CENTRAL COMMUNITY HOSPITAL: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL COMMUNITY HOSPITAL (EIN 42-0818642)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-13
- IRS object ID
- 202231339349300633
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-13T07:02:30-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420818642 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 5632457000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brooke Kensinger | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5632457000 | PhoneNum |
| Signature | 2022-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Brooke | PersonFirstNm |
| Person Last | Kensinger | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2022-05-12 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MercyOne Elkader Medical Center | BusinessNameLine1Txt |
| Business Name Line2 | MercyOne Elkader Ambulance | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Brooke Kensinger | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,957,540 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.mercyone.org/elkader | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | Provide healthcare services to the surrounding community | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 103 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,142,010 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,180,612 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,698,290 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,680,863 | CYProgramServiceRevenueAmt |
| PY Investment Income | $40,309 | PYInvestmentIncomeAmt |
| CY Investment Income | $39,995 | CYInvestmentIncomeAmt |
| PY Other Revenue | $39,025 | PYOtherRevenueAmt |
| CY Other Revenue | $32,355 | CYOtherRevenueAmt |
| PY Total Revenue | $9,919,634 | PYTotalRevenueAmt |
| CY Total Revenue | $10,933,825 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $200 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $200 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,324,979 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,663,524 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $16,693 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,346,692 | PYOtherExpensesAmt |
| CY Other Expenses | $4,680,567 | CYOtherExpensesAmt |
| PY Total Expenses | $8,671,871 | PYTotalExpensesAmt |
| CY Total Expenses | $9,344,291 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,247,763 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,589,534 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,449,839 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,041,952 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,327,874 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,306,709 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,121,965 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,735,243 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MercyOne serves with fidelity to the Gospel as a compassionate, healing ministry of Jesus Christ to transform the health of our communities. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,314,371 | ExpenseAmt |
| Grant | $200 | GrantAmt |
| Revenue | $9,680,863 | RevenueAmt |
| Desc | Central Community Hospital is a 25-Bed Critical Access Hospital serving residents of Clayton County. Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Central Community Hospital's charitable mission.Central Community Hospital is governed by MercyOne and a local Board of Directors, which includes community leaders, consumer representatives and business experts. The Board has a history of commitment to acting with the highest integrity. During this year, the Board and MercyOne worked with management to continue to make improvements to assure the organization is in compliance with all rules and regulations governing the healthcare industry and non-profit organizations. Central Community Hospital makes care accessible to the entire community it serves. Central Community Hospital operates a full-time emergency room and provides care regardless of ability to pay. Central Community Hospital had 1,026 emergency visits and 76 outpatient surgery cases this year.The Hospital provided 458 acute days, 583 skilled days, 58 respite patient days as well as and 14,621 outpatient visits to the residents in the service area. Central Community Hospital provided care at many levels including Acute, Skilled, Same-Day-Surgery, Observation Care, Outpatient, and Rehabilitation services. In addition, Central Community Hospital provides non-emergency services. These services are accessible to the community through participation in government programs like Medicare and Medicaid. Financial counseling is available to patients.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were $97,562 for the year ended June 30, 2021. The direct and indirect costs related to these forgone charges were $57,000 at June 30, 2021, based on an average ratio of costs to gross charges.The Hospital also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. | Desc |
| Total Program Service Expenses | $7,314,371 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 24 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 103 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 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 | Brooke Kensinger | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5632457000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| LaVonne AugustonPresident | |||||||
| (Jul-Jan)/Member (Jan-Apr) | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jay Moser | |||||||
| Member (Jul-Jan)/Pres (Feb-Jun) | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jennifer Cowsert | |||||||
| Vice President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tom Neuhaus | |||||||
| Treasurer | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Justin Vorwald | |||||||
| Secretary | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Robert Hauber | |||||||
| Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Gary Guetzko | |||||||
| Member until October | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Jacqueline Brunssen | |||||||
| Member starting October | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| William Reimer | |||||||
| Member until February | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Robert Hankey | |||||||
| Member starting February | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Chelsea Dreyer | |||||||
| Member starting May | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Brooke Kensinger | |||||||
| CEO | 40.00 | Yes (X) | $189,614 | $0 | $11,903 | ||
| Rebecca Johnson | |||||||
| Controller | 40.00 | Yes (X) | $86,154 | $0 | $19,232 | ||
| Lael Aspenson | |||||||
| Interim CNO/OR Manager | 36.00 | $107,776 | $0 | $10,744 | Yes (X) | ||
| Donna Lawlor MD | |||||||
| Physician | 40.00 | $209,380 | $0 | $31,059 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $592,924 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $72,938 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | 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 |
|---|---|---|---|---|---|
| Northern Iowa Therapy | |||||
| 217 East Bremer Ave | Waverly | IA | 50677 | Therapy Services | $407,860 |
| MercyOne Dubuque Medical Center | |||||
| 250 Mercy Drive | Dubuque | IA | 52001 | Pharmacy, Dietary, Laundry | $302,576 |
| Medical Associates Clinic PC | |||||
| 1500 Associates Dr | Dubuque | IA | 520022260 | ER Coverage | $300,294 |
| Cerner Corporation | |||||
| 2800 Rockcreek Parkway | Kansas City | MO | 64117 | IT Service | $272,930 |
| MercyOne | |||||
| 1449 NW 128th Street | Clive | IA | 50325 | CEO Service | $195,620 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,018,729 | GovernmentGrantsAmt |
| All Other Contributions | $161,883 | AllOtherContributionsAmt |
| Total Contributions | $1,180,612 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621110 | $9,565,993 | $9,565,993 |
| Electronic health record incentiv | 900099 | $86,813 | $86,813 |
| Supporting revenue | 900099 | $28,057 | $28,057 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,680,863 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,382 | TotalRevenueColumnAmt |
| Exclusion | $40,382 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $52,483 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,128 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $32,355 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,355 | TotalRevenueColumnAmt |
| Exclusion | $32,355 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,200 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,587 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$387 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$387 | TotalRevenueColumnAmt |
| Exclusion | -$387 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,933,825 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,680,863 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $72,350 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200 | TotalAmt |
| Program Services | $200 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,451 | TotalAmt |
| Management And General | $340,451 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,537,118 | TotalAmt |
| Program Services | $2,969,861 | ProgramServicesAmt |
| Management And General | $556,993 | ManagementAndGeneralAmt |
| Fundraising | $10,264 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,952 | TotalAmt |
| Program Services | $67,943 | ProgramServicesAmt |
| Management And General | $11,731 | ManagementAndGeneralAmt |
| Fundraising | $278 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,530 | TotalAmt |
| Program Services | $393,298 | ProgramServicesAmt |
| Management And General | $74,621 | ManagementAndGeneralAmt |
| Fundraising | $1,611 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,473 | TotalAmt |
| Program Services | $193,877 | ProgramServicesAmt |
| Management And General | $41,802 | ManagementAndGeneralAmt |
| Fundraising | $794 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,726 | TotalAmt |
| Management And General | $62,726 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,526,979 | TotalAmt |
| Program Services | $2,014,605 | ProgramServicesAmt |
| Management And General | $512,374 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,517 | TotalAmt |
| Program Services | $300 | ProgramServicesAmt |
| Management And General | $15,217 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,097 | TotalAmt |
| Program Services | $241,266 | ProgramServicesAmt |
| Management And General | $134,787 | ManagementAndGeneralAmt |
| Fundraising | $44 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,595 | TotalAmt |
| Program Services | $102,215 | ProgramServicesAmt |
| Management And General | $7,380 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,766 | TotalAmt |
| Program Services | $17,975 | ProgramServicesAmt |
| Management And General | $5,791 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,255 | TotalAmt |
| Management And General | $1,255 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $665,353 | TotalAmt |
| Program Services | $584,732 | ProgramServicesAmt |
| Management And General | $76,919 | ManagementAndGeneralAmt |
| Fundraising | $3,702 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,675 | TotalAmt |
| Management And General | $110,675 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $467,836 | $467,590 | $246 |
| Repairs and maintenance | $222,397 | $214,202 | $8,195 |
| Recruiting | $42,774 | $42,774 | |
| Food | $34,045 | $34,045 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,552 | TotalAmt |
| Program Services | $12,262 | ProgramServicesAmt |
| Management And General | $9,290 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,344,291 | TotalAmt |
| Program Services | $7,314,371 | ProgramServicesAmt |
| Management And General | $2,013,227 | ManagementAndGeneralAmt |
| Fundraising | $16,693 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,917,660 | BOYAmt |
| EOY | $5,675,895 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,007,289 | BOYAmt |
| EOY | $924,729 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,304 | BOYAmt |
| EOY | $171,052 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,179 | BOYAmt |
| EOY | $118,352 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,722,323 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,963,939 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,422,236 | BOYAmt |
| EOY | $3,758,384 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $867,375 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $967,796 | BOYAmt |
| EOY | $1,393,540 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,449,839 | BOYAmt |
| EOY | $12,041,952 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $488,233 | BOYAmt |
| EOY | $1,240,343 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,753,974 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,667 | BOYAmt |
| EOY | $66,366 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,327,874 | BOYAmt |
| EOY | $1,306,709 | 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 | $8,168,169 | BOYAmt |
| EOY | $9,757,803 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $953,796 | BOYAmt |
| EOY | $977,440 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,121,965 | BOYAmt |
| EOY | $10,735,243 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,449,839 | BOYAmt |
| EOY | $12,041,952 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,589,534 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $23,744 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $300,000 | OtherCostOrOtherBasisAmt |
| Book Value | $300,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,576,048 | OtherCostOrOtherBasisAmt |
| Depreciation | $240,708 | DepreciationAmt |
| Book Value | $1,335,340 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,846,275 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,723,231 | DepreciationAmt |
| Book Value | $2,123,044 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,758,384 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Interest in net assets of Central Community Hospital Foundation | $976,540 |
| Estimated third-party payor settlements | $417,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,393,540 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,977,697 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $23,744 | OtherRevenueAmt |
| Revenue Not Reported | $23,744 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,953,953 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$20,128 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$20,128 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,933,825 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,364,419 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $20,128 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $20,128 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,344,291 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $9,344,291 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Medical Center has determined that it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. |
| Part XI, Line 2d - Other Adjustments: | Change in interest in net assets of Central Community Hospital Foundation 23,744. |
| Part XI, Line 4b - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990 -20,128. |
| Part XII, Line 2d - Other Adjustments: | Monona Clinic rent expenses included in revenue on Form 990 20,128. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $57,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $57,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $57,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,558 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $33,558 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00360 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,622,186 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,680,246 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $941,940 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10080 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,133 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,133 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,664,877 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,687,246 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $977,631 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10460 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,721,877 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,687,246 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,034,631 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $27,783 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $2,470 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,975,952 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,926,686 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $49,266 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | Central Community Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 Davidson St NW | AddressLine1Txt |
| City | Elkader | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520439015 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.mercyone.org/elkader | WebsiteAddressTxt |
| State License | 220051H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Central Community Hospital | 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 | 18 | 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 Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 8 | 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 | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Page 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Page 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Page 8 | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Central Community Hospital | Part V, Section B, Line 5: In February 2018, MercyOne Elkader Medical Center and Clayton County Public Health met to begin planning the Community Health Needs Assessment (CHNA) process. In March 2018, representatives from MercyOne Elkader Medical Center, Guttenberg Municipal Hospital, Clayton County Public Health, Clayton County Emergency Management, Medical Associates, Clayton County Visiting Nurses Association and Home Health met to formulate a survey that could be sent out to residents and organizations of Clayton County. The survey was developed and marketed to the community and local business through email, Facebook and the MercyOne Elkader Medical Center community newsletter (county-wide distribution) in the months of April and May. The survey closed on May 25, 2018. On May 30, 2018, Clayton County Public Health and MercyOne Elkader Medical Center hosted a meeting for Clayton County stakeholders to review the results of the survey as well bring additional relevant data that could help in the CHNA process. During this meeting, the group reviewed and updated the 2016-2018 health improvement plans, reviewed the results of the survey as well as other data brought to the meeting by stakeholders and prioritized areas of need based on the data. On August 30, 2018 this same group met again to review the prioritized areas of need based on the CHNA data and create a 2019 - 2021 community health improvement plan (HIP). This HIP is a collaborative effort that addresses health problems in the community over a period of time and defines a vision of health of the community. For each priority area, existing efforts and resources were examined, new efforts identified, and goals and objectives established. Between September and December 2018, the community health improvement plan was developed and refined. In January 2019, the community health improvement plan received support from the MercyOne Elkader Medical Center Board of Directors. The report was made available in February 2019. |
| Central Community Hospital | Part V, Section B, Line 6a: The community health needs assessment was conducted with Guttenberg Municipal Hospital & Clinics in Guttenberg, Iowa. |
| Central Community Hospital | Part V, Section B, Line 6b: The CHNA was conducted with Clayton County Public Health. |
| Central Community Hospital | Part V, Section B, Line 11: The five priority areas identified in the CHNA are addressed in the 2019 - 2021 Community Health Improvement Plan for MercyOne Elkader Medical Center and Clayton County Public Health. The number and scope of the priorities selected are reasonable to address given the time and resources available in Clayton County. Below is a listing of the five priorities identified along with a summary of the goals that were set for the 2019 - 2021 timeframe. Priority Area #1: Mental Health 1. By 2021, improve communication within the community on current entry points into Mental Health Services and work towards creating additional entry points. 2. By 2021, collaborate with community partners to reduce nicotine use and the misuse of alcohol and drugs, including prescription drugs (ex. Opioids). 3. By 2021, increase awareness of signs and symptoms of suicidal thoughts and behaviors. **2020 Progress: MercyOne Elkader is currently contracted with Integrated Telehealth Partners to provide consults to patients who are in crisis. This is paid for entirely by county social services at this point in time and is not billed to the patient. It is a great community benefit that the hospital can facilitate to those in need. The hospital Facebook page is a great way to promote resources for those who may need help with quitting smoking, drug-use or mental health concerns. The hospital has partnered with Avera Health and MercyOne Dubuque Medical Center to offer resources to emergency responders and hospital staff after an in-hospital or in-field crisis. MercyOne Elkader has chosen to move forward with Mental Health First Aid training in 2021. We will offer it to community partners as well. Priority Area #2: Emergency Preparedness 1. By 2021, increase community awareness of the "Stop the Bleed" program. 2. By 2021, strengthen the EMS system in Clayton County. 3. By 2021, increase communication between hospitals, EMS, local agencies and law enforcement during community emergencies. 4. By 2021, increase community awareness of CPR training and recertification classes. 5. By 2021, all law enforcement and fire departments within Clayton County have AED units in their response vehicles. 6. By 2021, research and implement other types of training and/or resources that might be able to be offered to assist first responders as they deal with the after effects of emergencies. **2020 Progress - Priority Area #2: Emergency PreparednessThe MercyOne Elkader Medical Center ER and MercyOne Elkader Ambulance teams have been teaching community "Stop the Bleed Programs". MercyOne Elkader Ambulance transitioned in 2018 towards 24/7/365 Paramedic coverage for the community. The ambulance is able to respond to other first responder units who are in need of a Paramedic in the county. The City of Elkader purchased a third ambulance for MercyOne Elkader Ambulance in December 2018. With three ambulances in the fleet this has allowed the service to handle multiple 911 calls and transfers at the same time - which ultimately helps patients get access to healthcare quickly. Recuitment efforts continue to be a challenge for the service.MercyOne Elkader Medical Center has one EMS staff member who is certified to teach ACLS and PALS. MercyOne Elkader Medical Center has six EMS staff and one RN, qualified BLS instructors. The hospital has been marketing their ability to provide CPR training to the community/businesses.MercyOne Elkader Medical Center and the Central Community Hospital Foundation partnered together to implement a grant program for the area non-profits to obtain AEDs. Those organizations that were awarded the grant have 50% of the cost of an AED paid for by the partnership. No-cost training is available for employees/patrons through MercyOne Elkader EMS team. MercyOne Elkader obtained a fit testing machine. Offered fit testing at no charge to partner agencies in the county during the pandemic.The hospital has partnered with Avera Health and MercyOne Dubuque Medical Center to offer resources to emergency responders and hospital staff after an in-hospital or in-field crisis. MercyOne Elkader supported a paramedic getting certified in Nonviolent Crisis Intervention Training Program. This program was offered to staff within the hospital in 2020.The Covid-19 pandemic continued through 2020 and emergency preparedness/execution of public health response work continued between county/state agencies. Huge emphasis on vaccination roll-out and operations. Priority Area #3: Obesity 1. By 2021, reduce the risk for obesity and chronic disease through health promotion programs which facilitate healthy lifestyle changes. **2020 Progress - Priority Area #3: ObesityThe hospital offers diabetic educator sessions with our licensed dietician/diabetic educator. This same person also is able to go to the local school to talk about healthy eating. School visits were paused during the pandemic.Priority Area #4: Caregiver Support 1. By 2021, improve communication regarding available resources for caregivers in Clayton County. (Baseline: No county wide resource list) 2. By 2021, investigate potential community partners for assisting with disease related caregiver support groups. **2020 Progress - Priority Area #4: Caregiver SupportMercyOne Elkader has continued exploring who the community partners are that are able to assist with caregiver support. The pandemic has challenged healthcare entities due to restrictions on group gatherings. Priority Area #5: Environment 1. By 2021, increase community awareness of incidence and mitigation of Radon gas. 2. By 2021, increase community awareness of water quality and testing. 3. By 2021, increase the availability of sharps containers in public areas in Clayton County. **2020 Progress - Priority Area #5: EnvironmentMercyOne Elkader Medical Center did add sharps containers to restrooms in the hospital in 2018. The hospital is looking to partner with the City of Elkader to help with marketing water quality testing and radon gas testing. |
| Central Community Hospital | Part V, Section B, Line 13h: Patients whose family income exceeds 300% of the FPG may be eligible to receive free care on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of Central Community Hospital. There are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. Central Community Hospital may use outside agencies to determine eligibility. These resources may use demographic and household information and/or credit scoring technology to determine eligibility. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application. Presumptive eligibility awards must be 100% discounts. Other forms of presumptive eligibility include: bankruptcy, death with no estate resources, and Title XIX eligible and receiving non-covered services. |
| Central Community Hospital | Part V, Section B, Line 16j: At the time of registrations, CCH staff makes every effort to determine if a patient may possibly need or qualify for any financial assistance. We notify patients of the availability of these programs by posting information in our registration and emergency room areas. We offer a private meeting with a financial counselor. Inpatients are offered an opportunity to meet with the counselor upon discharge. Financial assistance information is provided in all correspondence regarding patient bills. Our financial counselor attempts phone contact whenever possible. |
| Central Community Hospital | Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
| Part V, Section B, line 7a: | Community Health Needs Assessmenthttps://www.mercyone.org/elkader/about-us/community-benefit |
| Part V, Section B, Line 10a: | Implementation Strategyhttps://www.mercyone.org/elkader/about-us/community-benefit |
| Part V, Section B, Line 16a-c: | Financial Assistance Policy, Financial Assistance Application and Financial Assistance Plain Language Summary:https://www.mercyone.org/elkader/for-patients/billing-and-financial-information/financial-assistance |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The Hospital does not offer discounted care. |
| Part I, Line 6a: | The community benefit report is available at the front desk of the facility. It can also be found on its website at https://www.mercyone.org/elkader/about-us/community-benefit |
| Part I, Line 7: | Charity care expense was reported at cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. Community health improvement services on line 7e and cash and in-kind contributions for community benefit on line 7i were determined using the general ledger. The cost for subsidized health services on line 7g was determined using the Medicare Cost Report. |
| Part III, Line 2: | The Medical Center determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. |
| Part III, Line 3: | A reasonable estimate of the Hospital's implicit price concessions attributable to patients eligible under the charity care policy is 8.89% of implicit price concessions. This is based on the percentage of individuals below the poverty level in the area. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on pages 11-13 of the attached audited financial statements. |
| Part III, Line 8: | Central Community Hospital has a Medicare shortfall and considers this a community benefit. The Hospital provides services to Medicare patients regardless of the shortfall because access to healthcare and individual's health is important. Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $266,427Medicare fee schedule revenue $ 310,224Medicare estimated costs of care relating to payments (576,651)Net (Shortage) $ (266,427) |
| Part III, Line 9b: | We send 4 statements in house. After 30 days past due, we start sending letters to inform patients about our financial assistance and the amount past due. The final letter the patient gets is during the last statement, informing them of the date the account will go to collections. Once the account is sent to collections, our collection agency is waiting another 120 days before they credit report, allowing the patient that time to apply for financial assistance. |
| Part VI, Line 2: | The Community Health Needs Assessment (CHNA) and Community Health Improvement Plan was made available to the public and posted to the website in February 2019. The assessment was conducted beginning February 2018 in conjunction with Clayton County Public Health, Guttenberg Municipal Hospital (Guttenberg, Iowa also in Clayton County) and multiple other agencies within the county. Five priorities areas were identified and incorporated into the Community Health Improvement Plan for the county Mental Health, Emergency Preparedness, Obesity, Caregiver Support and Environment.MercyOne Elkader Medical Center continuously monitors the needs of the community by revisiting the community health improvement plan and updating the plan with actions taken as well as new strategies that need to be deployed based on new data. MercyOne Elkader Medical Center is an active partner with the local schools, city/townships, hospitals, public health agencies, emergency management agencies, law enforcement, fire and EMS and often is made aware of community needs through those partnerships. MercyOne Elkader Medical Center also partners with the Clayton County VNA (public health) on their CHNA/Health Improvement Plan and gathers information from that process in terms of community needs. |
| Part VI, Line 3: | At the time of registrations, staff makes every effort to determine if a patient may possibly need or qualify for any financial assistance. We notify patients of the availability of these programs by posting information in our registration and emergency room areas. We offer a private meeting with a financial counselor. Inpatients are offered an opportunity to meet with the counselor upon discharge. Financial assistance information is provided in all correspondence regarding patient bills. Our financial counselor attempts phone contact whenever possible. Our charity program information is available on our website. |
| Part VI, Line 4: | Central Community Hospital serves the residents of the central part of Clayton County into the northeast section of the county. It is a rural, agricultural area. The geographic area of Clayton County is 793 square miles. The nearest larger city is Dubuque, Iowa, which is 72 miles from Elkader, the county seat. Clayton County has a population of 17,672 (American Community Survey) and is the fifth-largest county in Iowa by area. In 2018, the median household income of Clayton County residents was $52,828. 10.9% of Clayton County children under 18 live in poverty. The median age for Clayton County residents is 47.1 years. The largest Clayton County racial/ethnic groups are White (97.4%), Black (1.0%) Other (1.6%). |
| Part VI, Line 5: | Central Community Hospital's board members reside in the primary service area. None of the board members are employed by the Hospital nor are they contractors of the Hospital. None of the board members have family members employed by Central Community Hospital. Central Community Hospital extends hospital privileges to all qualified physicians in our service area extending to Dubuque, Iowa, where specialists serve our area. Central Community Hospital encourages specialists to offer clinics in our facility to improve access for our local residents. Many of the older patients are apprehensive to drive 72 miles one-way to a large city to see a specialist. When the Hospital creates its budget, efforts are made by the Administrative Team to allocate funds to improve patient care through updating equipment, expanding supplies or hiring staff. Each year dollars are allocated to improve services based on recommendations submitted by department managers or the Administrative Team.The management team and board work to align the Community Health Needs Assessment with hospital budget/goals. The management team takes these goals and works to inspire staff to cooperatively improve the health of the community. Any surplus that is present at the end of the fiscal year is invested back into the organization in a form of capital dollars. These capital dollars are invested in equipment or projects that help meet the needs of the community. CCH partners with the City of Elkader on the EMS service. The hospital employs all of the staff, provides Medical Directorship, purchases equipment/supplies/medications, pays for half of the gas and does all of the billing. The City of Elkader purchases/maintains the ambulances, provides storage for the ambulances, pays for insurance and half of the gas. The City of Elkader does receive dollars from local townships that can help defray the cost of the ambulances/maintenance.There are two critical access hospitals in Clayton County, Iowa - Central Community Hospital (CCH) in Elkader, Iowa and Guttenberg Municpal Hospital & Clinics in Guttenberg, Iowa. Central Community Hospital is 25-30 minutes away from Guttenberg Municipal Hospital & Clinics as well as the same distance away from the three other critical access hospitals. The residents of Elkader and surrounding areas depend on the emergency room being available 24/7/365 when an emergency health need arises. The hospital also employs all EMS personnel. The service is also available 24/7/365 for all 911 calls and transfer calls. The hospital works relentlessly to ensure that coverage for both the ER and the EMS service is always available for the community, in an increasingly tough recruitment market. If these services were not available - the community would suffer tremendously. It is a huge task to ensure that healthcare personnel are up to date on all required training. We offer training for physicians, APPs, nurses and EMS personnel each year in CPR-BLS, CPR-ACLS, CPR-PALS, CPR-NRP, ATLS, TNCC.CCH has been involved in community workgroups and coalitions. The hospital is involved in the Clayton County Coalition that involves other healthcare providers, public health and emergency management. The hospital is also involved in a regional coalition that includes six other counties that works towards emergency preparedness strategies together. The hospital also participates in the Hospital Alliance for Preparedness in Iowa (HAPI). |
| Part VI, Line 6: | Central Community Hospital had a management agreement with Mercy Health Network, Des Moines, IA until 09/30/2018. On 10/01/2018, Central Community Hospital became a wholly-owned subsidiary of Mercy Health Network. Central Community Hospital adopted a d/b/a of MercyOne Elkader Medical Center and MercyOne Elkader Ambulance on February 1, 2019, the same day that Mercy Health Network adopted the d/b/a of MercyOne. There are over 25+ affinity meetings on a regular basis covering all aspects of services in the hospital (administrative, clinical, supportive). The staff of MercyOne are available daily to answer questions, provide assistance with policies and procedures and assign experts to offer classes, webinars, written materials and telephone conferences. They offer additional services that include provider recruitment, legal services and administrative support for major decision-making projects including major construction, adding service line or addressing new regulatory mandates. CCH continues to have a Critical Access Hospital Network Agreement with MercyOne Dubuque Medical Center - Dubuque, IA to meet the regulations regarding support for critical access hospital designation including transportation, communication, quality and credentialing. MercyOne Dubuque Medical Center - Dubuque IA is committed to supporting health care in rural areas as demonstrated by their joint operations with Medical Associates of Dubuque of their subsidiary, Family Care Network, and the clinics that operate in Elkader and Monona. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Donna Lawlor MD | ||||||||||||||
| Physician | $196,064 | $0 | $1,500 | $0 | $11,816 | $0 | $6,619 | $0 | $24,947 | $0 | $240,946 | $0 | $0 | $0 |
| Brooke Kensinger | ||||||||||||||
| CEO | $179,946 | $0 | $0 | $0 | $9,668 | $0 | $11,903 | $0 | $1,760 | $0 | $203,277 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Conmittee shall consist of the officers of the Board. Ihe Chair of the Board shall chair the Executive Committee. The Executive Committee shall have and may exercise the power and authority of the Board when necessary or advisable between the meetings of the Board. The Executive Committee shall report all of its actions to the Board at the next regular or special meeting of the Board. and such actions shall be subject to revision and alteration by the Board at such meeting; provided, however, that the rights of third parties shall not be affected by the any such revision or alteration. The Executive Comrnittee shall be charged with the duty of reviewing the Bylaws at least annually and recommending to the Board of Directors and the Member any amendments. The Executive Committee shall oversee compliance of the hospital with requirernents of regulatory bodies. The Executive Committee shall meet on the call of the Chair. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Organization is Mercy Community Hospital Group, LLC of which Mercy Health Network, Inc. is the sole member. |
| Form 990, Part VI, Section A, line 7a | The sole member, Mercy Community Hospital Group, LLC, is responsible for the appointment and removal of the Organization's directors and Board Chair from individuals nominated by the Board. |
| Form 990, Part VI, Section A, line 7b | The Member has reserved powers related to the following: * Approval of amendments to the Corporation's Governance Documents; * Approval of appointment and removal of the Corporation's directors aud Board Chair: * Approval of appointment and removal of the Administrator: * Recommend annual capital expenditures and operating budgets for the Corporation; * Recommend periodic business plans for the Corporation: * Recommend a major change (merger, consolidation, transfer, sale or encumbrance of all or substantially all assets) affecting the Corporation: * Approval of Clinical Quality and Safety lmplementation Plan, Patient Satisfaction Plan. Employee Satisfaction Plan and Physician Satisfaction Plan for the Hospital; * Approval of annual review of the Hospital's quality and safety; * Approval of appointments to the Hospital's Medical Staff, * Approval of philanthropy plan of the Corporation; * Approval of contracts in which the Corporation is Financially Obligated up to $2,000,000. Mercy Health Network, Inc. the sole member of the member, has the following reserved powers: * Approval of changes in Required Provisions in the Corporation's Governance Documents; * Approval of annual capital expenditure and operating budgets for the Corporation: * Approval of periodic business plans for the Corporation; * Approval of major changes (merger, consolidation, transfer. sale or encumbrance of all or substantially all assets) affecting the Corporation; * Recommend acquisition, sale or encumbrance of a Material Asset of the Corporation; * Approval of a new Joint Venture entered into by the Corporation; * Approval of quality and safety standards adopted by the Corporation; * Approval of Clinical Quality and Safety implementation Plan, Patient Satisfaction Plan. Employee Satisfaction Plan and Physican Satisfaction Plan for the Hospital; * Approval of selection of auditors for the Corporation and its subsidiaries; and * Approval of contracts in which the Corporation is Financially Obligated between $2,000,000 and $5,000,000. Trinity Health Corporation and CommonSpirit Health as members of Mercy Health Network have the following reserve powers: * Approval of the acquisition, sale or encumbrance of a Material Asset of the Corporation; and * Approval of contracts in which the Corporation is Financial Obligated in excess of $5,000,000. |
| Form 990, Part VI, Section A, line 8b | No committees have authority to act on behalf of the board. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is made available to all Board Members before it is filed. The CEO reviews and approves the 990. |
| Form 990, Part VI, Section B, line 12c | Any duality of interest or possible conflict of interest on the part of any Board member and officer is disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any individual having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter and should not be counted in determining the quorum for the meeting, even where permitted by law. The minutes of the meeting reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing board and CEO complete and sign the conflict of interest form yearly. The forms are reviewed by the Board President, and if a potential conflict is identified the Board President follows up. |
| Form 990, Part VI, Section B, line 15a | Central Community Hospital is a wholly owned entity of Mercy Health Network, Inc. d/b/a MercyOne. MercyOne is a joint venture between CommonSpirit Health and Trinity Health Corporation. The CEO is leased to Central Community Hospital from Catholic Health Initiatives - Iowa Corp dba MercyOne Des Moines Medical Center, which is a wholly owned subsidiary of CommonSpirit Health. The process for determining compensation for the CEO is based on salary adjustment recommendations using various tools. The process includes a 360-degree annual evaluation, CEO wage scales from a variety of sources and the CommonSpirit Health compensation system. All of the tools include a review of wages in comparison to comparable positions, bed size of hospital, size of community, and other factors. Human Resources of CommonSpirit Health documents and provides substantiation of the recommended CEO wage to the board. The process is done on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents and conflict of interest policy are available upon written request. The financial statements are attached to the Form 990 and therefore available for public inspection. |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 490,670. Management and general expenses 493,739. Fundraising expenses 0. Total expenses 984,409. Contract Labor: Program service expenses 1,523,935. Management and general expenses 18,635. Fundraising expenses 0. Total expenses 1,542,570. |
| Form 990, Part XI, line 9: | Change in interest in net assets of Central Community Hospital Foundation 23,744. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mercy Community Hospital Group LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1449 NW 128th St Bldg 5 Ste 200 | AddressLine1Txt |
| City | Clive | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50325 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352473948 | EIN |
| Primary Activities | Accountable Care | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mercy Health Network Inc | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Mercy Health Network Inc | |||||||||||
| 1449 NW 128th Street Bldg 5 Ste 200 | Clive | IA | 50325 | 421478417 | Health Care System Management | DE | 501(c)(3) | Line 12b, II | N/A | 0 | |
| Wheaton Franciscan Healthcare - Iowa | |||||||||||
| 3421 West Ninth Street | Waterloo | IA | 50702 | 421177001 | Health Care System Management | IA | 501(c)(3) | Line 12c, III-FI | 0 | Mercy Health Network Inc | |
| Sartori Memorial Hospital Inc | |||||||||||
| 515 College Street | Cedar Falls | IA | 50613 | 420758901 | Health Care and Hospital Services | IA | 501(c)(3) | Line 3 | 0 | Wheaton Franciscan Healthcare - Iowa Inc | |
| Sartori Health Care Foundation Inc | |||||||||||
| 3421 West Ninth Street | Cedar Falls | IA | 50613 | 421240996 | Foundation | IA | 501(c)(3) | Line 12a, I | 0 | Sartori Memorial Hospital Inc | |
| Mercy Hospital of Franciscan Sisters Inc | |||||||||||
| 3421 West Ninth Street | Cedar Falls | IA | 50613 | 421178403 | Health Care and Hospital Services | IA | 501(c)(3) | Line 3 | 0 | Wheaton Franciscan Healthcare - Iowa Inc | |
| Covenant Medical Center Inc | |||||||||||
| 3421 West Ninth Street | Cedar Falls | IA | 50613 | 421264647 | Health Care and Hospital Services | IA | 501(c)(3) | Line 3 | 0 | Wheaton Franciscan Healthcare - Iowa Inc | |
| Covenant Foundation Inc | |||||||||||
| 3421 West Ninth Street | Cedar Falls | IA | 50613 | 421295784 | Foundation | IA | 501(c)(3) | Line 10 | 0 | Covenant Medical Center Inc | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |