2023-03-08T08:27:33-06:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 421231996 Virginia Gay Hospital Inc VIRG 3194726255 502 N 9th Ave Vinton IA 523492254 Michele Schoonover CEO 3194726255 2023-03-02 1 Michele Schoonover 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-03-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Michele Schoonover 502 N 9th Ave Vinton IA 523492254 35333852 0 X www.myvghinc.org X 1923 IA Provision of health care services 9 7 389 25 0 0 8280776 734726 30350427 34020155 264471 578971 0 0 38895674 35333852 8000 12500 0 0 17872708 18567174 0 0 92615 13526513 15626030 31407221 34205704 7488453 1128148 40007620 40884116 3541402 4580946 36466218 36303170 X Our purpose is to provide quality health care services by using innovative, growth-oriented techniques and maintaining a sound financial base. 0 0 29600874 12500 34020155 Virginia Gay Hospital is a 25-bed acute care hospital and a 40-bed long-term care facility located in Vinton, Iowa. The Hospital leads delivery of healthcare to its region through over 300 associates (including 18 providers) who coordinate care to deliver patient care as an integrated unit. Virginia Gay Hospital and its affiliates also work seamlessly to meet the needs of the communities they serve. The Hospital provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amounts of charges foregone for services provided under the Hospital's charity care policy were $158,433 for the year ended June 30, 2022. Total direct and indirect costs related to these charges foregone were approximately $81,000 at June 30, 2022, based on an average ratio of cost to gross charges.In addition, the Hospital provides services to other patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided.The Hospital also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable.Virginia Gay Hospital also makes medical care accessible to the entire community it serves. The Hospital operates a full-time emergency room and provides emergency care regardless of ability to pay. The Hospital provides clinical services needed to operate the emergency room and provides on-site emergency medical care and medical transportation services through an area ambulance service, van service, and an onsite helipad.The Hospital had 38,641 outpatient visits and the rural health clinics had 40,481 visits. 29600874 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 35 0 1 389 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Barry Dietsch 3194726255 502 N 9th Ave Vinton IA 52349 Dr Brian Meeker DO Director 40.00 0.00 X 676828 0 29540 Dr Erica Silbernagel DO Family Medicine 40.00 0.00 X 321894 0 5275 Dr Michelle Elgin DO Director 40.50 0.30 X 262497 0 28249 Tammy Madsen PA-C ER/Hospitalist 40.00 0.00 X 239487 0 13040 Rita Taylor-Stewart PA-C Family Medicine 40.00 0.00 X 236866 0 10689 Michele Burnes PA-C Family Medicine 40.00 0.00 X 223062 0 23851 Matthew Wilden PA-C ER/Hospitalist 40.00 0.00 X 204050 0 28627 Michele Schoonover CEO 40.00 3.30 X 171164 0 26581 Barry Dietsch CFO 40.00 3.30 X 165824 0 4295 John Yundt Chair 0.50 1.30 X X 0 0 0 John Ketchen Chair (Until Oct 2021) 0.50 1.30 X X 0 0 0 David Vermedahl Vice Chair 0.50 0.90 X X 0 0 0 Sara Stuefan Secretary 0.50 0.30 X X 0 0 0 John Mossman Treasurer 0.90 0.30 X X 0 0 0 Marie Therese Foth Director 0.50 0.30 X 0 0 0 Bud Maynard Director 0.50 0.30 X 0 0 0 Kyle Koeppen Director 0.50 0.30 X 0 0 0 2501672 0 170147 23 0 1 0 Modern Piping Inc 500 Walford Road SW Cedar Rapids IA 52404 Construction 1632263 National Therapeutic Association 11623 Arbor Street Omaha NE 68144 Speech/Occupational/Physical Therapy 1150663 Iowa Anesthesia LC PO Box 1665 Cedar Rapids IA 52406 CRNA & Ultrasound 520416 ProLink Healthcare 4600 Montgomery Rd Ste 300 Cincinnati OH 45212 Contract Staffing 352364 Grapetree Medical Staffing PO Bxo 5340 Sioux Falls SD 57117 Contract Staffing 303510 13 620863 113863 734726 Patient & resident revenue 621110 32031471 32031471 Pharmacy Revenue 900099 1663250 1663250 325434 325434 34020155 526971 526971 52000 0 52000 52000 52000 35333852 34020155 0 578971 X 12500 12500 1346578 967536 379042 162379 68088 94291 14423766 13195278 1169980 58508 179490 165959 12816 715 1399031 1249271 144557 5203 1055930 936586 115518 3826 6260 6260 58387 58387 6617707 5617891 997116 2700 92512 7596 67088 17828 1617059 1298170 315707 3182 506338 102393 403945 65906 64082 1778 46 67860 65267 2433 160 8961 6813 2148 2026908 1695994 330907 7 245120 6240 238880 Medical Supplies 3496690 3491646 5044 Repairs and maintenance 465842 371377 94465 Food 181453 181453 Grant Expense 8 8 169019 96734 71845 440 34205704 29600874 4512215 92615 7384420 8962248 3172121 2919926 20000 10000 376730 366126 345507 284616 37016637 20960757 16122043 16055880 10501109 11356783 1037142 580593 407718 347944 640830 0 40007620 40884116 2191279 2411727 597846 1235700 752277 523519 0 410000 3541402 4580946 X 36332885 36165738 133333 137432 36466218 36303170 40007620 40884116 1128148 -1291196 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 116660 13007 13007 116660 116660 16513 16513 116660 116660 1251 1251 116660 116660 7544 7544 116660 116660 5813 5813 116660 0.00000 1.00000 0.00000 0 0 141794 141794 151876 25168873 12797845 12522904 10282115 7284585 2997530 1271979 878327 393652 16055880 Estimated Third Party Payor 410000 410000 X Part V, Line 4: Income from the endowment funds is to be used for repairs and maintenance and capital improvements. Part X, Line 2: The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 220.000000000000 0 1 1 0 1 1 81000 81000 0.00240 81000 81000 0.00240 4479722 3856187 623535 0.01820 4479722 3856187 623535 0.01820 4560722 3856187 704535 0.02060 1 554194 158433 7277475 7188051 89424 X 1 1 1 1 Virginia Gay Hospital Inc 502 N 9th Avenue Vinton IA 523492254 myvghinc.org 060178H X X X X 4 provider based rural health clinics Virginia Gay Hospital Inc 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V Supplemental Info X https://www.bentoncountyia.gov/public_health/ X 1 21 1 See Part V Supplemental Info 0 1 X 220.000000000000 1 1 X X X X 1 X https://myvgh.org/financial-assistance/ X https://myvgh.org/financial-assistance/ X https://myvgh.org/financial-assistance/ X X X X X X 1 X 0 X X X X 1 X 0 0 Virginia Gay Hospital, Inc. Part V, Section B, Line 5: A strategic planning session for fiscal year 2022 was held on 2/18/22. Key members of VGH including but not limited to senior management, members of the VGH Board of Directors, and medical providers discussed the future needs and actions of the organization to ensure our service area's health needs continued to be met.Senior management meets twice monthly to discuss the current and future needs for our service area and the actions necessary to meet the needs of our communities served. The most recent meeting was held on 8/1/22. Obtaining input from key stakeholders was another crucial step in the assessment process. These stakeholders were drawn from private and public organizations that serve people in the Benton County area and were invited to identify the top health issues confronting the populations they served. The health issues these various groups and individuals identified reflected the overarching theme of social determinants/health equity. Analysis of the input received was completed to help determine the priority health needs. Meetings were held to discuss the following Public Health topics to help assess and prioritize the community health needs: Promotion of Healthy Living Prevent Injuries/Violence Protect Against Environmental Hazards Prevent Epidemics/Spread of Disease Prepare for Respond to/Recover from Public Health Emergencies Strengthen the Health Infrastructure. Discussions, correspondence, strategizing, and implementation continue amongst members of the above groups to address the identified health needs and concerns.VGH engaged several tactics to ensure different members of our community were contacted, including those knowledgeable of health care needs of vulnerable populations. This was completed through personal interviews, emails, surveys, and meetings that occurred between the Fall of 2020 to Spring of 2022. The following community partners were involved in the CHNA process: Virginia Gay Hospital, Clinics, Home Health, and Nursing & Rehab VGH Board of Directors Benton County Board of Supervisors Benton County Board of Health Benton County Public Health Benton County Environmental Health Benton County Emergency Management Benton County Disaster Recovery Coalition Benton County Coalition Benton County Social Services Benton County Department of Human Services Benton County TransportationBenton County School Districts Benton County Development Group Benton County Wellness CoalitionRegion 6 Emergency Preparedness CoalitionVinton Unlimited Above the Influence Coalition (Substance Abuse) Iowa State Benton County Extension Office Benton County Police DepartmentsBenton County School DistrictsBetter Tomorrows (Early Childhood Iowa) Benton-Iowa Decategorization Hawkeye Area Community Action Programs (HACAP)Area Substance Abuse Council (ASAC)Vinton Parks & Recreation DepartmentAbbe Center for Community Mental Health Virginia Gay Hospital, Inc. Part V, Section B, Line 11: Highest Priority Health NeedsA survey was conducted March 2022 resulting in 118 completed surveys. The surveys were from anonymous participants. The goal of this survey was to better help us understand the health concerns and needs in Benton County.Following the collection of statistical data and community input, each health indicator was analyzed by comparing it to the state rates to determine our county's priority health concerns.It was determined that Mental Health 78.81%, Obesity 64.41% along with Chronic Health conditions 53.35% and Substance abuse 38.14% were the top health priorities in Benton County. We will continue our current goals for Mental Health, Substance Abuse and have added Health Prevention as our top three priorities. Health prevention will encompass our previous objectives on obesity while including other chronic illness needs as identified from the Benton County 2022 CHNA survey data.1.Preventive HealthGoal 1: Promote current Health programs and provide education to residents of Benton CountyActions: *Community events held to provide information, resources, and support in relation to preventive health. *Quarterly education per provider, in-person and/or recorded. Spotlight services/monthly awareness. VGH promotion through news articles and local media. *Promote current services; Diabetes program, Gifts of Hope, PT, Yoga, Childcare, Health Fair, Financial navigator/SHIP, 3D Mammograms *VGH Diabetes prevention program 2019-present. *Benton County Food pantry Flier distributions monthly. HACAP partnership, Feeding America: 10/2022 *The City and Vinton Park and Recreation Department have been working on plans for a new Wellness Center that would be located adjacent to the high school and combine, indoor/outdoor pool areas, gym, walking track, meeting rooms and exercise. This is a partnership that will benefit the community as well as allow Virginia Gay to provide services: diabetes prevention/weight loss/cooking demos/ CPR-first Aide/Baby-sitting/ Coordination support groups/Mental Health peer support/ Grieving/Ministerial services *Daycare partnership in progress *Cancer Screening clinics in collaboration with Mercy HPCCGoal 2: Increase Health prevention services to the residents of Benton CountyActions:*PH clinics: Sexual Health Clinic 8/22 (quarterly), SHIP program 9/22, BP clinics 9/22, Vaccine clinics *Promotion of services events2.Mental HealthGoal 1: Reduce intentional injuries among Benton County residents; reduce percent of Benton County students who have in the past 12 months seriously considered suicide by 1%. Actions: *Community events held to provide information, resources, and support in relation to suicide prevention. *VGH depression screenings on every patient that is 12 years or older. *HACAP 1st Five program offered the ACES training. ASAC, ACES training *Benton County Community School Districts Opportunity for ACES training and Mental health first aide to all teachers and administrators along with suicide awareness. *Depression Screenings at WIC clinics. *Benton County Rural Access promotionGoal 2: Increase mental health services for Benton County residentsActions: *Actively recruiting/hiring behavioral health specialist at Vinton Family Medical Clinic. *Promotion of the mental health services available in Benton County. *Second VGH Full time ARNP hired for Behavioral Health 11/2020. *Promoting and support of The Benton County CISM (Critical Incident Stress Management) Team established 2020.3.Substance AbuseGoal 1: Decrease substance abuse among Benton County Youth; Decrease the percentage of 11th graders who reported it was "easy/very easy" to have access to alcohol by 3%.Actions: *ASAC, Benton County Schools: "What you cannot see" trailer, Upcoming Community Speaker "Steered Straight" *Above the Influence Core Measurement Survey-Benton County Data collection monitoring Iowa Youth Survey Data review and monitoring *Community events held to provide information, resources, and support in relation to substance abuse and prevention.Goal 2: Decrease prescription drug abuse among Benton County residents; increase the number of pounds of prescription medications collected through drop boxes by 50 pounds. Actions: *Provide information to the community on Count, Lock-Up, Dispose campaign through various forms of media and sustainable locations. Example: Benton County Health Fair, Community events. *Posters/fliers distributed to the health care locations throughout the county, including medical clinics and pharmacies. *Promote Take Back Days for prescription medications. *Benton County Above the Influence Coalition. ASAC; Generation Rx and drug drop box materials distributed at 6 locations 9/2021 *Continue to work with Benton County Above the Influence Coalition subcommittees for Substance prevention, Mental HealthResults: *2021: 187 pounds Virginia Gay Hospital, Inc. Part V, Section B, Line 16j: A summary of the policy and financial assistance information is posted in the emergency, admitting and waiting rooms, admissions and business offices, included with patient bills and information is available on our website. Schedule H, Part V, Section B, Line 7a and 10a: CHNA and Implementation Strategy:https://myvgh.org/community-health-needs-assessment/ 2 1 - Virginia Gay Nursing & Rehab 502 N 9th Avenue Vinton IA 52349 Intermediate care facility 2 - Virginia Gay Hosp Home Health Agency 502 N 9th Avenue Vinton IA 52349 Skilled nursing care, PT, OT, ST, home health aide, homemaker services Part I, Line 6a: The community benefit report is available upon request. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. The cost for subsidized health services on line 7g was determined using the Medicare cost report. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: Virginia Gay Hospital used the percentage of applications denied due to lack of information. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 10 and 11 of the attached audited financial statements. Part III, Line 8: There was a Medicare shortfall for the fiscal year. Even at a loss the Hospital continues to provide services to these patients because access to healthcare and individual's health is important. Therefore, the Hospital considers the Medicare shortfall a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $324,350.Medicare fee schedule revenue $ 187,938Medicare estimated costs of care relating to payments (560,595)Net (Shortage) $ (372,657) Part III, Line 9b: Statements are sent out every 30 days. Up to four statements are sent. Accounts are sent to collections at 121 days, with all collection practices adhering to 501(r) guidelines. If an approved application is received between 122-240 days the account is cancelled from the collection agency. Part VI, Line 2: The Hospital provides staff to attend Community Coalitions and Advisory Committees which are focused on specific populations and/or community health issues. Examples of the committees include but are not limited to the Benton County (Provider) Coalition, the Benton County Disaster Recovery Coalition, Above the Influence (substance abuse) Coalition and the Benton County Wellness Coalition. These coalitions meet regularly throughout the year, gather/assess data to identify problems, and work towards resolution of the identified problems. Virginia Gay Hospital's staff participates in the community needs assessment process for public health. The target area for the 2022 Community Health Needs Assessment (CHNA) is Benton County, Iowa. Special attention was paid to recruiting diverse subsets of the population to help accurately identify the most critical issues in the area. Following the collection of all the statistical data, each health indicator was analyzed by comparing it regionally, to the state average rate, and national rates to determine the community's priority health concerns. Preventive Health, Mental Health, and Substance Abuse were identified as the highest priority health needs in Benton County. The CHNA and implementation strategy are posted on our website and can be viewed in their entirety at www.myvghinc.org . Part VI, Line 3: Virginia Gay Hospital is committed to providing charity care to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care based on their individual financial situation. Virginia Gay Hospital strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. Patients are expected to cooperate with Virginia Gay Hospital's procedures for obtaining charity care or other forms of payment of financial assistance, to contribute to the cost of their care based on their individual ability to pay. The charity care policy includes all departments of the facility, including Vinton Family Medical Clinic, Urbana Family Medical Clinic, Van Horne Family Medical Clinic, Atkins Family Medical Clinic and the Nursing and Rehab. The Virginia Gay Hospital Home Health Agency has a separate financial assistance procedure, due to their Public Health role in the community. VGH has a commitment to establish/maintain effective partnerships throughout the county and work with all entities that influence community health. To improve and strengthen the local planning process multiple community partners have been involved in the CHNA process. Notification about charity care is available by the publication of notices in patient bills, posting of notices in the emergency rooms, admitting and registration departments, the Business Office, and other public places the Hospital may elect. Information is also included on the facility website, and in the patient information packets. A request for charity may be made by the patient or a family member, close friend or associate of the patient, subject to the applicable privacy laws Part VI, Line 4: The community VGH serves, as defined for the CHNA, is based on the primary service area of our hospital. The major service area is Benton County, serving an estimated population of nearly 26,000 with an area of 716.27 square miles. VGH also services several other counties and states. Per the Iowa Hospital Association Dimensions Program (2020) 82.70% of the 26,070 outpatient visits, were from residents of Benton County and of the 288 VGH inpatient discharges, 82.70% were Benton County residents.Unique to Benton County population is the presence of an AmeriCorps National Civilian Community Corps (NCCC) training campus. AmeriCorps NCCC strengthens communities and develops leaders through direct, team-based national and community service. In partnership with non-profitssecular and faith basedlocal municipalities, state governments, federal government, national and state parks, Indian tribes, and schools, members complete service projects throughout the region they are assigned. AmeriCorps NCCC is a full-time, team-based residential program for men and women ages 18-24.The closest hospitals are located 37 miles away in Cedar Rapids, Iowa. Virginia Gay Hospital currently operates four separate clinics; one clinic is located on the hospital campus in Vinton, another located in the rural town of Van Horne, Iowa which is 15 miles from Vinton, another located in the rural community of Urbana, 13 miles from Vinton, and the other located in the rural community of Atkins which is 19 miles from Vinton. The Hospital and clinics serve a large number of Medicare and Medicaid patients. The median household income for Benton County was $67,729. The 2022 unemployment rate was 5.0%. Part VI, Line 5: Virginia Gay Hospital is proudly recognized as having one of the lowest costs per stay rates in the state of Iowa. The Hospital offers twenty-five beds in an acute care setting with state of the art technology and professional services. Virginia Gay Hospital also offers 24 hour acute care, short term skilled nursing services, radiology, respiratory care, cardio-pulmonary rehabilitation, physical therapy, occupational therapy, speech therapy, laboratory services, surgical services, outpatient clinics and emergency care. In addition, our staff has contributed multiple hours providing uncompensated time in areas such as family/parenting/sibling education, medical expertise for the schools' athletic teams, health fairs, information and referrals to community services, safety classes, sports physicals and many other uncompensated services.Requirements of the IRS community benefit standard for tax-exempt organizations are integral to the Hospital's larger charitable mission of improving health and quality of life. Specifically, Virginia Gay Hospital is governed by an independent board including community leaders, physicians, consumer representatives, business experts and clinical healthcare experts who reside in our primary service area. The Board has a history of commitment to acting with the highest integrity and has been proactively evaluating opportunities to voluntarily adopt governance best practices to ensure the organization continues to operate with the highest of integrity for the benefit of the community.To meet the needs of our community, the Hospital extends privileges to medical staff that are qualified through licensure in the state of Iowa.Excess funds are reinvested and used for patient care and facility upgrades.Virginia Gay's Home Health Agency offers a variety of services to all ages in the rural population of Benton County, Including Skilled nursing, Home Care Aide and Homemaking services. The Hospital also offers such services as skilled and non-skilled service home care, blood pressure checks, and group teaching classes such as cardiopulmonary resuscitation (CPR), Advanced Life Support (ALS) and Pediatric Advanced Life Support (PALS).In addition, Virginia Gay Hospital, through its integrated network of providers, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare and Medicaid and by offering assistance through their Financial assistance program.Virginia Gay Hospital's Financial Assistance Policy provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The Financial Assistance Policy is designed to ensure the entire community served by the Hospital has access to needed healthcare services.Virginia Gay Hospital takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the community. It strives to identify community needs beyond basic healthcare, respond to them, aiming to make a positive, life-enhancing difference in the community.Contributing to Community Education: The nursing staff and Home Health Agency nurses participate in several county wide events and community health fairs. These events provide information and guidelines to those in need of medical information.Preventive Care is a Priority: The Hospital has taken steps to enhance preventive care for people of all ages by ensuring that those who come here for preventive care receive the screenings and recommendations appropriate to their personal and family history. 1 High School Scholarships 12 12500 Part I, Line 2: Scholarships were awarded to high school applicants received from 3 school districts in the area. Awards were based on pursuing a career in health related studies, applicant showing a need in support, success in completion of prior class work, and participation in extracurricular activities. A scholarship committee reviewed applications and made recommendations to the VGH Board of Directors for approval to extend scholarships. X X X 0 0 0 0 0 0 0 0 0 Dr Brian Meeker DO Director 402856 0 273972 0 0 0 6182 0 23374 0 706384 0 0 0 Dr Erica Silbernagel DO Family Medicine 289727 0 32167 0 0 0 3727 0 1563 0 327184 0 0 0 Dr Michelle Elgin DO Director 172630 0 89867 0 0 0 1873 0 26392 0 290762 0 0 0 Tammy Madsen PA-C ER/Hospitalist 239487 0 0 0 0 0 3953 0 9103 0 252543 0 0 0 Rita Taylor-Stewart PA-C Family Medicine 163210 0 73656 0 0 0 3199 0 7506 0 247571 0 0 0 Michele Burnes PA-C Family Medicine 153738 0 69324 0 0 0 3243 0 20624 0 246929 0 0 0 Matthew Wilden PA-C ER/Hospitalist 204050 0 0 0 0 0 3631 0 25012 0 232693 0 0 0 Michele Schoonover CEO 171164 0 0 0 0 0 3573 0 23024 0 197761 0 0 0 Barry Dietsch CFO 165824 0 0 0 0 0 3095 0 1216 0 170135 0 0 0 Dr Michelle Elgin DO Director Forgivable medical educational loan X 20000 10000 0 1 1 10000 Kelly Henkle Daughter of Chair, John Ketchen 94291 Compensation as an employee 0 Shannon Maynard Spouse of Director, Bud Maynard 26743 Compensation as an employee 0 Autumn Conrad Family member of Treasurer, John Yundt 33905 Compensation as an employee 0 Payton Dietsch Family member of CFO, Barry Dietsch 7440 Compensation as an employee 0 Form 990, Part VI, Section A, line 1a The Executive Committee consists of the officers of the Board of Directors. The Executive Committee has the power to transact all regular business of the Hospital during the period between the meetings of the Governing Board, subject to any prior limitation imposed by the Governing Board and with the understanding that all matters of major importance will be referred to the Governing Board. The Executive Committee must submit to the Governing Board at its last meeting before the end of the fiscal year, a budget showing the expected receipts, income, and expense for the coming year. Minutes of the Executive Committee meetings must be submitted to the Board, and its actions are subject to approval or disapproval at the next regular board meeting. Form 990, Part VI, Section A, line 7a One of the Directors of the Board is the Mayor of the city of Vinton, Iowa. Two Directors are appointed by the Mayor and approved by the City Council of the City of Vinton for such terms as the City Council determines. One of these appointments is a physician in active practice and a resident of Benton County, Iowa. The second Director appointed by the City of Vinton is a resident of Benton County, Iowa. Form 990, Part VI, Section B, line 11b The Form 990 is distributed to the Board members prior to filing. The 990 is reviewed by the Hospital's CEO and CFO. Form 990, Part VI, Section B, line 12c Any director, officer, key employee, Medical Staff member or committee member having an existing or potential interest in a contract or other transaction presented to the Board of Directors for deliberation, authorization, approval, or ratification, or any such person who reasonably believes such an interest exists in another person should make a prompt disclosure of the interest to the Board or committee prior to its acting on such contract or transaction. The interested party is required to disclose the nature and extent of his/her interest and any relevant and material facts known to him/her about the contract or transaction which might reasonably be construed to be adverse to the organization's interest. The Board requires annual statements from officers, directors, key employees, and key members of the Medical Staff. The body to which such disclosure is made determines, by majority vote, whether the disclosure shows that the non-voting and non-participation provisions below must be observed. If so, such persons should not vote on, nor use his/her personal influence on, nor participate (other than to present factual information or to respond to questions) in the discussions or deliberations with respect to such contract or transaction. Such persons may not be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted upon. The minutes of the meeting reflect the disclosure made and, where applicable, the abstention from voting and participation and whether a quorum was present. Form 990, Part VI, Section B, line 15 The Board Wage & Salary Committee and full board reviews compensation increases for the CEO based on annual evaluations and the IHA Salary Survey. Comparisons to state averages are used. Substantiation of the deliberation and decision is documented in the Board minutes. The process is completed annually. The CEO determines compensation for the CFO with approval from the Board Wage & Salary committee and full Board, based on annual performance evaluations and the IHA Salary Survey. Contemporaneous substantiation of the deliberation and decision is provided for any actions taken regarding compensation. The process is completed annually. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. Form 990, Part IX, line 11g Purchased services: Program service expenses 5,617,891. Management and general expenses 997,116. Fundraising expenses 0. Total expenses 6,615,007. OTHER PURCHASED SVCS-FOUNDATN: Program service expenses 0. Management and general expenses 0. Fundraising expenses 2,700. Total expenses 2,700. Virginia Gay Trust 502 N 9th Avenue Vinton IA 52349 426367590 Provide financial support for Virginia Gay Hospital, Inc. IA 501(c)(3) Line 12c, III-FI Virginia Gay Hospital Inc 1 Vernon S Flechner Trust 502 N 9th Avenue Vinton IA 52349 426351376 Provide income for maint of the Hospital and annex buildings IA Virginia Gay Hospital Inc T 43839 1.00000 1 JW Fry Trust 502 N 9th Avenue Vinton IA 52349 426287710 Provide unrestricted and corpus restricted income for Hospital additions IA Virginia Gay Hospital Inc T 182656 1.00000 1 Cedar View Retirement Community Inc 502 N 9th Avenue Vinton IA 52349 421398570 Provide an 18-unit housing alternative for the elderly IA Virginia Gay Hospital Inc C 32155 423247 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0