2011-01-13T08:59:50-05:00 2010-08-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2009-09-01 370512290 Shelby Memorial Hospital Association Inc SHEL 2177743961 200 South Cedar Street Shelbyville IL 62565 PHILIP MILLER 2011-01-12 true Donna J Larson 3142315544 2009 2016-02-24 21:20:13Z MARILYN SEARS 200 SOUTH CEDAR SHELBYVILLE IL 62565 17520967 false X N/A X 1916 IL 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. 12 12 212 0 104697 -139952 313199 69326 15346910 14550846 -417524 322339 163450 157813 15406035 15100324 0 0 0 0 7245520 6680692 0 0 0 8591049 8086318 15836569 14767010 -430534 333314 31032742 32054721 8721515 9043418 22311227 23011303 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 12296840 14409721 OPERATION OF A 30 BED HOSPITAL FACILITY AND A 19 BED ATTACHED NURSING HOME FACILITY WHICH PROVIDE ALL ROUTINE AND ANCILLARY SERVICES. SERVICES INCLUDED 25,979 OUTPATIENT REGISTRATIONS, 7,023 RURAL HEALTH CLINIC VISITS, 4,260 INPATIENT DAYS & 4,919 EMERGENCY ROOM VISITS. 12296840 true true false false false false false false true true false true false false false false false false false false true false false true false false false false false false false false false false false false false true true false true 16 0 true 212 true true true false false false false false false false false 12 12 false false false false false false false true true false false false true true true true true true true false IL X PHILIP MILLER 2177743961 200 SOUTH CEDAR SHELBYVILLE IL 62565 ELAINE BERRY 1.0 X X 0 0 0 DR DAVID OLIGSCHLAEGER 1.0 X 0 0 0 SUSAN TYNAN 1.0 X 0 0 0 MARK LUCE 1.0 X 0 0 0 JACK YOCKEY 1.0 X 0 0 0 PAUL KARRAKER 1.0 X 0 0 0 TADD BRACHBILL 1.0 X 0 0 0 DAVID CRUITT 1.0 X 0 0 0 TAD MAYHALL 1.0 X 0 0 0 LARRY DILLEY 1.0 X X 0 0 0 JAMES KLEPZIG 1.0 X X 0 0 0 KEVIN ROSS 1.0 X 0 0 0 JOHN BENNETT 40.0 X 154368 0 10410 MARILYN SEARS 40.0 X 110950 0 7431 REGINA CALVERT 40.0 X 81533 0 7321 DR ARNOLD AGAPITO 40.0 X 137374 0 6602 484225 0 31764 3 false true false CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY MANAGEMENT 961321 EMERGENCY STAFFING SOLUTIONS 17304 PRESTON ROAD SUITE 555 DALLAS TX 75252 ER PHYSICIANS 609720 SBLHC 1000 HEALTH CENTER DRIVE MATTOON IL 61938 LABORATORY SERVICES 106926 SPECIAL CARE HOSPITAL 12303 Depaul Drive 2nd Floor ST LOUIS MO 63045 DAY REHAB SERVICES 161448 4 24996 44330 69326 CHARGE FOR MEDICAL SRVC, ROOM, CARE & OTHER 621110 14337650 14337650 SHE ANCILLARY 446199 104697 104697 CAFETERIA SALES 722100 36428 36428 MISCELLANEOUS INCOME 900099 72071 72071 14550846 396510 396510 0 0 0 0 169472 12802 156670 156670 156670 2333670 2407841 -74171 -74171 -74171 0 0 0 0 0 0 CATERING INCOME 722320 1143 1143 1143 15100324 14409721 104697 516580 0 0 0 0 363000 0 363000 0 0 4889270 4370065 519205 175759 147032 28727 887676 766349 121327 364987 305332 59655 0 18311 18311 93612 93612 0 0 0 2118473 2118473 19945 19945 1721345 1378660 342685 0 0 313161 313161 51498 37880 13618 0 0 187397 187397 0 1056279 950651 105628 345252 345252 BAD DEBT EXPENSE 1439567 1439567 IPA ASSESSMENT FEE 252221 252221 PHARMACY 131774 131774 COLLECTION & ADMINISTRATION 120008 120008 DUES & FEES 170817 50613 120204 46658 15117 31541 14767010 12296840 2470170 0 1728431 2454034 834875 845773 2023351 2323384 297036 73212 209123 185064 308933 435863 24588570 17155412 8001940 7433158 16271033 16944038 4356 4356 22235 18333 1331429 1337506 31032742 32054721 956515 1068418 7525000 7315000 240000 660000 8721515 9043418 X 22211227 22911303 60000 60000 40000 40000 22311227 23011303 31032742 32054721 X false true false X false X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1348180 9900 240 1358320 1324418 22970 792 1348180 0.92630 0.02950 0.04420 false false 473600 473600 10860799 6342244 4518555 245904 74989 170915 3819729 3210430 609299 9188538 7527749 1660789 7433158 0 EST. THIRD PARTY SETTLEMENTS 660000 660000 USE OF ENDOWMENT FUNDS PART V, LINE 4 THE FUNDS ARE TO BE USED FOR BOND RESERVE FUND, A LETTER OF CREDIT AGREEMENT, OPERATIONS, AND MAINTENANCE OF ASSOCIATION. true true X true X true X true true false false 217613 0 217613 0.01630 1867627 1118148 749479 0.05620 0 0 0 0.00000 2085240 1118148 967092 0.07250 15605 0 15605 0.00120 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 15605 0 15605 0.00120 2100845 1118148 982697 0.07370 true 473000 7982947 6090929 1892018 X false SHELBY MEMORIAL HOSPITAL ASSOCIATIONINC

200 SOUTH CEDAR STREET SHELBYVILLE IL 62565

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201 SOUTH PINE SHELBYVILLE IL 62565

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200 SOUTH CEDAR SHELBYVILLE IL 62565

LONG TERM CARE 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 WAS USED FOR ALL PATIENT SEGMENTS. THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,439,567 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. THE ASSOCIATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE ASSOCIATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE ASSOCIATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE AMOUNT REPORTED ON LINE 2 WAS DETERMINED USING THE COST TO CHARGE RATIO. THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT. 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. 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. SHELBY MEMORIAL HOSPITAL PRIMARILY SERVES THE RESIDENTS OF SHELBY COUNTY, ILLINOIS. TOTAL POPULATION IS 21,874 ACCORDING TO THE 2008 CENSUS ESTIMATES 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 POVERTY LEVEL. 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 EMERGENT AND NON-EMERGENT 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, THE MID-ILLINOIS CHAPTER OF THE AMERICAN RED CROSS 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 TWO YEARS. ADDITIONALLY, SMH HAS SPENT MONIES AND TIME IN MEETING MEANINGFUL USE FOR THE COMPUTERIZED MEDICAL RECORD. SMH'S COMMITMENT TO ELECTRONIC MEDICAL RECORDS MAKES US ONE OF THE FEW SMALL RURAL HOSPITALS IN THE NATION APPLYING TO THE FEDERAL GOVERNMENT FOR THE FUNDS AS OF JANUARY 2011 UNDER THE AMERICAN RECOVERY ACT OF 2009. ALL FUNDS ARE RETAINED BY THE CORPORATION AND REINVESTED IN THE HEALTHCARE NEEDS OF THE COMMUNITY PRESENT OR FUTURE. X X X X false false false false false false false false false JOHN BENNETT 154368 0 0 0 0 0 6338 0 4072 0 164778 0 0 0 REVIEW PROCESS FORM 990, PART IV, SECTION A, LINE 11 THE 990 IS REVIEWED BY THE CFO FOR ACCURACY. NO REVIEW WAS OR WILL BE CONDUCTED BY THE ORGANIZATION'S GOVERNING BODY. COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART IV, SECTION B, LINE 12C 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. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINE 15A/B 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 CFO. PROCESS FOR MAKING DOCUMENTS AVAILABLE TO PUBLIC FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SHELBY MEMORIAL HOSPITAL FOUNDATIONINC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371294401 FUNDRAISING IL 501(C)(3) 11 - I NA false false true false false false false false false false false false true true false false false true SHELBY MEMORIAL HOSPITAL FOUNDATION INC R 82979