2023-05-11T14:14:01-05:00 2022-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2021-07-01 421087612 KNOXVILLE COMMUNITY HOSPITAL INC KNOX 6418421407 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 MAGGIE HAMILTON-BEYER CFO 6418421407 2023-05-11 1 MAGGIE HAMILTON-BEYER 999009999 MEGAN L KOZIOL CPA P01544037 4023302660 2023-05-10 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KNOXVILLE HOSPITAL & CLINICS MAGGIE HAMILTON-BEYER 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 49566820 0 X WWW.KNOXVILLEHOSPITAL.ORG X 1981 IA TO FAITHFULLY PROVIDE EXCEPTIONAL HEALTHCARE TO THE PEOPLE OF KNOXVILLE & SURROUNDING COMMUNITIES AND TO BE A HEALTHCARE DESTINATION BUILT ON COMPASSION AND INNOVATION. 7 7 336 18 797 0 4374846 1992747 42022393 47261547 83168 57928 108683 226937 46589090 49539159 11543 26926 0 0 18329296 19642283 0 0 0 22627872 25187091 40968711 44856300 5620379 4682859 48903473 49211220 25349005 21045774 23554468 28165446 X WE ARE DEDICATED TO PROVIDING PERSONAL PROGRESSIVE QUALITY HEALTHCARE WITH COMPASSION TO THE PEOPLE OF KNOXVILLE AND SURROUNDING AREAS. WE VALUE TEAMWORK, INNOVATION, COMPASSION, INTEGRITY, SERVICE, AND PEOPLE-CENTERED CARE. 0 0 40220324 26926 47261547 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 2022, THE HOSPITAL PROVIDED 568 DAYS OF SKILLED NURSING CARE AND 200,006 OUTPATIENT OCCASIONS OF SERVICE. 40220324 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 84 0 1 336 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 LOGAN MILLER PHYSICIAN 40.00 0.00 X 441528 0 34974 SAMANTHA KEADY PHYSICIAN 40.00 0.00 X 387036 0 36856 DYLAN LOWE PHYSICIAN 40.00 0.00 X 357424 0 19223 JAMES LAW PHYSICIAN 40.00 0.00 X 292261 0 37945 THOMAS HOEHNS PHYSICIAN 40.00 0.00 X 278638 0 23899 MAGGIE HAMILTON -BEYER CFO 40.00 0.00 X 206872 0 14627 JIM BUTLER PRESIDENT & TREASURER 1.00 0.00 X X 0 0 0 MEGAN MCKAY PRESIDENT THRU 12/21 1.00 0.00 X X 0 0 0 PATRICK STOCKTON 2ND VP & TREASURER THRU 12/21 1.00 0.00 X X 0 0 0 CINDI FULLER SECRETARY 1.00 1.00 X X 0 0 0 TODD CHAMBERS MEMBER 1.00 0.00 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 1963759 0 167524 23 0 1 1 CAPITAL ORTHOPEDICS AND SPORTS MEDICINE 12499 UNIVERSITY AVE 210 CLIVE IA 50325 ORTHOPEDIC SURGEONS/DOCTORS 1560317 21ST CENTURY REHAB PC PO BOX 461 NEVADA IA 50201 PT/OT SERVICES 1520617 DOCS EMERGENCY MEDICINE INC 800 W FRONTIER LN OLATHE KS 66061 ER PHYSICIAN COVEREAGE 1510252 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 COMPUTER SOFTWARE SYSTEMS 1414161 MERCY ONE 1111 6TH AVE DES MOINES IA 50314 MANAGEMENT CONTRACT 1063907 32 44272 1930850 17625 1992747 NET PATIENT SERVICE REVENUE 621110 24987971 24987971 MEDICARE 621110 15500261 15500261 MEDICAID 621110 4440957 4440957 PHARMACY 621110 2305936 2305936 26422 26422 47261547 81029 81029 110772 0 110772 110772 110772 4560 27661 -23101 -23101 -23101 CAFETERIA 900099 116165 797 115368 116165 49539159 47261547 797 284068 X 26926 26926 221499 221499 15698056 13654390 2043666 3722728 3205848 516880 548576 128446 420130 24988 24988 99872 99872 11839 11839 7603946 7118012 485934 76130 76130 2275094 2028752 246342 89395 76682 12713 1854279 1639357 214922 77846 53398 24448 570410 557870 12540 1608517 1572265 36252 276594 209237 67357 MEDICAL SUPPLIES 6280854 6280854 BAD DEBT 3343873 3343873 DUES & LICENSES 303144 182680 120464 FOOD COST 141734 141734 44856300 40220324 4635976 0 81673 83447 26389204 25484941 3510216 5877902 607788 575114 251012 241970 34078006 20451938 14092062 13626068 2872964 3321778 29215 0 1069339 0 48903473 49211220 2972628 3055822 13880746 13451774 1028564 826269 150000 148807 7317067 3563102 25349005 21045774 X 23554468 27665446 500000 23554468 28165446 48903473 49211220 4682859 -71881 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 3533 3533 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 22023432 11797834 10225598 11047169 8654104 2393065 746499 746499 13626068 CAPITAL LEASES 590307 ACCRUED INTEREST PAYABLE 14342 CONTRACT LIABILITY - MEDICARE ACCELERATED AND ADVANCE PAYMENTS 2357767 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 600686 3563102 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, 2022 AND 2021, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 0 1 X 1 1 1 0 1 1 99742 99742 0.00240 5682954 4273878 1409076 0.03390 5782696 4273878 1508818 0.03630 4628 1725 2903 0.00010 255977 6250 249727 0.00600 57885 0 57885 0.00140 318490 7975 310515 0.00750 6101186 4281853 1819333 0.04380 282 0 282 0.00000 1380 0 1380 0.00000 266 0 266 0.00000 4212 0 4212 0.00010 9597 0 9597 0.00020 15737 15737 0.00030 0 3343873 0 14062655 13949049 113606 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 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 3J: THE TOP FOUR HEALTH NEEDS IDENTIFIED FROM THE 2021 CHNA REPORT WERE MENTAL HEALTH, AFFORDABLE HOUSING, TRANSPORTATION AND NUTRITION. THESE TOP FOUR NEEDS WERE DETERMINED BY PRIMARY DATA (SURVEY) AND SECONDARY DATA INCLUDING COUNTY HEALTH RANKINGS, IOWA HOSPITAL ASSOCIATION INPATIENT AND OUTPATIENT DATABASES, CITY DATA, AND VITAL STATISTICS. OTHER HEALTH NEEDS IDENTIFIED WERE OBESITY, SUBSTANCE MISUSE, DOMESTIC ABUSE, SUICIDE PREVENTION AND SUPPORT AND POVERTY. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 5: RESEARCH WAS DONE AND DATA WAS COLLECTED TO ENSURE PROPER TOWN HALL REPRESENTATION AND TO DETERMINE THE PRIMARY SERVICE AREA. A PUBLIC RELATIONS STORY WAS PREPARED AND POSTED ON SOCIAL MEDIA, AS WELL AS SENT TO THE LOCAL MEDIA TO PUBLISH AND ANNOUNCE UPCOMING CHNA WORK AND REQUEST PUBLIC SURVEY PARTICIPATION. 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 RETURNS. 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. SINCE NOVEMBER OF 2019, MOST OF THESE EFFORTS HAVE BEEN CONCENTRATED ON STATEWIDE AND COUNTYWIDE INITIATIVES. MOST HOURS WERE SPENT IN COLLABORATION WITH THE MARION COUNTY SHERIFF'S OFFICE AND THE LEADERS OF THE COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA ACCESS CENTER LOCATED IN OSCEOLA, IA. THE ACCESS CENTER WAS CREATED IN THIS REGION OF IOWA AND IN OTHER REGIONS AROUND THE STATE. REFERRALS ARE MADE TO THE ACCESS CENTER FOR PATIENTS EXPERIENCING A MENTAL HEALTH CRISIS. THE ACCESS CENTER HAS PROVIDED SOME RELIEF FOR AREA HOSPITALS BUT, FOR SEVERAL REASONS, SOME MENTAL HEALTH PATIENTS DO NOT QUALIFY FOR THESE SERVICES OR REQUIRE INTENSIVE INPATIENT PSYCHIATRIC CARE, SO KHC CONTINUES TO HOLD SOME MENTAL HEALTH PATIENTS IN THE EMERGENCY ROOM FOR A SIGNIFICANT NUMBER OF DAYS.B. KHC CONTINUES TO UTILIZE VIRTUAL VISITS TO ADDRESS (NON-CRISIS) MENTAL HEALTH CONCERNS FOR PATIENTS IDENTIFIED VIA AN ANNUAL DEPRESSION SCREEN AT THE MEDICAL CLINICS. CLINIC PROVIDER TIMELY ASSESSMENTS TO IDENTIFY ISSUES AND INTERVENTIONS INCLUDING A REFERRAL TO VARIOUS RESOURCES ASSIST IN THE PREVENTION OF A CRISIS. ALSO, THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT CONTINUES TO UTILIZE TELE-PSYCH TO IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS IN THE EMERGENCY DEPARTMENT. THE TELE-PSYCH SYSTEM IS UTILIZED FOR ALMOST ALL OUTPATIENT MENTAL HEALTH PATIENTS THAT PRESENT TO THE EMERGENCY ROOM. ALSO, KHC HAS AN AGREEMENT WITH CENTRAL IOWA JUVENILE DETENTION CENTER WHICH PROVIDES TRANSPORT FOR MEDICALLY STABLE PATIENTS IN A SECURE CAR. THIS SERVICE IS NECESSARY BECAUSE OF THE LIMITED AVAILABILITY OF LOCAL EMS CREWS TO TRANSPORT THESE PATIENTS.C. KEVIN KINCAID CONTINUES TO LOBBY FOR IMPROVEMENTS IN INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES FOR MEMBERS OF THE COMMUNITY. IN FEBRUARY OF 2021 A NEW 100 BED MENTAL HEALTH HOSPITAL WILL OPEN IN CLIVE, IOWA THROUGH A PARTNERSHIP BETWEEN MERCYONE AND UHS IN CLIVE, IOWA. KNOXVILLE HOSPITAL & CLINICS AS AN AFFILIATE OF MERCYONE MAY BENEFIT WITH A FASTER REFERRAL PROCESS TO THIS ORGANIZATION FOR MEMBERS OF THE COMMUNITY IN NEED OF INPATIENT MENTAL HEALTH SERVICES.2. SUBSTANCE ABUSE REDUCE THE CONCERN FOR AND PRESENCE OF SUBSTANCE ABUSE RELATED HEALTH/SAFETY ISSUES.A. KNOXVILLE HOSPITAL & CLINICS APPLIED AND RECEIVED THE RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP) THIS IS A MULTI-YEAR HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) INITIATIVE AIMED AT REDUCING THE MORBIDITY AND MORTALITY OF SUBSTANCE USE DISORDER (SUD), INCLUDING OPIOID USE DISORDER (OUD) IN HIGH-RISK RURAL COMMUNITIES. THE GRANT IS A COLLABORATION OF MULTIPLE COMMUNITY GROUPS IN MARION COUNTY INCLUDING MARION COUNTY PUBLIC HEALTH, THE WELL RESOURCE CENTER, UCS HEALTHCARE, CROSS MENTAL HEALTH REGION, KNOXVILLE COMMUNITY SCHOOL DISTRICT, PELLA REGIONAL HEALTH CENTER AND KNOXVILLE HOSPITAL & CLINICS. INITIATIVES HAVE INCLUDED PROVIDING EDUCATION, PARTICIPATION IN NATIONAL TAKE BACK DAY, PROVIDING SAFE MEDICATION DISPOSAL BAGS FOR FREE TO PATIENTS, AND COLLABORATING WITH OTHER ENTITIES TO ADVANCE THE GOALS OF THE PROGRAM. THE WORK WILL CONTINUE THROUGH 2024. B. KNOXVILLE PROVIDERS HAVE AND WILL CONTINUE TO REFER PATIENTS TO UCS AS NEEDED. PROVIDERS HAVE MATERIALS REGARDING UCS AND THOSE MATERIALS ARE SHARED WITH PATIENTS AS NEEDED. ALSO, OTHER COMMUNITY PARTNERS SUCH AS THE WELL, LAW ENFORCEMENT, AND SCHOOLS ARE AWARE OF THE SERVICES UCS PROVIDERS AND PASS THAT INFORMATION ON TO PEOPLE IN NEED OF THE SERVICES.C. KHC CONTINUES TO PARTNER WITH UCS, DHS, LAW ENFORCEMENT, AND MC3 TO EXPLORE TRANSPORTATION SERVICES WITHIN THE COMMUNITY. THE HIRTA SYSTEM IS STILL AVAILABLE IN MARION COUNTY BUT, SERVICES CONTINUE TO BE QUITE LIMITED.3. CHRONIC DISEASE MANAGEMENT REDUCE IMPACT OF CHRONIC DISEASE ON PHYSICAL AND MENTAL HEALTH FOR RESIDENTS IN THE COMMUNITIES.A. KNOXVILLE HOSPITAL & CLINICS LAUNCHED #HEALTHYKNOXVILLE, A MONTHLY COMMUNITY WELLNESS CHALLENGE DESIGNED TO INSPIRE COMMUNITY MEMBERS TO LIVE A HEALTHIER LIFESTYLE PHYSICALLY, MENTALLY, EMOTIONALLY, SPIRITUALLY, INTELLECTUALLY, AND FINANCIALLY. KNOXVILLE HOSPITAL & CLINICS TOGETHER WITH OUR PARTNERS THE KNOXVILLE WELLNESS COALITION, KNOXVILLE COMMUNITY SCHOOL DISTRICT, KNOXVILLE CHAMBER OF COMMERCE, AND THE CITY OF KNOXVILLE PROVIDE FUN CHALLENGES TO HELP INDIVIDUALS ASPIRE TO BE THE BEST VERSION OF THEMSELVES. THE PROGRAM AVERAGES ABOUT 15 PARTICIPANTS EACH MONTH. KNOXVILLE HOSPITAL & CLINICS LEADERS ARE WORKING WITH THE SCHOOLS TO ENCOURAGE ELEMENTARY TEACHERS TO DO IT AS A CLASS ACTIVITY AS WELL.B. IN LATE 2018 KNOXVILLE HOSPITAL & CLINICS AND 21ST CENTURY REHABILITATION SERVICES OPENED A MEDICALLY ORIENTED GYM (MOG). A MOG IS A REVOLUTIONIZING THE WAY PEOPLE IMPROVE AND MAINTAIN THEIR HEALTH. THE MOG IS STAFFED BY PHYSICAL THERAPISTS, PHYSICAL THERAPIST ASSISTANTS, AND CERTIFIED ATHLETIC TRAINERS WHO WORK CLOSELY WITH YOUR DOCTOR AND OTHER HEALTHCARE PROVIDERS TO HELP YOU ACHIEVE AND MAINTAIN AN EXCEPTIONAL QUALITY OF LIFE BY FOCUSING ON ALL ASPECTS OF YOUR HEALTH. THE PRIMARY GOAL OF THE MOG IS TO DECREASE DEPENDENCY ON MEDICINE, ADOPT EXERCISE AS A LIFESTYLE, AND REDUCE THE IMPACTS OF CHRONIC DISEASE. MOG ON AVERAGE CARES FOR BETWEEN 25 TO 35 MEMBERS A MONTH WHICH IS AN INCREASE OF ABOUT 10 MEMBERS PER MONTH OVER THE LAST YEAR. C. KHC HAS CONTINUED TO REACH OUT TO PATIENTS/COMMUNITY MEMBERS WITH DIETARY COUNSELING NEEDS THROUGH OUR INTENSIVE BEHAVIOR THERAPY FOR OBESITY. FOLLOWING OUR PATIENT-CENTERED MEDICAL HOME MODEL, PROVIDERS SEND REFERRALS TO NUTRITION SERVICES, WHERE OUR STAFF OF TWO LICENSED AND REGISTERED DIETITIANS (RDS) PROVIDE AN INDIVIDUALIZED AND EVIDENCED-BASED WEIGHT MANAGEMENT PROGRAM. CHANGING BEHAVIORS TAKES TIME AND THE JOURNEY IS DIFFERENT FOR EVERYONE, WHICH THIS SERVICE ADDRESSES BY MEETING THE PARTICIPANT WHERE HE/SHE IS AT, AND THEN COLLABORATIVELY, WITH THE RD UTILIZING MOTIVATIONAL INTERVIEWING, SHE AND THE PATIENT IDENTIFY SMART GOAL(S) TO WORK TOWARDS. FOR PATIENTS NOT INTERESTED IN A 'IBT-LIKE' PROGRAM, OUR RDS COLLABORATE WITH OUR HEALTH COACH (A REGISTERED NURSE) TO DETERMINE THE BEST PATH FORWARD. KHC DIETITIANS CONTINUE TO WORK WITH PATIENTS/COMMUNITY MEMBERS WITH DIETARY COUNSELING NEEDS FOR VARIOUS CHRONIC DISEASE STATES THROUGH NUTRITION MANAGEMENT. ALSO, DIABETES SUPPORT GROUPS HAVE RESTARTED WHICH ENCOURAGE ATTENDANCE FROM CURRENT PATIENTS AS WELL AS COMMUNITY MEMBERS. DAY AND EVENING OPTIONS ARE AVAILABLE TO REACH A WIDER RANGE OF INDIVIDUALS. TOPICS RANGE FROM DIABETES-FRIENDLY COOKING DEMONSTRATIONS, CURRENT ADVANCES IN DIABETES TECHNOLOGY, AND PRESENTATIONS FROM LOCAL SPECIALISTS IN DIABETES-RELATED AREAS.UPON REQUEST, KHC DIETITIANS' PARTNER WITH THE LOCAL HIGH SCHOOL TO PROVIDE NUTRITION EDUCATION TO ATHLETES AND STUDENTS. D. CARDIOPULMONARY REHAB HAS PARTICIPATED IN COMMUNITY HEALTH INITIATIVES AS A PREVENTION MEASURE OF HEART AND LUNG DISEASE. THIS PAST YEAR THE OPPORTUNITY OCCURRED WITH WOMEN'S HEALTH INITIATIVE OFFERED OCTOBER 6, 2022. IN ADDITION, THE CARDIOPULMONARY REHAB PROGRAM CONTINUES TO OFFER FREE SMOKING CESSATION EDUCATION TO ANYONE IN THE COMMUNITY THAT NEEDS SUPPORT. 4. TRANSPORTATION MAKE ACCESSIBLE (EASY) FOR INDIVIDUALS TO USE WITH REASONABLE ACCESS & AFFORDABILITY.A. KHC HAS UTILIZED HOME INSTEAD FOR PRIVATE-PAY CARE AND TRANSPORTATION FOR INDIVIDUALS UNDERGOING ANESTHESIA FOR PROCEDURES AT KHC. KNOXVILLE CURRENTLY HAS TWO TAXI SERVICES IN KNOXVILLE: STANTON TAXI AND LYDIA'S TAXI THAT HAVE BEEN UTILIZED TO TRANSPORT PATIENTS IN NEED. ALSO, EVERY STEP SENIOR COMPANION PROGRAM AND HIRTA PSVP PARTNER WITH INDIVIDUAL VOLUNTEERS WHO ARE TO PROVIDE TRANSPORTATION AS WELL AS COMPANIONSHIP AND LIGHT HOUSEKEEPING.B. KHC IS EXPLORING THE UTILIZATION OF UBER/HEALTHCARE AS AN OPTION FOR PATIENT TRANSPORTATION IN THE COMMUNITY. C. KHC IS DEVELOPING A PLAN TO PROVIDE TRANSPORTATION TO PATIENTS IN NEED TO ENSURE THEY MAKE APPOINTMENTS FOR DOCTOR VISITS AND NECESSARY PROCEDURES. FOCUS ON PATIENTS WITH THE GREATEST NEED IN THE COMMUNITY. ALSO, EXPLORING AN ORGANIZED VOLUNTEER SYSTEM THAT WOULD MINIMIZE PHONE CALLS AND PROVIDE AN OPPORTUNITY FOR VOLUNTEERS TO BE EASILY CONNECTED WITH SERVICES OPPORTUNITIES, INCLUDING ONE-TIME NEEDS. 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. 4 1 - KNOXVILLE AREA COMMUNITY HOSPITAL CLINIC 1202 WEST HOWARD STREET KNOXVILLE IA 50138 PHYSICIAN CLINIC 2 - MELCHER PHYSICIANS CLINIC 113 NORTH MAIN STREET MELCHER IA 50163 PHYSICIAN CLINIC 3 - PLEASANTVILLE PHYSICIAN CLINIC 104 NORTH WASHINGTON STREET PLEASANTVILLE IA 50225 PHYSICIAN CLINIC 4 - RED ROCK HEALTH CENTER 615 WASHINGTON STREET PELLA IA 50219 PHYSICIAN CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE OR 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 I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,343,873. 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.COMMUNITY SUPPORT: MONETARY AND IN-KIND DONATIONS ARE GIVEN TO MANY COMMUNITY ORGANIZATIONS AND SCHOOL GROUPS. THE HOSPITAL SUPPORTS CANCER FUND RAISERS, PROM SAFETY EVENTS, SPORTING TEAMS, AND OTHER EVENTS. THE HOSPITAL PARTICIPATES IN LOCAL PARADES AND STRONGLY SUPPORTS LOCAL CHAMBER EVENTS AS WELL AS THE THRIVE PROGRAM. HOSPITAL EMPLOYEES SERVE ON LOCAL COMMUNITY BOARDS; SPEAK AT SCHOOL HEALTH AND CAREER EVENTS; TEACH SUNDAY SCHOOL; PROVIDE COACHING FOR AREA SPORTS TEAMS; AND DONATE TIME TO HABITAT FOR HUMANITY, 4H CLUBS, AND THE HISTORICAL SOCIETY. THE HOSPITAL OFFERED A WELCOME TO MEDICARE CLASS. THE HOSPITAL DONATES TO THE LOCAL THRIVE ORGANIZATION.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.COALITION BUILDING: THE HOSPITAL PROVIDES STAFF MEMBERS FOR THE MARION COUNTY HEALTH COALITION TEAM, WHICH INCLUDES A NUMBER OF NURSES EMPLOYED BY THE HOSPITAL. OUR ER COORDINATOR IS INVOLVED IN SERVICE AREA COALITION AND IS ON THE REGIONAL MASS CASUALTY TASK FORCE. HOSPITAL EMPLOYEES WORK WITH THE LOCAL PUBLIC HEALTH DEPARTMENT. THE HOSPITAL ALSO PERFORMS THE COMMUNITY HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENT AND MAINTAINS A PRESENCE IN THE COMMUNITY MENTAL HEALTH TEAM. THE HOSPITAL, IN CONJUNCTION WITH OTHER LOCAL AGENCIES, MAINTAINS A SUICIDE PREVENTION TASK FORCE. THE HOSPITAL PARTICIPATES IN AND SUPPORTS THE LOCAL BACK TO SCHOOL EVENTS. EMPLOYEES SERVE ON A LOCAL DAY CARE BOARD.COMMUNITY HEALTH IMPROVEMENT: THE HOSPITAL IS DESIGNATED AS A PATIENT CENTERED MEDICAL HOME BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE. THE HOSPITAL HOSTS, PARTICIPATES IN, OR PROVIDES SUPPORT FOR A VARIETY OF COMMUNITY PROGRAMS AND EVENTS INCLUDING PICK A BETTER SNACK SCHOOL PROGRAM, LOCAL HEALTH FAIRS, GIRLS NIGHT OUT, LOVE YOUR HEART DAY, SPORTS PHYSICALS, SPORTING EVENTS, DIABETES EDUCATION, CPR AND BLS CLASSES, FLU SHOT CLINICS, AND MORE. OUR PHYSICAL THERAPY DEPARTMENT OFFERS A VARIETY OF CLASSES ON PATIENTS PHYSICAL HEALTH IMPROVEMENT. PHYSICIANS PARTICIPATE IN LOCAL HEALTH BOARDS AND CONSULT FREE OF CHARGE TO THE OTHER ORGANIZATIONS. THE HOSPITAL HAS ACUTE CARE FROM 7AM TO 7PM FOR QUICKER ACCESS FOR PATIENTS WHO DON'T HAVE APPOINTMENTS. THE HOSPITAL CEO IS NOW ON OTHER ORGANIZATIONS' BOARDS, AND CONTINUES TO WORK ON A PLAN TO IMPROVE ACCESS TO MENTAL HEALTH CARE TO PATIENTS IN OUR AREA. THE HOSPITAL OFFERS VIRTUAL CARE VISITS. THE HOSPITAL SURVEYS ITS PATIENTS REGULARLY AND USES THE DATA TO IMPROVE CARE. IN 2021, THE HOSPITAL CREATED A PERMANENT COVID CLINIC SPACE AND IS IN THE PLANNING STAGES FOR A TRAVELING MOBILE CLINIC.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 THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE HOSPITAL'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE HOSPITAL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. 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 HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. 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 FOR THE HOSPITAL. THE COSTS OF CARING FOR PATIENTS WHO QUALIFY UNDER THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE POLICY FOR THE YEAR ENDED JUNE 30, 2022 WERE $205,000. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 11 AND 12 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES" "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: THERE IS NO SHORTFALL REPORTED DURING THE YEAR, THEREFORE NO AMOUNT 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 2021, 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 X X 0 0 0 0 0 0 0 0 0 LOGAN MILLER PHYSICIAN 403709 0 35694 0 2125 0 8550 0 26424 0 476502 0 0 0 SAMANTHA KEADY PHYSICIAN 385274 0 0 0 1762 0 10913 0 25943 0 423892 0 0 0 DYLAN LOWE PHYSICIAN 340214 0 15000 0 2210 0 10134 0 9089 0 376647 0 0 0 JAMES LAW PHYSICIAN 280380 0 9756 0 2125 0 8700 0 29245 0 330206 0 0 0 THOMAS HOEHNS PHYSICIAN 276513 0 0 0 2125 0 5485 0 18414 0 302537 0 0 0 MAGGIE HAMILTON -BEYER CFO 197372 0 9500 0 0 0 5183 0 9444 0 221499 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 $329,596 MERCYONE MEDICAL CENTER IS PART OF CATHOLIC HEALTH INITIATIVES. A CITY OF KNOXVILLE IOWA 426004843 2014-09-20 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 1396104 8650000 128143 6527480 1994377 2016 1 0 1 1 B 704758 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 DURING THE YEAR, THE BY-LAWS OF THE ORGANIZATION WERE AMENDED TO INCLUDE THE FOLLOWING CHANGE: THE BOARD OF DIRECTORS SHALL BE COMPRISED OF NO MORE THAN NINE MEMBERS, WHERE PREVIOUSLY, THE BOARD HAD A NINE MEMBER MINIMUM REQUIREMENT. 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 3,816,154. MANAGEMENT AND GENERAL EXPENSES 485,934. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,302,088. NURSING SERVICES: PROGRAM SERVICE EXPENSES 244,415. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,415. EMERGENCY ROOM SERVICES: PROGRAM SERVICE EXPENSES 724,920. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 724,920. PHYSICAL THERAPY SERVICES: PROGRAM SERVICE EXPENSES 784,163. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 784,163. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 566,139. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 566,139. LAB SERVICES: PROGRAM SERVICE EXPENSES 444,972. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 444,972. NUCLEAR MEDICINE SERVICES: PROGRAM SERVICE EXPENSES 285,909. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 285,909. RESPIRATOR SERVICES: PROGRAM SERVICE EXPENSES 251,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 251,340. 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 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0