2022-05-11T09:41:54-05:00 2021-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-07-01 421087612 KNOXVILLE COMMUNITY HOSPITAL INC KNOX 6418421407 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 MAGGIE HAMILTON-BEYER CFO 6418421407 2022-05-10 1 MAGGIE HAMILTON-BEYER 999009999 MEGAN L KOZIOL P01544037 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MAGGIE HAMILTON-BEYER 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 46766145 0 X WWW.KNOXVILLEHOSPITAL.ORG X 1981 IA TO FAITHFULLY PROVIDE EXCEPTIONAL HEALTHCARE TO THE PEOPLE OF KNOXVILLE & SURROUNDING COMMUNITIES AND TO BE A HEALTHCARE DESTINATION BUILT ON COMPASSION AND INNOVATION. 9 9 325 13 515 0 3173061 4374846 40015370 42022393 111894 83168 131022 108683 43431347 46589090 8495 11543 0 0 17036053 18329296 0 0 0 22296910 22627872 39341458 40968711 4089889 5620379 46919221 48903473 29210357 25349005 17708864 23554468 X WE ARE DEDICATED TO PROVIDING PERSONAL PROGRESSIVE QUALITY HEALTHCARE WITH COMPASSION TO THE PEOPLE OF KNOXVILLE AND SURROUNDING AREAS. WE VALUE TEAMWORK, INNOVATION, COMPASSION, INTEGRITY, SERVICE, AND PEOPLE-CENTERED CARE. 0 0 36383617 11543 42022393 KNOXVILLE COMMUNITY HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN BOTH INPATIENT AND OUTPATIENT SETTINGS. DURING FISCAL YEAR 2021, THE HOSPITAL PROVIDED 752 DAYS OF SKILLED NURSING CARE AND 177,665 OUTPATIENT OCCASIONS OF SERVICE. 36383617 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 85 0 1 325 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MAGGIE HAMILTON-BEYER 6418421402 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 LOGAN MILLER PHYSICIAN 40.00 0.00 X 401896 0 33771 SAMANTHA KEADY PHYSICIAN 40.00 0.00 X 370044 0 39332 THOMAS HOEHNS PHYSICIAN 40.00 0.00 X 338662 0 27244 JAMES LAW PHYSICIAN 39.00 0.00 X 266655 0 37121 RYAN LAUGHLIN PHYSICIAN 40.00 0.00 X 263148 0 38578 MAGGIE HAMILTON -BEYER CFO 40.00 0.00 X 176171 0 14087 MEGAN MCKAY PRESIDENT 1.00 0.00 X X 0 0 0 JIM BUTLER 1ST VICE PRESIDENT 1.00 0.00 X X 0 0 0 PATRICK STOCKTON 2ND VP & TREASURER 1.00 0.00 X X 0 0 0 CINDI FULLER SECRETARY 1.00 1.00 X X 0 0 0 TODD CHAMBERS MEMBER 1.00 0.00 X 0 0 0 LISA CROSSETT MEMBER 1.00 0.00 X 0 0 0 DAVE JOHNSON MEMBER 1.00 0.00 X 0 0 0 LORI BAILEY MEMBER 1.00 0.00 X 0 0 0 CONNIE CHRISMAN MEMBER 1.00 0.00 X 0 0 0 KEVIN KINCAID CEO 40.00 0.00 X 0 0 0 1816576 0 190133 21 0 1 1 DOCS EMERGENCY MEDICINE INC 800 W FRONTIER LN OLATHE KS 66061 ER PHYSICIAN COVEREAGE 1055222 21ST CENTURY REHAB PC PO BOX 461 NEVADA IA 50201 PT/OT SERVICES 1033683 CAPITAL ORTHOPEDICS AND SPORTS MEDICINE 12499 UNIVERSITY AVE 210 CLIVE IA 50325 ORTHOPEDIC SURGEONS/DOCTORS 1005220 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 COMPUTER SOFTWARE SYSTEMS 911109 MERCY ONE 1111 6TH AVE DES MOINES IA 50314 MANAGEMENT CONTRACT 727148 27 26382 4329486 18978 4374846 NET PATIENT SERVICE REVENUE 621110 20192477 20192477 MEDICARE 621110 14595676 14595676 MEDICAID 621110 4548940 4548940 PHARMACY 621110 2662704 2662704 22596 22596 42022393 74683 74683 10331 0 10331 10331 10331 185540 177055 8485 8485 8485 CAFETERIA 900099 98352 515 97837 98352 46589090 42022393 515 191336 X 11543 11543 190258 190258 14707731 12771918 1935813 3431307 2955408 475899 546405 146221 400184 17132 17132 86069 86069 10922 10922 7331884 6851000 480884 83589 83589 777900 342640 435260 103129 83020 20109 1718792 1571684 147108 65666 37689 27977 564539 551189 13350 1777385 1734245 43140 249462 193531 55931 MEDICAL SUPPLIES 6237944 6237944 BAD DEBT 2619967 2619967 DUES & LICENSES 305238 143769 161469 FOOD COST 131849 131849 40968711 36383617 4585094 0 742155 81673 23666696 26389204 3762622 3510216 430842 607788 289184 251012 34099601 20007539 14457839 14092062 2521690 2872964 65733 29215 982460 1069339 46919221 48903473 2183961 2972628 14299566 13880746 420113 1028564 2488715 150000 9818002 7317067 29210357 25349005 X 17708864 23554468 17708864 23554468 46919221 48903473 5620379 225225 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3381 3381 0 PART II-B, LINE 1: KNOXVILLE COMMUNITY HOSPITAL, INC. PAYS DUES TO THE IOWA HOSPITAL ASSOCIATION, OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. 260906 260906 22023432 10903293 11120139 11407384 9104246 2303138 407879 407879 14092062 CAPITAL LEASES 634909 ACCRUED INTEREST PAYABLE 15229 CONTRACT LIABILITY - MEDICARE ACCELERATED AND ADVANCE PAYMENTS 5992951 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 673978 7317067 X PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL AND FOUNDATION HAVE RECEIVED DETERMINATION LETTERS INDICATING THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HOSPITAL'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2021 AND 2020, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 0 1 X 1 1 1 0 1 1 73235 73235 0.00190 4900385 4190755 709630 0.01850 4973620 4190755 782865 0.02040 4483 1610 2873 0.00010 307452 3000 304452 0.00790 58923 258 58665 0.00150 370858 4868 365990 0.00950 5344478 4195623 1148855 0.02990 24320 0 24320 0.00060 160 0 160 0.00000 504 0 504 0.00000 2013 411 1602 0.00000 26997 411 26586 0.00060 0 2619967 0 13623563 13488676 134887 X 1 1 1 1 KNOXVILLE COMMUNITY HOSP INC & CLINICS 1002 S LINCOLN STREET KNOXVILLE IA 50138 WWW.KNOXVILLEHOSPITAL.ORG 630031H X X X X KNOXVILLE COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X X 18 1 0 0 1 X WWW.KNOXVILLEHOSPITAL.ORG X 1 19 1 WWW.KNOXVILLEHOSPITAL.ORG 0 1 X 300.000000000000 X X X 1 1 X X X X 1 X WWW.KNOXVILLEHOSPITAL.ORG X WWW.KNOXVILLEHOSPITAL.ORG X WWW.KNOXVILLEHOSPITAL.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 3J: THE TOP FOUR HEALTH NEEDS IDENTIFIED FROM THE 2019 CHNA REPORT WERE MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC DISEASE MANAGEMENT, AND TRANSPORTATION. THESE TOP FOUR NEEDS WERE DETERMINED BY PRIMARY DATA (SURVEY) AND SECONDARY DATA INCLUDING COUNTY HEALTH RANKINGS, IOWA HOSPITAL ASSOCIATION INPATIENT AND OUTPATIENT DATABASES, CITY DATA, AND VITAL STATISTICS. OTHER HEALTH NEEDS IDENTIFIED WERE OBESITY, ACCESS TO VISITING SPECIALIST, SUICIDE PREVENTION AND SUPPORT. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 5: RESEARCH WAS DONE AND DATA WAS COLLECTED TO ENSURE PROPER TOWN HALL REPRESENTATION AND TO DETERMINE THE PRIMARY SERVICE AREA. A PUBLIC RELATIONS STORY WAS PREPARED AND POSTED ON SOCIAL MEDIA, AS WELL AS SENT TO THE LOCAL MEDIA TO PUBLISH AND ANNOUNCE UPCOMING CHNA WORK AND REQUEST PUBLIC SURVEY PARTICIPATION. A PAPER SURVEY AS WELL AS AN ONLINE LINK TO THE SURVEY WAS MADE AVAILABLE FOR THE PUBLIC TO RESPOND. KHC STAFF ALSO VISITED WITH MANY LOCAL GROUPS SUCH AS ROTARY ABOUT THE CHNA PROCESS AND REQUESTED COMPLETION OF SURVEYS FOR THOSE PRESENT AT THAT MEETING. A PAPER SURVEY WAS USED WITH AN ONLINE LINK TO PSA RESIDENTS. THE SURVEY WAS SENT TO 1,000 PARTICIPANTS WITH THE ANTICIPATION OF RECEIVING 250 RETURNS. WE PREPARED AND PUBLISHED A TOWN HALL INVITATION TO THE PUBLIC AND COLLABORATING PARTIES SUCH AS PUBLIC HEALTH, SCHOOL LEADERS, FAITH-BASED LEADERS, PHYSICIANS AND OTHER CARE PROVIDERS, AS WELL AS THE MENTAL HEALTH PROVIDER COMMUNITY, FREE CLINICS, LOCAL RESIDENTS, COMMUNITY LEADER, BUSINESS LEADERS, LOCAL GOVERNMENT, PEOPLE WITH CHRONIC CONDITIONS, AND UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS ALONG WITH KNOXVILLE HOSPITAL & CLINICS. WE PREPARED A BRIEF OF GOALS, OBJECTIVE, PURPOSE, OUTCOMES, ROLES, AND COMMUNITY INVOLVEMENT AND HELD A KICK-OFF MEETING. COMMUNITY HEALTH FACTS AND PRACTICE DATA WERE COLLECTED AND PUBLISHED. COMMUNITY OPINIONS WERE COLLECTED ON HEALTH NEEDS, AND NEEDS IDENTIFIED. COMMUNITY OPINIONS WERE ALSO COLLECTED ON HEALTH NEEDS, PRACTICES, AND PHYSICIAN AND CARE PROVIDER AVAILABILITY. THE COMMUNITY HEALTH NEEDS REPORT WAS THEN PREPARED AND PRESENTED TO THE COMMUNITY WITH RECOMMENDED ACTIONS. THE TOWN HALL MEETING INCLUDED DISCUSSION ON PURPOSE, ROLES, REVIEW OF HISTORICAL DATA, PARTICIPANT DISCUSSIONS TALLY AND RANKING OF HEALTH CONCERNS, AND REFLECTION ON THE HEALTH NEEDS OF THE COMMUNITY. THE MEETING CONCLUDED WITH INFORMATION ABOUT THE NEXT STEPS. THE COMMUNITY WAS ENCOURAGED TO CONTINUE TO PARTICIPATE BY CONTRIBUTING IDEAS TO THE HOSPITAL AND PUBLIC HEALTH DEPARTMENT VIA EMAIL OR PERSONAL CONVERSATION. IN ADDITION, OTHER MEETINGS, INTERVIEWS, AND FOCUS GROUPS WERE HELD. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 11: 1) MENTAL HEALTHA. INPATIENT MENTAL HEALTH SERVICES-KEVIN KINCAID, CEO OF THE HOSPITAL CONTINUES TO SPEND NUMEROUS HOURS ON ACTIVITIES SPECIFIC TO MENTAL HEALTH REDESIGN AND IMPROVEMENTS. THROUGH THE IOWA HOSPITAL ASSOCIATION THERE HAVE BEEN INTERACTIONS WITH THE GOVERNOR OF THE STATE OF IOWA, INDIVIDUAL LEGISLATORS AND SUBCOMMITTEE HEARINGS ON MENTAL HEALTH CONTINUE. MOST OF THESE EFFORTS WERE CONCENTRATED ON STATEWIDE AND COUNTYWIDE INITIATIVES. SOME OF THOSE HOURS WERE SPENT IN COLLABORATIONS WITH THE MARION COUNTY SHERIFF'S OFFICE, MARION COUNTY PUBLIC HEALTH AND THE LEADERS OF THE COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA ACCESS CENTER LOCATED IN OSCEOLA, IA. THE IOWA ACCESS CENTER WAS CREATED IN THIS REGION OF IOWA AND IN OTHER REGIONS AROUND THE STATE. REFERRALS ARE MADE TO THE ACCESS CENTER FOR PATIENTS EXPERIENCING A MENTAL HEALTH CRISIS. THE CENTER IS AVAILABLE 24 HOURS DAY AND SERVICES OFFERED INCLUDE ASSESSMENT, 23-HOUR OBSERVATION, CRISIS STABILIZATION, SUBACUTE, SOBERING SERVICES, COUNSELING, PSYCHIATRIC MEDICATION MANAGEMENT, SUBSTANCE DISORDER SERVICES AND ASSISTANCE WITH RESOURCES/ONGOING SERVICES FOR A SAFE TRANSITION TO HOME. THOUGH THIS COLLABORATION HAS NOT RESULTED IN AN INCREASE OF INPATIENT BEDS IN THE STATE, PATIENTS CONTINUE TO HAVE FASTER ACCESS TO MENTAL HEALTH EXPERTS WHO CAN PROVIDE APPROPRIATE CARE, THAN IN THE PAST SOMETIME WAITING FOR SEVERAL DAYS IN A RURAL COMMUNITY HOSPITAL EMERGENCY ROOM. THE HOSPITAL IS STILL STRUGGLING AT TIMES WITH THE IOWA ACCESS CENTER AND INPATIENT MENTAL HEALTH HOSPITALS THROUGHOUT THE STATE TO ACCEPT SOME OF THE MOST DIFFICULT MENTAL HEALTH PATIENTS WHO HAVE LIMITED INTELLECTUAL CAPACITIES OR HAVE VIOLENT BEHAVIORAL TENDENCIES. THESE PATIENTS TEND TO REMAIN IN EMERGENCY ROOMS ACROSS FOR LENGTHY STAYS UNTIL AN APPROPRIATE HOSPITAL CAN/WILL ACCEPT THEM. KEVIN KINCAID AND THE COUNTY RURAL OFFICES OF SOCIAL SERVICES ARE CURRENTLY IN DISCUSSIONS HOW WE CAN EFFECTIVELY MEET THE NEEDS OF THESE CHALLENGING PATIENTS IN THE FUTURE AND IMPROVE KHC EMERGENCY ROOM ACCOMMODATIONS FOR THESE MOST CHALLENGING PATIENTS.B. KEVIN KINCAID CONTINUES TO LOBBY FOR INPATIENT MENTAL HEALTH SERVICES FOR MEMBERS OF THE COMMUNITY. FEBRUARY OF 2021 A NEW 100 BED MENTAL HEALTH HOSPITAL OPENED IN CLIVE, IOWA THROUGH A PARTNERSHIP BETWEEN MERCYONE AND UHS IN CLIVE, IOWA. KNOXVILLE HOSPITAL & CLINICS AS AN AFFILIATE OF MERCYONE MAY BENEFIT WITH A FASTER REFERRAL PROCESS TO THIS ORGANIZATION FOR MEMBERS OF THE COMMUNITY IN NEED OF INPATIENT MENTAL HEALTH SERVICES. COVID CONTINUES TO IMPACT TRANSFERS OF PATIENTS TO GENERAL ACUTE AND MENTAL HEALTH HOSPITALS DIFFICULT AND SLOW BECAUSE OF CAPACITY OR STAFFING ISSUES.C. IN 2021 BRENDA GOODALE, ASSUMED THE ROLE AT KHC- COMMUNITY HEALTH RESOURCE NAVIGATOR. THIS POSITION IS FUNDED IN PART BY THE "RURAL COMMUNITY HEALTH INTEGRATION NETWORK AND IS DESIGNED TO ADDRESS HEALTH-RELATED SOCIAL NEEDS. THE PROGRAM, CALLED JOURNEYS, HELPS BRIDGE THE GAP BETWEEN HEALTHCARE FACILITIES AND EXISTING COMMUNITY-BASED ORGANIZATIONS. PATIENTS ARE SCREENED FOR VARIOUS SOCIAL NEEDS AND THEN CONNECTED TO VARIOUS HELPING RESOURCES THAT MEET THEIR NEEDS- SUBSTANCE USE/ABUSE AND MENTAL HEALTH SUPPORT ARE AMONG THESE NEEDS. THIS ROLE HAS CONTINUED TO PROVIDE MUCH ASSISTANCE TO PATIENTS AND COMMUNITY MEMBERS WITH THE GREATEST NEEDS SUCH AS MENTAL HEALTH SUPPORT, SUICIDE PREVENTION, AND SOCIAL NEEDS. D. EARLY IN 2017 THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT IMPLEMENTED TELE-PSYCH TO IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS IN THE EMERGENCY DEPARTMENT. THE TELE-PSYCH SYSTEM IS UTILIZED FOR ALMOST ALL OF OUTPATIENT MENTAL HEALTH PATIENTS THAT PRESENT IN THE EMERGENCY ROOM. THIS SYSTEM ASSISTS WITH TRANSFERRING OF THOSE PATIENTS TO A MENTAL HEALTH FACILITY, OR SOME PATIENTS COULD RETURN TO HOME WITH OUTPATIENT THERAPY UNDER THE RECOMMENDATIONS OF THE ITP TELE-PSYCH PROVIDER. UTILIZATION OF THE TELE-PSYCH SERVICE FREES UP NURSING TIME BECAUSE ITP STAFF WILL DO THE SEARCH FOR HOSPITALS FOR INPATIENT PLACEMENT FOR PATIENTS. THIS SERVICE DOES FACILITATE AND EXPEDITE GETTING PATIENTS TO A HIGHER LEVEL OF CARE SINCE THE NUMBER OF MENTAL HEALTH HOSPITAL BEDS THROUGHOUT THE STATE IS LIMITED. ALSO, KHC HAS CONTINUED AN AGREEMENT WITH CENTRAL IOWA JUVENILE DETENTION CENTER WHICH PROVIDES TRANSPORT OF MEDICALLY STABLE PATIENTS IN A SECURE CAR. THIS SERVICE IS NECESSARY BECAUSE OF LIMITED AVAILABILITY OF LOCAL EMS CREWS TO TRANSPORT THESE PATIENTS.2) SUBSTANCE ABUSEA. IN MARCH OF 2021, KNOXVILLE HOSPITAL & CLINICS APPLIED FOR AND WAS APPROVED SOME GRANT FUNDING UNDER THE RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP) WHICH IS A MULTI-YEAR HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) INITIATIVE AIMED AT REDUCING THE MORBIDITY AND MORTALITY OF SUBSTANCE USE DISORDER (SUD), INCLUDING OPIOID USE DISORDER (OUD) IN HIGH-RISK RURAL COMMUNITIES. THE SUBMITTED APPLICATION WAS A COLLABORATION OF MULTIPLE COMMUNITY GROUPS IN MARION COUNTY INCLUDING MARION COUNTY PUBLIC HEALTH, THE WELL RESOURCE CENTER, UCS HEALTHCARE, CROSS MENTAL HEALTH REGION, KNOXVILLE COMMUNITY SCHOOL DISTRICT, PELLA REGIONAL HEALTH CENTER AND KNOXVILLE HOSPITAL & CLINICS. GROUP WAS APPROVED TO MOVE FORWARD AND BEGIN TO LAY PLANS TO ADDRESS THE FOLLOWING, VARIOUS SUBSTANCE USE PREVENTION, TREATMENT AND RECOVERY ACTIVITIES WILL BE IMPLEMENTED DURING THE NEXT THREE YEARS. WORK WILL BE SPREAD ACROSS ALL MEMBERS OF THE COLLABORATING CONSORTIUM MEMBERS. GROUP HAS MET THROUGHOUT THE LAST YEAR TO LAY OUT STRATEGY FOR BOTH COMMUNITY AND HEALTHCARE PROVIDER OUTREACH, COMPLETE HOSPITAL AND RURAL CLINIC NEEDS ASSESSMENT TO UNDERSTAND THE CHALLENGES AND IDENTIFY OPPORTUNITIES FOR IMPROVEMENT IN MARION COUNTY. ELLY SHAW, KHC COMPLIANCE OFFICER SERVES AS A REPRESENTATIVE FOR KNOXVILLE HOSPITAL & CLINICS FOR THIS MULTIDISCIPLINARY GROUP. SOME RECENT ACTIVITIES THAT WERE LED BY THE GROUP INCLUDE:I. SHARED COMMUNICATION REGARDING NATIONAL POVERTY AWARENESS MONTH AND NATIONAL PRESCRIPTION DRUG TAKE BACK DAYII. INCREASED COMMUNITY AND HOSPITAL AWARENESS OF NALOXONE ACCESS.III. INCREASED COMMUNITY AWARENESS OF SAFE DRUG DISPOSAL.IV. PROVIDED DOTERRA DRUG DISPOSAL BAGS FOR THE DISPOSAL OF MEDICATIONS.V. DEVELOPING SCREENING AND REFERRAL WORKFLOWS (NOT YET COMPLETED) BETWEEN HEALTHCARE FACILITIES AND OTHER COMMUNITY SUPPORT SERVICES. 3) CHRONIC DISEASE MANAGEMENTA. KNOXVILLE HOSPITAL & CLINICS LAUNCHED #HEALTHYKNOXVILLE, A MONTHLY COMMUNITY WELLNESS CHALLENGE DESIGNED TO INSPIRE COMMUNITY MEMBERS TO LIVE A HEALTHIER LIFESTYLE - PHYSICALLY, MENTALLY, EMOTIONALLY, SPIRITUALLY, INTELLECTUALLY, AND FINANCIALLY. KNOXVILLE HOSPITAL & CLINICS TOGETHER WITH OUR PARTNERS THE KNOXVILLE WELLNESS COALITION, KNOXVILLE COMMUNITY SCHOOL DISTRICT, KNOXVILLE CHAMBER OF COMMERCE, AND THE CITY OF KNOXVILLE PROVIDE FUN CHALLENGES TO HELP INDIVIDUALS ASPIRE TO BE THE BEST VERSION OF THEMSELVES. THE CHALLENGES ARE DIFFERENT EVERY MONTH AND HAVE COME IN THE FORM OF FILLING A HEART TO PROMOTE HEART HEALTHY MONTH, OR A LIFE-GIVING TREE TO ENCOURAGE HEALTHY-LIVING ACTIVITIES THAT ARE ENVIRONMENTALLY FRIENDLY. THE PROGRAM AVERAGES ABOUT 15 PARTICIPANTS EACH MONTH. B. IN LATE 2018 KNOXVILLE HOSPITAL & CLINICS AND 21ST CENTURY REHABILITATION SERVICES OPENED A MEDICALLY ORIENTED GYM (MOG). A MOG IS A REVOLUTIONIZING THE WAY PEOPLE IMPROVE AND MAINTAIN THEIR HEALTH. WHILE TRADITIONAL FITNESS CLUBS AND GYMS ARE GREAT FOR WORKING OUT ON YOUR OWN, THE MOG OFFERS YOU PROFESSIONAL GUIDANCE, BASED ON SCIENTIFIC RESEARCH - IT BRIDGES THE GAP BETWEEN MEDICINE AND PHYSICAL FITNESS. IN FACT, MANY OF OUR MEMBERS STARTED AS PHYSICAL THERAPY PATIENTS AND TRANSITIONED TO THE MOG ONCE THEIR THERAPY SESSIONS ENDED. THE MOG IS STAFFED BY PHYSICAL THERAPISTS, PHYSICAL THERAPIST ASSISTANTS, AND CERTIFIED ATHLETIC TRAINERS WHO WORK CLOSELY WITH YOUR DOCTOR AND OTHER HEALTHCARE PROVIDERS TO HELP YOU ACHIEVE AND MAINTAIN AN EXCEPTIONAL QUALITY OF LIFE BY FOCUSING ON ALL ASPECTS OF YOUR HEALTH. THE PRIMARY GOAL OF THE MOG IS TO DECREASE DEPENDENCY ON MEDICINE, ADOPT EXERCISE AS A LIFESTYLE, AND REDUCE THE IMPACTS OF CHRONIC DISEASE. MOG ON AVERAGE CONTINUES TO CARE FOR 20 TO 25 MEMBERS A MONTH. AT LEAST TWICE A YEAR KNOXVILLE HOSPITAL & CLINICS WILL PROMOTE THE PROGRAM TO THE COMMUNITY THROUGH PHYSICIAN CONTACT, ADVERTISING, AND SOCIAL MEDIA.C. FOR MOST OF 2021, COMMUNITY PROGRAMS REMAINED LIMITED. HOWEVER, IN OCTOBER, OUR FACILITY PRESENTED GIRLS NIGHT OUT, AN ANNUAL EVENT THAT CELEBRATES WOMEN AND RAISES AWARENESS ABOUT HEART DISEASE, CANCER, AND OTHER DISEASES THAT IMPACT THE HEALTH OF WOMEN. 4) TRANSPORTATIONA. THE HIRTA TRANSPORTATION ADVISORY GROUP (TAG) "PAUSED" ACTIVITIES DURING THE 2020 AND 2021 PANDEMIC BUT IS EXPECTED TO RESUME IN THE FUTURE. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 13H: THE HOSPITAL CONSIDERED FAMILY SIZE IN ADDITION TO THE CRITERIA ABOVE. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 15E: A LETTER IS SENT PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. KNOXVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 16J: A LETTER IS SENT, AND IN MANY CASES TWO, PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY. 4 1 - KNOXVILLE AREA COMMUNITY HOSPITAL CLINIC 1202 WEST HOWARD STREET KNOXVILLE IA 50138 PHYSICIAN CLINIC 2 - MELCHER PHYSICIANS CLINIC 113 NORTH MAIN STREET MELCHER IA 50163 PHYSICIAN CLINIC 3 - PLEASANTVILLE PHYSICIAN CLINIC 104 NORTH WASHINGTON STREET PLEASANTVILLE IA 50225 PHYSICIAN CLINIC 4 - RED ROCK HEALTH CENTER 615 WASHINGTON STREET PELLA IA 50219 PHYSICIAN CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE OR DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED PARTY. PART I, LINE 7: THE COST TO CHARGE RATIO AS FOLLOWS WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST: (TOTAL EXPENSES - BAD DEBT) / (GROSS PATIENT SERVICE REVENUE + OTHER REVENUE) = PERCENTAGE OF COST TO CHARGE. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST BASED ON KNOXVILLE COMMUNITY HOSPITAL INC.'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,619,967. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SERVICE: THE HOSPITAL PROVIDES MEETING ROOM SPACE TO A NUMBER OF COMMUNITY ORGANIZATIONS AT NO COST. THE HOSPITAL PROVIDES SUPPORT TO THE LOCAL CHAMBER WITH MONETARY AND TIME DONATIONS. A FIRST AID TENT INCLUDING LABOR AND SUPPLIES FOR MEDICAL TREATMENT IS PROVIDED DURING KNOXVILLE NATIONALS AND CHAMBER EVENTS. THE HOSPITAL HOSTS AN ANGEL TREE EVERY YEAR TO HELP FAMILIES IN NEED AT CHRISTMAS. WE SUPPORT THE ANNUAL CHRISTMAS LIGHT SHOW AT MARION COUNTY PARK. THE PROCEEDS GO TO THE LOCAL HISTORICAL SOCIETY. THE HOSPITAL OFFERS HEALTH FAIRS ANNUALLY TO MEN, WOMEN AND CHILDREN. THE HOSPITAL MAINTAINS A STRONG RELATIONSHIP WITH THE LOCAL SCHOOL SYSTEM, PROVIDING ATHLETIC TRAINING CARE AT EVENTS AND FREE SPORT PHYSICALS. WE HELD A BREAST CANCER SUPPORT EVENT ON THE SQUARE WITH HEALTH INFORMATION VENDORS.ECONOMIC DEVELOPMENT: THE HOSPITAL PROVIDES LEADERSHIP DEVELOPMENT TRAINING QUARTERLY TO DEPARTMENT LEADERS. ROTATIONS AND PRECEPTORSHIPS ARE MADE AVAILABLE IN VARIOUS SPECIALTIES FOR STUDENTS GOING INTO THE MEDICAL FIELD. THE HOSPITAL IS A MEMBER OF THE LOCAL CHAMBER AND ROTARY CLUB, WITH EMPLOYEES PARTICIPATING IN BOTH. THE HOSPITAL'S ADMISSIONS DIRECTOR IS ON THE LOCAL DAY CARE BOARD. THE HOSPITAL DONATES TO LOCAL PROJECTS ON A REGULAR BASIS. THE HOSPITAL HAS EMPLOYEES ATTENDING CAREER FAIRS IN THE AREA, AND IS PART OF THE LOCAL THRIVE PROGRAM.COMMUNITY SUPPORT: MONETARY AND IN-KIND DONATIONS ARE GIVEN TO MANY COMMUNITY ORGANIZATIONS AND SCHOOL GROUPS. THE HOSPITAL SUPPORTS CANCER FUND RAISERS, PROM SAFETY EVENTS, SPORTING TEAMS, AND OTHER EVENTS. THE HOSPITAL PARTICIPATES IN LOCAL PARADES AND STRONGLY SUPPORTS LOCAL CHAMBER EVENTS AS WELL AS THE THRIVE PROGRAM. HOSPITAL EMPLOYEES SERVE ON LOCAL COMMUNITY BOARDS; SPEAK AT SCHOOL HEALTH AND CAREER EVENTS; TEACH SUNDAY SCHOOL; PROVIDE COACHING FOR AREA SPORTS TEAMS; AND DONATE TIME TO HABITAT FOR HUMANITY, 4H CLUBS, AND THE HISTORICAL SOCIETY. THE HOSPITAL OFFERED A WELCOME TO MEDICARE CLASS. THE HOSPITAL DONATES TO THE LOCAL THRIVE ORGANIZATION.ECONOMIC IMPROVEMENTS: THE HOSPITAL AGGRESSIVELY RECRUITS FOR NEW PROVIDERS IN AN EFFORT TO SUSTAIN AND GROW. THE HOSPITAL IS PLANNING AN EXTENSIVE REMODEL TO EXPAND ITS EMERGENCY ROOM AND SURGERY AREA. THE HOSPITAL CONTINUOUSLY LOOKS FOR NEW WAYS TO IMPROVE THE HEALTH OFFERINGS PROVIDED TO THE COMMUNITY. THE HOSPITAL HAS EXPANDED COMMUNITY INVOLVEMENT IN IMPROVEMENT AND EXPANSION OF HOSPITAL SPACES. THE HOSPITAL HAS A RELATIONSHIP WITH AREA SCHOOLS, OFFERING FREE SPORTS PHYSICALS. THE HOSPITAL IS CURRENTLY WORKING ON PLANS FOR A NEW PROVIDER CLINIC AND RELOCATION OF CONTRACTED SPECIALISTS TO A BIGGER SPACE AS WELL AS A NEW INFUSION CENTER.COALITION BUILDING: THE HOSPITAL PROVIDES STAFF MEMBERS FOR THE MARION COUNTY HEALTH COALITION TEAM, WHICH INCLUDES A NUMBER OF NURSES EMPLOYED BY THE HOSPITAL. OUR ER COORDINATOR IS INVOLVED IN SERVICE AREA COALITION AND IS ON THE REGIONAL MASS CASUALTY TASK FORCE. HOSPITAL EMPLOYEES WORK WITH THE LOCAL PUBLIC HEALTH DEPARTMENT. THE HOSPITAL ALSO PERFORMS THE COMMUNITY HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENT AND MAINTAINS A PRESENCE IN THE COMMUNITY MENTAL HEALTH TEAM. THE HOSPITAL, IN CONJUNCTION WITH OTHER LOCAL AGENCIES, MAINTAINS A SUICIDE PREVENTION TASK FORCE. THE HOSPITAL PARTICIPATES IN AND SUPPORTS THE LOCAL BACK TO SCHOOL EVENTS. EMPLOYEES SERVE ON A LOCAL DAY CARE BOARD.COMMUNITY HEALTH IMPROVEMENT: THE HOSPITAL IS DESIGNATED AS A PATIENT CENTERED MEDICAL HOME BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE. THE HOSPITAL PARTICIPATES IN MEALS ON WHEELS THROUGHOUT THE YEAR. THE HOSPITAL HOSTS, PARTICIPATES IN, OR PROVIDES SUPPORT FOR A VARIETY OF COMMUNITY PROGRAMS AND EVENTS INCLUDING PICK A BETTER SNACK SCHOOL PROGRAM, LOCAL HEALTH FAIRS, GIRLS NIGHT OUT, LOVE YOUR HEART DAY, SPORTS PHYSICALS, SPORTING EVENTS, DIABETES EDUCATION, CPR AND BLS CLASSES, FLU SHOT CLINICS, AND MORE. OUR PHYSICAL THERAPY DEPARTMENT OFFERS A VARIETY OF CLASSES ON PATIENTS PHYSICAL HEALTH IMPROVEMENT. PHYSICIANS PARTICIPATE IN LOCAL HEALTH BOARDS AND CONSULT FREE OF CHARGE TO THE OTHER ORGANIZATIONS. THE HOSPITAL HAS ACUTE CARE FROM 7AM TO 7PM FOR QUICKER ACCESS FOR PATIENTS WHO DON'T HAVE APPOINTMENTS. THE HOSPITAL CEO IS NOW ON OTHER ORGANIZATIONS' BOARDS, AND CONTINUES TO WORK ON A PLAN TO IMPROVE ACCESS TO MENTAL HEALTH CARE TO PATIENTS IN OUR AREA. THE HOSPITAL OFFERS VIRTUAL CARE VISITS. THE HOSPITAL SURVEYS ITS PATIENTS REGULARLY AND USES THE DATA TO IMPROVE CARE. IN 2021, THE HOSPITAL CREATED A PERMANENT COVID CLINIC SPACE AND IS IN THE PLANNING STAGES FOR A TRAVELING MOBILE CLINIC.OTHER: THE HOSPITAL PROVIDES CAB FARE FROM THE EMERGENCY ROOM FOR INDIGENTS AND USE OF OUR ROOMS FOR LOCAL CLUBS AND COMMUNITY MEETINGS. ADMINISTRATIVE ASSISTANCE IS OFFERED TO VARIOUS ORGANIZATIONS. ONE OF OUR DOCTORS IS PRESIDENT OF THE IOWA PHYSICIANS SOCIETY AND PHYSICIAN CHAMPION FOR THE ACO HEALTH GRANT. THE HOSPITAL NOW OFFERS TELEHEALTH TO HELP PROVIDE ACCESS TO MENTAL HEALTH PROFESSIONALS TO OUR AREA PATIENTS, AND WE PAY FOR PATIENT TRANSPORTATION TO FACILITIES THAT CAN PROVIDE MENTAL HEALTH SERVICES WE DO NOT PROVIDE. PART III, LINE 2: IN FYE 2021 THERE WAS NO ESTIMATION PROCESS FOR BAD DEBT DUE TO ACCOUNTING RULE CHANGES AND ALL BAD DEBT EXPENSE INCLUDED ON THE RETURN WERE WRITE-OFFS OF UNCOLLECTIBLE ACCOUNTS. PART III, LINE 3: THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR THE HOSPITAL. THE COSTS OF CARING FOR PATIENTS WHO QUALIFY UNDER THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE POLICY FOR THE YEAR ENDED JUNE 30, 2021 WERE $315,812. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 7, 10 AND 11 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES" "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: THERE IS NO SHORTFALL REPORTED DURING THE YEAR, THEREFORE NO AMOUNT IS TREATED AS A COMMUNITY BENEFIT. "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT D & E WORKSHEETS, OR PS&R. PART III, LINE 9B: THE CHARITY CARE POLICY ALLOWS FOR PROACTIVE WRITE OFF TO ALLOWANCE FOR CHARITY CARE OF ANY BALANCE OWED BY A PATIENT KNOWN TO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. COLLECTION PROCEDURES DO NOT ENSUE ON ANY ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: DURING TAX YEAR 2018, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS, IN COLLABORATION WITH MARION COUNTY PUBLIC HEALTH, HELD TOWN HALL MEETINGS BY SENDING OUT SURVEYS TO DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT TO SET HEALTH GOALS AND PROGRAMS TO ADDRESS THE HEALTH NEEDS AND DESIRES OF THE COMMUNITY CAPTURED IN THE HOSPITAL'S ANNUAL COMMUNITY BENEFIT REPORT. ALSO, THE HOSPITAL ALWAYS UTILIZES INPUT FROM MEDICAL STAFF, THE BOARD OF DIRECTORS AND VARIOUS HOSPITAL ADMINISTRATIVE STAFF WHO REGULARLY REVIEW THE TREATMENT OF PATIENTS TO ENSURE MEDICAL NECESSITY AND APPROPRIATE LEVELS OF CARE ARE CONSISTENTLY PROVIDED TO THE PATIENTS OF THE HOSPITAL. PART VI, LINE 3: CUSTOMER SERVICE AND BILLING STAFF CONTINUALLY MONITOR BALANCES WITHOUT ACTIVITY AND THEN CONTACT THE PATIENTS TO OFFER FINANCIAL ASSISTANCE OR ARRANGE PAYMENT PLANS. THE HOSPITAL ALSO OFFERS THE ABILITY TO MAKE PAYMENTS VIA A WEB-BASED PORTAL. THE PORTAL CONTAINS INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE AND PAYMENT PLAN POLICIES. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING CITIES IN MARION COUNTY: KNOXVILLE (POP. 11,583), PLEASANTVILLE (POP. 2,954), AND MELCHER/DALLAS (POP. 1,625). THE KNOXVILLE COMMUNITY IS 40 MILES SOUTHEAST OF DES MOINES, IOWA. PART VI, LINE 5: KNOXVILLE COMMUNITY HOSPITAL, INC. AND THE CLINICS PROVIDE NUMEROUS OUTPATIENT SPECIALTY PROVIDER CLINICS SUCH AS PODIATRY, ORTHOPEDICS, CARDIOLOGY, UROLOGY, DERMATOLOGY, SLEEP STUDY, ONCOLOGY, AUDIOLOGY, NEPHROLOGY, RHEUMATOLOGY AND EMG TESTING AND OBGYN. PROVIDERS AND STAFF PROVIDE VARIOUS FREE EDUCATIONAL/WELLNESS PROGRAMS FOR THE COMMUNITY/SCHOOLS. THE HOSPITAL IS ADDING TO ITS SPECIALTIES YEARLY, HOSTING ANNUAL PUBLIC EVENTS INCLUDING FREE SKIN CANCER SCREENING. THESE ARE PUBLISHED IN LOCAL NEWSPAPERS. PART VI, LINE 6: DURING TAX YEAR 2020, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS WERE AFFILIATED MEMBERS OF THE MERCY HEALTH NETWORK - CENTRAL IOWA THROUGH MERCY HOSPITAL - DES MOINES, IOWA. MERCY HEALTH NETWORK - CENTRAL IOWA INCLUDES 17 CAH/TWEENER HOSPITALS ALL LOCATED IN CENTRAL IOWA. BENEFITS OF THE AFFILIATION ARE NUMEROUS AND INCLUDE: A. SHARING OF BEST PRACTICES B. SAVINGS ON GROUP PURCHASING AGREEMENTS C. SAVINGS THROUGH GROUP CONTRACTING FOR NUMEROUS SERVICES D. ACCESS TO NUMEROUS HEALTH CARE EXPERTS E. ACCESS TO PROVIDERS OF ALL TYPES AND SPECIALTIES F. ACCESS TO COMPARATIVE REPORTING G. SUPPORT FOR HUMAN RESOURCES, MEDICAL CLINICS, PURCHASING, FINANCE, NUTRITION, MEDICAL SURGERY, AND ANCILLARY AREAS. PART VI, LINE 7, REPORTS FILED WITH STATES IA 1 X X 0 0 0 0 0 0 0 0 0 LOGAN MILLER PHYSICIAN 399886 0 0 0 2010 0 8550 0 25221 0 435667 0 0 0 SAMANTHA KEADY PHYSICIAN 369102 0 0 0 942 0 9834 0 29498 0 409376 0 0 0 THOMAS HOEHNS PHYSICIAN 331652 0 5000 0 2010 0 7327 0 19917 0 365906 0 0 0 JAMES LAW PHYSICIAN 258395 0 6250 0 2010 0 8691 0 28430 0 303776 0 0 0 RYAN LAUGHLIN PHYSICIAN 255692 0 6250 0 1206 0 7748 0 30830 0 301726 0 0 0 MAGGIE HAMILTON -BEYER CFO 176171 0 0 0 0 0 6256 0 7831 0 190258 0 0 0 SCHEDULE J, PART II: KEVIN KINCAID, CEO, WAS PAID BY AN UNRELATED ORGANIZATION, MERCYONE MEDICAL CENTER - DES MOINES. MERCYONE MEDICAL CENTER HAS A MANAGEMENT AGREEMENT WITH KNOXVILLE COMMUNITY HOSPITAL INC. KNOXVILLE COMMUNITY HOSPITAL PAYS MERCYONE MEDICAL CENTER FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. THE AMOUNT OF COMPENSATION PAID BY MERCYONE MEDICAL CENTER TO KEVIN KINCAID FOR HIS SERVICES AS CEO TO KNOXVILLE COMMUNITY HOSPITAL WAS $314,836 MERCYONE MEDICAL CENTER IS PART OF CATHOLIC HEALTH INITIATIVES. A CITY OF KNOXVILLE IOWA 426004843 2014-09-20 8650000 REFINANCE INDEBTEDNESS INCURRED TO RENOVATE FACILITIES AND PURCHASE EQUIP. 0 0 0 B MARION COUNTY IOWA 421182528 2014-09-20 8650000 FINANCE RENOVATION OF FACILITIES AND PURCHASE EQUIP. 0 0 0 A 1110870 8650000 128143 6527480 1994377 2016 1 0 1 1 B 560956 8650000 128143 7161857 1360000 2016 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 1 B 1 SCHEDULE K, PART II, COLUMN A, LINE 11: $1,994,377 FOR OTHER PROCEEDS WERE SPENT TO REFUND THE 2012 BONDS THAT WERE CALLED ON AUGUST 20, 2014. SCHEDULE K, PART II, COLUMN B, LINE 12: $1,360,000 OF THE BOND ISSUE PRICE WAS NEVER DRAWN UPON AND THERE WILL NEVER BE ANY MONEY BORROWED UPON OR SPENT FROM THIS AMOUNT. SCHEDULE K, PART II, COLUMNS A AND B, LINE 13: THE PROJECT WAS DONE AS A PHASE IN PROJECT WITH MULTIPLE AREAS RENOVATED AND NEW AREAS BUILT. THE ENTIRE PROJECT WAS CONSIDERED COMPLETED BY JUNE 3, 2016. SCHEDULE K, PART III, COLUMNS A AND B, LINE 4: IN 2021, NONE OF THE NEW CLINIC SPACE WAS LEASED. ALL OF THE LEASED SPACE BY SPECIALTY DOCTORS HAS BEEN CONVERTED TO CONTRACT PROVIDER AGREEMENTS OR MOVED TO A NON-BOND FINANCED AREA. THE HOSPITAL HAD ALL OF THE CONTRACT PROVIDER AGREEMENTS REVIEWED BY LEGAL COUNSEL TO ENSURE THAT THE CONTRACTS MEET THE SAFE HARBOR REQUIREMENTS FOR SERVICE AND MANAGEMENT CONTRACTS, THEREBY RESULTING IN NO PRIVATE USE IN THE NEW CLINIC. FORM 990, PART VI, SECTION A, LINE 3 KNOXVILLE COMMUNITY HOSPITAL CONTRACTS WITH MERCYONE MEDICAL CENTER - DES MOINES FOR OVERSIGHT OF MANAGEMENT SERVICES. MERCYONE MEDICAL CENTER PROVIDES A FULL-TIME HOSPITAL CHIEF EXECUTIVE OFFICER/ADMINISTRATOR TO PROVIDE MANAGEMENT SERVICES AND ADMINISTRATIVE DIRECTION. KNOXVILLE COMMUNITY HOSPITAL PAYS MERCYONE MEDICAL CENTER FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS SIGNED BY THE CFO PRIOR TO BEING FILED, IT IS REVIEWED BY THE BOARD OF DIRECTORS AT THE NEXT BOARD MEETING, WHICH MAY OCCUR AFTER FORM 990 HAS BEEN FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER PROVIDES A COMPLIANCE OVERVIEW AND BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY. THE COMPLIANCE OFFICER REVIEWS THE POLICIES AND UPDATES THEM ANNUALLY. THE COMPLIANCE TEAM MEETS QUARTERLY TO REVIEW ALL COMPLIANCE AREAS AND CONFLICT OF INTEREST IS ONE OF THOSE AREAS. THE COMPLIANCE OFFICER ATTENDS SPECIAL TRAININGS ON COMPLIANCE REGULATIONS. EVERY CONFLICT OF INTEREST ONCE RECOGNIZED, MUST BE EVALUATED. IF A CONFLICT EXISTS, THE INDIVIDUAL WILL NOT BE PRESENT DURING GENERAL DISCUSSION NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 PER HUMAN RESOURCE POLICIES, KNOXVILLE COMMUNITY HOSPITAL UTILIZES THE IHA WAGE SURVEY AND COMPARATIVE ANALYSIS AND MARKET RATES. MOST WAGES ARE ADJUSTED WHEN THE BOARD OF DIRECTORS APPROVES PAY INCREASE PERCENTAGES. KNOXVILLE COMMUNITY HOSPITAL DOES PAY FOR PERFORMANCE IN CONJUNCTION WITH SALARY SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 KNOXVILLE COMMUNITY HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST AT ORGANIZATION'S ADMINISTRATIVE OFFICES DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G OUTSIDE MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,448,051. MANAGEMENT AND GENERAL EXPENSES 480,884. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,928,935. NURSING SERVICES: PROGRAM SERVICE EXPENSES 18,999. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,999. EMERGENCY ROOM SERVICES: PROGRAM SERVICE EXPENSES 786,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 786,260. PHYSICAL THERAPY SERVICES: PROGRAM SERVICE EXPENSES 903,710. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 903,710. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 424,528. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 424,528. LAB SERVICES: PROGRAM SERVICE EXPENSES 697,776. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 697,776. NUCLEAR MEDICINE SERVICES: PROGRAM SERVICE EXPENSES 327,469. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 327,469. RESPIRATOR SERVICES: PROGRAM SERVICE EXPENSES 244,207. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,207. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. KNOXVILLE HOSPITAL & CLINICS FOUNDATION 1002 SOUTH LINCOLN STREET KNOXVILLE IA 50138 900126510 SUPPORT FOR KNOXVILLE COMMUNITY HOSPITAL IA 501(C)(3) LINE 7 KNOXVILLE COMMUNITY HOSPITAL INC 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0