2013-05-15T16:30:00-05:00 2012-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2011-07-01 201347269 Renown Skilled Nursing RENO 7759824404 1155 Mill Street C/O Tax Treasury Z-5 Reno NV 89502 Dawn D Ahner 7759824404 2013-05-15 1 Kim Hunwardsen CPA P00484560 6122536500 2013-05-15 2011 2016-02-24 21:20:13Z Dawn D Ahner 1155 Mill Street C/O Tax Treasury Z-5 Reno NV 89502 10516800 0 X www.renown.org X 2004 NV A 160 bed long-term acute care nursing facility specializing in rehabilitative care. 3 0 0 8 0 0 2779730 2825316 8795487 7689721 -145 -90 1475 1763 11576547 10516710 0 0 0 0 9018902 8019845 0 0 0 4943347 4082415 13962249 12102260 -2385702 -1585550 2035397 1633463 11928420 13112036 -9893023 -11478573 X Our purpose is to make a genuine difference for the many lives we touch by optimizing our patients' healthcare experience. 0 0 9383097 7691484 See Schedule ORenown Skilled Nursing is a 160-bed nursing facility designed to serve the healthcare needs of long- and short-term, acute-care patients. Services include physical, occupational and speech rehabilitation and restorative therapy programs. This valuable facility serves a need that otherwise would be unmet in northern Nevada. By accepting the long-term, acute-care patients for rehabilitative services, other hospital beds in the health network are available for higher-acuity, shorter-term care. Renown Skilled Nursing provided 33,862 patient care days for patients transferred from other hospital beds in the health network because they required a level of care delivered most appropriately in a skilled nursing facility. Included in the total patient care days was 35 days of long-term care services that were not funded and were designated for patients awaiting Medicaid qualification. It also includes 733 days of care provided for individuals with no source of payment.Our patients at Renown Skilled Nursing have access to transportation, laundry, a barber and beauty shop, on-site dental and podiatry services, financial advice, and spiritual support - in short, everything patients need to enjoy the best possible quality of life. In an effort to provide patients with the opportunity for social interaction, Renown Skilled Nursing also offered musical performances and pet therapy visits. The facility is proud to have been chosen to be a focus center for the Centers for Medicare & Medicaid Services' Nursing Home Quality Initiative.For the fiscal year ending June 30, 2012, Renown Skilled Nursing, along with its parent, Renown Health and its subsidiaries, provided more than $134 million in benefit to the community (using community benefit numbers gathered by the Nevada Hospital Association using state-approved criteria to ensure consistency). For a full report on the benefit Renown Health provided to our community, as well as our community needs assessment and community benefit plan, go to www.renown.org/communitybenefit. 9383097 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Dawn D Ahner 7759824404 1155 Mill St Z-6 Reno NV 89502 X James Miller 1.00 X X 0 1237327 350164 Dawn Ahner 1.00 X X 0 648819 94963 Ellen Kelly 60.00 X 116460 0 9859 Barbara Coruna 60.00 X 113198 0 19087 Imelda Decorion-Sayo 60.00 X 116686 0 23268 Joseph Moniz 60.00 X 101500 0 5808 Virginia Alelis 60.00 X 100406 0 18941 548250 1886146 522090 5 0 1 0 Talent Framework 5596 Longley Ln Ste A Reno NV 89502 Temp Labor 257366 1 2825316 2825316 PATIENT SERVICE REVENU 623000 7689721 7689721 7689721 90 -90 -90 -90 OTHER REVENUE 900099 1763 1763 1763 10516710 7691484 0 -90 6646768 5686137 960631 1373077 1152132 220945 12519 12519 698720 314732 383988 1705696 1649533 56163 848071 708 847363 2985 904 2081 951 734 217 210673 146478 64195 51261 51261 Licenses & Taxes 55972 150 55822 Management Expense 43011 0 43011 Dues & Subscriptions 13752 1028 12724 Business Meals/Entertai 1310 244 1066 437494 430317 7177 12102260 9383097 2719163 0 36472 19366 973768 629331 35655 36084 24061 9530 3276183 2337031 965441 939152 2035397 1633463 570581 324654 24731 16479 11333108 12770903 11928420 13112036 X -9893023 -11478573 -9893023 -11478573 2035397 1633463 -1585550 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 1443393 970566 472827 1832790 1366465 466325 939152 Due to Affliates 12770903 12770903 Part IV, Line 2b: The organization acts as custodian for the funds of the residents of the skilled nursing facility. These funds are included in cash and custodial liability in the financial statements. Description of Uncertain Tax Positions Under FIN 48: Part X: Renown Skilled Nursing undergoes an annual analysis of its various tax positions, assessing the likelihood of these positions being upheld upon examination with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. Renown Skilled Nursing believes that it is compliant with all IRS tax regulations and as of June 30, 2012 has not recorded a tax liability for a tax uncertainty. Renown Skilled Nursing would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Under normal circumstances, Renown Skilled Nursing is no longer subject to federal tax examinations by tax authorities for years before 2009. X X X X X 0 1 0 0 0 0 0 0 0 James Miller 0 850127 0 374054 0 13146 0 334830 0 15334 0 1587491 0 0 Dawn Ahner 0 463146 0 184000 0 1673 0 76431 0 18532 0 743782 0 0 Part I, Line 4b Dawn Ahner is party to a supplemental nonqualified retirement plan. Contribution of $69,000 to Dawn Ahner was included in Schedule J, Part II, Column (C). Supplemental Information Part III Part I, Line 3: Renown Skilled Nursing relies on Renown Health, a related organization, to establish compensation for officers and other key employees. Renown Health uses the identified methods to establish compensation. See Schedule O, Form 990, Part VI, Section B, Line 15 for a description of the process utilized by Renown Health. Form 990, Part VI, Section A, line 2 James Miller and Dawn Ahner have a business relationship because James Miller serves on the board of an organization where Dawn Ahner is an employee. Form 990, Part VI, Section A, line 6 Renown Health is the sole corporate member of Renown Skilled Nursing. Form 990, Part VI, Section A, line 7a Renown Health, acting through its Board of Directors, appoints the members of the Board of Governors of Renown Skilled Nursing. Form 990, Part VI, Section A, line 7b Renown Health must approve any merger, consolidation or dissolution of Renown Skilled Nursing, any borrowing in excess of $1 million in any fiscal year, and encumbrances of assets and certain other actions not in the ordinary course of business. Form 990, Part VI, Section A, line 8b There was no committee during the year that had the broad authority to act on behalf of the board. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by the organization's tax department with support from a certified tax preparer. The form is reviewed by the organization's Chief Accounting Officer and/or the Chief Financial Officer prior to the final Form 990 being sent to the board. The IRS Form 990, as filed with the IRS, is sent to each voting member of the Renown Health Board prior to filing. Along with the forms, the Renown Health board is provided with a narrative that explains the various parts of the Form and their content. Form 990, Part VI, Section B, line 12c On an annual basis at or prior to the first regular meeting following the election of new board members, the members of the Renown Skilled Nursing Board are given an Annual Disclosure Statement. They are expected to perform a reasonable investigation into their business, financial, family or significant personal relationships to disclose any actual or potential conflicts of interest. If, in connection with a proposed transaction or arrangement involving a Renown Health entity, a board member discovers that an actual or possible conflict of interest has arisen that was not disclosed on the Annual Statement, then the board member must disclose the existence and nature of his or her financial interests to the remaining directors that are considering the proposed transaction or arrangement in a timely manner. If a board member discloses an actual or possible conflict of interest, the board member shall leave the board or committee meeting while the remaining board members discuss the financial interest. The remaining board members shall vote upon and decide whether a conflict of interest actually exists. If the remaining board members determine that a conflict does exist, then appropriate measures are taken to ensure the issue is addressed. Form 990, Part VI, Section B, line 15 Renown Health's executive compensation is set by the Renown Health Compensation Committee. Members of this committee review and approve various employee pay practices and parameters, as well as compensation for the CEO and certain executives. The Compensation Committee is comprised of independent members of the Renown Health Board of Directors unrelated to and not subject to the control or undue influence of executives, with no material financial interest in transactions of the Company or any other perceived or actual conflicts of interest. The Compensation Committee members are appointed by the Chairman of the Renown Health Board of Directors. The Compensation Committee meets approximately five times per year. Meeting minutes are kept documenting the deliberations and decisions regarding the compensation arrangements. Total cash compensation for the organization's executives are targeted at competitive compensation levels, relative to market surveys of comparable healthcare organizations, based upon the level of performance required to achieve the targeted compensation levels. Base compensation and total cash compensation is reviewed at a minimum of every two years in comparison to the surveys for comparable businesses and responsibilities and adjusted as to maintain equity with the survey information. The Compensation Committee undertook the process outlined above for the fiscal year 2012 executive compensation. Form 990, Part VI, Section C, line 19 Renown Skilled Nursing does not make its governing documents, conflict of interest policy, or financial statements available to the general public. Average hours per week Form 990, Part VII, Column B Jim Miller, President & CEO, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. Dawn Ahner, CFO, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. Audit Committee Form 990, Part XI, Line 2b Renown Health, the sole member of this entity, has an audit committee that assumes responsibility for the consolidated audit and selection of the independent accountant. Number of employees on W-3 Form 990, Part V, Line 2a Renown Skilled Nursing has its own employees, however, Renown Health, the parent organization, pays all compensation and employee benefit amounts under a common paymaster arrangement. The actual compensation of each employee is directly charged to their assigned entity. Salaries are reported on line 7 of Part IX. Renown Health 1155 Mill Street Z-5 Reno NV 89502 942972845 Health Care NV 501(c)(3) III-Fi Renown Health 0 Renown Health Foundation 1155 Mill Street Z-5 Reno NV 89502 942972749 Foundation NV 501(c)(3) 7 Renown Health 0 Renown Regional Medical Center 1155 Mill Street Z-5 Reno NV 89502 880213754 Hospital NV 501(c)(3) 3 Renown Health 0 Renown South Meadows Medical Center 1155 Mill Street Z-5 Reno NV 89502 460517825 Hospital NV 501(c)(3) 3 Renown Health 0 Hometown Health Plan 1155 Mill Street Z-5 Reno NV 89502 880231433 HMO NV 501(c)(4) Renown Health 0 Renown Network Services 1155 Mill Street Z-5 Reno NV 89502 880231828 Outpatient Imaging and Pregnancy Center NV 501(c)(3) 3 Renown Health 0 Routt Dialysis LLC 1155 Mill St Z-5 Reno NV 89502 263558729 Kidney Dialysis NV N/A Nevada Heart Institute Clinic LLC 1155 Mill St Z-5 Reno NV 89502 453571779 Cardiology NV N/A Renown Businesses 1155 Mill St Z-5 Reno NV 89502 880228030 Health Care NV N/A C Hometown Health Managment Company 1155 Mill St Z-5 Reno NV 89502 880236758 Management Services NV N/A C The Provider Network Inc 1155 Mill St Z-5 Reno NV 89502 880376369 Health Care NV N/A C Remittance Assistance Corporation 1155 Mill St Z-5 Reno NV 89502 880277761 Collections NV N/A C Hometown Health Providers Insurance Co 1155 Mill St Z-5 Reno NV 89502 880177026 Insurance NV N/A C Nevada Heart Institute 1155 Mill St Z-5 Reno NV 89502 880247743 Cardiology NV N/A C NHI-1 Inc 1155 Mill St Z-5 Reno NV 89502 880303924 Cardiology NV N/A C Elko Heart Insititute 1155 Mill St Z-5 Reno NV 89502 452152594 Cardiology NV N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 Hometown Health Plan Inc K 584903 General Ledger