HENRY COUNTY HEALTH CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HENRY COUNTY HEALTH CENTER INC (EIN 86-2701018)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202311359349308516
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T15:42:30-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 862701018 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HENR | BusinessNameControlTxt |
| Phone | 3193853141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 S WHITE STREET | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID MUHS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3193853141 | PhoneNum |
| Signature | 2023-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DAVID | PersonFirstNm |
| Person Last | MUHS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY CPA | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2023-05-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Initial Return | Yes (X) | InitialReturnInd |
| Principal Officer | TERESA COLGAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 S WHITE STREET | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,818,304 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.GREATRIVERHEALTH.ORG/HENRY-COUNTY-HEA | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2021 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | HENRY COUNTY HEALTH CENTER IS COMMITTED TO ENHANCING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES THROUGH HIGH QUALITY, EFFECTIVE AND EFFICIENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| CY Contributions Grants | $4,609,874 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $36,067,916 | CYProgramServiceRevenueAmt |
| CY Investment Income | $13,599 | CYInvestmentIncomeAmt |
| CY Other Revenue | $2,069,607 | CYOtherRevenueAmt |
| CY Total Revenue | $42,760,996 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $18,430,169 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| CY Other Expenses | $20,874,232 | CYOtherExpensesAmt |
| CY Total Expenses | $39,304,401 | CYTotalExpensesAmt |
| CY Revenues Less Expenses | $3,456,595 | CYRevenuesLessExpensesAmt |
| Total Assets EOY | $8,730,020 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $3,167,059 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | $5,562,961 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HENRY COUNTY HEALTH CENTER IS COMMITTED TO ENHANCING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES THROUGH HIGH QUALITY, EFFECTIVE AND EFFICIENT SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $33,298,334 | ExpenseAmt |
| Revenue | $37,599,812 | RevenueAmt |
| Desc | HENRY COUNTY HEALTH CENTER, INC., HAS ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT WILL LEASE ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. WILL MANAGE AND OPERATE HEALTH CARE ORGANIZATIONS. THIS WILL INCLUDE OPERATING THE 74 BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49 BED LONG-TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. WILL ALSO MANAGE AND OPERATE A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND FOUR RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDE COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. | Desc |
| Total Program Service Expenses | $33,298,334 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID MUHS | PersonNm |
| Phone | 3193853141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 S WHITE STREET | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| MATT WENZEL | |||||||
| DIRECTOR | 0.50 | 39.50 | Yes (X) | $0 | $1,109,111 | $58,133 | |
| DAVID FILE | |||||||
| CHAIRPERSON | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| MIKE PATTEN | |||||||
| VICE CHAIRPERSON | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| SARA BETH SCHURR | |||||||
| SECRETARY | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| WHITNEY ROGERS | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR DEWAYNE FRAZIER | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR JOEL RYON | |||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR FRED FRANK | |||||||
| DIRECTOR THRU 01/22 | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ROBB GARDNER | |||||||
| CEO | 40.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| DAVID MUHS | |||||||
| CFO | 40.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,109,111 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $58,133 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WAPITI MEDICAL GROUP | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | EMERGENCY ROOM SERVICES | $1,385,919 |
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND ST SUITE 300 | OMAHA | NE | 68114 | CONTRACTED LABOR | $770,131 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| 8 CADILLAC DRIVE 230 | BRENTWOOD | TN | 37027 | MEDICAL PHYSICIAN | $461,736 |
| LOCUMTENENES | |||||
| PO BOX 405547 | ATLANTA | GA | 30384 | MEDICAL PHYSICIAN | $418,575 |
| MUTUAL CONSULTING | |||||
| 1221 S GEAR AVE | WEST BURLINGTON | IA | 52655 | MANAGEMENT SERVICES | $417,445 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,208,689 | GovernmentGrantsAmt |
| All Other Contributions | $401,185 | AllOtherContributionsAmt |
| Total Contributions | $4,609,874 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| COMMERCIAL AND SELF PAY REVENUE | 621400 | $19,938,495 | $19,938,495 |
| NET MEDICARE REVENUE | 621400 | $15,717,427 | $15,717,427 |
| NET MEDICAID REVENUE | 621400 | $219,051 | $219,051 |
| ALL OTHER PATIENT SERVICE REVENUE | 621400 | $96,621 | $96,621 |
| 340B REVENUE | 621400 | $327 | $327 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $95,995 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $95,995 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,067,916 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,599 | TotalRevenueColumnAmt |
| Exclusion | $13,599 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $437,207 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $57,308 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $379,899 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $379,899 | TotalRevenueColumnAmt |
| Exclusion | $379,899 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| EMPLOYEE BENEFIT CREDIT | 900099 | $1,531,896 | $1,531,896 | |
| CAFETERIA | 900099 | $156,679 | $156,679 | |
| CATERING | 900099 | $1,133 | $1,133 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,689,708 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,760,996 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,599,812 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $551,310 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,109,817 | TotalAmt |
| Program Services | $12,573,529 | ProgramServicesAmt |
| Management And General | $1,536,288 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,320,352 | TotalAmt |
| Program Services | $3,347,403 | ProgramServicesAmt |
| Management And General | $972,949 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158 | TotalAmt |
| Management And General | $158 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,936 | TotalAmt |
| Management And General | $22,936 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,120,584 | TotalAmt |
| Program Services | $8,496,847 | ProgramServicesAmt |
| Management And General | $1,623,737 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,331 | TotalAmt |
| Program Services | $259,891 | ProgramServicesAmt |
| Management And General | $97,440 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,933,443 | TotalAmt |
| Program Services | $1,734,599 | ProgramServicesAmt |
| Management And General | $198,844 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,498 | TotalAmt |
| Program Services | $2,498 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,863 | TotalAmt |
| Management And General | $145,863 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & EQUI | $2,940,830 | $2,940,830 | |
| PHARMACY | $1,927,422 | $1,927,422 | |
| LEASES & RENTALS | $1,798,758 | $579,377 | $1,219,381 |
| BAD DEBT EXPENSE | $826,827 | $826,827 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $797,582 | TotalAmt |
| Program Services | $609,111 | ProgramServicesAmt |
| Management And General | $188,471 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,304,401 | TotalAmt |
| Program Services | $33,298,334 | ProgramServicesAmt |
| Management And General | $6,006,067 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,476 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,121,696 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,944,436 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $947,715 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $248,524 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,465,173 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $8,730,020 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,395,954 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,771,105 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,167,059 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $5,562,961 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $5,562,961 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $8,730,020 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,456,595 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $2,106,366 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $6,887 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,887 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | HENRY COUNTY HEALTH CENTER PAYS ASSOCIATION DUES TO THE IOWA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). PORTIONS OF THE ASSOCIATION DUES ARE EXPENDED BY THE ASSOCIATIONS FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| THIRD-PARTY SETTLEMENTS | $349,237 |
| RECEIVABLE FROM HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOPSITAL | $1,115,936 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,465,173 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO SOUTHEAST IOWA REGIONAL MEDICAL CENTER | $454,143 |
| DUE TO HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL | $1,316,962 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,771,105 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2022, THE HEALTH CENTER HAS NO UNCERTAIN TAX POSITIONS ACCRUED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $109,939 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $109,939 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $286,121 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $219,051 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $67,070 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $396,060 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $219,051 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $177,009 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,116 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,116 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $405,176 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $219,051 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $186,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00470 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $826,827 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $85,163 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,276,525 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $15,216,602 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $59,923 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HEALTH CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 407 S WHITE ST | AddressLine1Txt |
| City | MT PLEASANT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52641 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GREATRIVERHEALTH.ORG/HENRY-COUNTY- | WebsiteAddressTxt |
| State License | 440047H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY COUNTY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (1) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | HENRY COUNTY HEALTH CENTER, INC. | FormAndLineReferenceDesc |
| Explanation | PART V, SECTION B, LINE 2: HENRY COUNTY HEALTH CENTER, INC., RECEIVED TAX EXEMPT STATUS AS A 501(C)(3) IN MARCH 2021 AND ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS. THIS INCLUDES OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG-TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND FOUR RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDES COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - PARK PLACE ELDER LIVING | ||||
| 401 S VAN BUREN ST | MT PLEASANT | IA | 52641 | NURSING HOME CARE |
| 2 - HCHC - MT PLEASANT CLINIC | ||||
| 407 S WHITE ST STE 103 | MT PLEASANT | IA | 52641 | PROVIDER HEALTH CLINIC |
| 3 - HCHC - WINFIELD CLINIC | ||||
| 110 W PINE ST | WINFIELD | IA | 52659 | PROVIDER HEALTH CLINIC |
| 4 - HCHC - WAYLAND CLINIC | ||||
| 227 W MAIN ST | WAYLAND | IA | 52654 | PROVIDER HEALTH CLINIC |
| 5 - HCHC - NEW LONDON CLINIC | ||||
| 111 W WASHINGTON ST | NEW LONDON | IA | 52645 | PROVIDER HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $826,827. |
| PART III, LINE 2: | THE HEALTH CENTER 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 HEALTH CENTER'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE HEALTH CENTER DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE HEALTH CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. |
| PART III, LINE 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL. 10.3% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8 THROUGH 10 OF THE ATTACHED AUDITED 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: | EACH PATIENT RECEIVES CARE REGARDLESS OF THE ABILITY TO PAY. ANY PATIENT CAN APPLY FOR FINANCIAL ASSISTANCE PRIOR TO OR AFTER RECEIVING A STATEMENT FOR SERVICES. THERE ARE NO COLLECTION EFFORTS WHILE AN INDIVIDUAL IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES ON PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST STATEMENT AND PROVIDES PATIENTS 240 DAYS TO APPLY FOR ASSISTANCE. |
| PART VI, LINE 2: | THE ORGANIZATION WORKS WITH PHYSICIANS, THE HEALTH DEPARTMENT, AND OTHER HEALTH CARE PROVIDERS IN THE COMMUNITY TO DETERMINE THE HEALTH CARE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 3: | GREAT RIVER HEALTH SYSTEM ADVISES PATIENTS AND THEIR FAMILIES OF THE FINANCIAL ASSISTANCE POLICY THROUGH THE FOLLOWING MEANS:- DIRECT PATIENT CONTACT, IN PERSON, OR BY PHONE.- AT THE POINT OF REGISTRATION AT ALL CLINIC AND HOSPITAL LOCATIONS.- IN THE EMERGENCY DEPARTMENT DURING REGISTRATION OR DISCHARGE.- ON THE BACK OF PATIENT STATEMENTS.- ONLINE AT HTTPS://GREATRIVERHEALTH.ORG AND HTTPS://HCHC.ORG- THE POLICY AND APPLICATION ARE DOWN LOADABLE AND PRINTABLE.- PUBLIC AGENCIES AND NOT-FOR-PROFIT AGENCIES SERVING THE COMMUNITY MEMBER WHO ARE LIKELY TO USE FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | HENRY COUNTY HEALTH CENTER, INC., ENTERED INTO A HOSPITAL LEASE AGREEMENT WHERE IT LEASES ALL OF THE FACILITIES AND OPERATIONS, EXCEPT THE AMBULANCE SERVICE, OF HENRY COUNTY SOLDIERS AND SAILORS MEMORIAL HOSPITAL, A COUNTY HOSPITAL ORGANIZED UNDER IOWA CODE CHAPTER 347. HENRY COUNTY HEALTH CENTER, INC. MANAGES AND OPERATES HEALTH CARE ORGANIZATIONS. THIS INCLUDES OPERATING THE 74-BED CRITICAL ACCESS HOSPITAL THAT FEATURES 25 ACUTE CARE BEDS ALONG WITH A 49-BED LONG-TERM CARE FACILITY, PARK PLACE. HENRY COUNTY HEALTH CENTER, INC. ALSO MANAGES AND OPERATES A CLINICAL/GROUP PRACTICE LOCATED ON THE GROUNDS OF THE HOSPITAL AND FOUR RURAL HEALTH CLINICS IN THE SURROUNDING RURAL COMMUNITIES AND PROVIDE COMMUNITY HEALTH EDUCATION FOR THE COMMUNITY.LOCATED IN SOUTHEAST IOWA, MOUNT PLEASANT IS AT THE CROSSROADS OF U.S. HIGHWAY 218 AND U.S. 34. HENRY COUNTY HAS 11 CITIES AND MORE THAN 20,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IN HENRY COUNTY IS $52,428. THIS IS LOWER THAN THE STATE MEDIAN ($58,580) AND NATIONAL MEDIAN ($60,293). ELEVEN PERCENT OF ALL RESIDENTS AND 15% OF CHILDREN UNDER THE AGE OF 18 LIVE IN HOUSEHOLDS EARNING LESS THAN THE FEDERAL POVERTY LEVEL. ACCORDING TO THE UNITED WAY'S ALICE REPORT, THE HOUSEHOLD SURVIVAL INCOME LEVEL FOR A SINGLE ADULT IN HENRY COUNTY IS $20,352 AND FOR A FAMILY OF FOUR IS $57,072. THIS IS MUCH HIGHER THAN THE FEDERAL POVERTY LEVEL WHICH IS $12,760 FOR A SINGLE PERSON AND $26,000 FOR A FAMILY OF FOUR. FORTY-ONE PERCENT OF HOUSEHOLDS IN HENRY COUNTY HAVE INCOMES BELOW THE SURVIVABLE WAGE AS DEFINED BY UNITED WAY. 51.6% OF THE POPULATION IS MALE AND 48.4% OF THE POPULATION IS FEMALE. NINETEEN PERCENT OF THE POPULATION IS 65 YEARS OR OLDER WHICH IS HIGHER THAN IOWA'S OVERALL RATE OF 17.1%. THERE IS A LOWER PERCENTAGE OF YOUNG PEOPLE LIVING IN HENRY COUNTY (21.6%) COMPARED TO IOWA (23.2%). ACCORDING TO THE U.S. CENSUS 2019 ESTIMATES, HENRY COUNTY IS 92% WHITE, 2.8% BLACK OR AFRICAN AMERICAN, 0.4% AMERICAN INDIAN AND ALASKA NATIVE, 2.6% ASIAN, AND 1.7% TWO OR MORE RACES. IN ADDITION, 5% OF THE POPULATION OF HENRY COUNTY IS ESTIMATED TO BE HISPANIC OR LATINO. |
| PART VI, LINE 5: | THE BOARD MEMBERS LIVE IN THE HOSPITAL SERVICE AREA AND USE THE FACILITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. HENRY COUNTY HEALTH CENTER USES SURPLUS FUNDS TO INVEST IN HOSPITAL EQUIPMENT AND IMPROVEMENTS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MATT WENZEL | PersonNm |
| Title | DIRECTOR | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $856,956 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $248,615 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $3,540 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $14,500 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $43,633 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $1,167,244 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | ROBB GARDNER WAS PAID BY AN UNRELATED ORGANIZATION, MUTUAL CONSULTING, FOR HIS POSITION AS CEO. MUTUAL CONSULTING USES APPROVAL BY THE BOARD IN DETERMINING HIS COMPENSATION. |
| SCHEDULE J, PART II: | ROBB GARDNER WAS PAID BY AN UNRELATED ORGANIZATION, MUTUAL CONSULTING, FOR HIS POSITION AS CEO. TOTAL COMPENSATION AND BENEFITS PAID TO MR. GARDNER FOR 2021 WAS $249,976. DAVID MUHS WAS PAID BY AN UNRELATED ORGANIZATION, HENRY COUNTY SOLDIERS & SAILORS MEMORIAL HOSPITAL, FOR HIS POSITION AS CFO. TOTAL COMPENSATION AND BENEFITS PAID TO MR. MUHS FOR 2021 WAS $233,546. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | EXECUTIVES AND EMPLOYEES OF GREAT RIVER HEALTH SYSTEM, INC., MANAGE THE ACTIVITIES OF THE HENRY COUNTY HEALTH CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT RIVER HEALTH SYSTEM, INC., AN IOWA NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF HENRY COUNTY HEALTH CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | GREAT RIVER HEALTH SYSTEM, INC. HAS THE POWER TO ELECT OR REMOVE THE BOARD OF DIRECTORS OR ANY OTHER MEMBER OF THE BOARD OF DIRECTORS OF THE HOSPITAL OR ANY AFFILIATE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | GREAT RIVER HEALTH SYSTEM, INC. RESERVES THE FOLLOWING POWERS AT ITS SOLE DISCRETION: - ELECT OR REMOVE THE BOARD OF DIRECTORS OR ANY OTHER MEMBER OF THE BOARD OF DIRECTORS OF THE HOSPITAL AND ANY AFFILIATED ORGANIZATION; - AMEND THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE HOSPITAL; - DISSOLVE THE HOSPITAL OR MERGER OF THE HOSPITAL WITH ANY OTHER CORPORATE ENTITY; - APPROVE STRATEGIC OR OTHER BUSINESS PLANS FOR THE HOSPITAL; - APPROVE CAPITAL AND OPERATING BUDGETS OF THE HOSPITAL; - APPROVE ANY INDEBTEDNESS INCURRED BY THE HOSPITAL; - TRANSFER, SALE OR CLOSURE OF ANY FACILITY, DEPARTMENT OR FUNCTION OF THE HOSPITAL; - APPROVE ANY CHARITABLE DISBURSEMENT, WHETHER INTERNAL OR EXTERNAL, IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000.00) MADE BY THE HOSPITAL OR ANY FOUNDATION ENTITY ASSOCIATED WITH HOSPITAL; - THE SALE, DISPOSITION OR ANY ENCUMBRANCE (OTHER THAN ROUTINE LEASE TRANSACTIONS) OF ANY REAL ESTATE OWNED BY THE HOSPITAL OR ANY AFFILIATED ORGANIZATION; - ADOPT, AMEND, OR TERMINATE EMPLOYEE BENEFIT PROGRAMS OR PLANS; - APPOINT OR TERMINATE THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL OR ANY AFFILIATED ORGANIZATION; - APPROVE THE ELECTION OF ANY OFFICER OR CHAIRPERSON OF THE BOARD OF DIRECTORS OF THE HOSPITAL OR ANY AFFILIATED ORGANIZATION; - TO TAKE ANY OTHER ACTION NECESSARY DEEMED IN THE BEST INTERESTS OF GRHS. |
| 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 | A COPY OF THE FORM 990 IS MADE AVAILABLE TO THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS MUST ANNUALLY DISCLOSE INTERESTS THAT MAY GIVE RISE TO CONFLICTS. BOARD MEMBERS MUST EXCUSE THEMSELVES FROM VOTING IN MATTERS IN WHICH THEY HAVE A PERSONAL INTEREST. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY WITH BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS DETERMINED BY USING SEVERAL DATA COMPARISONS. THE REVIEW ALSO LOOKS AT INTERNAL EQUITY TO ENSURE A POSITION IS NOT OUT-OF-LINE WITH OTHER SIMILAR POSITIONS. THIS IS COMPLETED BY THE HUMAN RESOURCE DEPARTMENT, WITH THE SYSTEM CEO'S APPROVAL, ALONG WITH THE SYSTEM BOARD APPROVAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 3,375,191. MANAGEMENT AND GENERAL EXPENSES 1,623,737. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,998,928. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 5,121,656. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,121,656. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER FROM SOUTHEAST IOWA REGIONAL MEDICAL CENTER 2,106,366. |
| FORM 990, PAGE 12, PART XII, LINE 2C: | THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY OF SELECTING THE INDEPENDENT ACCOUNTANT TO COMPLETE THE AUDIT WORK. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE BOARD OF DIRECTORS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT RIVER HEALTH SYSTEM INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 SOUTH GEAR AVENUE | AddressLine1Txt |
| City | WEST BURLINGTON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52655 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421193185 | EIN |
| Primary Activities | SUPPORT GREAT RIVER MEDICAL CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12B, II | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |