Community Benefit Insight - Tax-exempt hospital

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Shenandoah Medical Center

Shenandoah Medical Center

300 Pershing Ave
Shenandoah, IA 51601

Bed count	25	Medicare provider number	161366	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 421101835

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

2.97%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 51,893 0.11 %
Medicaid as % of operating expenses	$ 1,365,383 2.81 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 1,331 0.00 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 11,314 0.02 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 13,701 0.03 %
Community building* as % of operating expenses	$ 1,141,074 2.35 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	5,880
Physical improvements and housing	0
Economic development	0
Community support	5,880
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 1,141,074 2.35 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 1,141,074 100 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 3,676,826 7.57 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 42715612 including grants of $ 0) (Revenue $ 46670412)
SHENANDOAH MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN AN INPATIENT AND OUTPATIENT SETTING. IN JUNE OF 2020 THE SHENANDOAH MEDICAL CENTER ASSUMED RESPONSIBILITY FOR THE CANCER TREATMENT CENTER. IN 2021 THE CANCER CENTER PROVIDED 1,024 VISITS. SHENANDOAH MEDICAL CENTER CONTINUES TO LEASE SPACE TO THE DIALYSIS TREATMENT CENTER. DURING 2021 THE HOSPITAL PROVIDED 1,113 DAYS OF ACUTE CARE, 804 DAYS OF SKILLED CARE, 157 NURSERY DAYS AND 201,882 OUTPATIENT OCCASIONS OF SERVICE.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SHENANDOAH MEDICAL CENTER
PART V, SECTION B, LINE 5: THE CHNA TOWN HALL WAS HELD OVER LUNCH ON WEDNESDAY, FEBRUARY 13, 2019 AT THE THE HISTORICAL SOCIETY IN SHENANDOAH, IA. VINCE VANDEHAAR, MBA, AND ALEXA BACKMAN FACILITATED THIS 1-1/2 HOUR SESSION WITH THIRTY SIX (36) COMMUNITY ATTENDEES. SMC CONSULTED WITH VVV RESEARCH & DEVELOPMENT, INC. TO COMPLETE THE NEEDS ASSESSMENT WHICH WAS FINALIZED IN 2019. SMC PARTNERED WITH PAGE COUNTY PUBLIC HEALTH AND CLARINDA REGIONAL HEALTH CENTER IN CLARINDA, IA TO COMPLETE THE ASSESSMENT. ONGOING MEETINGS WITH CHNA STAKEHOLDERS WERE HELD THURSDAY, APRIL 4, 2019 AT SHENANDOAH MEDICAL CENTER IN SHENANDOAH, IA.

SHENANDOAH MEDICAL CENTER
PART V, SECTION B, LINE 6A: CLARINDA REGIONAL HEALTH CENTER IN CLARINDA, IA

SHENANDOAH MEDICAL CENTER
PART V, SECTION B, LINE 6B: PAGE COUNTY PUBLIC HEALTH

SHENANDOAH MEDICAL CENTER
PART V, SECTION B, LINE 11: SHENANDOAH MEDICAL CENTER HAS WORKED TO EXPAND MENTAL HEALTH SERVICES IN PAGE COUNTY BY CONTINUING TO PARTNER WITH OTHER MENTAL HEALTH ORGANIZATIONS IN SHENANDOAH TO INCREASE ACCESS TO CARE. SMC HAS ALSO WORKED TO IMPLEMENT TELEHEALTH SERVICES THROUGH A PARTNERSHIP WITH THE UNIVERSITY OF IOWA HOSPITAL AND HEALTH CLINICS IN AN EFFORT TO GAIN ACCESS TO PSYCHIATRIC TELEHEALTH SERVICES FOR CHILDREN. ADDITIONALLY, TELEHEALTH PARTNERSHIPS WERE DEVELOPED TO GAIN ACCESS TO BEHAVIORAL HEALTH CARE IN BOTH THE EMERGENCY ROOM AND THE ELM HEIGHTS CARE CENTER, WHICH HAS PROVIDED MUCH IMPROVED ACCESS TO CARE. SMC FIGHTS DRUG ABUSE THROUGH USE OF SPECIFIC PAIN CONTRACTS ENTERED INTO BETWEEN PROVIDERS AND PATIENTS WITH DRUG ABUSE HISTORY. SMC ALSO PARTNERS WITH SEVERAL ORGANIZATIONS SUCH AS ZION RECOVERY SERVICES TO INCREASE THE ACCESS TO TREATMENT FOR DRUG ABUSE PATIENTS. SMC HAS AN ACCREDITED PATIENT CENTERED MEDICAL HOME THAT INCLUDES TWO HEALTH COACHES THAT MANAGE THE CARE OF ACUTE DIABETIC PATIENTS VIA PARTNERSHIP WITH IOWA MEDICAID. SMC CONTINUES TO WORK CLOSELY WITH SHENANDOAH COMMUNITY SCHOOLS TO PROVIDE EDUCATION ON SEXUALLY TRANSMITTED INFECTIONS AND PROVIDES A GREAT DEAL OF PATIENT COUNSELING VIA ITS THREE OB-GYN PHYSICIANS. SMC CONTINUES TO ADVOCATE FOR OUR PATIENTS TO ASSIST WITH THE RISING COSTS OF HEALTHCARE THROUGH THE IOWA HOSPITAL ASSOCIATION. SMC HAS DEVELOPED WELLNESS PARTNERSHIPS WITH SEVERAL LOCAL EMPLOYERS THAT INCLUDE BLOOD DRAWS WITH WELLNESS LAB TESTING, A REVIEW OF LAB RESULTS WITH OUR OCCUPATIONAL HEALTH NURSE, A FORMULATION OF AN INDIVIDUALIZED WELLNESS PLAN, AND MEMBERSHIP TO OUR WELLNESS CENTER. THE IMPLEMENTATION OF THESE SERVICES HAS A GOAL OF LOWERING INSURANCE CLAIMS EXPERIENCE FOR LOCAL EMPLOYERS TO ENSURE MORE AFFORDABLE HEALTH INSURANCE. A NEED THAT DID NOT GET DIRECTLY ADDRESSED BY SMC WAS THE IMPROVEMENT OF ACCESS TO DENTAL SERVICES FOR OUR MEDICAID PATIENTS. THIS ITEM WAS NOT CONSIDERED RELATED TO THE FACILITY'S MISSION CRITICAL OPERATIONS. AS A RESULT, SMC WILL CONTINUE TO HELP SUPPORT COMMUNITY PARTNERS IN ORDER TO ADDRESS THOSE NEEDS.

SHENANDOAH MEDICAL CENTER
PART V, SECTION B, LINE 13H: THE ELIGIBILITY OF EACH APPLICANT FOR FINANCIAL ASSISTANCE IS DETERMINED ON A CASE BY CASE BASIS THROUGH COORDINATION OF THE PATIENT FINANCIAL COUNSELOR, BUSINESS OFFICE MANAGER, AND CHIEF FINANICAL OFFICER. ELIGIBILITY IS BASED ON A REVIEW AND VERIFICATION OF INCOME OF AN INDIVIDUAL OR FAMILY, INCLUDING THE SIZE OF THE FAMILY. VERIFICATION INCLUDES BUT IS NOT LIMITED TO: TAX RETURNS, PAY STUBS, SOCIAL SECURITY CHECKS, DISABILITY CHECKS OR BANK STATEMENTS. DETERMINATION IS BASED UPON INCOME DATA DIRECTLY RELATED TO FEDERAL POVERY LEVEL AFTER APPLYING ALL OTHER RESOURCES. CHARITY CARE IS BASED ON 200% OF POVERTY LEVEL. AN UNINSURED DISCOUNT OF 35% IS GRANTED TO ALL PATIENTS WITH NO INSURANCE. AN ADDITIONAL 20% DISCOUNT IS AUTOMATICALLY GRANTED TO THESE INDIVIDUALS ONCE THEY COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. FURTHER DISCOUNTING IS APPLIED BASED ON THE APPLICANT'S ABILITY TO MEET THE ELIGIBILITY CRITERIA.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
NOT APPLICABLE

PART I, LINE 6A:
THE ANNUAL COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED ORGANIZATION.

PART I, LINE 7:
THE ORGANIZATION UTILIZED AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE.

PART I, LINE 7G:
THERE WERE NO SUBSIDIZED HEALTH SERVICES DURING THE YEAR.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,676,826.

PART II, COMMUNITY BUILDING ACTIVITIES:
"SHENANDOAH MEDICAL CENTER PROVIDES JOB SHADOWING OPPORTUNITIES TO HIGH SCHOOL STUDENTS OF SHENANDOAH, AND PROFESSIONAL STUDENT ROTATIONS FOR PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, PHLEBOTOMY, RADIOLOGY TECHNOLOGIST, MEDICAL TECHNOLOGIST, ANESTHESIA, REHABILITATION, NURSING, AND MEDICAL STUDENTS. THESE ACTIVITIES HELP TO FURTHER THE EDUCATION OF THE COMMUNITY ON HEALTH IMPROVEMENT AND MAINTENANCE AND ALSO ASSIST IN THE DEVELOPMENT OF LOCAL INDIVIDUALS IN BECOMING HEALTH CARE PROFESSIONALS. SMC ALSO PROVIDES AN ANNUAL ""SCRUBS CAMP"" TO GRADE SCHOOL AND MIDDLE SCHOOL STUDENTS TO PROVIDE THEM WITH EXPOSURE TO HEALTHCARE RELATED FIELDS. COVID-19 HAD A DRAMATIC IMPACT ON PARTICIPATION IN THESE PROGRAMS."

PART III, LINE 2:
GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE MEDICAL CENTER PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE MEDICAL CENTER ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON 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. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE.FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENTS ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.

PART III, LINE 3:
THE MEDICAL CENTER PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE MEDICAL CENTER NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE MEDICAL CENTER DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE MEDICAL CENTER DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEAR ENDED DECEMBER 31, 2021 AND 2020 WAS APPROXIMATELY $115,000 AND $66,000, RESPECTIVELY.

PART III, LINE 4:
"THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOOTNOTES TITLED ""PATIENT RECEIVABLES,"" ""PATIENT SERVICE REVENUE, AND ""PATIENT FINANCIAL ASSISTANCE"" CAN BE FOUND ON PAGES 8, 11, AND 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS."

PART III, LINE 8:
THERE IS NO MEDICARE SHORTFALL IN THE CURRENT YEAR. ANY SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE IT REPRESENTS UNCOMPENSATED CARE PROVIDED TO INDIVIDUALS IN THE SHENANDOAH AND SURROUNDING COMMUNITIES. IT HAS BEEN DETERMINED BASED ON THE OVERALL MEDICARE ALLOWABLE COST AS A PERCENT OF TOTAL CHARGES, APPLIED TO THE TOTAL MEDICARE CHARGES.

PART III, LINE 9B:
ONCE A PATIENT HAS BEEN DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT IS UPDATED WITH THE APPROPRIATE AMOUNT OF FINANCIAL ASSISTANCE. IF A PATIENT HAS HAD ALL ACCOUNTS GRANTED FULL FINANCIAL ASSISTANCE, THE PATIENT RECEIVES NOTICE THAT ALL OBLIGATIONS HAVE BEEN SATISFIED. IF THERE IS A REMAINING PATIENT BALANCE, SMC'S FINANCIAL COUNSELOR WORKS CLOSELY WITH THE PATIENT TO AGREE UPON A PAYMENT PLAN THAT IS FINANCIALLY FEASIBLE FOR THE PATIENT.

PART VI, LINE 2:
THE ORGANIZATION'S LEADERSHIP INFORMALLY MEETS WITH LEADERS IN THE COMMUNITY TO DISCUSS COMMUNITY ISSUES, AS WELL AS ATTEMPTS TO IDENTIFY AREAS WHERE SMC CAN BE OF SERVICE TO THE EMPLOYERS IN THE COMMUNITY.

PART VI, LINE 3:
THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO ALL PATIENTS ON THE WEBSITE. ADDITIONALLY, OUR THIRD PARTY SELF-PAY ORGANIZATION MAILS APPLICATIONS TO THOSE PATIENTS WHO INDICATE THAT THEY DO NOT HAVE THE MEANS TO PAY THEIR ACCOUNTS. UPON CONTACT AT SMC, OUR SOCIAL SERVICES REPRESENTATIVE AND PATIENT FINANCIAL COUNSELOR DISCUSS OPTIONS WITH PATIENTS AND ALSO ASSIST IN THE COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATIONS, MEDICARE AND MEDICAID APPLICATIONS IF APPLICABLE, AND MAKING ANY OTHER ARRANGEMENTS NECESSARY TO ASSIST PATIENTS IN FINANCIALLY SATISFYING THEIR OBLIGATIONS. PATIENTS ARE ALSO NOTIFIED OF THE FINANCIAL ASSISTANCE POLICY AT ADMISSION AND DISCHARGE.

PART VI, LINE 4:
THE MEDIAN HOUSEHOLD INCOME WAS $51,867 AND $56,750 FOR PAGE AND FREMONT COUNTIES, RESPECTIVELY IN 2019, AS COMPARED TO THE STATE MEDIAN HOUSEHOLD INCOME OF $60,523. AS A BYPRODUCT OF THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA, SHENANDOAH MEDICAL CENTER TREATS A SIGNIFICANT NUMBER OF MEDICAID, UNINSURED, AND UNDERINSURED PATIENTS. THE AREA POPULATION IS PREDOMINATELY WHITE, NON-HISPANIC.

PART VI, LINE 5:
IN ADDITION TO ITS EFFORTS TO ADDRESS THE NEEDS IDENTIFIED BY ITS COMMUNITY HEALTH NEEDS ASSESSMENT, THE FACILITY ALSO HAS AN ACTIVE INTERNAL WELLNESS PROGRAM THAT IT IS CURRENTLY ROLLING OUT TO THE COMMUNITY. ADDITIONALLY, THE HOSPITAL OPERATES A WELLNESS CENTER THAT PROVIDES VERY AFFORDABLE MEMBERSHIP RATES AND PERSONAL TRAINING OPTIONS TO HELP PROMOTE WELLNESS IN THE COMMUNITY.

PART VI, LINE 6:
SMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Operating expenses	$ 48,568,243
Total amount spent on community benefits as % of operating expenses	$ 1,443,622 2.97 %