2024-11-04T09:49:09-06:00 2023-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-01-01 420843389 IDA COUNTY IOWA COMMUNITY HOSPITAL INC IDAC 7123643311 701 EAST 2ND STREET IDA GROVE IA 51445 SHANNON FOX CFO 7123643311 2024-10-31 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-10-31 2023 2024-10-15 13:58:12Z HORN MEMORIAL HOSPITAL GLEN WINEKAUF 701 EAST 2ND STREET IDA GROVE IA 51445 27982371 0 X WWW.HORNMEMORIALHOSPITAL.ORG X 1966 IA TO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF IDA GROVE & THE SURROUNDING COMMUNITIES. 9 9 232 16 0 0 1737904 1470483 25368481 26111393 111654 80557 164561 185867 27382600 27848300 0 0 0 0 13537932 14690148 0 0 0 12843821 13808058 26381753 28498206 1000847 -649906 34695468 36220594 10475409 12384162 24220059 23836432 TO PROVIDE QUALITY CARE AND EDUCATION AS A PARTNER IN YOUR HEALTH AND WELLNESS. 0 0 26261732 26111393 IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC. D/B/A HORN MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICE TO PATIENTS IN THE AREA OF IDA GROVE, IOWA. IT ALSO OPERATES HOME HEALTH AND HOSPICE AGENCIES, PROVIDER-BASED RURAL HEALTH CLINICS IN IDA GROVE, IOWA AND SURROUNDING COMMUNITIES, AND OTHER HEALTHCARE SERVICES.HEALTHCARE SERVICES PROVIDED TO PATIENTS: 556 ACUTE PATIENT DAYS, 858 SKILLED PATIENT DAYS, 13 INTERMEDIATE DAYS, 22,819 OUTPATIENT OCCASIONS OF SERVICE, 3,241 HOME HEALTH VISITS. 26261732 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 232 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X SHANNON FOX 7123643311 701 EAST 2ND STREET IDA GROVE IA 51445 ALBERT VELTRI PHYSICIAN 40.00 0.00 X 358576 0 58448 MAX DELANEY CRNA 40.00 0.00 X 239275 0 52982 SHARON VANDEVEGTE PHYSICIAN 40.00 0.00 X 236411 0 52131 CURTIS HESSE PHYSICIAN 40.00 0.00 X 239618 0 23072 GLEN WINEKAUF CEO 40.00 1.00 X 211996 0 11936 SHELLY ELSE PA 40.00 0.00 X 156713 0 50251 JONI SCHUMANN CFO THRU 9/23 40.00 1.00 X 118046 0 19750 NICHOLE EHRIG CFO 40.00 1.00 X 110407 0 2330 JEAN BURNS CHAIR 0.50 0.00 X X 0 0 0 DAVID FORBES VICE CHAIR 0.50 0.00 X X 0 0 0 KELLI BOYLE SECRETARY 0.50 0.00 X X 0 0 0 COLE BOGER TREASURER 0.50 1.00 X X 0 0 0 PETER GOLDSMITH DIRECTOR THRU 4/23 0.50 0.00 X 0 0 0 CHRISTINA HANSON DIRECTOR 0.50 0.00 X 0 0 0 VANCE LUNDELL DIRECTOR 0.50 0.00 X 0 0 0 ROB PAULSEN DIRECTOR 0.50 0.00 X 0 0 0 KRIS GUNDERSON DIRECTOR 0.50 0.00 X 0 0 0 DENISE REDENIUS DIRECTOR 0.50 1.00 X 0 0 0 1671042 0 270900 16 0 1 0 BADDING CONSTRUCTION COMPANY 814 W 9TH STREET CARROLL IA 51401 CONSTRUCTION SERVICES 2574196 WMG RED HAWTHORNE LLC 912 INDUSTRIAL DRIVE SUITE 102 MILBANK SD 57252 PROVIDER SERVICES 2044550 SPORTS REHAB & PHYSICAL THERAPY CENTER 11623 ARBOR STREET OMAHA NE 68144 REHAB SERVICES 1141386 NEXT LEVEL RESPIRATORY SERVICES LLC 4105 145TH STREET URBANDALE IA 50323 RESPIRATORY THERAPY SERVICES 474962 CERNER CORPORATION PO BOX 203448 DALLAS TX 75320 HEALTH INFORMATION TECHNOLOGY 393669 28 36760 1046111 387612 1470483 MEDICARE/MEDICAID PAYMENTS 624100 17535190 17535190 PATIENT SERVICE REVENUE 624100 6905608 6905608 340B REVENUE 624100 1470243 1470243 200352 200352 26111393 164225 164225 73090 0 73090 73090 73090 35700 119368 -83668 -83668 -83668 24738 14703 10035 10035 CAFETERIA/DIETARY 722514 102742 102742 102742 27848300 26111393 0 266424 X 481764 481764 10838081 10357654 480427 434270 411743 22527 2161910 1974188 187722 774123 711207 62916 204943 204943 137767 137767 5808126 5683354 124772 70060 5772 64288 1200672 1122596 78076 1238835 1179723 59112 260702 249173 11529 29335 28181 1154 230889 205763 25126 1832697 1619136 213561 48731 48731 MEDICAL SUPPLIES 2204011 2204011 DUES AND SUBSCRIPTIONS 398816 333838 64978 MISCELLANEOUS 75134 75134 LEASE AND RENTAL 47795 43161 4634 19545 8367 11178 28498206 26261732 2236474 0 13872 20193 10760743 6164536 305374 232495 3267778 5347366 530148 571320 73555 158077 39558953 21228771 15631350 18330182 2454613 2799276 449633 318033 1208402 2279116 34695468 36220594 1857698 3305192 94152 8275769 7459551 1116098 341942 409169 10475409 12384162 X 23751859 22112329 468200 1724103 24220059 23836432 34695468 36220594 -649906 266279 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 3867 3867 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING. 253789 253789 22495775 13049334 9446441 8934616 7597826 1336790 7874773 581611 7293162 18330182 RIGHT OF USE ASSET - FINANCING LEASE (NET) 396449 THIRD-PARTY PAYOR SETTLEMENTS 1882667 2279116 RIGHT OF USE ASSET - FINANCING LEASE (NET) 409169 409169 X 28104544 266279 266279 27838265 10035 10035 27848300 28495095 0 28495095 3111 3111 28498206 PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY GROSS MARGIN 10,035. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 3,111. 1 1 X 1 X 1 X 1 1 0 1 1 35 16061 0 16061 0.00060 5182467 5012545 169922 0.00600 35 5198528 5012545 185983 0.00660 24459 20256 2483 17773 0.00060 70 3690 0 3690 0.00010 24529 23946 2483 21463 0.00070 24564 5222474 5015028 207446 0.00730 1 596986 11900 11027780 11233924 -206144 X 1 1 1 1 HORN MEMORIAL HOSPITAL 701 EAST 2ND STREET IDA GROVE IA 51445 HORNMEMORIALHOSPITAL.ORG 470061H X X X X IDA COUNTY IOWA COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_NEEDS X 1 22 1 WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_NEEDS 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X 1 X WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=PAYMENT_ARRANGEMENTS X WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=PAYMENT_ARRANGEMENTS X WWW.HORNMEMORIALHOSPITAL.ORG/GETPAGE.PHP?NAME=PAYMENT_ARRANGEMENTS X X X X X X 1 X 0 X X X X 1 X 0 0 IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC PART V, SECTION B, LINE 5: PARTICIPANTS VIA ONLINE SURVEY INCLUDED 19 HEALTH PROVIDERS, 1 SOCIAL SERVICES PROVIDER, AND 26 OTHER COMMUNITY LEADERS. MULTIPLE OTHER DATA SOURCES WERE ALSO CONSULTED TO COMPLEMENT THE RESEARCH QUALITY OF THE CHNA. WRITTEN COMMENTS AND FEEDBACK WERE ALSO REQUESTED THROUGH HORN'S WEBSITE. COMMUNITY DEFINED FOR THE CHNA INCLUDED THE THREE COUNTIES OF IDA, MONONA, AND SAC BASED ON THE AREAS OF RESIDENCE OF MOST RECENT PATIENTS OF HORN MEMORIAL HOSPITAL. IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC PART V, SECTION B, LINE 11: HORN'S COMMITTEE OF NINE MEMBERS MET TO DISCUSS AND PRIORITIZE THE TOP HEALTH NEEDS IDENTIFIED FROM THE CHNA. THE BOARD OF TRUSTEES OFFICIALLY REVIEWED AND APPROVED THE FOUR PRIORITIZED SIGNIFICANT COMMUNITY NEEDS AND INITIATIVES RELATED TO THESE AREAS:1) MENTAL HEALTH - INCREASE AWARENESS AND ACCESS TO MENTAL HEALTH SERVICES.2) HEART DISEASE & STROKE - INCREASE ACCESS AND AWARENESS OF HEART DISEASE AND STROKE RESOURCES.3) CANCER - PROMOTE/ENCOURAGE REFERRALS FOR PREVENTABLE CANCER SCREENINGS.4) ACCESS TO HEALTHCARE - INCREASE ACCESS TO HEALTHCARE SERVICES IN OUR SERVICE AREA AND INCREASE COMMUNITY AWARENESS OF SERVICES AVAILABLE FOR HORN.HORN IS NOT ADDRESSING THE FOLLOWING NEEDS IDENTIFIED: 1) SUBSTANCE ABUSE - OTHER FACILITIES OR ORGANIZATIONS IN THE COMMUNITY ARE ADDRESSING THE NEED.2) RESPIRATORY DISEASE - DUE TO RESOURCE CONSTRAINTS.3) ORAL HEALTH - DUE TO THE RELATIVELY LOW PRIORITY ASSIGNED TO THE NEED.4) INJURY & VIOLENCE - DUE TO THE RELATIVELY LOW PRIORITY ASSIGNED TO THE NEED.IN 2023, HORN TOOK THE FOLLOWING ACTIONS TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED:1) MENTAL HEALTH: MENTAL HEALTH MATTERS NEWSPAPER AD, CALL 988 ON FACEBOOK, MENTAL HEALTH Q&A, MAKE IT OK EDUCATION AND NEWSLETTER- IDA COUNTY MENTAL HEALTH COALITION (SOCIAL WORKER JOINED), ITP USE FOR ALL SUICIDAL PATIENTS. 2) HEART DISEASE/STROKE: MERCY CARDIOLOGY STARTED COMING IN 2023, STROKE EDUCATION, INFORMATIONAL FLYERS POSTED, HEART HEALTH EDUCATION AND STROKE AWARENESS.3) CANCER: EDUCATION ON CANCER SCREENINGS AND RISKS.4) ACCESS TO HEALTHCARE: ANNUAL WELLNESS VISIT EDUCATION, HPC CLINIC HOURS AND SPECIALTY SERVICES AVAILABLE EDUCATION. IDA COUNTY, IOWA COMMUNITY HOSPITAL, INC PART V, SECTION B, LINE 13B: DISCOUNTS FOR PATIENTS WITH NO INSURANCE AND PROMPT PAYMENT ARE NOT BASED ON ANY INCOME LEVEL. 4 1 - HORN PHYSICIANS CLINIC IDA GROVE 700 EAST 2ND STREET IDA GROVE IA 51445 PHYSICIAN CLINIC 2 - HORN PHYSICIANS CLINIC ODEBOLT 300 SOUTH MAPLE STREET ODEBOLT IA 51458 PHYSICIAN CLINIC 3 - HORN PHYSICIANS CLINIC MAPLETON 412 MAIN STREET MAPLETON IA 51034 PHYSICIAN CLINIC 4 - HORN PHYSICIANS CLINIC HOLSTEIN 1400 SOUTH KIEL STREET HOLSTEIN IA 51025 PHYSICIAN CLINIC PART I, LINE 3C: THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. THE ORGANIZATION ALSO USES ASSET LEVEL, MEDICAL INDIGENCY AND INSURANCE STATUS. DISCOUNTS FOR PATIENTS WITH NO INSURANCE AND PROMPT PAYMENT ARE NOT BASED ON ANY INCOME LEVEL. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT WAS NOT PREPARED BY A RELATED PARTY. PART I, LINE 7: THE COST TO CHARGE RATIO PER IRS WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS IN THE UPPER PORTION OF THE TABLE. COSTING OF THE "OTHER BENEFITS" PORTION OF THE TABLE WAS CALCULATED PER GUIDANCE PROVIDED BY THE IOWA HOSPITAL ASSOCIATION IN TERMS OF PROPER REPORTING OF COMMUNITYBENEFITS. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL DOES NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES. 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: THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTH CARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN THE STATEMENTS OF OPERATIONS. THE HOSPITAL 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 THE OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR PATIENT FINANCIAL ASSISTANCE PATIENTS FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022 WERE APPROXIMATELY $11,900 AND $14,900, RESPECTIVELY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS CONTAIN A FOOTNOTE TITLED "PATIENT SERVICE REVENUE" DESCRIBING IMPLICIT PRICE CONCESSIONS WHICH CAN BE FOUND ON PAGES 10 & 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS, THEREFORE THE ENTIRE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. PART III, LINE 9B: ONCE A PATIENT HAS BEEN DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PAYMENT PLAN IS ESTABLISHED. IF THEY DEFAULT, AFTER TWO MONTHS OUR BAD DEBT COLLECTION POLICIES ARE ENACTED AND FOLLOWED. PART VI, LINE 2: COMMUNITY NEEDS ARE ASSESSED REGULARLY THROUGH FEEDBACK FROM PATIENT SURVEYS, OUR MEDICAL STAFF (MANY OF WHOM ARE COMMUNITY RESIDENTS) AND EMPLOYEES, AS WELL AS OUR BOARD OF TRUSTEES WHO LIVE IN AND REPRESENT THECOMMUNITIES WE SERVE. A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS CONDUCTED EVERY THREE YEARS TO EVALUATE OUR ONGOING SERVICE REQUIREMENTS, IDENTIFY NEW SIGNIFICANT HEALTH NEEDS, AND IMPLEMENT STRATEGIES TO ADDRESS THEM. PART VI, LINE 3: OUR CONSENT TO TREATMENT FORM INCLUDES LANGUAGE REGARDING FINANCIAL ASSISTANCE AND CONTACT INFORMATION. THIS IS ALSO PRINTED AT THE REGISTRATION DESKS. IN ADDITION, OUR FINANCIAL ASSISTANCE POLICY IS POSTED IN REGISTRATION AREAS OF BOTH THE HOSPITAL AND ITS CLINICS. OUR HOSPITAL WEBSITE OFFERS ADDITIONAL INFORMATION UNDER THE PATIENTS AND VISITORS, PAYMENT ARRANGEMENTS SECTION REGARDING OUR PAYMENT REQUIREMENTS, FINANCIAL ASSISTANCE POLICY, SLIDING FEE SCALES, AND THE APPLICATION FORM FOR FINANCIAL ASSISTANCE. MAIL AND PHONE INQUIRIES REGARDING PATIENT INVOICES OR PAYMENT ARRANGEMENTS ARE REFERRED TO OUR FINANCIAL COUNSELOR FOR ASSISTANCE. PART VI, LINE 4: THE HOSPITAL SERVES THE COUNTIES OF IDA, MONONA AND SAC IN THE STATE OF IOWA. THE POPULATION OF THIS AREA IS OVER 25,000 RESIDENTS. IN THE TOTAL SERVICE AREA, 21.8% OF THE POPULATION ARE CHILDREN AGE 0-17; ANOTHER 55.4% ARE AGE 18 TO 64, WHILE 22.8% ARE AGE 65 AND OLDER. THE PROPORTION OF OLDER ADULTS (AGE 65+) IS SIGNIFICANTLY ABOVE THAT SEEN STATEWIDE OR (ESPECIALLY) NATIONALLY. PART VI, LINE 5: AS A PRIVATE, NON-PROFIT CRITICAL ACCESS HOSPITAL, HORN MEMORIAL HOSPITAL AND ITS CLINICS ARE ABLE TO IMPROVE ACCESS TO HEALTHCARE TO THOSE AT RISK BECAUSE OF FINANCIAL ABILITY, LACK OF ADEQUATE INSURANCE, MINORITY, OR OTHER BARRIERS, THROUGH OUR FOUR LOCATIONS WITHIN THREE RURAL COUNTIES.WE OFFER A VARIETY OF SPECIALTY CLINICS TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE, AND MAINTAIN FOUR RURAL HEALTH CLINICS, A 24 HOUR EMERGENCY DEPARTMENT AND A 20 BED INPATIENT WING. THE HOSPITAL SPONSORS WEEKLY RADIO BROADCASTS ADDRESSING A WIDE VARIETY OF HEALTHCARE SERVICES AND ISSUES/CONCERNS. A MONTHLY NEWSLETTER IS ALSO PUBLISHED WHICH INCLUDES INFORMATION REGARDING SCHEDULED SPECIALTY CLINICS AND OTHER TIMELY CONCERNS OR INFORMATION FOR OUR READERSHIP. WE PROVIDE TRANSLATION SERVICES AT ALL LOCATIONS. WE PARTNER THROUGH LOCAL, COUNTY, AND STATE AGENCIES TO PROVIDE PUBLIC HEALTH SERVICES TO OUR COMMUNITIES. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES IA X X X X 0 0 0 0 0 0 0 1 0 ALBERT VELTRI PHYSICIAN 289839 0 68737 0 0 0 16500 0 45224 0 420300 0 0 0 MAX DELANEY CRNA 210080 0 29195 0 0 0 11964 0 44235 0 295474 0 0 0 SHARON VANDEVEGTE PHYSICIAN 236161 0 250 0 0 0 11821 0 43587 0 291819 0 0 0 CURTIS HESSE PHYSICIAN 239368 0 250 0 0 0 11981 0 14290 0 265889 0 0 0 GLEN WINEKAUF CEO 211496 0 500 0 0 0 10600 0 4863 0 227459 0 0 0 SHELLY ELSE PA 156463 0 250 0 0 0 7836 0 44559 0 209108 0 0 0 PART I, LINE 7 HEALTHCARE PROVIDERS ARE ELIGIBLE TO RECEIVE INCENTIVE PAYMENTS BASED ON PRODUCTION METRICS SET OUT IN THEIR EMPLOYMENT CONTRACT. PROVIDERS RECEIVING THESE TYPES OF PAYMENTS DURING THE YEAR INCLUDE THE FOLLOWING: ALBERT VELTRI MAX DELANEY A CITY OF IDA GROVE IOWA 426004785 NONEAVAIL 2016-08-08 7457000 REFUND PRIOR ISSUES (SERIES 2004) 0 0 0 B CITY OF IDA GROVE IOWA 426004785 NONEAVAIL 2016-08-08 4843000 REFUND PRIOR ISSUES (SERIES 2004) 0 0 0 A 7457000 7457000 2016 1 0 1 1 B 4513235 4843000 92 4842908 2016 1 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 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION WERE AMENDED IN 2023 TO ADD AN ARTICLE SPECIFYING THAT THERE WILL BE NO PRIVATE INUREMENT OF THE NET EARNINGS OR ASSETS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE ORGANIZATION SHALL BE THOSE PERSONS WHO SHALL CONTRIBUTE NOT LESS THAN $10.00 PER PERSON OR $20.00 PER FAMILY ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE ORGANIZATION'S CEO AND CFO AND A COPY IS PROVIDED TO ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SIGNED ANNUALLY BY EACH BOARD MEMBER. IF A POSSIBLE CONFLICT EXISTS, A BOARD MEMBER ABSTAINS FROM VOTING ON THE MATTER. COMPLIANCE WITH THE POLICY IS MONITORED BY THE ADMINISTRATION AND THE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15 SALARY CHANGES FOR THE CEO OCCUR EACH JANUARY. CHANGES ARE BASED ON SEVERAL FACTORS WHICH ARE PROVIDED TO THE BOARD CHAIR UPON REQUEST; AFTER BOARD REVIEW AND APPROVAL, THE CHANGE IS COMMUNICATED TO THE CFO. COMPENSATION FOR ALL OTHER EMPLOYEES USES SIMILAR DATA, AND IS REVIEWED AND APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO DISCLOSED AT THE ANNUAL MEETING WHICH IS OPEN TO THE PUBLIC. FORM 990, PART IX, LINE 11G SURGERY SERVICES: PROGRAM SERVICE EXPENSES 130,529. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,529. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,410,902. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,410,902. PHYSICAL THERAPY SERVICES: PROGRAM SERVICE EXPENSES 902,409. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 902,409. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,226,837. MANAGEMENT AND GENERAL EXPENSES 124,772. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,351,609. INFORMATION TECHNOLOGY SERVICES: PROGRAM SERVICE EXPENSES 542,215. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 542,215. RESPIRATORY THERAPY SERVICES: PROGRAM SERVICE EXPENSES 470,462. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 470,462. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HORN MEMORIAL HOSPITAL FOUNDATION AUXILIARY AND VOLUNTEERS 701 EAST 2ND STREET IDA GROVE IA 51445 421478302 FUNDRAISING IA 501(C)(3) LINE 12B, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0