PALMER LUTHERAN HEALTH CENTER INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- PALMER LUTHERAN HEALTH CENTER INC (EIN 42-1320763)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-02
- IRS object ID
- 202303069349302395
- Schema version
- 2022v5.0
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-02T15:03:33-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421320763 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PALMER LUTHERAN HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PALM | BusinessNameControlTxt |
| Phone | 5634223811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON ST | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDA MOSER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5634223811 | PhoneNum |
| Signature | 2023-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | BRENDA | PersonFirstNm |
| Person Last | MOSER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2023-11-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSON PALMER LUTHERAN HOSPITAL AND CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PATRICE KUENNEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON ST | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,147,925 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.GUNDERSENHEALTH.ORG/PALMER/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 256 | TotalEmployeeCnt |
| Total Volunteers | 3 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,856,172 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,169,279 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,706,881 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,746,381 | CYProgramServiceRevenueAmt |
| PY Investment Income | $58,538 | PYInvestmentIncomeAmt |
| CY Investment Income | $76,376 | CYInvestmentIncomeAmt |
| PY Other Revenue | $224,665 | PYOtherRevenueAmt |
| CY Other Revenue | $155,889 | CYOtherRevenueAmt |
| PY Total Revenue | $42,846,256 | PYTotalRevenueAmt |
| CY Total Revenue | $38,147,925 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $6,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,611,368 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,684,761 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,009,546 | PYOtherExpensesAmt |
| CY Other Expenses | $15,585,844 | CYOtherExpensesAmt |
| PY Total Expenses | $33,626,914 | PYTotalExpensesAmt |
| CY Total Expenses | $36,270,605 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $9,219,342 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,877,320 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $40,855,020 | TotalAssetsBOYAmt |
| Total Assets EOY | $35,735,329 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,079,586 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,052,051 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,775,434 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,683,278 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $31,071,175 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $36,746,381 | RevenueAmt |
| Desc | PALMER LUTHERAN HEALTH CENTER IS A 25-LICENSED BED CRITICAL ACCESS HOSPITAL. THE ONLY HOSPITAL IN WEST UNION, IOWA, AND EMPLOYS ABOUT 230 EMPLOYEES. PALMER LUTHERAN HEALTH CENTER ALSO HAS THREE RURAL HEALTH CLINICS IN THE COMMUNITIES OF WEST UNION, FAYETTE AND POSTVILLE, A HOME CARE DEPARTMENT, HOSPICE DEPARTMENT, AND HOME MEDICAL EQUIPMENT DEPARTMENT. IN ADDITION, PALMER OPERATES AN AFTERHOURS AND WEEKEND WALK-IN CLINIC, ALLOWING PATIENTS TO BE SEEN 7 DAYS A WEEK IN THIS SETTING. THIS IS OFFERED TO SPECIFICALLY MEET COMMUNITY HEALTH NEEDS OF WORKING FAMILIES. ANNUALLY, PALMER HAS ABOUT 415 ADMISSIONS, OVER 752LIVE BIRTHS; OVER 3,300 EMERGENCY CENTER VISITS, ABOUT 20,000 PATIENT VISITS IN THE CLINICS AND PERFORMS OVER 550 SURGERIES (INCLUDING AMBULATORY).ACCOMPLISHMENTS: WHEN RENOVATED, THE HOSPITAL WAS DESIGNED TO ACHIEVE THREE GOALS - CREATE A HEALING ENVIRONMENT THAT WELCOMES AND SUPPORTS PATIENTS/FAMILIES, DESIGN WORK AREAS TO BETTER ACCOMMODATE CURRENT AND FUTURE TECHNOLOGIES, SYSTEMS AND APPROACHES TO CARE, AND TO COMPLY MORE FULLY WITH HIPPA REGULATIONS. PALMER LUTHERAN HEALTH CENTER LEADS DELIVERY OF HEALTHCARE TO ITS REGION THROUGH OVER 215 ASSOCIATES (INCLUDING 5 PHYSICIANS, 5 PHYSICIANS ASSISTANTS, 3 NURSE PRACTITIONERS, 1 CERTIFIED NURSE MIDWIFE AND 2 BEHAVIORAL HEALTH PROVIDERS ON STAFF) WHICH COORDINATE CARE TO DELIVER PATIENT CARE AS AN INTEGRATED UNIT. PALMER LUTHERAN HEALTH CENTER AND ITS AFFILIATES ALSO WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARDS FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO PALMER LUTHERAN HEALTH CENTER'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLY, PALMER LUTHERAN HEALTH C\CENTER IS GOVERNED BY A BOARD THAT INCLUDES 3 INDEPENDENT BOARD MEMBERS WHO ARE COMMUNITY LEADERS, CONSUMER REPRESENTATIVES, BUSINESS EXPERTS, AND CLINICAL HEALTHCARE EXPERTS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST OF INTEGRITY FOR THE BENEFIT OF THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER ALSO MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. PALMER OPERATES A FULL-TIME EMERGENCY ROOM AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. PALMER PROVIDES CLINICAL SERVICES NEEDED TO OPERATE THE EMERGENCY CENTER AND PROVIDES ON-SITE EMERGENCY MEDICAL, RESCUE AND MEDICAL TRANSPORTATION SERVICES. IN ADDITION, PALMER LUTHERAN HEALTH CENTER, 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 HELPING THROUGH PALMER'S CHARITY CARE POLICY, AND SOCIAL SERVICES DEPARTMENT. PALMER LUTHERAN HEALTH CENTER UTILIZES TECHNOLOGY THAT PROVIDES A COMPLETE ELECTRONIC MEDICAL RECORD. OUR ELECTRONIC HEALTH RECORD IS CONNECTED TO GUNDERSEN HEALTH SYSTEM, WHICH ALLOWS US TO SHARE TEST RESULTS AND OTHER PATIENT INFORMATION. THIS ENHANCES THE PATIENT CARE AT OUR FACILITY, AS WELL AS OTHER GUNDERSEN ENTITIES THROUGHOUT THE REGION. THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNTS OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE HEALTH CENTER'S CHARITY CARE POLICY WERE $948,351 FOR THE YEAR ENDED DECEMBER 31, 2022. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION WERE $608,643. THE HEALTH CENTER 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. PALMER LUTHERAN HEALTH CENTER TAKES ITS MISSION TO IMPROVE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVICES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE COMMUNITY. IT STRIVES TO IDENTIFY COMMUNITY NEEDS BEYOND BASIC HEALTHCARE, THEN RESPOND TO THEM, AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER TAKES A STRATEGIC, COMMUNITY NEEDS-BASED APPROACH TO DELIVERING BENEFITS TO THE COMMUNITY.IN 2022, PALMER LUTHERAN HEALTH CENTER BEGAN PROVIDING BEHAVIORAL HEALTH SERVICES WITHIN OUR WEST UNION RURAL HEALTH CLINIC. WE CURRENTLY HAVE 2 PROVIDERS SEEING PATIENTS VIA TELEMED SERVICES. | Desc |
| Total Program Service Expenses | $31,071,175 | 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 | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 78 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 256 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRENDA MOSER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5634223811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON ST | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LYNN LAUER | ||||||||
| CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KRISTI FLACK | ||||||||
| VICE CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DR MORDECHAI LEDERMAN | ||||||||
| SECRETARY / TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $304,693 | $68,552 | ||
| RACHEL ALBRECHT | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $151,435 | $46,902 | 39.50 | ||
| SARA CARPENTER | ||||||||
| DIRECTOR - THRU 03/22 | 0.50 | Yes (X) | $0 | $51,243 | $15,514 | 39.50 | ||
| CHUCK JOHNSON | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $134,297 | $49,130 | 39.50 | ||
| TOM TORNSTROM | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $146,760 | $39,263 | 39.50 | ||
| ANDREW WENTHE | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| LISA WIED | ||||||||
| DIRECTOR - THRU 01/22 | 0.50 | Yes (X) | $0 | $43,135 | $7,088 | 39.50 | ||
| PATRICE KUENNEN | ||||||||
| CEO | 40.00 | Yes (X) | $0 | $180,536 | $48,455 | |||
| BRENDA MOSER | ||||||||
| FINANCE ADMINISTRATOR | 32.00 | Yes (X) | $0 | $166,265 | $47,301 | 8.00 | ||
| KEN BEACH | ||||||||
| CRNA | 40.00 | $207,135 | $0 | $37,916 | Yes (X) | |||
| EMILY MORK | ||||||||
| PHARMACY MANAGER | 40.00 | $137,872 | $0 | $42,564 | Yes (X) | |||
| DEBBIE BRINK | ||||||||
| RN | 40.00 | $133,971 | $0 | $19,201 | Yes (X) | |||
| NICHOLE STEFFENS | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $116,379 | $0 | $5,687 | Yes (X) | |||
| JESSICA LOBAN | ||||||||
| NURSE PRACTITIONER | 40.00 | $114,060 | $0 | $7,362 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $709,417 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,178,364 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $434,935 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| IOWA EMERGENCY PHYSICIANS | |||||
| 200 CORPORATE BLVD | LAFAYETTE | LA | 70508 | PHYSICIAN SERVICES | $1,822,393 |
| REHAB VISIONS | |||||
| 11623 ARBOR ST | OMANA | NE | 68144 | REHAB SERVICES | $1,625,120 |
| STAFFENCY | |||||
| 221 W COLLEGE AVE FLOOR 2 | APPLETON | WI | 54911 | STAFFING SERVICES | $599,710 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | PHYSICIAN SERVICES | $576,267 |
| GRAPE TREE MEDICAL STAFFING LL | |||||
| PO BOX 5340 | SIOUX FALLS | SD | 571175340 | STAFFING SERVICES | $328,351 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,143,322 | GovernmentGrantsAmt |
| All Other Contributions | $25,957 | AllOtherContributionsAmt |
| Total Contributions | $1,169,279 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $27,529,181 | $27,529,181 |
| PHARMACY REVENUE | 621110 | $8,862,709 | $8,862,709 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $354,491 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $354,491 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,746,381 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,376 | TotalRevenueColumnAmt |
| Exclusion | $76,376 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $45,348 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $45,348 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,348 | TotalRevenueColumnAmt |
| Exclusion | $45,348 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $51,709 | TotalRevenueColumnAmt |
| Exclusion | $51,709 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,832 | TotalRevenueColumnAmt |
| Exclusion | $58,832 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $110,541 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,147,925 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,746,381 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $232,265 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $442,557 | TotalAmt |
| Management And General | $442,557 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,341,401 | TotalAmt |
| Program Services | $15,552,599 | ProgramServicesAmt |
| Management And General | $1,788,802 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $459,873 | TotalAmt |
| Program Services | $429,841 | ProgramServicesAmt |
| Management And General | $30,032 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,629,591 | TotalAmt |
| Program Services | $1,186,132 | ProgramServicesAmt |
| Management And General | $443,459 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $811,339 | TotalAmt |
| Program Services | $698,945 | ProgramServicesAmt |
| Management And General | $112,394 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $347,940 | TotalAmt |
| Management And General | $347,940 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $382 | TotalAmt |
| Management And General | $382 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,200 | TotalAmt |
| Management And General | $40,200 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,730,486 | TotalAmt |
| Program Services | $5,585,727 | ProgramServicesAmt |
| Management And General | $144,759 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,855 | TotalAmt |
| Program Services | $1,136 | ProgramServicesAmt |
| Management And General | $56,719 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,936 | TotalAmt |
| Program Services | $134,076 | ProgramServicesAmt |
| Management And General | $112,860 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,044,655 | TotalAmt |
| Program Services | $13,544 | ProgramServicesAmt |
| Management And General | $1,031,111 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,051,217 | TotalAmt |
| Program Services | $1,006,295 | ProgramServicesAmt |
| Management And General | $44,922 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,746 | TotalAmt |
| Program Services | $166,898 | ProgramServicesAmt |
| Management And General | $8,848 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,114 | TotalAmt |
| Program Services | $26,193 | ProgramServicesAmt |
| Management And General | $10,921 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,537 | TotalAmt |
| Program Services | $149,267 | ProgramServicesAmt |
| Management And General | $37,270 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $932,375 | TotalAmt |
| Program Services | $745,900 | ProgramServicesAmt |
| Management And General | $186,475 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,958 | TotalAmt |
| Program Services | $500 | ProgramServicesAmt |
| Management And General | $78,458 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,618,266 | $4,600,320 | $17,946 |
| OTHER EXPENSES | $327,657 | $120,243 | $207,414 |
| BAD DEBT | $319,279 | $319,279 | |
| MEDICAL EQUIPMENT | $196,774 | $184,779 | $11,995 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,467 | TotalAmt |
| Program Services | $149,501 | ProgramServicesAmt |
| Management And General | $43,966 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,270,605 | TotalAmt |
| Program Services | $31,071,175 | ProgramServicesAmt |
| Management And General | $5,199,430 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,934 | BOYAmt |
| EOY | $1,934 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,780,414 | BOYAmt |
| EOY | $17,974,592 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,718,297 | BOYAmt |
| EOY | $5,856,960 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $874,503 | BOYAmt |
| EOY | $812,804 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,381 | BOYAmt |
| EOY | $109,457 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,704,244 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,026,070 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,579,801 | BOYAmt |
| EOY | $8,678,174 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,765,690 | BOYAmt |
| EOY | $2,301,408 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,855,020 | BOYAmt |
| EOY | $35,735,329 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,828,972 | BOYAmt |
| EOY | $2,890,763 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,353,942 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,069,311 | BOYAmt |
| EOY | $4,384,704 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,455,698 | BOYAmt |
| EOY | $2,088,423 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,371,663 | BOYAmt |
| EOY | $5,688,161 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,079,586 | BOYAmt |
| EOY | $15,052,051 | 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) |
|---|---|---|
| BOY | $18,064,809 | BOYAmt |
| EOY | $19,975,629 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $710,625 | BOYAmt |
| EOY | $707,649 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,775,434 | BOYAmt |
| EOY | $20,683,278 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,855,020 | BOYAmt |
| EOY | $35,735,329 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,877,320 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $30,524 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $4,238 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,238 | 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 | PALMER LUTHERAN HEALTH CENTER PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND TO THE IOWA HOSPITAL ASSOCIATION (IHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THESE ORGANIZATIONS HAVE NOTIFIED PALMER LUTHERAN HEALTH CENTER THAT $4,238 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $168,281 | OtherCostOrOtherBasisAmt |
| Book Value | $168,281 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,750,927 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,944,516 | DepreciationAmt |
| Book Value | $5,806,411 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,298,570 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,026,684 | DepreciationAmt |
| Book Value | $2,271,886 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $486,466 | OtherCostOrOtherBasisAmt |
| Depreciation | $54,870 | DepreciationAmt |
| Book Value | $431,596 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,678,174 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| RIGHT OF USE ASSETS | $1,593,759 |
| INTEREST IN NET ASSETS OF FOUNDATION | $707,649 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,301,408 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| 3RD PARTY SETTLEMENTS PAYABLE | $3,085,448 |
| ADVANCE COVID PAYMENTS | $2,443,233 |
| DUE FROM RELATED PARTY | $159,480 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,688,161 | 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 SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | 0 | FinancialAssistancePolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $539,387 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $539,387 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01490 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,024,104 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,956,731 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,067,373 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02940 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,563,491 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,956,731 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,606,760 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04430 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $84,166 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $84,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,183,628 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,999,073 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,184,555 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,200 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,200 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,279,494 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,999,073 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,280,421 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17310 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,842,985 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,955,804 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,887,181 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21740 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 23766 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $5,141 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 72 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,987 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,987 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 23838 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $7,128 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,128 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $181,989 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $90,995 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,983,654 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,029,115 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$45,461 | 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 | PALMER LUTHERAN HEALTH CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON STREET | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GUNDERSENHEALTH.ORG/PALMER | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PALMER LUTHERAN HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL SECTION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL SECTION | StrategyWebsiteURLTxt |
| 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | 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 |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | 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 Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 5: IN PARTNERSHIP WITH FAYETTE COUNTY PUBLIC HEALTH, GUNDERSEN PALMER DEVELOPED A SURVEY TO DISSEMINATE WITHIN THE SERVICE AREA- SEE APPENDIX A. THE FAYETTE COUNTY HEALTH ASSESSMENT DATA COLLECTION PROCESS WAS CONDUCTED BY FIRST SURVEYING THE CITIZENS OF FAYETTE COUNTY AT THE FAYETTE COUNTY FAIR IN JULY OF 2022. A TEAM CONSISTING OF A UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH STRIKE TEAM AND A COMMUNITY HEALTH INTERN UTILIZED SOCIAL MEDIA, IPADS, AND PAPER SURVEYS IN ORDER TO CONNECT WITH THE PUBLIC AT THE COUNTY FAIR. FOLLOWING THE FAIR, THE SURVEY WAS DISSEMINATED WITHIN THE FAYETTE COUNTY COMMUNITY AND SENT THE SURVEY OUT THROUGH SOCIAL MEDIA AND EMAIL, WHERE COMMUNITY MEMBERS AND ORGANIZATIONS CONTINUALLY SHARED IT. FOR THE ASSESSMENT, GUNDERSEN PALMER PARTNERED WITH THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH, THE IOWA DEPARTMENT OF PUBLIC HEALTH, FAYETTE COUNTY PUBLIC HEALTH, THE HEALTHY FAYETTE COUNTY COALITION, AND MERCYONE. IN ADDITION TO UTILIZING THE DATA COLLECTED FOR OUR ASSESSMENT, WE HAVE ALSO REFERENCED MERCYONE'S, ANOTHER HOSPITAL WITHIN OUR COUNTY, COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN. INFORMATION PROVIDED BY PARTNERS AT LOCAL ORGANIZATIONS,GUNDERSEN HEALTH SYSTEM, IOWA DEPARTMENT OF PUBLIC HEALTH, HELPING SERVICES, NORTH FAYETTE VALLEY COMMUNITY COALITION, AND FAYETTE COUNTY PUBLIC HEALTH WAS UTILIZED AS WELL. DURING THE ASSESSMENT PROCESS, INPUT WAS GATHERED FROM A NUMBER OF SOURCES WORKING AS PUBLIC HEALTH PROFESSIONALS, INCLUDING INDIVIDUALS EMPLOYED AT FAYETTE COUNTY PUBLIC HEALTH AND THE IOWA DEPARTMENT OF PUBLIC HEALTH, AS WELL AS AN INDIVIDUAL WORKING IN THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH. INPUT FOR THE SURVEY WAS GATHERED BY SENDING OUT DRAFTS OF THE ASSESSMENT FOR FEEDBACK, ALONG WITH CONDUCTING ZOOM MEETINGS TO GO OVER POTENTIAL REVISIONS. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY, WITH OPPORTUNITIES FOR PAPER COPIES, WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, AND NUMEROUS OTHER INDIVIDUALS AND ORGANIZATIONS THROUGHOUT THE SERVICE AREA. A TOTAL OF 193 ELECTRONIC AND PAPER SURVEYS WERE COLLECTED, WITH PAPER RESPONSES BEING ENTERED INTO THE ELECTRONIC SURVEY DATABASE. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY.THE COLLECTED DATA FROM THE SURVEY, COMBINED WITH SECONDARY DATA COLLECTED, HELPED IN IDENTIFYING OPPORTUNITIES TO IMPROVE THE HEALTH OF FAYETTE COUNTY. SECONDARY DATA SOURCES INCLUDE, BUT ARE NOT LIMITED TO, ROBERT WOOD JOHNSON FOUNDATION (RWJF) COUNTY HEALTH RANKINGS & ROADMAPS; PREVIOUS DATA COLLECTED FROM FAYETTE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT; OTHER LOCAL HOSPITAL HEALTH NEEDS ASSESSMENT; IOWA DEPARTMENT OF PUBLIC HEALTH; THE CENTER FOR DISEASE CONTROL AND PREVENTION; US CENSUS BUREAU; GUNDERSEN HEALTH SYSTEM; NORTH FAYETTE VALLEY COMMUNITY COALITION; DATA USA; NORTH CAROLINA RURAL HEALTH RESEARCH; IOWA HOSPITAL ASSOCIATION; AND OTHER SOURCES NOTED WITHIN THE REPORT.GUNDERSEN PALMER LEADERS CONTRIBUTED EXPERTISE IN EVALUATING DATA, RESEARCH, AND OTHER INFORMATION, WHILE TAKING INTO ACCOUNT TRENDS WITHIN THE COMMUNITY AND INDIVIDUALIZED PRACTICE SETTING, PATIENT FEEDBACK AND HOSPITAL UTILIZATION DATA TO HELP FINALIZE THE STRATEGIES. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 6A: MERCYONE |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 6B: FAYETTE COUNTY PUBLIC HEALTHUNIVERSITY OF IOWA PUBLIC HEALTHIOWA DEPARTMENT OF PUBLIC HEALTHHEALTHY FAYETTE COUNTY COALITION |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 11: PALMER LUTHERAN HEALTH CENTER HAS SEVERAL INITIATIVES IN PLACE TO HELP ADDRESS THE TOP THREE PRIORITIES SELECTED IN THE CHNA. THE HOSPITAL WORKS WITH A VARIETY OF COMMUNITY PARTNERS TO DEVELOP, IMPLEMENT, AND SUSTAIN THESE PROGRAMS AND ACTIVITIES. A LIST OF THE CURRENT ACTIONS AND GOALS FOR EACH OF THE TOP THREE PRIORITIES IS INCLUDED IN THE IMPLEMENTATION PLAN POSTED ON THE HOSPITAL'S WEBSITE. SOME OF THE INITIATIVES THAT OCCURRED IN 2022 INCLUDE LUNCH AND LEARNS ON FITNESS, HEALTHY DIETS AND OTHER WELLNESS TOPICS, SPONSORING THE HEALTH AND WELLNESS FAIR DURING THE FAYETTE COUNTY FAIR, PARTNER WITH THE SCHOOL AND OTHER COMMUNITY PARTNERS ON EDUCATION ON ACES (ADVERSE CHILDHOOD EXPERIENCES) AND TIC (TRAUMA INFORMED CARE) AND RECRUIT PROVIDERS AND START A BEHAVIORAL HEALTH PROGRAM IN OUR WEST UNION CLINIC. AS WITH ALL HEALTH CARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITY'S PALMER LUTHERAN HEALTH CENTER SERVES. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, THE HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 13H: THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 15E: ALL SELF-PAY PATIENTS ARE GIVEN INFORMATION ON THE HOSPITAL'S CHARITY CARE POLICY AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 16J: OUR SELF-PAY COLLECTION AGENCY UTILIZES INFORMATION TO IDENTIFY ACCOUNTS THAT SHOULD QUALIFY FOR THE FAP. WE WRITE THESE ACCOUNTS OFF WITHOUT REQUIRING ANY PAPERWORK OR APPLICATION. |
| PART VI, SECTION B, LINE 7A & 10: | HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - GUNDERSEN PALMER - WEST UNION CLINIC | ||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | RURAL HEALTH CLINIC |
| 2 - GUNDERSEN PALMER - POSTVILLE CLINIC | ||||
| 111 SOUTH REYNOLDS STREET | POSTVILLE | IA | 52162 | RURAL HEALTH CLINIC |
| 3 - GUNDERSEN PALMER HOME HEALTH | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | HOME HEALTH |
| 4 - GUNDERSEN PALMER HOME HEALTH - OELWEIN | ||||
| 230 2ND AVE SE | OELWEIN | IA | 50662 | HOME HEALTH |
| 5 - GUNDERSEN PALMER - FAYETTE CLINIC | ||||
| 110 KING STREEET | FAYETTE | IA | 52142 | RURAL HEALTH CLINIC |
| 6 - GUNDERSEN PALMER MEDICAL SUPPLY-W UNION | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | MEDICAL SUPPLY AND EQUIPMENT |
| 7 - GUNDERSEN PALMER MEDICAL SUPPLY-OELWEIN | ||||
| 230 2ND AVE SE | OELWEIN | IA | 50662 | MEDICAL SUPPLY AND EQUIPMENT |
| 8 - GUNDERSEN PALMER HOSPICE - WEST UNION | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | HOSPICE SERVICES |
| 9 - GUNDERSEN PALMER HOSPICE - OELWEIN | ||||
| 230 2ND AVE SE | OELWEIN | IA | 50662 | HOSPICE SERVICES |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CATASTROPHIC CARE ASSISTANCE:FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME.DISCOUNTED CARE:FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL. POVERTY LEVEL.1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE.2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE.3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE.4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE.FREE CARE:A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT:PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING:1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY, NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY.2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES.3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY.4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS |
| PART I, LINE 7: | THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES AT PALMER LUTHERAN HEALTH CENTER INCLUDE THE ADULTS AND PEDIATRICS UNIT AND 3 RURAL HEALTH CLINICS. ALL THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF THE HOSPITAL AND SHARE MANY OF THE SUPPORT FUNCTIONS OF THE HOSPITAL TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON A COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF PALMER LUTHERAN HEALTH CENTER TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATE TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR FORM 990 PURPOSES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY HEALTH IMPROVEMENT ADVOCACY PROMOTES THE HEALTH OF THE COMMUNITY BY ADDRESSING THE NEEDS OF THE COMMUNITY, SUCH AS JOBS, CLEAN WATER/SEWER, INDUSTRY ATTRACTION, ADDRESSING THE NEEDS OF THE SCHOOL AND COUNTY, AND INSURING WE OFFER THE SERVICES THAT ARE IMPORTANT TO THE COMMUNITY. WE ALSO PROVIDE EDUCATION FOR SCHOOL AGE CHILDREN HOPING TO REACH THOSE THAT DON'T HAVE ACCESS TO HEALTH INFORMATION. |
| PART III, LINE 2: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. |
| PART III, LINE 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. |
| PART III, LINE 4: | THE ORGANIZATION IS PART OF THE GUNDERSEN HEALTH SYSTEM'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 10, 11, 18 AND 19. |
| PART III, LINE 8: | THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT PALMER LUTHERAN HEALTH CENTER, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| PART III, LINE 9B: | THE ORGANIZATION FOLLOWS GUNDERSEN HEALTH SYSTEM'S GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. |
| PART VI, LINE 2: | IN PARTNERSHIP WITH FAYETTE COUNTY PUBLIC HEALTH, GUNDERSEN PALMER DEVELOPED A SURVEY TO DISSEMINATE WITHIN THE SERVICE AREA. THE FAYETTE COUNTY HEALTH ASSESSMENT DATA COLLECTION PROCESS WAS CONDUCTED BY FIRST SURVEYING THE CITIZENS OF FAYETTE COUNTY AT THE FAYETTE COUNTY FAIR IN JULY OF 2022. A TEAM CONSISTING OF A UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH STRIKE TEAM AND A COMMUNITY HEALTH INTERN UTILIZED SOCIAL MEDIA, IPADS, AND PAPER SURVEYS IN ORDER TO CONNECT WITH THE PUBLIC AT THE COUNTY FAIR. FOLLOWING THE FAIR, THE SURVEY WASDISSEMINATED WITHIN THE FAYETTE COUNTY COMMUNITY AND SENT THE SURVEY OUT THROUGH SOCIAL MEDIA AND EMAIL, WHERE COMMUNITY MEMBERS AND ORGANIZATIONS CONTINUALLY SHARED IT. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY, WITH OPPORTUNITIES FOR PAPER COPIES, WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, AND NUMEROUS OTHER INDIVIDUALS AND ORGANIZATIONS THROUGHOUT THE SERVICE AREA. A TOTAL OF 193 ELECTRONIC AND PAPER SURVEYS WERE COLLECTED, WITH PAPER RESPONSES BEING ENTERED INTO THE ELECTRONIC SURVEY DATABASE. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY. FOR THE ASSESSMENT, GUNDERSEN PALMER PARTNERED WITH THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH, THE IOWA DEPARTMENT OF PUBLIC HEALTH, FAYETTE COUNTY PUBLIC HEALTH, THE HEALTHY FAYETTE COUNTY COALITION, AND MERCYONE. |
| PART VI, LINE 3: | THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. ALL SELF-PAY PATIENTS ARE REFERRED TO SOCIAL SERVICES FOR INFORMATION ON ABOVE PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. ALL PATIENT STATEMENTS REFERENCE THE AVAILABILITY OF FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | PALMER LUTHERAN HEALTH CENTER IS A 25-BED ACUTE CARE HEALTH CENTER SERVING A RURAL POPULATION OF 2,490 PER THE 2020 U.S. CENSUS. AS THE ONLY HOSPITAL IN WEST UNION, IOWA, IT ALSO SERVES A 30 TO 40-MILE RADIUS AROUND WEST UNION. THE CLOSEST HOSPITAL IS MERCY ONE OELWEIN MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL, LOCATED ABOUT 19 MILES FROM WEST UNION. IN ADDITION, OUR HOMECARE DEPARTMENT SERVES A POPULATION IN A 50-MILE RADIUS. WE ARE A MEDICARE DEPENDENT HOSPITAL AND HAVE A LARGE MEDICAID POPULATION AS WELL. THE MOST COMMON INDUSTRIES IN WEST UNION ARE MANUFACTURING AND CONSTRUCTION. 12.06% OF RESIDENTS IN WEST UNION HAD INCOME BELOW THE POVERTY LEVEL IN 2021. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2021 WAS $66,708 WHICH IS DOWN COMPARED TO THE STATE OF IOWA MEDIAN OF $72,429. UNEMPLOYMENT WAS 5.1% IN 2021 COMPARED TO THE NATIONAL AVERAGE OF 3.9%. |
| PART VI, LINE 5: | 3 OF THE 7 MEMBERS OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL ITS DEPARTMENTS. THE ORGANIZATION APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE BY PURCHASING UP-TO-DATE EQUIPMENT, AND A STATE-OF-THE-ART FACILITY. CREATE MORE COMMUNITY OUTREACH, AWARENESS AND EDUCATION" IS ONE OF OUR STRATEGIC OBJECTIVES. TO MEET THAT OBJECTIVE, WE HAVE AN ONGOING PROCESS IN PLACE TO MONITOR OUR THREATS AND OUR OPPORTUNITIES IN OUR SERVICE AREA. WE UTILIZE THE IOWA HOSPITAL ASSOCIATION DIMENSIONS SOFTWARE TO DETERMINE THE ORIGIN AND DESTINATION OF OUR PATIENT POPULATION. OUR STRATEGIC PLANNING TEAM INCLUDES OUR GOVERNING BOARD AND SENIOR MANAGEMENT WHO HAVE AN EXTENSIVE KNOWLEDGE BASE OF THE ORGANIZATION. THE SENIOR MANAGEMENT TEAM INCLUDES REPRESENTATION FROM FINANCE, NURSING, HR., MARKETING, FAMILY PRACTICE PROVIDERS AND DIRECTORS OF HOSPITAL OUTPATIENT SERVICES. THE GOVERNING BOARD HAS AN ACTIVE ROLE IN THIS PROCESS AS WELL. THEY HAVE THE BENEFIT OF BEING OUT IN THE COMMUNITY AND GAINING A UNIQUE INSIGHT AND THE PULSE OF THE COMMUNITY. IN ADDITION, WE ARE A CLINICAL SITE FOR STUDENTS OF PHARMACY, NURSING, HIM, PA, AND MEDICAL STUDENTS. |
| PART VI, LINE 6: | PALMER LUTHERAN HEALTH CENTER IS AN AFFILIATE HOSPITAL OF THE GUNDERSEN HEALTH SYSTEM IN LACROSSE, WISCONSIN. GUNDERSEN HEALTH SYSTEM PROVIDES THE PRIMARY CARE PROVIDERS WHO SEE PATIENTS IN OUR THREE CLINICS. THEY ALSO PROVIDE A NUMBER OF SPECIALISTS WHO TRAVEL TO THE CLINICS IN OUR SERVICE AREA AND UTILIZE TELEMEDICINE OPPORTUNITIES TO MEET THE NEEDS OF THE POPULATION. PATIENTS ARE TRANSFERRED TO THE TERTIARY LEVEL OF CARE AS INDICATED. GUNDERSEN HEALTH SYSTEM IS INVOLVED IN OUR COMMUNITY, BEING A COMMUNITY PARTNER TO FURTHER HEALTH CARE INITIATIVES. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
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 (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR MORDECHAI LEDERMAN | ||||||||||||||
| SECRETARY / TREASURER | $0 | $304,546 | $0 | $147 | $0 | $0 | $0 | $44,225 | $0 | $24,327 | $0 | $373,245 | $0 | $0 |
| KEN BEACH | ||||||||||||||
| CRNA | $207,112 | $0 | $23 | $0 | $0 | $0 | $9,614 | $0 | $28,302 | $0 | $245,051 | $0 | $0 | $0 |
| PATRICE KUENNEN | ||||||||||||||
| CEO | $0 | $180,205 | $0 | $331 | $0 | $0 | $0 | $26,361 | $0 | $22,094 | $0 | $228,991 | $0 | $0 |
| BRENDA MOSER | ||||||||||||||
| FINANCE ADMINISTRATOR | $0 | $160,818 | $0 | $5,447 | $0 | $0 | $0 | $24,607 | $0 | $22,694 | $0 | $213,566 | $0 | $0 |
| RACHEL ALBRECHT | ||||||||||||||
| DIRECTOR | $0 | $142,608 | $0 | $289 | $0 | $8,538 | $0 | $22,658 | $0 | $24,244 | $0 | $198,337 | $0 | $0 |
| TOM TORNSTROM | ||||||||||||||
| DIRECTOR | $0 | $146,714 | $0 | $46 | $0 | $0 | $0 | $21,537 | $0 | $17,726 | $0 | $186,023 | $0 | $0 |
| CHUCK JOHNSON | ||||||||||||||
| DIRECTOR | $0 | $129,391 | $0 | $216 | $0 | $4,690 | $0 | $20,636 | $0 | $28,494 | $0 | $183,427 | $0 | $0 |
| EMILY MORK | ||||||||||||||
| PHARMACY MANAGER | $137,128 | $0 | $744 | $0 | $0 | $0 | $6,554 | $0 | $36,010 | $0 | $180,436 | $0 | $0 | $0 |
| DEBBIE BRINK | ||||||||||||||
| RN | $127,672 | $0 | $544 | $0 | $5,755 | $0 | $6,498 | $0 | $12,703 | $0 | $153,172 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART 1, LINE 3 | FormAndLineReferenceDesc |
| Explanation | A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE COUNTY IOWA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 426005367 | BondIssuerEIN |
| Bond Issued | 2013-08-29 | BondIssuedDt |
| Issue Price | $8,382,387 | IssuePriceAmt |
| Purpose | HOSPITAL FACILITY IMPROVEMENTS | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $684,607 | RetiredAmt |
| Total Proceeds | $8,382,387 | TotalProceedsAmt |
| Other Spent Proceeds | $8,382,387 | OtherSpentProceedsAmt |
| Substantial Completion | 2007 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE K, PART IV, LINE 2B | FormAndLineReferenceDesc |
| Explanation | BONA FIDE DEBT SERVICE FUND EXCEPTION | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | GUNDERSEN AND BELLIN HEALTH SYSTEMS, INC. (BELLIN), EACH A WISCONSIN NONPROFIT, NON-STOCK CORPORATION, ENTERED INTO A COMBINATION AGREEMENT DATED JULY 29, 2022 (THE AGREEMENT), TO ALIGN THEIR RESPECTIVE OPERATIONS AND TO FORM A SINGLE NONPROFIT HEALTH SYSTEM THROUGH THE CREATION OF BELLIN GUNDERSEN HEALTH SYSTEM, INC., A WISCONSIN NONPROFIT, NON-STOCK CORPORATION (BELLIN GUNDERSEN). ON DECEMBER 1, 2022, UPON CONSUMMATION OF THE ALIGNMENT OF THE TWO SYSTEMS (THE AFFILIATION), BELLIN GUNDERSEN BECAME THE SOLE CORPORATE MEMBER OF BOTH BELLIN AND GUNDERSEN. BELLIN AND GUNDERSEN AND THEIR RESPECTIVE AFFILIATES ARE EXPECTED TO MAINTAIN THEIR RESPECTIVE CORPORATE EXISTENCE. IN DECEMBER 2022, THE BYLAWS OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. WERE AMENDED AND RESTATED TO UPDATE THE SOLE CORPORATE MEMBER TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF BELLIN GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ARTICLES OF INCORPORATION OF PALMER LUTHERAN HEALTH CENTER PROVIDE FOR ONE MEMBER OF THE CORPORATION. THE SOLE CORPORATE MEMBER OF PALMER LUTHERAN HEALTH CENTER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS THE SOLE CORPORATE MEMBER AND UNDER TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. GUNDERSEN LUTHERAN HEALTH SYSTEM INC. MAY APPOINT FOUR MEMBERS TO THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN THE APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CFO AND PRESIDENT/CEO REVIEW THE 990 BEFORE IT IS FILED. THE ENTIRE BOARD OF DIRECTORS RECEIVES A COPY OF THE 990 AFTER IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REQUIRED TO BE SIGNED ANNUALLY BY OFFICERS, DIRECTORS AND KEY EMPLOYEES. THE SIGNED POLICIES ARE THEN REVIEWED BY PALMER LUTHERAN HEALTH CENTER'S COMPLIANCE COMMITTEE TO DETERMINE IF THERE IS A DEEMED CONFLICT OF INTEREST. BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON AREAS WHERE THERE IS A CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | FOR THE PURPOSES OF DETERMINING COMPENSATION,PALMER LUTHERAN HEALTH CENTER INC. RELIED ON IT'S AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSON LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990. |
| FORM 990, PART IX, LINE 11G | SURGERY SERVICES: PROGRAM SERVICE EXPENSES 290,454. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 290,454. EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 43,318. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,318. LAB SERVICES: PROGRAM SERVICE EXPENSES 541,735. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 541,735. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,151,675. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,151,675. HOME HEALTH SERVICES: PROGRAM SERVICE EXPENSES 343,137. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 343,137. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,734,043. MANAGEMENT AND GENERAL EXPENSES 144,759. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,878,802. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 481,365. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 481,365. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 30,524. |
| FORM 990, PART IV, LINE 12B AND PART XII, LINE 2: | THE ORGANIZATION WAS INCLUDED IN A SHORT YEAR CONSOLIDATED AUDIT FOR THE 11-MONTH PERIOD JANUARY 1, 2022 THROUGH NOVEMBER 30, 2022. THE ANSWERS FOR PART IV, LINE 12B AND PART XII, LINES 2A-2C HAVE BEEN ANSWERED YES EVEN THOUGH THE FORM 990 COVERS THE 12-MONTH PERIOD JANUARY 1, 2022 THROUGH DECEMBER 31, 2022. THE REASON FOR THIS CHANGE IS DUE TO A MERGER WITH THE BELLIN GUNDERSEN HEALTH SYSTEM. THE ACTIVITY OF DECEMBER 2022 WILL BE INCLUDED IN A CONSOLIDATED AUDIT FOR THE PERIODS OF DECEMBER 2022 - SEPTEMBER 2023 AS ALL THE RELATED PARTIES LISTED IN SCHEDULE R WILL BE TRANSITIONING TO THAT YEAR END. |
| FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS GIVES THE FINAL APPROVAL OF THE AUDIT FIRM AND AUDIT REPORTS AND TAKES TIME ANNUALLY TO MEET WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT. THERE WAS NO CHANGE TO THIS PROCESS DURING THE FILING PERIOD. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (29 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING COLLEGE | WI | 501(C)(3) | LINE 2 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 390884478 | HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN PSYCHIATRIC CENTER INC | |||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54305 | 391657627 | PSYCHIATRIC HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| GUNDERSEN ADMINISTRATIVE SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING SERVICES | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORGANIZATION | WI | LINE 12B, II | 0 | N/A | ||
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE S | HARMONY | MN | 55939 | 410711606 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C)(3) | LINE 12B, II | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| LUTHERAN HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| LUTHERAN REAL ESTATE HOLDING CORPORATION | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 56401 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL HEALTHCARE FOUNDATION INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | |||||||||||
| 402 W LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTERHAN HEALTH SYSTEM INC | Yes (1) | |
| OCONTO HOSPITAL & MEDICAL CENTER INC | |||||||||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | 061745397 | HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN MEMORIAL HOSPITAL INC | Yes (1) | |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA | |||||||||||
| 1200 5TH GRANT BOULEVARD WEST | WABASHA | MN | 55981 | 410693877 | HEALTH CARE | MN | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | ST JOSEPH'S HEALTH SERVICES INC | Yes (1) | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C)(3) | LINE 7 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | TRI-COUNTY MEMORIAL HOSPITAL INC | Yes (1) | |
| TRI-COUNTY MEMORIAL HOSPITAL INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| BELLIN GUNDERSEN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 920504278 | PARENT | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BELLIN INVESTMENTS INC | |||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391564939 | OTHER | WI | N/A | C | 0 |
| BEL-REGIONAL HOME MEDICAL INC | |||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | 0 |
| GUNDERSEN LUTHERAN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | 0 |
| 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 | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | 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 | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |