2024-05-09T07:46:48-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 421087612 KNOXVILLE COMMUNITY HOSPITAL INC KNOX 6418421407 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 MAGGIE HAMILTON-BEYER CFO 6418421407 2024-05-08 1 MAGGIE HAMILTON-BEYER 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-05-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KNOXVILLE HOSPITAL & CLINICS MAGGIE HAMILTON-BEYER 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 48780050 0 X WWW.KNOXVILLEHOSPITAL.ORG X 1981 IA TO PROVIDE EXCEPTIONAL HEALTHCARE TO THE PEOPLE OF KNOXVILLE & SURROUNDING COMMUNITIES. 7 7 369 17 200 0 1992747 1177590 47261547 47231844 57928 159265 226937 211208 49539159 48779907 26926 20654 0 0 19642283 20688437 0 0 0 25187091 23965008 44856300 44674099 4682859 4105808 49211220 52447323 21045774 20057598 28165446 32389725 FAITHFULLY PROVIDING EXCEPTIONAL HEALTH CARE. 0 0 40273214 20654 47231844 KNOXVILLE COMMUNITY HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN BOTH INPATIENT AND OUTPATIENT SETTINGS. DURING FISCAL YEAR 2023, THE HOSPITAL PROVIDED 599 DAYS OF SKILLED NURSING CARE AND 201,700 OUTPATIENT OCCASIONS OF SERVICE. 40273214 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 93 0 1 369 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MAGGIE HAMILTON-BEYER 6418421402 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 SAMANTHA KEADY PHYSICIAN 40.00 0.00 X 394307 0 40150 LOGAN MILLER PHYSICIAN 40.00 0.00 X 385190 0 43293 THOMAS HOEHNS PHYSICIAN 40.00 0.00 X 329266 0 33129 JAMES LAW PHYSICIAN 40.00 0.00 X 313490 0 42380 DYLAN LOWE PHYSICIAN 40.00 0.00 X 309575 0 28137 MAGGIE HAMILTON -BEYER CFO 40.00 0.00 X 201062 0 18251 JIM BUTLER PRESIDENT & TREASURER 1.00 0.00 X X 0 0 0 TODD CHAMBERS VICE PRESIDENT 1.00 0.00 X X 0 0 0 CINDI FULLER 2ND VICE PRESIDENT & SECRETARY 1.00 1.00 X X 0 0 0 LISA CROSSETT MEMBER 1.00 0.00 X 0 0 0 DAVE JOHNSON MEMBER 1.00 0.00 X 0 0 0 LORI BAILEY MEMBER 1.00 0.00 X 0 0 0 CONNIE CHRISMAN MEMBER 1.00 0.00 X 0 0 0 KEVIN KINCAID CEO 40.00 0.00 X 0 0 0 1932890 0 205340 23 0 1 1 CAPITAL ORTHOPEDICS AND SPORTS MEDICINE 12499 UNIVERSITY AVE 210 CLIVE IA 50325 ORTHOPEDIC SURGEONS/DOCTORS 1202980 21ST CENTURY REHAB PC PO BOX 461 NEVADA IA 50201 PHYSICAL/OCC THERAPY SERVICES 1042223 DOCS EMERGENCY MEDICINE INC 800 W FRONTIER LN OLATHE KS 66061 ER DOC, HOSPITALIST, CLINIC SERVICES 960305 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 COMPUTER SOFTWARE SYSTEMS 797927 MERCY ONE 1111 6TH AVE DES MOINES IA 50314 MANAGEMENT CONTRACT 688243 40 48300 989090 140200 1177590 NET PATIENT SERVICE REVENUE 621110 23930085 23930085 MEDICARE 621110 16078982 16078982 MEDICAID 621110 4168637 4168637 PHARMACY 621110 3004018 3004018 50122 50122 47231844 146251 146251 80615 0 80615 80615 80615 13157 143 13014 13014 13014 CAFETERIA 900099 130593 200 130393 130593 48779907 47231844 200 370273 X 20654 20654 219313 219313 16445938 14395861 2050077 4023186 3477434 545752 584906 120819 464087 33405 33405 72370 72370 11170 11170 8463026 8187566 275460 85847 85847 2287899 2103276 184623 69276 59608 9668 1924664 1732302 192362 103015 73827 29188 541426 529358 12068 1564115 1528864 35251 301103 225877 75226 MEDICAL SUPPLIES 7432177 7432177 DUES & LICENSES 310450 205432 105018 FOOD COST 180159 180159 44674099 40273214 4400885 0 83447 115201 25484941 26042193 5877902 5924778 575114 468816 241970 291964 36770099 21337709 13626068 15432390 3321778 3621402 0 550579 49211220 52447323 3055822 4370068 13451774 14473479 826269 617540 148807 144709 3563102 451802 21045774 20057598 X 27665446 31889725 500000 500000 28165446 32389725 49211220 52447323 4105808 118471 0 X 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 4518 4518 0 PART II-B, LINE 1: KNOXVILLE COMMUNITY HOSPITAL, INC. PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. 260906 260906 22725059 12699289 10025770 10364441 8638420 1726021 3419693 3419693 15432390 CAPITAL LEASES 436839 ACCRUED INTEREST PAYABLE 14963 451802 X PART X, LINE 2: THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2023, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 0 1 X 1 1 1 0 1 1 28181 0 28181 0.00060 6038363 4168637 1869726 0.04190 6066544 4168637 1897907 0.04250 863 18063 11950 6113 0.00010 60436 292764 5000 287764 0.00640 62284 78127 0 78127 0.00170 123583 388954 16950 372004 0.00820 123583 6455498 4185587 2269911 0.05070 101 265 0 265 0.00000 1101 2536 0 2536 0.00010 1202 2801 2801 0.00010 0 1407141 0 14596013 14669188 -73175 X 1 1 1 1 KNOXVILLE COMMUNITY HOSP INC & CLINICS 1002 S LINCOLN STREET KNOXVILLE IA 50138 WWW.KNOXVILLEHOSPITAL.ORG 630031H X X X X KNOXVILLE COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X WWW.KNOXVILLEHOSPITAL.ORG X 1 21 1 WWW.KNOXVILLEHOSPITAL.ORG 0 1 X 300.000000000000 X X X 1 1 X X X X 1 X WWW.KNOXVILLEHOSPITAL.ORG/BILLING-INFORMATION-POLICIES/BILLING-PAYMENTS X WWW.KNOXVILLEHOSPITAL.ORG/BILLING-INFORMATION-POLICIES/BILLING-PAYMENTS X WWW.KNOXVILLEHOSPITAL.ORG/BILLING-INFORMATION-POLICIES/BILLING-PAYMENTS X X X X X X 1 X 0 X X X X 1 X 0 0 KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 5: RESEARCH TO ENSURE PROPER TOWN HALL REPRESENTATION AND TO DETERMINE THE PRIMARY SERVICE AREA WAS DONE AND DATA WAS COLLECTED. TO ANNOUNCE UPCOMING CHNA WORK AND REQUEST PUBLIC SURVEY PARTICIPATION, A PUBLIC RELATIONS STORY WAS PREPARED AND POSTED ON SOCIAL MEDIA, AS WELL AS SENT TO THE LOCAL MEDIA. A PAPER SURVEY AS WELL AS AN ONLINE LINK TO THE SURVEY WAS MADE AVAILABLE FOR THE PUBLIC TO RESPOND. KHC STAFF ALSO VISITED WITH MANY LOCAL GROUPS SUCH AS ROTARY ABOUT THE CHNA PROCESS AND REQUESTED COMPLETION OF SURVEYS FOR THOSE PRESENT AT THAT MEETING. A PAPER SURVEY WAS USED WITH AN ONLINE LINK TO PSA RESIDENTS. THE SURVEY WAS SENT TO 1,000 PARTICIPANTS WITH THE ANTICIPATION OF RECEIVING 250 COMPLETED SURVEYS. WE PREPARED AND PUBLISHED A TOWN HALL INVITATION TO THE PUBLIC AND COLLABORATING PARTIES SUCH AS PUBLIC HEALTH, SCHOOL LEADERS, FAITH-BASED LEADERS, PHYSICIANS AND OTHER CARE PROVIDERS, AS WELL AS THE MENTAL HEALTH PROVIDER COMMUNITY, FREE CLINICS, LOCAL RESIDENTS, COMMUNITY LEADER, BUSINESS LEADERS, LOCAL GOVERNMENT, PEOPLE WITH CHRONIC CONDITIONS, AND UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS ALONG WITH KNOXVILLE HOSPITAL & CLINICS. WE PREPARED A BRIEF OF GOALS, OBJECTIVE, PURPOSE, OUTCOMES, ROLES, AND COMMUNITY INVOLVEMENT AND HELD A KICK-OFF MEETING. COMMUNITY HEALTH FACTS AND PRACTICE DATA WERE COLLECTED AND PUBLISHED. COMMUNITY OPINIONS WERE COLLECTED ON HEALTH NEEDS, AND NEEDS IDENTIFIED. COMMUNITY OPINIONS WERE ALSO COLLECTED ON HEALTH NEEDS, PRACTICES, AND PHYSICIAN AND CARE PROVIDER AVAILABILITY. THE COMMUNITY HEALTH NEEDS REPORT WAS THEN PREPARED AND PRESENTED TO THE COMMUNITY WITH RECOMMENDED ACTIONS. THE TOWN HALL MEETING INCLUDED DISCUSSION ON PURPOSE, ROLES, REVIEW OF HISTORICAL DATA, PARTICIPANT DISCUSSIONS TALLY AND RANKING OF HEALTH CONCERNS, AND REFLECTION ON THE HEALTH NEEDS OF THE COMMUNITY. THE MEETING CONCLUDED WITH INFORMATION ABOUT THE NEXT STEPS. THE COMMUNITY WAS ENCOURAGED TO CONTINUE TO PARTICIPATE BY CONTRIBUTING IDEAS TO THE HOSPITAL AND PUBLIC HEALTH DEPARTMENT VIA EMAIL OR PERSONAL CONVERSATION. IN ADDITION, OTHER MEETINGS, INTERVIEWS, AND FOCUS GROUPS WERE HELD. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 11: 1. MENTAL HEALTH: INCREASE THE PROVIDED AND BREATH OF SERVICES FOR MENTAL HEALTH NEEDS IN THE COMMUNITIES. A. COMPREHENSIVE EDUCATION OF THE PUBLIC OF MENTAL HEALTH SERVICES AVAILABLE IN THE COMMUNITY SUCH AS THE CROSS REGION ACCESS CENTER, INFINITY HEALTH, EFR IN DES MOINES, UCS HEALTHCARE. KNOXVILLE HOSPITAL & CLINICS WORKS CLOSELY WITH EACH OF THE ORGANIZATIONS. B. CONTINUE TO ASSESS THE AVAILABILITY FOR, OR, POTENTIAL PARTNERSHIP FOR PSYCH/MENTAL HEALTH MEDICAL PROVIDER VIA A CLINIC OR TELEHEALTH. C. DEVELOP A FOCUSED PROGRAM TO ADDRESS THE RISING MENTAL HEALTH NEEDS OF YOUTH/TEENS IN THE COMMUNITY D. PLACEMENT OF COMMUNITY SERVICE WORKERS TO ASSIST POLICE AND COUNTY SHERIFF WHEN WORKING WITH COMMUNITY MEMBERS IN MENTAL HEALTH CRISIS. E. KEVIN KINCAID, CEO, CONTINUES TO LOBBY FOR IMPROVEMENTS IN INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES FOR MEMBERS OF THE COMMUNITY. 2. INCREASE THE AVAILABILITY OF AFFORDABLE HOUSING IN THE COMMUNITY: DEVELOP/FORMALIZE COUNTYWIDE IMPACT PLAN TO ADDRESS HOMELESSNESS. A. COMPLETE TRACKING DATA TO DETERMINE THE CURRENT LEVEL OF HOMELESSNESS/UNSHELTERED INDIVIDUALS IN EACH COMMUNITY. B. FORM A TASKFORCE OF LOCAL RESOURCES AND COMMUNITY REPRESENTATIVES TO IDENTIFY BARRIERS TO OBTAINING HOUSING AND BRAINSTORM WAYS TO ADDRESS THOSE BARRIERS. C. INCREASE IN ENROLLMENT IN ROLLING HILL REGION COORDINATED ENTRY THROUGH INCREASED COMMUNITY AWARENESS/REFERRALS. D. COMPILE A COMPREHENSIVE LIST OF RENTAL PROPERTIES AVAILABLE IN EACH COMMUNITY INCLUDING CONTACT INFORMATION FOR PROPERTY OWNER/MANAGERS. 3. TRANSPORTATION: MAKE ACCESSIBLE (EASY) FOR INDIVIDUALS TO USE WITH REASONABLE ACCESS & AFFORDABILITY. A. DEVELOP A PLAN FOR OFF-HOUR TRANSPORTATION SERVICES INCLUDING BUSINESS SYSTEMS/ROUTE. B. DEVELOP PLANS FOR IMMEDIATE TRANSPORTATION NEEDS INCLUDING AWARENESS OF RESOURCES C. EXPLORE THE OPPORTUNITY FOR ORGANIZED VOLUNTEER SYSTEM FOR TRANSPORTATION IN COMMUNITIES D. EXPLORE POTENTIAL TRANSPORTATION ROUTES FOR PRESCHOOL TO DAYCARE. 4. FOOD INSECURITY: INCREASE THE AVAILABILITY OF AFFORDABLE HEALTHY FOOD OPTIONS FOR MEMBERS OF THE COMMUNITY. A. DEVELOP PLAN FOR AFFORDABLE GROCERY/FOOD PANTRY DELIVERY FOR THE ELDERLY/DISABLED INDIVIDUALS WHO LACK TRANSPORTATION. B. USE SOCIAL MEDIA/PRINT PUBLICATIONS TO PROMOTE AWARENESS OF FOOD RESOURCES TO INCREASE ACCESS AND UNDERSTANDING OF LOCAL/STATE/NATIONAL RESOURCES INCLUDING SNAP FOOD ASSISTANCE, WIC, MEALS ON WHEELS, AND LOCAL FOOD PANTRIES. C. EVALUATE CURRENT FOOD PANTRY USAGE TO DETERMINE POTENTIAL BENEFIT OF ADDITIONAL LOCATIONS/HOURS. D. EXPLORE OPPORTUNITIES FOR FOOD WASTE REDUCTION THROUGH FOOD RESCUE/REDISTRIBUTION OF SURPLUS FOODS. THERE ARE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED AT THIS TIME. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 13H: THE HOSPITAL CONSIDERED FAMILY SIZE IN ADDITION TO THE CRITERIA ABOVE. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 15E: A LETTER IS SENT PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 16J: A LETTER IS SENT, AND IN MANY CASES TWO, PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. 3 1 - KNOXVILLE AREA COMMUNITY HOSPITAL CLINIC 1202 WEST HOWARD STREET KNOXVILLE IA 50138 PHYSICIAN CLINIC 2 - PLEASANTVILLE PHYSICIAN CLINIC 104 NORTH WASHINGTON STREET PLEASANTVILLE IA 50225 PHYSICIAN CLINIC 3 - RED ROCK HEALTH CENTER 615 WASHINGTON STREET PELLA IA 50219 PHYSICIAN CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES, AS WELL AS INSURANCE STATUS, UNDERINSURANCE STATUS, AND FAMILY SIZE, ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED PARTY. PART I, LINE 7: THE COST TO CHARGE RATIO AS FOLLOWS WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST: (TOTAL EXPENSES - BAD DEBT) / (GROSS PATIENT SERVICE REVENUE + OTHER REVENUE) = PERCENTAGE OF COST TO CHARGE. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST BASED ON KNOXVILLE COMMUNITY HOSPITAL INC.'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SERVICE: THE HOSPITAL PROVIDES MEETING ROOM SPACE TO A NUMBER OF COMMUNITY ORGANIZATIONS AT NO COST. THE HOSPITAL PROVIDES SUPPORT TO THE LOCAL CHAMBER WITH MONETARY AND TIME DONATIONS. A FIRST AID TENT INCLUDING LABOR AND SUPPLIES FOR MEDICAL TREATMENT IS PROVIDED DURING KNOXVILLE NATIONALS AND CHAMBER EVENTS. THE HOSPITAL HOSTS AN ANGEL TREE EVERY YEAR TO HELP FAMILIES IN NEED AT CHRISTMAS. WE SUPPORT THE ANNUAL CHRISTMAS LIGHT SHOW AT MARION COUNTY PARK. THE PROCEEDS GO TO THE LOCAL HISTORICAL SOCIETY. THE HOSPITAL OFFERS HEALTH FAIRS ANNUALLY TO MEN, WOMEN AND CHILDREN. THE HOSPITAL MAINTAINS A STRONG RELATIONSHIP WITH THE LOCAL SCHOOL SYSTEM, PROVIDING ATHLETIC TRAINING CARE AT EVENTS AND FREE SPORT PHYSICALS. WE HELD A BREAST CANCER SUPPORT EVENT ON THE SQUARE WITH HEALTH INFORMATION VENDORS.ECONOMIC DEVELOPMENT: THE HOSPITAL PROVIDES LEADERSHIP DEVELOPMENT TRAINING QUARTERLY TO DEPARTMENT LEADERS. ROTATIONS AND PRECEPTORSHIPS ARE MADE AVAILABLE IN VARIOUS SPECIALTIES FOR STUDENTS GOING INTO THE MEDICAL FIELD. THE HOSPITAL IS A MEMBER OF THE LOCAL CHAMBER AND ROTARY CLUB, WITH EMPLOYEES PARTICIPATING IN BOTH. THE HOSPITAL'S ADMISSIONS DIRECTOR IS ON THE LOCAL DAY CARE BOARD. THE HOSPITAL DONATES TO LOCAL PROJECTS ON A REGULAR BASIS. THE HOSPITAL HAS EMPLOYEES ATTENDING CAREER FAIRS IN THE AREA, AND IS PART OF THE LOCAL THRIVE PROGRAM.ECONOMIC IMPROVEMENTS: THE HOSPITAL AGGRESSIVELY RECRUITS FOR NEW PROVIDERS IN AN EFFORT TO SUSTAIN AND GROW. THE HOSPITAL IS PLANNING AN EXTENSIVE REMODEL TO EXPAND ITS EMERGENCY ROOM AND SURGERY AREA. THE HOSPITAL CONTINUOUSLY LOOKS FOR NEW WAYS TO IMPROVE THE HEALTH OFFERINGS PROVIDED TO THE COMMUNITY. THE HOSPITAL HAS EXPANDED COMMUNITY INVOLVEMENT IN IMPROVEMENT AND EXPANSION OF HOSPITAL SPACES. THE HOSPITAL HAS A RELATIONSHIP WITH AREA SCHOOLS, OFFERING FREE SPORTS PHYSICALS. THE HOSPITAL IS CURRENTLY WORKING ON PLANS FOR A NEW PROVIDER CLINIC AND RELOCATION OF CONTRACTED SPECIALISTS TO A BIGGER SPACE AS WELL AS A NEW INFUSION CENTER.OTHER: THE HOSPITAL PROVIDES CAB FARE FROM THE EMERGENCY ROOM FOR INDIGENTS AND USE OF OUR ROOMS FOR LOCAL CLUBS AND COMMUNITY MEETINGS. ADMINISTRATIVE ASSISTANCE IS OFFERED TO VARIOUS ORGANIZATIONS. ONE OF OUR DOCTORS IS PRESIDENT OF THE IOWA PHYSICIANS SOCIETY AND PHYSICIAN CHAMPION FOR THE ACO HEALTH GRANT. THE HOSPITAL NOW OFFERS TELEHEALTH TO HELP PROVIDE ACCESS TO MENTAL HEALTH PROFESSIONALS TO OUR AREA PATIENTS, AND WE PAY FOR PATIENT TRANSPORTATION TO FACILITIES THAT CAN PROVIDE MENTAL HEALTH SERVICES WE DO NOT PROVIDE. PART III, LINE 2: THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: NO AMOUNT OF IMPLICIT PRICE CONCESSIONS ARE INCLUDED AS COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 10, 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES" "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: NONE OF THE SHORTFALL IS TREATED AS A COMMUNITY BENEFIT. "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT D & E WORKSHEETS, OR PS&R. PART III, LINE 9B: THE CHARITY CARE POLICY ALLOWS FOR PROACTIVE WRITE OFF TO ALLOWANCE FOR CHARITY CARE OF ANY BALANCE OWED BY A PATIENT KNOWN TO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. COLLECTION PROCEDURES DO NOT ENSUE ON ANY ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: DURING TAX YEAR 2021, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS, IN COLLABORATION WITH MARION COUNTY PUBLIC HEALTH, HELD TOWN HALL MEETINGS BY SENDING OUT SURVEYS TO DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT TO SET HEALTH GOALS AND PROGRAMS TO ADDRESS THE HEALTH NEEDS AND DESIRES OF THE COMMUNITY CAPTURED IN THE HOSPITAL'S ANNUAL COMMUNITY BENEFIT REPORT. ALSO, THE HOSPITAL ALWAYS UTILIZES INPUT FROM MEDICAL STAFF, THE BOARD OF DIRECTORS AND VARIOUS HOSPITAL ADMINISTRATIVE STAFF WHO REGULARLY REVIEW THE TREATMENT OF PATIENTS TO ENSURE MEDICAL NECESSITY AND APPROPRIATE LEVELS OF CARE ARE CONSISTENTLY PROVIDED TO THE PATIENTS OF THE HOSPITAL. PART VI, LINE 3: CUSTOMER SERVICE AND BILLING STAFF CONTINUALLY MONITOR BALANCES WITHOUT ACTIVITY AND THEN CONTACT THE PATIENTS TO OFFER FINANCIAL ASSISTANCE OR ARRANGE PAYMENT PLANS. THE HOSPITAL ALSO OFFERS THE ABILITY TO MAKE PAYMENTS VIA A WEB-BASED PORTAL. THE PORTAL CONTAINS INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE AND PAYMENT PLAN POLICIES. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING CITIES IN MARION COUNTY: KNOXVILLE (POP. 11,583), PLEASANTVILLE (POP. 2,954), AND MELCHER/DALLAS (POP. 1,625). THE KNOXVILLE COMMUNITY IS 40 MILES SOUTHEAST OF DES MOINES, IOWA. PART VI, LINE 5: KNOXVILLE COMMUNITY HOSPITAL, INC. AND THE CLINICS PROVIDE NUMEROUS OUTPATIENT SPECIALTY PROVIDER CLINICS SUCH AS PODIATRY, ORTHOPEDICS, CARDIOLOGY, UROLOGY, DERMATOLOGY, SLEEP STUDY, ONCOLOGY, AUDIOLOGY, NEPHROLOGY, RHEUMATOLOGY AND EMG TESTING AND OBGYN. PROVIDERS AND STAFF PROVIDE VARIOUS FREE EDUCATIONAL/WELLNESS PROGRAMS FOR THE COMMUNITY/SCHOOLS. THE HOSPITAL IS ADDING TO ITS SPECIALTIES YEARLY, HOSTING ANNUAL PUBLIC EVENTS INCLUDING FREE SKIN CANCER SCREENING. THESE ARE PUBLISHED IN LOCAL NEWSPAPERS. PART VI, LINE 6: DURING TAX YEAR 2022, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS WERE AFFILIATED MEMBERS OF THE MERCY HEALTH NETWORK - CENTRAL IOWA THROUGH MERCY HOSPITAL - DES MOINES, IOWA. MERCY HEALTH NETWORK - CENTRAL IOWA INCLUDES 17 CAH/TWEENER HOSPITALS ALL LOCATED IN CENTRAL IOWA. BENEFITS OF THE AFFILIATION ARE NUMEROUS AND INCLUDE: A. SHARING OF BEST PRACTICES B. SAVINGS ON GROUP PURCHASING AGREEMENTS C. SAVINGS THROUGH GROUP CONTRACTING FOR NUMEROUS SERVICES D. ACCESS TO NUMEROUS HEALTH CARE EXPERTS E. ACCESS TO PROVIDERS OF ALL TYPES AND SPECIALTIES F. ACCESS TO COMPARATIVE REPORTING G. SUPPORT FOR HUMAN RESOURCES, MEDICAL CLINICS, PURCHASING, FINANCE, NUTRITION, MEDICAL SURGERY, AND ANCILLARY AREAS. PART VI, LINE 7, REPORTS FILED WITH STATES IA 1 KNOXVILLE HOSPITAL & CLINICS FOUNDATION 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 900126510 501(C)(3) 10000 0 TRANSFER FUNDS RECEIVED BY THE HOSPITAL THAT WERE INTENDED FOR THE FOUNDATION 1 0 PART I, LINE 2: GRANTS ARE PROVIDED TO KNOXVILLE HOSPITAL & CLINICS FOUNDATION, A RELATED ORGANIZATION. GRANTS ARE MONITORED THROUGH THE USE OF A SHARED ACCOUNTING SYSTEM. 1 X X 0 0 0 0 0 0 0 0 0 SAMANTHA KEADY PHYSICIAN 392287 0 0 0 2020 0 12136 0 28014 0 434457 0 0 0 LOGAN MILLER PHYSICIAN 383150 0 0 0 2040 0 12726 0 30567 0 428483 0 0 0 THOMAS HOEHNS PHYSICIAN 327226 0 0 0 2040 0 11375 0 21754 0 362395 0 0 0 JAMES LAW PHYSICIAN 283686 0 27764 0 2040 0 10743 0 31637 0 355870 0 0 0 DYLAN LOWE PHYSICIAN 307535 0 0 0 2040 0 12889 0 15248 0 337712 0 0 0 MAGGIE HAMILTON -BEYER CFO 186062 0 15000 0 0 0 7598 0 10653 0 219313 0 0 0 SCHEDULE J, PART II: KEVIN KINCAID, CEO, WAS PAID BY AN UNRELATED ORGANIZATION, MERCYONE MEDICAL CENTER - DES MOINES. MERCYONE MEDICAL CENTER HAS A MANAGEMENT AGREEMENT WITH KNOXVILLE COMMUNITY HOSPITAL INC. KNOXVILLE COMMUNITY HOSPITAL PAYS MERCYONE MEDICAL CENTER FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. THE AMOUNT OF COMPENSATION PAID BY MERCYONE MEDICAL CENTER TO KEVIN KINCAID FOR HIS SERVICES AS CEO TO KNOXVILLE COMMUNITY HOSPITAL WAS $345,940. MERCYONE MEDICAL CENTER IS PART OF CATHOLIC HEALTH INITIATIVES. A CITY OF KNOXVILLE IOWA 426004843 2014-08-20 8650000 REFINANCE INDEBTEDNESS INCURRED TO RENOVATE FACILITIES AND PURCHASE EQUIP. 0 0 0 B MARION COUNTY IOWA 421182528 2014-09-20 8650000 FINANCE RENOVATION OF FACILITIES AND PURCHASE EQUIP. 0 0 0 A 1952375 8650000 128143 6527480 1994377 2016 1 0 1 1 B 986967 8650000 128143 7161857 1360000 2016 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 1 B 1 SCHEDULE K, PART II, COLUMN A, LINE 11: $1,994,377 FOR OTHER PROCEEDS WERE SPENT TO REFUND THE 2012 BONDS THAT WERE CALLED ON AUGUST 20, 2014. SCHEDULE K, PART II, COLUMN B, LINE 12: $1,360,000 OF THE BOND ISSUE PRICE WAS NEVER DRAWN UPON AND THERE WILL NEVER BE ANY MONEY BORROWED UPON OR SPENT FROM THIS AMOUNT. SCHEDULE K, PART II, COLUMNS A AND B, LINE 13: THE PROJECT WAS DONE AS A PHASE IN PROJECT WITH MULTIPLE AREAS RENOVATED AND NEW AREAS BUILT. THE ENTIRE PROJECT WAS CONSIDERED COMPLETED BY JUNE 3, 2016. SCHEDULE K, PART III, COLUMNS A AND B, LINE 4: IN 2022, NONE OF THE NEW CLINIC SPACE WAS LEASED. ALL OF THE LEASED SPACE BY SPECIALTY DOCTORS HAS BEEN CONVERTED TO CONTRACT PROVIDER AGREEMENTS OR MOVED TO A NON-BOND FINANCED AREA. THE HOSPITAL HAD ALL OF THE CONTRACT PROVIDER AGREEMENTS REVIEWED BY LEGAL COUNSEL TO ENSURE THAT THE CONTRACTS MEET THE SAFE HARBOR REQUIREMENTS FOR SERVICE AND MANAGEMENT CONTRACTS, THEREBY RESULTING IN NO PRIVATE USE IN THE NEW CLINIC. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, COMPRISED OF THE PRESIDENT, FIRST VICE PRESIDENT, SECOND VICE PRESIDENT, SECRETARY AND TREASURER, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 3 KNOXVILLE COMMUNITY HOSPITAL CONTRACTS WITH MERCYONE MEDICAL CENTER - DES MOINES FOR OVERSIGHT OF MANAGEMENT SERVICES. MERCYONE MEDICAL CENTER PROVIDES A FULL-TIME HOSPITAL CHIEF EXECUTIVE OFFICER/ADMINISTRATOR TO PROVIDE MANAGEMENT SERVICES AND ADMINISTRATIVE DIRECTION. KNOXVILLE COMMUNITY HOSPITAL PAYS MERCYONE MEDICAL CENTER FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION WERE UPDATED MAY 16, 2023. SIGNIFICANT CHANGES INCLUDE UPDATING THE ADDRESS AND REGISTERED AGENT AND STREAMLINING THE PURPOSE OF THE ORGANIZATION. LANGUAGE WAS ALSO ADDED RELATED TO NO PRIVATE INUREMENT OF ASSETS, REFRAINING FROM ACTIVITIES DISALLOWED FOR A 501(C)(3) ORGANIZATION, AND INDEMNIFICATION OF THOSE CONNECTED TO THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS SIGNED BY THE CFO PRIOR TO BEING FILED, IT IS REVIEWED BY THE BOARD OF DIRECTORS AT THE NEXT BOARD MEETING, WHICH MAY OCCUR AFTER FORM 990 HAS BEEN FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER PROVIDES A COMPLIANCE OVERVIEW AND BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY. THE COMPLIANCE OFFICER REVIEWS THE POLICIES AND UPDATES THEM ANNUALLY. THE COMPLIANCE TEAM MEETS QUARTERLY TO REVIEW ALL COMPLIANCE AREAS AND CONFLICT OF INTEREST IS ONE OF THOSE AREAS. THE COMPLIANCE OFFICER ATTENDS SPECIAL TRAININGS ON COMPLIANCE REGULATIONS. EVERY CONFLICT OF INTEREST ONCE RECOGNIZED, MUST BE EVALUATED. IF A CONFLICT EXISTS, THE INDIVIDUAL WILL NOT BE PRESENT DURING GENERAL DISCUSSION NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 PER HUMAN RESOURCE POLICIES, KNOXVILLE COMMUNITY HOSPITAL UTILIZES THE IHA WAGE SURVEY AND COMPARATIVE ANALYSIS AND MARKET RATES. MOST WAGES ARE ADJUSTED WHEN THE BOARD OF DIRECTORS APPROVES PAY INCREASE PERCENTAGES. KNOXVILLE COMMUNITY HOSPITAL DOES PAY FOR PERFORMANCE IN CONJUNCTION WITH SALARY SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 KNOXVILLE COMMUNITY HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST AT ORGANIZATION'S ADMINISTRATIVE OFFICES DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G OUTSIDE MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 4,050,439. MANAGEMENT AND GENERAL EXPENSES 275,460. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,325,899. NURSING SERVICES: PROGRAM SERVICE EXPENSES 894,280. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 894,280. EMERGENCY ROOM SERVICES: PROGRAM SERVICE EXPENSES 724,561. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 724,561. PHYSICAL THERAPY SERVICES: PROGRAM SERVICE EXPENSES 866,455. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 866,455. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 610,920. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 610,920. LAB SERVICES: PROGRAM SERVICE EXPENSES 433,207. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 433,207. NUCLEAR MEDICINE SERVICES: PROGRAM SERVICE EXPENSES 350,230. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350,230. RESPIRATOR SERVICES: PROGRAM SERVICE EXPENSES 257,474. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 257,474. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. KNOXVILLE HOSPITAL & CLINICS FOUNDATION 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 900126510 SUPPORT FOR KNOXVILLE COMMUNITY HOSPITAL IA 501(C)(3) LINE 7 KNOXVILLE COMMUNITY HOSPITAL INC 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0