMMUNITIES THAT ARE SERVED BY MARSHALLTOWN MEDICAL & SURGICAL CENTER. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ALL RELATED SCHEDULES AND SUPPLEMENTAL INFORMATION WERE EMAILED TO THE BOARD FOR A REVIEW PERIOD AND ALL QUESTIONS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE PRIOR TO FILING WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY REQUIRES ANNUAL CERTIFICATION THAT EACH TRUSTEE HAS THE CONFLICT OF INTEREST POLICY, THAT THEY HAVE A COPY OF THE SECTION OF THE ORGANIZATIONAL BY-LAWS THAT DISCUSS CONFLICTS OF INTEREST, AND THAT THEY AGREE TO COMPLY WITH THE POLICY. THE EXECUTIVE ASSISTANT TO THE PRESIDENT IS ASSIGNED TO ASSURE THAT ALL RECIPIENTS ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY. THE DIRECTOR OF ACCOUNTING/FINANCE REVIEWS THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE IF A CONFLICT DOES EXIST. IF A POTENTIAL CONFLICT IS DISCLOSED, THE INDIVIDUAL IS ALLOWED TO MAKE A PRESENTATION CONCERNING THE PROPOSED TRANSACTION BUT IS THEN ASKED TO LEAVE THE ROOM WHILE FURTHER DISCUSSION TAKES PLACE AND THE REST OF THE BOARD DETERMINES WHETHER OR NOT TO ENTER THE TRANSACTION. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT BOARD MEMBERS WHO MEET MULTIPLE TIMES PER YEAR TO REVIEW THE IOWA HOSPITAL ASSOCIATION'S WAGE SURVEY DATA. THE COMMITTEE RECOMMENDS CHANGES BASED ON SURVEY COMPARISONS AND ANNUAL PERFORMANCE EVALUATIONS. THE RECOMMENDATIONS ARE PRESENTED TO THE FULL BOARD. NO INCREASES WERE GIVEN IN THE CURRENT YEAR. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT STAFF TOTAL FEES:103694 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER CONSULTING TOTAL FEES:540462 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:UTILIZATION REVIEW TOTAL FEES:495605 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:LAB PURCHASED SERVICES TOTAL FEES:496485 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYS PROFESSIONAL FEE TOTAL FEES:900473 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:ER PROFESIONAL FEES TOTAL FEES:1775693 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:HOSPITALISTS TOTAL FEES:502579 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:ORTHO PROFESSIONAL FEES TOTAL FEES:567500 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:ORTHO CALL TOTAL FEES:304475 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:LAB PROFESSIONAL FEES TOTAL FEES:364675 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:CLINICAL ENG TOTAL FEES:356443 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:DIAG SERV AGREE TOTAL FEES:693399 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:DIAG SERV TOTAL FEES:81842 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:BILLING SERVICES TOTAL FEES:443486