2024-02-05T09:43:33-06:00 2023-03-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-04-01 880256932 SOUTH LYON HEALTH CENTER INC DBA SOUTH LYON MEDICAL CENTER SOUT 7754632301 PO BOX 940 YERINGTON NV 89447 TONI INSERRA CHIEF EXECUTIVE OFFICER 7754632301 2024-02-02 1 TONI INSERRA 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-02-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TONI INSERRA PO BOX 940 YERINGTON NV 89447 17383758 0 X WWW.SLMCNV.ORG X 1990 NV PROVIDE HEALTHCARE FOR THE RESIDENTS AND VISITORS TO THE CITY OF YERINGTON AND LYON COUNTY, NEVADA. 8 7 198 7 0 0 3266641 1560041 14124772 15728448 0 -6544 53584 87269 17444997 17369214 0 0 0 0 8523936 8816415 0 0 0 6698248 8409712 15222184 17226127 2222813 143087 12479449 11003105 3840593 2221162 8638856 8781943 TO PROVIDE ACCESS TO QUALITY HEALTH CARE SERVICES NEEDED BY THE COMMUNITY. 0 0 10993639 0 11789539 THE HOSPITAL IS A 14-BED ACUTE HOSPITAL WITH 24 HOUR EMERGENCY ROOM, FULL SERVICE LAB, AND X-RAY DEPARTMENTS. THE E/R SEES APPROXIMATELY 312 PATIENTS A MONTH. CLOSE COMMUNICATIONS WITH LARGER FACILITIES AND SPECIALISTS IN MANY DISCIPLINES ALLOW BOTH HELICOPTER AND AIR AMBULANCE SERVICES TO TAKE PATIENTS TO THOSE HOSPITALS WITHIN A SHORT AMOUNT OF TIME. HOSPITAL HAS A SLIDING FEE SCALE AND FINANCIAL ASSISTANCE AVAILABLE FOR PATIENTS COMPLETING APPLICATIONS. THE HOSPITAL PROVIDES THE STANDARD INFLUENZA VACCINE AT A NOMINAL COST. 2299280 0 2465739 THE LONG-TERM CARE PROGRAM IS A MEDICARE APPROVED 49-BED SKILLED NURSING AND LONG-TERM CARE FACILITY WITH IN-HOUSE PHYSICAL THERAPY AVAILABLE. STAFF TO PATIENT RATIO IS ABOVE REQUIRED. A SOCIAL WORKER/RESIDENT ADVOCATE AND AN ENTHUSIASTIC ACTIVITIES PROGRAM MAKE OUR LTC ONE OF THE FINEST ANYWHERE. 1373718 0 1473170 THE CLINICS PROGRAM CONSISTS OF THREE RURAL HEALTH CLINICS. WE HAVE PHYSICIANS, PHYSICIANS ASSISTANTS, AND NURSE PRACTITIONERS THAT WORK OUT OF OUR CLINICS TO SERVE THE NEEDS OF THE COMMUNITY. ONE OF OUR CLINICS IS A WALK-IN CLINIC AVAILABLE AT CONVENIENT HOURS FOR OUR PATIENTS WHO NEED TO SEE A PROVIDER IMMEDIATELY OR WHO DO NOT HAVE A REGULAR DOCTOR. ALL CLINICS OFFER SERVICES AT A REDUCED FEE FOR THOSE WHO NEED IT. A FINANCIAL COUNSELOR IS AVAILABLE FOR ASSISTANCE AT ALL TIMES. 14666637 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 19 0 198 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID BEZARD 7754636402 213 SOUTH WHITACRE STREET YERINGTON NV 89447 ROBERT ROWLEY PRESIDENT 1.00 X X 0 0 0 JOHN DIEKMANN VICE PRESIDENT (THRU 08/2022) 1.00 X X 0 0 0 KALEB WARTGOW DIRECTOR/CHIEF OF STAFF 40.00 X 258250 0 29774 JOANNE LAWSON VICE PRESIDENT 1.00 X X 0 0 0 EMILY CHRISTENSEN DIRECTOR 1.00 X 0 0 0 SCOTT HUNTLY DIRECTOR 1.00 X 0 0 0 MYRTLE MCDOWELL DIRECTOR 1.00 X 0 0 0 ALYCE REESE DIRECTOR 1.00 X 0 0 0 DALE THEISS DIRECTOR (THRU 07/2022) 1.00 X 0 0 0 RONNIE WEIR-COOLEY DIRECTOR 1.00 X 0 0 0 TONI INSERRA CEO 40.00 X 166050 0 13262 DAVID BEZARD CFO 40.00 X 143377 0 26630 LOREN SIMPSON MD 32.00 X 277721 0 29417 DANIEL VILLALOBOS JR PHYSICIAN ASSISTANT 40.00 X 125150 0 27111 THOMAS CLIFTEN PHYSICAL THERAPIST 40.00 X 156340 0 26798 THOMAS H ARD IT SUPERVISOR 40.00 X 151050 0 12962 TOM WALSH NURSE PRACTIONER 39.00 X 290342 0 5807 1568280 0 171761 12 0 1 0 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 55485 NURSING LOCUMS SERVICES 1967385 WESTERN HEALTHCARE LLC P O BOX 21228 DEPT 170 TULSA OK 74121 EMERGENCY ROOM LOCUMS SERVICES 764640 INTERIM PHYSICIANS LLC PO BOX 679139 DALLAS TX 75267 EMERGENCY ROOM LOCUMS SERVICES 685314 MILES CONSTRUCTION 61 INDUSTRIAL PARKWAY CARSON CITY NV 89706 CONSTRUCTION GENERAL CONTRACTOR 283201 RURAL PHYSICIANS GROUP PANNU 5575 DTC PARKWAY STE 225 GREENWOOD VILLAGE CO 80111 EMERGENCY ROOM LOCUMS SERVICES 115193 5 1535448 24593 1560041 PROGRAM SERVICE REVENUE-RELATED 621400 12816494 12816494 UPL REVENUE 621400 1288365 1288365 DISTRICT TAX SUBSIDY 900099 977277 977277 HOSPITAL DISTRICT REIMBURSEMENT 621400 626307 626307 20005 20005 15728448 2450 0 2450 2450 2450 8000 14544 -6544 -6544 -6544 EMPLOYEE MEALS 900099 30474 30474 54345 54345 84819 17369214 15728448 0 80725 X 657566 609647 47919 7031372 6212687 818685 105527 48169 57358 475654 215443 260211 546296 275418 270878 123944 123944 125 125 4930185 4714015 216170 69999 69999 270856 140448 130408 420372 420372 373823 370627 3196 52743 36892 15851 42098 36314 5784 1292 1151 141 466626 415795 50831 36684 31293 5391 MEDICAL SUPPLIES 914929 914929 BAD DEBT EXPENSE 636809 636809 TAXES AND LICENSES 32971 32971 DUES AND SUBSCRIPTIONS 23146 7000 16146 13110 13110 17226127 14666637 2559490 0 1400 1400 6435822 3490514 2205614 3167815 208527 195240 275016 255022 5037887 1206134 3353070 3831753 0 61361 12479449 11003105 1190916 946268 2588623 1226612 61054 8047 0 40235 3840593 2221162 X 8120303 8781943 518553 0 8638856 8781943 12479449 11003105 143087 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 125 125 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF NEVADA HOSPITAL ASSOCIATION AND NATIONAL RURAL HEALTH ASSOCIATION. A PORTION OF MEMBERSHIP DUES TO IS USED FOR LOBBYING. THE ASSOCIATIONS ADVOCATE ON BEHALF OF MEMBERS FOR IMPROVING EFFICIENCY AND ACCESSIBILITY TO THE HEALTHCARE DELIVERY SYSTEMS AND THE HEALTH STATUS OF PATIENTS. 2678001 190322 2487679 2359886 1015812 1344074 3831753 OPERATING LEASE OBLIGATIONS 40235 40235 1 1 X 1 X 1 X 1 0 0 146982 146982 0.00890 3020630 1551498 1469132 0.08860 3167612 1551498 1616114 0.09750 3167612 1551498 1616114 0.09750 0 507243 236031 2280817 3047255 -766438 X 1 1 1 1 SOUTH LYON MEDICAL CENTER PO BOX 940 YERINGTON NV 89447 WWW.SLMCNV.ORG 660RUH-19 X X X RURAL SOUTH LYON MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V, SECTION C, LINE 7D X X 1 21 1 SEE PART V, SECTION C, LINE 7D 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 5: INFORMATION WAS COLLECTED FROM PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY UNMET HEALTH NEEDS WITHIN THE COMMUNITY. INFORMATION FROM THESE SOURCES WAS SUMMARIZED INTO THEMES THAT REPRESENT THE COMMUNITY'S UNMET HEALTH NEEDS, WHICH SERVE AS THE BASIS OF THE CHNA.PRIMARY DATA:PRIMARY DATA REPRESENTS INFORMATION COLLECTED FIRSTHAND FROM STAKEHOLDERS WITHIN SLMC'S COMMUNITY. THIS DATA WAS COLLECTED TO VALIDATE SECONDARY DATA FINDINGS THAT PERTAIN TO SLMC'S SERVICE AREA, IDENTIFY ISSUES THAT WERE NOT REPRESENTED IN THE SECONDARY DATA, AND UNDERSTAND WHAT SPECIFIC SUBGROUPS OF THE COMMUNITY MAY FACE ADDITIONAL CHALLENGES OR DISPARITIES.INTERVIEWS WERE CONDUCTED WITH COMMUNITY STAKEHOLDERS WHO BEST REPRESENTED THE BROAD INTERESTS, EXPERIENCES, AND NEEDS OF SLMC'S COMMUNITY, PARTICULARLY PEOPLE WHO REPRESENT MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS. A COMMUNITY HEALTH SURVEY WAS ALSO DISTRIBUTED TO ENSURE THAT EACH PERSON HAD THE OPPORTUNITY TO PARTICIPATE AND BE HEARD IN THIS PROCESS. A COMPLETE LIST OF THE COMMUNITY STAKEHOLDERS CAN BE FOUND IN THE REFERENCES AND ACKNOWLEDGMENTS.THE INTERVIEWS AND SURVEYS WERE DESIGNED TO SOLICIT INFORMATION PERTAINING TO THE FOLLOWING TOPICS:- SIGNIFICANT HEALTHCARE ISSUES OR NEEDS- SOCIAL, BEHAVIORAL, AND ENVIRONMENTAL FACTORS THAT CONTRIBUTE TO HEALTH NEEDS- BARRIERS TO CARE WITHIN THE COMMUNITY- VULNERABLE POPULATIONS WHO EXPERIENCE DISPARITIES- SUGGESTIONS OR IDEAS TO ADDRESS THE COMMUNITY'S NEEDS- POTENTIAL RESOURCES OR INFRASTRUCTURE TO SUPPORT HEALTH, SOCIAL, BEHAVIORAL, OR ENVIRONMENTAL NEEDS- AREAS FOR COLLABORATION TO ADDRESS HEALTH NEEDSSECONDARY DATA:SECONDARY DATA WAS COLLECTED FROM STATISTICAL DATA SOURCES AVAILABLE AT THE LOCAL, REGIONAL, STATE, AND NATIONAL LEVEL. THIS DATA PROVIDES A PROFILE OF THE DEMOGRAPHIC, SOCIAL, ECONOMIC, AND HEALTH CHARACTERISTICS OF SLMC'S COMMUNITY. TO THE EXTENT POSSIBLE DATA WAS COLLECTED AT THE LOCAL LEVEL, AND COMPARED TO REGIONAL, STATE, OR NATIONAL BENCHMARKS WHEN DETERMINING HEALTH NEEDS.SOURCES OF SECONDARY DATA INCLUDE:- AMERICAN COMMUNITY SURVEY- BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM- CENTER FOR DISEASE CONTROL AND PREVENTION- COUNTY HEALTH RANKINGS- ESRI BUSINESS INFORMATION SOLUTIONS- HEALTHIEST COMMUNITIES, A COLLABORATION BETWEEN U.S. NEWS AND THE UNIVERSITY OF MISSOURI EXTENSION CENTER FOR APPLIED RESEARCH AND ENGAGEMENT SYSTEMS- U.S. CENSUS BUREAU SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7A & 10A:HTTPS://SLMCNV.ORG/COMMUNITY-NEEDS-ASSESSMENT/ SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 11: CHNA IMPLEMENTATION PLAN:IN COLLABORATION WITH WIPFLI AND THE ADVISORY COMMITTEE, SLMC DEVELOPED AN IMPLEMENTATION PLAN TO ADDRESS THE PRIORITIZED HEALTH NEEDS. SLMC WILL EXPLORE THE FOLLOWING STRATEGIC OBJECTIVES AND TACTICS TO ADDRESS THE PRIORITIZED HEALTH NEEDS:ACCESS TO PRIMARY CAREACCESS TO SPECIALTY CARESTRATEGIC OBJECTIVES:- REDUCE APPOINTMENT WAIT TIMES TO CREATE BETTER ACCESSIBILITY FOR PATIENTS- IMPROVE PROVIDER PRODUCTIVITY TO CREATE BETTER ACCESSIBILITY FOR PATIENTS- IMPROVE ACCESSIBILITY FOR SPANISH-SPEAKING PATIENTS- RIGHT-SIZE NUMBER OF PROVIDERS EMPLOYED BY SLMC TO ALIGN SUPPLY WITH DEMANDTACTICS:- IMPLEMENT AND ADVERTISE A TWO-WEEK APPOINTMENT GUARANTEE WITHIN THE COMMUNITY- DEVELOP AN ADVERTISEMENT STRATEGY TO REACH THE HISPANIC POPULATION AND INCREASE RECRUITMENT OF BI-LINGUAL EMPLOYEES- CONDUCT A CLINICAL OPERATIONAL ASSESSMENT TO ANALYZE PROVIDER THROUGHPUT AND PRODUCTIVITY AND OTHER FACTORS IMPACTING THE PATIENT EXPERIENCE AT SLMC- EXPLORE IMPLEMENTING PRODUCTIVITY-BASED COMPENSATION AGREEMENTS TO IMPROVE PROVIDER PRODUCTIVITY- CONDUCT AN ASSESSMENT TO DETERMINE NUMBER OF PRIMARY CARE PROVIDERS NEEDED TO SUPPORT COMMUNITY DEMAND- CONTINUE SUPPORTING PARTNERSHIPS/AFFILIATIONS WITH RURAL RESIDENT TRAINING PROGRAMS TO RECRUIT MORE PRIMARY CARE PROVIDERS COMMITTED TO RURAL HEALTH TO SLMCSTRATEGIC OBJECTIVES:- EXPLORE FEASIBILITY OF OFFERING NEW SPECIALTY SERVICES AT SLMC- RIGHT-SIZE NUMBER OF PROVIDERS EMPLOYED OR CONTRACTED BY SLMC TO ALIGN SUPPLY WITH DEMAND- IMPROVE ADVERTISEMENT OF SERVICES AVAILABLE AT SLMC, INCLUDING DIAGNOSTIC AND OUTREACH/VISITING SPECIALTY SERVICES- REDUCE TRANSPORTATION BARRIERS FOR PATIENTS WHO NEED TO ACCESS SPECIALTY SERVICESTACTICS:- EXPLORE FEASIBILITY OF IMPLEMENTING A CARDIAC ECHO PROGRAM TO SUPPORT PATIENTS WITH HEART DISEASE- IMPLEMENT PROVIDER EDUCATION FOR TELEHEALTH SPECIALTY REFERRALS- HIRE A SOCIAL MEDIA COORDINATOR TO IMPROVE SOCIAL MEDIA PRESENCE AND IMPROVE ADVERTISEMENT OF SERVICES WITHIN THE COMMUNITY, INCLUDING THE HISPANIC POPULATION- EXPLORE COLLABORATION WITH HELPING HANDS TO PROVIDE FINANCIAL/OPERATIONAL SUPPORTMENTAL HEALTH AND SUBSTANCE USE:STRATEGIC OBJECTIVES:- IMPROVE ACCESSIBILITY TO MENTAL HEALTH AND SUBSTANCE USE SERVICES AT SLMC- RECRUIT OR CONTRACT WITH MORE BEHAVIORAL HEALTH PROVIDERS TO IMPROVE OUTPATIENT AND EMERGENCY RESPONSE SERVICES- IMPROVE ADVERTISEMENT OF BEHAVIORAL HEALTH SERVICES AVAILABLE AT SLMCTACTICS:- CONTINUE PROVIDING ACCESSIBILITY TO TELE-MENTAL HEALTH SERVICES WITH RENOWN, AND EXPLORE VIRTUAL PRESCRIBING CAPABILITIES FOR MEDICATION-ASSISTED TREATMENT- EXPLORE NEED FOR AND BARRIERS TO TELE-MENTAL HEALTH ADOPTION AND UTILIZATION IN SLMC PATIENTS- EXPLORE CONTRACTING WITH BEHAVIORAL HEALTH SOLUTIONS TO PROVIDE BEHAVIORAL HEALTH SERVICES TO PATIENTS- EXPLORE CONTRACTING WITH A LICENSED CLINICAL SOCIAL WORKER TO PROVIDE EMERGENCY BEHAVIORAL HEALTH CASE MANAGEMENT SERVICES PART V, SECTION B, LINE 16 (A-C): HTTPS://SLMCNV.ORG/FINANCIAL-SERVICES/ 4 1 - LONG TERM CARE 213 S WHITACRE STREET YERINGTON NV 89447 LONG TERM CARE 2 - PHYSICIAN'S CLINIC 311 SURPRISE STREET YERINGTON NV 89447 RURAL HEALTH CLINIC 3 - BARNETT CLINIC 213 S WHITACRE STREET YERINGTON NV 89447 RURAL HEALTH CLINIC 4 - SMITH VALLEY CLINIC 445 STATE HWY 338 WELLINGTON NV 89444 RURAL HEALTH CLINIC PART I, LINE 7: THE COSTING METHODOLOGY IS THE COST TO CHARGES RATIO. THE COST-TO-CHARGES RATIO IS USED FOR ALL PATIENT SEGMENT LINE INPATIENT, OUTPATIENT, AND EMERGENCY ROOM. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 636,809. PART II, COMMUNITY BUILDING ACTIVITIES: THERE ARE A VARIETY OF ACTIVITIES THAT SLMC DOES TO SUPPORT AND PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS WEDNESDAY (OFFERING REDUCED COST FOR SERVICES), PROVIDING SPACE FOR SPECIALISTS FOR LOCAL VISITS, PROVIDING FREE MEETING ACCESS TO COMMUNITY SUPPORT ORGANIZATIONS, PROVIDING DIABETIC EDUCATION TO PATIENTS, THEIR FAMILIES, AND THE COMMUNITY. SLMC ALSO PROVIDES TRAVELING FLU VACCINATION CLINICS TO AREA BUSINESSES. MANY OF THESE PROGRAMS ARE NOT EASY OR COST EFFECTIVE TO TRACK IN OUR ACCOUNTING SYSTEM AND THEREFORE ARE NOT REPORTED. PART III, LINE 2: THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY IS DETERMINED BY THE ORGANIZATION USING INFORMATION AVAILABLE TO MAKE AN EDUCATED ESTIMATE. PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOOTNOTE INCLUDED HERE IS THE PATIENT AND RESIDENT ACCOUNTS RECEIVABLES AND CREDIT POLICY NOTE.PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT AND RESIDENT CARE SERVICES. PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS, WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT AND RESIDENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT AND RESIDENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORTED IN THE MEDICARE COST REPORT IS THE COST TO CHARGE RATIO. PART III, LINE 9B: EMERGENCY ROOM PATIENTS WITHOUT A PAYMENT SOURCE MAY BE CLASSIFIED AS CHARITY IF THEY DO NOT HAVE A JOB, MAILING ADDRESS, RESIDENCE, OR INSURANCE. CONSIDERATION MUST ALSO BE GIVEN TO CLASSIFYING EMERGENCY ROOM ONLY PATIENTS WHO DO NOT PROVIDE ADEQUATE INFORMATION AS TO THEIR FINANCIAL STATUS. IN MANY INSTANCES, THESE PATIENTS ARE HOMELESS AND HAVE FEW RESOURCES TO COVER THE COST OF THEIR CARE.IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE HOSPITAL'S CHARITY CARE ELIGIBILITY CRITERIA, THEIR PATIENT ACCOUNT MAY BE CONSIDERED CHARITY CARE, EVEN IF THEY WERE ORIGINALLY CLASSIFIED AS A BAD DEBT. COLLECTION AGENCY PATIENT ACCOUNTS MEETING CHARITY CARE CRITERIA SHOULD BE RETURNED TO THE HOSPITAL BILLING OFFICE AND REVIEWED FOR CHARITY CARE ELIGIBILITY. PART VI, LINE 2: SOUTH LYON MEDICAL CENTER (SLMC) CONDUCTS WELLNESS WEDNESDAY WEEKLY OFFERING REDUCED LAB TESTING TO ACCESS PATIENT HEALTH. SLMC WILL MEET WITH LOCAL ORGANIZATIONS (I.E., ROTARY, SOROPTIMISTS, ETC.) UPON REQUEST. SLMC IS ALSO DEVELOPING A COMMUNITY WELLNESS PROGRAM WITH A FOCUS ON DIABETES IN ENGLISH AND SPANISH. THE ORGANIZATION PROVIDES COMMENT BOXES, HCAPHS SURVEYS AND PATIENT COMPLAINT/CONCERNS SURVEYS TO GATHER INFORMATION ON COMMUNITY NEEDS. PART VI, LINE 3: PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE THROUGH THE CHARITY CARE POLICY ARE MADE THROUGH EACH OF THE FOLLOWING MEANS:1. POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMITTING OFFICES, AND HOSPITAL OUTPATIENT SERVICE SETTINGS.2. INCLUDING INFORMATION IN THE BILLS SENT TO UNINSURED PATIENTS STATEMENTS INDICATING:A) IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS, THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR FOR FINANCIAL ASSISTANCE FROM THE HOSPITAL.B) A HOSPITAL PHONE NUMBER THAT PATIENTS MAY CALL FOR FURTHER INFORMATION.3. POSTING NOTICE OF THE AVAILABILITY OF ASSISTANCE AND A CONTACT PHONE NUMBER ON THE SLMC WEB SITE.4. PROVIDING UNINSURED PATIENTS INFORMATION OUTLINING THE TYPES OF FINANCIAL ASSISTANCE AVAILABLE.POSTED NOTICES (AS LISTED ABOVE) SHALL BE IN THE PRIMARY LANGUAGE(S) OF SLMC'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. POSTED NOTICES SHALL CONTAIN THE FOLLOWING INFORMATION:1. A STATEMENT INDICATING THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS WHO MAY NOT BE ABLE TO PAY THEIR BILL AND THAT THIS POLICY PROVIDES FOR FULL OR PARTIAL CHARITY CARE WRITE-OFF.2. IDENTIFICATION OF A HOSPITAL CONTACT PHONE NUMBER THAT THE PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND ABOUT HOW TO APPLY FOR ASSISTANCE. PART VI, LINE 4: AS OF 2021, THE POPULATION OF THE PSA IS 8,897, WITH PROJECTIONS ESTIMATING THAT THE PSA IS ANTICIPATED TO GROW BY 3% OVER THE NEXT FIVE YEARS, OR BY ABOUT 286 PEOPLE.THE AGE DISTRIBUTION OF THE POPULATION ALSO IMPACTS THE NEED FOR HEALTHCARE SERVICES. THE COMMUNITY SERVED BY SLMC TRENDS SIGNIFICANTLY OLDER THAN STATE AND NATIONAL BENCHMARKS, WITH 30% OF THE POPULATION CONSISTING OF PEOPLE OVER THE AGE OF 65. THIS AGE COHORT IS ANTICIPATED TO CONTRIBUTE TO A MAJORITY OF THE GROWTH PROJECTED IN THE PSA OVER THE NEXT FIVE YEARS (321 PEOPLE) SLMC'S PSA IS PREDOMINANTLY WHITE, WITH 64% OF THE POPULATION CONSISTING OF INDIVIDUALS WHO IDENTIFY AS WHITE, NON-HISPANIC. APPROXIMATELY 26% OF THE POPULATION IDENTIFIES AS HISPANIC, HIGHER THAN THE NATIONAL BENCHMARK OF 19%. INCOME IS ONE OF THE MOST IMPORTANT SOCIAL DETERMINANTS OF HEALTH, IMPACTING NOT ONLY EDUCATION AND LIVING CONDITIONS, BUT ALSO PHYSICAL HEALTH, MENTAL HEALTH, AND HEALTH-RELATED BEHAVIORS SUCH AS DIET AND EXERCISE. HOUSEHOLD INCOME IN THE PSA TRENDS SIGNIFICANTLY LOWER THAN COUNTY, STATE, AND NATIONAL BENCHMARKS, WITH 38% OF HOUSEHOLDS IN THE PSA REPORTING A HOUSEHOLD INCOME BELOW $35,000, COMPARED TO 29% OF HOUSEHOLDS IN LYON COUNTY. THIS INDICATES THAT SLMC'S PSA IS SIGNIFICANTLY LESS AFFLUENT. PART VI, LINE 5: SOUTH LYON MEDICAL CENTER HAS A COMMUNITY-BASED BOARD OF DIRECTORS; AN OPEN MEDICAL STAFF AND USES SURPLUS FUNDS TO PAY FOR COMMUNITY SERVICES SUCH AS HEALTH FAIRS, SPACE FOR MEDICAL SPECIALISTS FOR LOCAL VISITS. X X 0 0 0 0 0 0 0 0 0 LOREN SIMPSON MD 277721 0 0 0 0 0 5554 0 23863 0 307138 0 0 0 TOM WALSH NURSE PRACTIONER 290342 0 0 0 0 0 5807 0 0 0 296149 0 0 0 KALEB WARTGOW DIRECTOR/CHIEF OF STAFF 258250 0 0 0 0 0 5165 0 24609 0 288024 0 0 0 THOMAS CLIFTEN PHYSICAL THERAPIST 156340 0 0 0 0 0 3155 0 23643 0 183138 0 0 0 TONI INSERRA CEO 166050 0 0 0 0 0 3321 0 9941 0 179312 0 0 0 DAVID BEZARD CFO 143377 0 0 0 0 0 2987 0 23643 0 170007 0 0 0 THOMAS H ARD IT SUPERVISOR 151050 0 0 0 0 0 3021 0 9941 0 164012 0 0 0 DANIEL VILLALOBOS JR PHYSICIAN ASSISTANT 125150 0 0 0 0 0 2503 0 24608 0 152261 0 0 0 REBECCA INSERRA EMPLOYEE OF HOSPITAL 63808 REBECCA INSERRA IS A FAMILY MEMBER OF TONI INSERRA. 0 TAMMY MCCONNELL EMPLOYEE OF HOSPITAL 55146 TAMMY MCCONNELL IS A FAMILY MEMBER OF MYRTLE MCDOWELL. 0 JOHSUA INSERRA EMPLOYEE OF HOSPITAL 17886 JOSHUA INSERRA IS A FAMILY MEMBER OF TONI INSERRA. 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS 48 MEMBERS. THERE IS ONLY ONE CLASS OF MEMBERS, ALL MEMBERS ARE VOTING MEMBERS. MEMBERSHIP IS LIMITED TO RESIDENTS OF THE SOUTH LYON HOSPITAL DISTRICT. MEMBERS ARE ACCEPTED ANNUALLY UPON COMPLETION OF AN APPLICATION AND PAYMENT OF ANNUAL DUES. MEMBERS MAY HAVE A MOTION CONSIDERED BY THE BOARD OF DIRECTORS. ANY WRITTEN MOTION THAT IS SECONDED WILL BE PRESENTED TO THE BOARD AND THERE WILL BE A DETERMINATION WITHIN 90 DAYS. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS HAVE UNLIMITED TERMS AND ARE ACCEPTED UPON YEARLY COMPLETION OF THE CORPORATION APPLICATION AND PAYMENT DUES. THE MEMBERS ARE REQUIRED TO MEET ANNUALLY AND MUST BE RESIDENTS OF THE SOUTH LYON HOSPITAL DISTRICT. MEMBERSHIP IS NOT TRANSFERABLE OR ASSIGNABLE. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE AUDIT FIRM BASED ON THE INFORMATION PROVIDED BY THE CFO OF THE ORGANIZATION. FORM 990 IS THEN REVIEWED AND APPROVED BY THE CEO PRIOR TO PRESENTING TO THE BOARD OF DIRECTORS. THE FORM IS THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, MEMBERS OF THE ADMINISTRATIVE STAFF, AND OTHER PERSONS EMPLOYED BY THE ORGANIZATION. COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. ADMINISTRATION AND RISK MANAGEMENT REVIEW FILES FOR SIGNATURES AND DISCLOSURES. IF A CONFLICT OF INTEREST DOES OCCUR, IT IS ANNOUNCED TO THE ENTIRE BOARD PRESENT. IF NECESSARY, THE BOARD ASKS FOR STAFF INPUT AND LEGAL OPINION TO DETERMINE IF A CONFLICT EXISTS IF THE BOARD CANNOT DO SO INDEPENDENTLY. THE INTERESTED BOARD MEMBER WILL ABSTAIN FROM VOTING ON ITEMS THAT HAVE BEEN IDENTIFIED AS A POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO, TOP MANAGEMENT AND OFFICERS OF THE ORGANIZATION IS DETERMINED BY USING SURVEYS FROM THE NEVADA HOSPITAL ASSOCIATION, NEVADA RURAL HOSPITAL PARTNERS, MGMA, MERRITT HAWKINS AND OTHER PROFESSIONAL SURVEY INSTRUMENTS. THE CEO'S COMPENSATION IS THEN APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. 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 AND ANNOUNCES SUCH AT BOARD MEETINGS AND THE ANNUAL SOUTH LYON HOSPITAL DISTRICT CORPORATION MEETING. FORM 990, PART IX, LINE 11G MED/SURG SERVICES: PROGRAM SERVICE EXPENSES 1,620,215. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,620,215. ER SERVICES: PROGRAM SERVICE EXPENSES 1,816,042. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,816,042. LTC SERVICES: PROGRAM SERVICE EXPENSES 585,578. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 585,578. OTHER SERVICES: PROGRAM SERVICE EXPENSES 350,863. MANAGEMENT AND GENERAL EXPENSES 101,838. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 452,701. MRI SERVICES: PROGRAM SERVICE EXPENSES 185,509. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 185,509. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 155,808. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 155,808. BUSINESS OFFICE PURCHASE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 114,332. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,332.