STEWART MEMORIAL COMMUNITY HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- STEWART MEMORIAL COMMUNITY HOSPITAL (EIN 42-0860039)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-17
- IRS object ID
- 202202909349301700
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-10-17T11:25:57-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420860039 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEWART MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STEW | BusinessNameControlTxt |
| Phone | 7124644200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 W MAIN | AddressLine1Txt |
| City | LAKE CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51449 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM HENKENIUS | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 7124644200 | PhoneNum |
| Signature | 2022-10-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JIM | PersonFirstNm |
| Person Last | HENKENIUS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2022-10-17 | 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 | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JIM HENKENIUS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 W MAIN | AddressLine1Txt |
| City | LAKE CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51449 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,740,796 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STEWARTMEMORIAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1958 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A COMPLETE CONTINUUM OF HEALTHCARE SERVICES TO THE PEOPLE OF LAKE CITY AND THE SURROUNDING COMMUNITIES WITHOUT REGARD FOR ABILITY TO PAY AND WITHOUT DISCRIMINATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 285 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,287,408 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,517,883 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,921,111 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $28,231,969 | CYProgramServiceRevenueAmt |
| PY Investment Income | $194,453 | PYInvestmentIncomeAmt |
| CY Investment Income | $160,814 | CYInvestmentIncomeAmt |
| PY Other Revenue | $519,377 | PYOtherRevenueAmt |
| CY Other Revenue | $468,025 | CYOtherRevenueAmt |
| PY Total Revenue | $29,922,349 | PYTotalRevenueAmt |
| CY Total Revenue | $34,378,691 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,349,152 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,562,464 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $281,376 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,406,227 | PYOtherExpensesAmt |
| CY Other Expenses | $11,460,353 | CYOtherExpensesAmt |
| PY Total Expenses | $27,755,379 | PYTotalExpensesAmt |
| CY Total Expenses | $30,022,817 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,166,970 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,355,874 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,974,096 | TotalAssetsBOYAmt |
| Total Assets EOY | $35,673,353 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,206,028 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,311,672 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,768,068 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,361,681 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | STEWART MEMORIAL COMMUNITY HOSPITAL IS COMMITTED TO QUALITY HEALTH AND WELLNESS FOR YOU AND YOUR FAMILY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,501,576 | ExpenseAmt |
| Revenue | $15,110,006 | RevenueAmt |
| Desc | STEWART MEMORIAL COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL THAT ALSO OPERATES 4 RURAL HEALTH CLINICS. STEWART MEMORIAL EMPLOYS 11 FAMILY PRACTICE PROVIDERS, 1 BEHAVIORAL HEALTH PROVIDER, 2 GENERAL SURGEONS AND 2 CRNAS. BESIDES OFFERING 24/7 EMERGENCY ROOM SERVICES, STEWART MEMORIAL ALSO PROVIDES GENERAL RADIOLOGY, CT SCANS, ULTRASOUND, MOBILE MRI, NUCLEAR SCANS, LABORATORY, BLOOD ADMINISTRATION, CARDIAC REHABILITATION, EKGS, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, OPERATING ROOM, PHARMACY, INFUSIONS AND OBSTETRICS. DURING 2021, STEWART MEMORIAL HAD 1,036 ACUTE PATIENT DAYS, 2,241 EMERGENCY ROOM VISITS, 1,267 OPERATING ROOM PROCEDURES AND 35,176 CLINIC ENCOUNTERS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,276,898 | ExpenseAmt |
| Revenue | $6,472,774 | RevenueAmt |
| Desc | STEWART MEMORIAL COMMUNITY HOSPITAL OWNS AND OPERATES RURAL HEALTH CLINICS IN THE COMMUNITIES OF LAKE CITY, GOWRIE, LAKE VIEW AND ROCKWELL CITY. WE EMPLOY 14 PROVIDERS WHICH ARE COMPOSED OF PHYSICIANS, PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS, THEY PROVIDE MEDICAL PROFESSIONAL SERVICES TO MEMBERS OF THESE COMMUNITIES AND SURROUNDING AREAS IN A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,263,265 | ExpenseAmt |
| Revenue | $4,421,239 | RevenueAmt |
| Desc | THE LABORATORY DEPARTMENT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY TESTING FOR PATIENTS OF STEWART MEMORIAL COMMUNITY HOSPITAL. IT ALSO PROVIDE SERVICES TO THE MCCRARY-ROST CLINIC IN LAKE CITY. REAGENT AND SALARY COSTS OF PERSONNEL ACCOUNT FOR THE MAJORITY OF THE DEPARTMENT'S EXPENSES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,159,529 | ExpenseAmt |
| Revenue | $2,227,950 | RevenueAmt |
| Desc | THE OPERATING AND RECOVERY ROOMS DEPARTMENT PROVIDE GENERAL SURGICAL AND ORTHOPEDIC PROCEDURES ALONG WITH PROCEDURES FOR ENT, CATARACT AND PODIATRY. THE SUPPLIES USED IN SUCH PROCEDURES ACCOUNT FOR A LARGE PORTION OF EXPENSES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,159,529 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $2,227,950 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $26,201,268 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | 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 | 0 | 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 | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 285 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 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 | JIM HENKENIUS CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7124644200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 W MAIN STREET | AddressLine1Txt |
| City | LAKE CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51449 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DR MARGARET VITIRITTO-KHAN | |||||||
| MEDICAL COUNSEL | 40.00 | Yes (X) | $341,869 | $0 | $42,239 | ||
| CHADRIC DIETRICH | |||||||
| BOARD CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BRADLEY LANE | |||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| THERESA HILDRETH | |||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SCOTT NESBITT | |||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SHEILA BERGER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CARMEN HOOD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SCOTT KLUVER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JORDAN LIETZ | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM HENKENIUS | |||||||
| CFO | 40.00 | $162,447 | $0 | $38,436 | Yes (X) | ||
| CYNTHIA CARSTENS | |||||||
| CEO | 40.00 | $0 | $0 | $0 | Yes (X) | ||
| DEREK DUNCAN | |||||||
| D.O. | 40.00 | $748,140 | $0 | $44,654 | Yes (X) | ||
| SUSAN HORNBACK | |||||||
| D.O. | 40.00 | $927,161 | $0 | $33,971 | Yes (X) | ||
| RONALD CHENEY | |||||||
| D.O. | 40.00 | $450,472 | $0 | $44,404 | Yes (X) | ||
| JOSH SMITH | |||||||
| D.O. | 40.00 | $375,781 | $0 | $1,000 | Yes (X) | ||
| TONJA PETERSEN-ANDERSON | |||||||
| ARNP | 40.00 | $230,271 | $0 | $5,996 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,236,141 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $210,700 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 24 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SHARED MEDICAL SERVICES INC | |||||
| 209 LIMESTONE PASS | COTTAGE GROVE | WI | 53551 | MOBILE MRI SERVICES | $166,950 |
| BARTON & ASSOCIATES INC | |||||
| 300 JUBILEE DRIVE | BOSTON | MA | 01960 | OB NURSING & RHC PROVIDERS COVERAGE | $161,161 |
| LOCUM TENENSCOM LLC | |||||
| 2575 NORTHWINDS PARKWAY | ALPHARETTA | GA | 30009 | ER & OBSTETRICS COVERAGE | $157,225 |
| WAPITI MEDICAL STAFFING | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | ER COVERAGE | $129,833 |
| FOCUSONE SOLUTIONS LLC | |||||
| PO BOX 850861 | MINNEAPOLIS | MN | 55485 | OB NURSING COVERAGE | $127,010 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $40,812 | FundraisingAmt |
| Government Grants | $2,319,465 | GovernmentGrantsAmt |
| All Other Contributions | $3,157,606 | AllOtherContributionsAmt |
| Total Contributions | $5,517,883 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ANCILLARY SERVICES | 621400 | $14,356,245 | $14,356,245 |
| RURAL HEALTH CLINICS | 621400 | $6,472,774 | $6,472,774 |
| LABORATORY | 621400 | $4,421,239 | $4,421,239 |
| OPERATING & RECOVERY ROOMS | 621400 | $2,227,950 | $2,227,950 |
| 340B PROGRAM REVENUE | 621400 | $434,286 | $434,286 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $319,475 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $319,475 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $28,231,969 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,540 | TotalRevenueColumnAmt |
| Exclusion | $71,540 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $246,074 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $106 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $245,968 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $245,968 | TotalRevenueColumnAmt |
| Exclusion | $245,968 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $447,273 | SecuritiesAmt |
| Other | $500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $358,499 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $88,774 | SecuritiesAmt |
| Other | $500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,274 | TotalRevenueColumnAmt |
| Exclusion | $89,274 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $2,500 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $40,812 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $3,500 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,000 | TotalRevenueColumnAmt |
| Exclusion | -$1,000 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA SALES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $223,057 | TotalRevenueColumnAmt |
| Exclusion | $223,057 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $223,057 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,378,691 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,231,969 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $628,839 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $584,991 | TotalAmt |
| Program Services | $384,108 | ProgramServicesAmt |
| Management And General | $200,883 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,871 | TotalAmt |
| Program Services | $37,871 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,683,062 | TotalAmt |
| Program Services | $13,315,229 | ProgramServicesAmt |
| Management And General | $1,156,231 | ManagementAndGeneralAmt |
| Fundraising | $211,602 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,063 | TotalAmt |
| Program Services | $246,370 | ProgramServicesAmt |
| Management And General | $23,693 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,040,449 | TotalAmt |
| Program Services | $1,742,010 | ProgramServicesAmt |
| Management And General | $298,266 | ManagementAndGeneralAmt |
| Fundraising | $173 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $946,028 | TotalAmt |
| Program Services | $803,882 | ProgramServicesAmt |
| Management And General | $127,082 | ManagementAndGeneralAmt |
| Fundraising | $15,064 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $474,949 | TotalAmt |
| Management And General | $474,949 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,236 | TotalAmt |
| Management And General | $91,236 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,210 | TotalAmt |
| Management And General | $75,210 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,590 | TotalAmt |
| Management And General | $22,590 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,782,197 | TotalAmt |
| Program Services | $2,335,021 | ProgramServicesAmt |
| Management And General | $430,649 | ManagementAndGeneralAmt |
| Fundraising | $16,527 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,768 | TotalAmt |
| Program Services | $90,317 | ProgramServicesAmt |
| Management And General | $5,340 | ManagementAndGeneralAmt |
| Fundraising | $32,111 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,431,450 | TotalAmt |
| Program Services | $1,387,141 | ProgramServicesAmt |
| Management And General | $40,545 | ManagementAndGeneralAmt |
| Fundraising | $3,764 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $608,220 | TotalAmt |
| Program Services | $558,764 | ProgramServicesAmt |
| Management And General | $49,456 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,796 | TotalAmt |
| Program Services | $398,626 | ProgramServicesAmt |
| Management And General | $3,170 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,496 | TotalAmt |
| Program Services | $75,647 | ProgramServicesAmt |
| Management And General | $34,709 | ManagementAndGeneralAmt |
| Fundraising | $140 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,921 | TotalAmt |
| Program Services | $6,757 | ProgramServicesAmt |
| Management And General | $73,164 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,100,310 | TotalAmt |
| Program Services | $1,010,856 | ProgramServicesAmt |
| Management And General | $89,454 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,703 | TotalAmt |
| Program Services | $27,769 | ProgramServicesAmt |
| Management And General | $178,934 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $3,032,932 | $3,032,932 | ||
| BAD DEBT | $614,114 | $614,114 | ||
| MISCELLANEOUS | $169,609 | $44,828 | $124,100 | $681 |
| DUES & SUBSCRIPTIONS | $130,852 | $89,026 | $40,512 | $1,314 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,022,817 | TotalAmt |
| Program Services | $26,201,268 | ProgramServicesAmt |
| Management And General | $3,540,173 | ManagementAndGeneralAmt |
| Fundraising | $281,376 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,984,165 | BOYAmt |
| EOY | $2,852,583 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,129,837 | BOYAmt |
| EOY | $2,487,581 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $449,226 | BOYAmt |
| EOY | $300,861 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,336,965 | BOYAmt |
| EOY | $2,958,069 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,364 | BOYAmt |
| EOY | $96,351 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $372,658 | BOYAmt |
| EOY | $417,595 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $231,410 | BOYAmt |
| EOY | $44,361 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $47,018,311 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,293,884 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,709,352 | BOYAmt |
| EOY | $21,724,427 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,613,498 | BOYAmt |
| EOY | $2,301,498 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,023,621 | BOYAmt |
| EOY | $2,490,027 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,974,096 | BOYAmt |
| EOY | $35,673,353 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,623,013 | BOYAmt |
| EOY | $3,980,235 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $619,136 | BOYAmt |
| EOY | $240,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,677,333 | BOYAmt |
| EOY | $1,228,856 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,237,745 | BOYAmt |
| EOY | $12,306,187 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,801 | BOYAmt |
| EOY | $1,556,394 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,206,028 | BOYAmt |
| EOY | $19,311,672 | 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 | $10,119,122 | BOYAmt |
| EOY | $14,481,898 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,648,946 | BOYAmt |
| EOY | $1,879,783 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,768,068 | BOYAmt |
| EOY | $16,361,681 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,974,096 | BOYAmt |
| EOY | $35,673,353 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,355,874 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $237,739 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,741 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,741 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | STEWART MEMORIAL COMMUNITY HOSPITAL PAID DUES TO THE AMERICAN HOSPITAL ASSOCATION AND THE IOWA HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $146,413 | OtherCostOrOtherBasisAmt |
| Book Value | $146,413 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,135,551 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,600,349 | DepreciationAmt |
| Book Value | $1,535,202 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,630,395 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,446,078 | DepreciationAmt |
| Book Value | $5,184,317 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,105,952 | OtherCostOrOtherBasisAmt |
| Depreciation | $247,457 | DepreciationAmt |
| Book Value | $14,858,495 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,724,427 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLE | $2,411,254 |
| INVESTMENT IN CAPTIVE | $78,773 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,490,027 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION LIABILITIES | $145,864 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $1,410,530 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,556,394 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $34,005,922 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $237,739 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $3,606 | OtherRevenueAmt |
| Revenue Not Reported | $241,345 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,764,577 | RevenueSubtotalAmt |
| Other Revenues Not Included | $614,114 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $614,114 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $34,378,691 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $29,412,309 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $3,606 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $3,606 | ExpensesNotReportedAmt |
| Expenses Subtotal | $29,408,703 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $614,114 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $614,114 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $30,022,817 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE 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 ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2021 AND 2020, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 106. FUNDRAISING EXPENSES 3,500. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 614,114. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 106. FUNDRAISING EXPENSES 3,500. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 614,114. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | TRIVIA ON THE GREENS | Event1Nm |
| Gross Receipts Event1 | $43,312 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $40,812 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $2,500 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $250 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $1,500 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $750 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $500 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $500 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $43,312 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $40,812 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $2,500 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $250 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $1,500 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $750 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $500 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $500 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $3,500 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$1,000 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | 0 | 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) |
|---|---|---|
| Persons Served | 165 | PersonsServedCnt |
| Total Community Benefit Expns | $245,143 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $245,143 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,706,191 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,449,941 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $256,250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00870 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 165 | PersonsServedCnt |
| Total Community Benefit Expns | $3,951,334 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,449,941 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $501,393 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01700 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 4957 | PersonsServedCnt |
| Total Community Benefit Expns | $94,434 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,322 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $82,112 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 14 | PersonsServedCnt |
| Total Community Benefit Expns | $127,620 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $127,620 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 41 | PersonsServedCnt |
| Total Community Benefit Expns | $18,757 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,757 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 20 | ActivitiesOrProgramsCnt |
| Persons Served | 5012 | PersonsServedCnt |
| Total Community Benefit Expns | $240,811 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,322 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $228,489 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 20 | ActivitiesOrProgramsCnt |
| Persons Served | 5177 | PersonsServedCnt |
| Total Community Benefit Expns | $4,192,145 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,462,263 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $729,882 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02470 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $3,585 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,585 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $2,055 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,055 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $5,640 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,640 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $614,114 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,338,613 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,040,299 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $298,314 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| 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 | STEWART MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 WEST MAIN STREET | AddressLine1Txt |
| City | LAKE CITY | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51449 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.STEWARTMEMORIAL.ORG | WebsiteAddressTxt |
| State License | 130029H | 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 | STEWART MEMORIAL 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 |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | WWW.STEWARTMEMORIAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.STEWARTMEMORIAL.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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 | WWW.STEWARTMEMORIAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.STEWARTMEMORIAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.STEWARTMEMORIAL.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: STEWART MEMORIAL COMMUNITY HOSPITAL, IN CONJUNCTION WITH CALHOUN COUNTY PUBLIC HEALTH DEVELOPED A SURVEY MONKEY QUESTIONNAIRE TO GET INPUT FROM COMMUNITY MEMBERS. THE QUESTIONNAIRE WAS DISTRIBUTED THROUGHOUT THE SMCH SERVICE AREA TO VARIOUS ORGANIZATIONS INCLUDING PUBLIC HEALTH, SCHOOLS, OTHER HEALTH CARE PROVIDERS AND LOCAL BUSINESSES ALONG WITH EMPLOYEES OF THE HOSPITAL AND ITS AUXILIARY. |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6B: CALHOUN COUNTY PUBLIC HEALTH |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 7D: A HARD COPY OF THE SURVEY WAS PRINTED AND DISTRIBUTED THROUGHOUT OUR SERVICE AREA INCLUDING THE LOCAL LIBRARY. |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: FOUR TOPICS WERE IDENTIFIED IN THE ASSESSMENT - 1) IMPROVE ACCESS TO QUALITY HEALTH SERVICES & SUPPORTS; 2) HEALTH EDUCATION AND INFORMATION RESOURCES; 3) HEALTHY LIVING; 4) HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH. THE FIRST TOPIC HAD 6 GOALS AND A FEW OBJECTIVES UNDER EACH. THE GOALS ARE TO REDUCE THE RATE OF CANCER DIAGNOSIS IN CALHOUN COUNTY, INCREASE THE USE OF CARE COORDINATION TO ASSIST WITH NAVIGATION THROUGH HEALTH CARE INFORMATION AND SERVICES, INCREASE ACCESS AND REFERRALS TO SHELTER SERVICES FOR VICTIMS OF ABUSE, VIOLENCE, OR SEX; INCLUDING INDIVIDUALS WITH DISABILITIES, REDUCE THE NUMBER OF REPORTED POOR MENTAL HEALTH DAYS TO IMPROVE QUALITY OF LIFE FOR CALHOUN COUNTY INDIVIDUALS AND FAMILIES, INCREASE AVAILABLE AND AFFORDABLE TRANSPORTATION SERVICES IN CALHOUN COUNTY, INCREASE THE AVAILABILITY OF SUBSTANCE ABUSE SUPPORT GROUPS FOR INDIVIDUALS AND FAMILIES. THE FIRST GOAL, REDUCE THE RATE OF CANCER DIAGNOSIS IN CALHOUN COUNTY, HAS 1 OBJECTIVE. THE OBJECTIVE IS TO INCREASE PREVENTATIVE BEHAVIORS IN PERSONS AT HIGH RISK FOR CANCER TO REDUCE CANCER RELATED DEATHS FROM 25 IN 2020 TO 15 IN 2025THE SECOND GOAL, INCREASE THE USE OF CARE COORDINATION TO ASSIST WITH NAVIGATION THROUGH HEALTH CARE INFORMATION AND SERVICES HAS 2 OBJECTIVES - INCREASE IDENTIFICATION OF INDIVIDUALS WITH MULTIPLE CARE CONDITIONS NEEDING REFERRAL FOR CARE COORDINATION TO INCREASE ACCESS AND FOLLOW UP FOR NEEDED SERVICES FROM CARE COORDINATION REFERRALS AND TO DEVELOP A TOOL TO TRACK HOME CARE REFERRALS AND FOLLOW UP. THE TARGET VALUE OF THE 1ST OBJECTIVE IS 50 INDIVIDUALS. THE 2ND OBJECTIVE IS TO DEVELOP A TOOL TO TRACK HOME CARE REFERRALS AND FOLLOW UP FROM THE BASELINE VALUE OF 0% TO 100%.THE 3RD GOAL, INCREASE ACCESS AND REFERRALS TO SHELTER SERVICES FOR VICTIMS OF ABUSE, VIOLENCE OR SEX; INCLUDING INDIVIDUALS WITH DISABILITIES HAS ONE OBJECTIVE AND ONE STRATEGY. THE OBJECTIVE IS TO INCREASE THE IDENTIFICATION OF VICTIMS OF INTIMATE PARTNER VIOLENCE WITH REFERRALS TO COMMUNITY SERVICES. CURRENT VALUE IS 46 WITH A TARGET OF 60 BY 2025.THE 4TH GOAL, REDUCE THE NUMBER OF REPORTED POOR MENTAL HEALTH DAYS TO IMPROVE QUALITY OF LIFE FOR CALHOUN COUNTY INDIVIDUALS HAS 1 OBJECTIVE. THE OBJECTIVE IS TO INCREASE KNOWLEDGE AND THE BENEFITS OF MENTAL HEALTH SERVICES FOR INDIVIDUALS WITH MENTAL HEALTH ISSUES AND THEIR FAMILIES SO THEY CAN MANAGE THEIR MENTAL HEALTH ON A DAILY BASIS AND RECEIVE APPROPRIATE SUPPORT DECREASING THE NUMBER OF REPORTED POOR MENTAL HEALTH DAYS. CURRENT BASELINE VALUE IS 3.6 DAYS, AND THE TARGET IS <3 DAYS BY 2025.THE FIFTH GOAL, INCREASE AVAILABLE AND AFFORDABLE TRANSPORTATION SERVICES IN CALHOUN COUNTY HAS ONE OBJECTIVE. THE OBJECTIVE IS TO INCREASE THE NUMBER OF RESOURCES FROM 2 (MIDAS AND MCO MEDICAL TRANSPORTATION) TO A MINIMUM OF 3 RESOURCES BY 2025. THE SIXTH GOAL FOR IMPROVE ACCESS TO QUALITY HEALTH SERVICES AND SUPPORTS IS TO INCREASE THE AVAILABILITY OF SUBSTANCE ABUSE SUPPORT GROUPS FOR INDIVIDUALS AND FAMILIES. THE OBJECTIVE IS TO INCREASE THE NUMBER OF AA/ALANON/NA GROUPS FROM 2 IN 2020 TO 4 IN 2025. THE SECOND TOPIC, HEALTH EDUCATION AND INFORMATION RESOURCES HAS 4 GOALS. THE GOALS ARE TO REDUCE THE STD RATES IN CALHOUN COUNTY, INCREASE THE NUMBER OF FAMILIES RECEIVING FAMILY FOUNDATION SERVICES, IMPROVE ACCESS TO QUALITY HEALTH SERVICES AND SUPPORTS AND TO DECREASE THE PERCENTAGE OF FOOD INSECURITY IN CALHOUN COUNTY.THE OBJECTIVE OF THE FIRST GOAL, REDUCE STD RATES IN CALHOUN COUNTY, IS TO INCREASE KNOWLEDGE OF PREVENTATIVE BEHAVIORS RELATED TO SEXUALLY TRANSMITTED INFECTIONS TO REDUCE THE NUMBER OF INFECTIONS FROM 236 IN 2020 TO 200 IN 2025. THE 2ND GOAL, INCREASE THE NUMBER OF FAMILIES RECEIVING FAMILY FOUNDATION SERVICES HAS ONE OBJECTIVE WITH FIVE STRATEGIES. THE OBJECTIVE IS TO INCREASE THE NUMBER OF FAMILIES AT 125% OF THE POVERTY RATE OR HIGHER. THE BASELINE VALUE IS 68% WITH A TARGET VALUE OF 78%. THE THIRD GOAL, IMPROVE ACCESS TO QUALITY HEALTH SERVICE AND SUPPORTS, HAS 1 OBJECTIVE. THE OBJECTIVE IS TO REDUCE THE NUMBER OF PERSONS THAT ARE UNABLE TO OBTAIN OR DELAY OBTAINING NECESSARY PRIMARY CARE OR MENTAL HEALTH CARE BY 5% BY 2025 FROM THE BASELINE VALUE OF 24%. THE FINAL GOAL IN THIS TOPIC, DECREASE THE PERCENTAGE OF FOOD INSECURITY IN CALHOUN COUNTY, ALSO HAS 1 OBJECTIVE. THE OBJECTIVE IS TO DISSEMINATE INFORMATION TO COMMUNITIES HOW TO ACCESS EMERGENCY FEEDING SITES/FOOD AND NUTRITION SITES TO REDUCE FOOD INSECURITY. THE CURRENT BASELINE VALUE IS 12% WITH A TARGET VALUE OF 6% BY 2025. THE THIRD TOPIC, HEALTHY LIVING, HAS 2 GOALS AND 2 OBJECTIVES. THE GOALS ARE TO REDUCE ADULT OBESITY RATES IN CALHOUN COUNTY AND INCREASE ACCESS TO EXERCISE OPPORTUNITIES IN CALHOUN COUNTY.THE OBJECTIVE OF GOAL 1, REDUCE ADULT OBESITY RATES IN CALHOUN COUNTY, IS TO INCREASE EDUCATIONAL AND SUPPORT PROGRAMS AVAILABLE IN CALHOUN COUNTY TO ADDRESS ADULT OBESITY AND REDUCE THE RATE. THERE IS A TARGET VALUE OF 30% FOR THIS OBJECTIVE. THE SECOND GOAL, INCREASE ACCESS TO EXERCISE OPPORTUNITIES IN CALHOUN COUNTY, HAS 1 OBJECTIVE. THE OBJECTIVE IS TO INCREASE ACCESS TO LOCATIONS OR PROGRAMS THAT SUPPORT INCREASE PHYSICAL ACTIVITY FOR CALHOUN COUNTY RESIDENTS. THE FOURTH AND FINAL TOPIC, HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH, HAS 2 GOALS. THESE GOALS ARE TO IMPROVE INCOME AND INCOME DISTRIBUTION AND TO IMPROVE HOUSING OPTIONS IN CALHOUN COUNTY.THE FIRST GOAL, IMPROVE INCOME AND INCOME DISTRIBUTION, HAS 1 OBJECTIVE - TO DECREASE INCOME INEQUALITY. BASED ON THE 2020 BASELINE YEAR, THE BASELINE VALUE IS 0.45 (GINI INDEX) WITH A TARGET VALUE OF 0.3 IN 2025. THE SECOND GOAL, IMPROVE HOUSING OPTIONS IN CALHOUN COUNTY, HAS 1 OBJECTIVE, THE OBJECTIVE IS TO DECREASE THE PERCENTAGE OF INDIVIDUALS LIVING IN INADEQUATE HOUSING. THE GOAL IS TO DECREASE TO A VALUE OF 15%. |
| STEWART MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 13H: STEWART MEMORIAL COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING NECESSARY HOSPITAL CARE AND TREATMENT TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ANY PATIENT WHO HAS RECEIVED SERVICES AND WHO FALLS BELOW CERTAIN INCOME AND ASSET LIMITS MAY BE ELIGIBLE FOR HOSPITAL CARE FREE OF CHARGE, OR AT A REDUCTION OF OUR ESTABLISHED CHARGES.THE HOSPITAL USES THE POVERTY INCOME GUIDELINES ISSUED BY THE COMMUNITY SERVICE ADMINISTRATION AS A BASIS FOR ELIGIBILITY CRITERIA FOR DISCOUNTED CARE. THESE GUIDELINES ARE ADJUSTED ANNUALLY BASED ON INCREASES IN THE CONSUMER PRICE INDEX. SUPPORT TO GRANT FINANCIAL ASSISTANCE MUST BE FULLY DOCUMENTED IN OUR FILES. SMCH HAS A SPREADSHEET BASED ON THE FEDERAL POVERTY GUIDELINES TO DETERMINE DISCOUNTED CARE. THE SPREADSHEET ALSO ACCOUNTS FOR THE FAMILY SIZE IN DETERMINING ELIGIBILITY. FOR THOSE APPLYING, IF THEIR INCOME FALLS BETWEEN 225-250% OF THE GUIDELINES, 75% OF THE PATIENT'S BILL IS FORGIVEN; IF THE INCOME IS BETWEEN 300-400% OF THE GUIDELINES, 50% IS FORGIVEN; IF THE INCOME AT 450% OF THE GUIDELINES, 35% IS FORGIVEN; IF THE INCOME IS AT 500% OF THE GUIDELINES, 25% IS FORGIVEN. THE NEW 501(R) REGULATIONS AND POLICIES THAT TOOK EFFECT JANUARY 1, 2016 WILL BE MADE AVAILABLE TO EVERY PATIENT AND ALSO MADE AVAILABLE ON OUR WEBSITE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - MCCRARY-ROST CLINIC | ||||
| 1351 WEST MAIN STREET | LAKE CITY | IA | 51449 | HEALTH CLINIC |
| 2 - GOWRIE CLINIC | ||||
| 1800 MAIN | GOWRIE | IA | 50543 | HEALTH CLINIC |
| 3 - LAKE VIEW CLINIC | ||||
| 1160 3RD STREET | LAKE VIEW | IA | 51540 | HEALTH CLINIC |
| 4 - ROCKWELL CITY CLINIC | ||||
| 505 EAST LAKE STREET | ROCKWELL CITY | IA | 50579 | HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NOT APPLICABLE |
| PART I, LINE 6A: | STEWART MEMORIAL COMMUNITY HOSPITAL'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. |
| PART I, LINE 7: | STEWART MEMORIAL COMMUNITY HOSPITAL USED THE WORKSHEETS PROVIDED IN THE IRS INSTRUCTIONS FOR SCHEDULE H IN ADDITION TO THE INTERNAL COST ACCOUNTING SYSTEM. |
| 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 $614,114. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ONE MEMBER OF THE ORGANIZATION IS A VOLUNTEER MEMBER ON THE LOCAL BETTERMENT ORGANIZATION. AT THE MONTHLY MEETINGS, THEY USE THEIR TIME TO PROMOTE THE SERVICES AND WELLNESS ACTIVITIES THE HOSPITAL PROVIDES. CURRENT AND PROSPECTIVE BUSINESSES UNDERSTAND THE VARIOUS HEALTH SERVICES THAT ARE MADE AVAILABLE TO THEM AND THEIR EMPLOYEES. OTHER STAFF MEMBERS SERVE ON VARIOUS PROJECT TEAMS IN OUR SURROUNDING COMMUNITIES TO REPRESENT THE HOSPITAL AND BUILD COMMUNITY AWARENESS. THE COO AND AN EMPLOYED PHYSICIAN ARE MEMBERS OF THE CALHOUN COUNTY BOARD OF HEALTH. STEWART MEMORIAL COMMUNITY HOSPITAL WORKED IN CONJUNCTION WITH CALHOUN COUNTY PUBLIC HEALTH TO COMPLETE A COMMUNITY NEEDS ASSESSMENT AND DEVELOP A HEALTH IMPROVEMENT PROGRAM. |
| PART III, LINE 2: | IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND ESTIMATES A PERCENTAGE OF THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON HISTORICAL ANALYSIS. THE ESTIMATED PERCENTAGE OF THOSE TRANSITION ACCOUNTS ARE ADDED TO RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8 THROUGH 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES" "PATIENT SERVICE REVENUE, AND "CHARITY CARE." |
| PART III, LINE 8: | SINCE THERE IS NO MEDICARE SHORTFALL CALCULATED FOR 2021, THERE IS NO SHORTFALL THAT IS TREATED AS COMMUNITY BENEFIT. THE 2021 FILED MEDICARE COST REPORT WAS USED TO DETERMINE THE ALLOWABLE COSTS. |
| PART III, LINE 9B: | COLLECTION POLICY:PATIENTS ARE ADMITTED INTO THE HOSPITAL COMPUTER SYSTEM WITH APPROPRIATE FINANCIAL INFORMATION INCLUDING INSURANCE INFORMATION AND ARE ASSIGNED A FINANCIAL CLASS (F/C) USED TO SEGREGATE ACCOUNTS IN ACCOUNTS RECEIVABLE (A/R) BY PAYER TYPE. PATIENTS WHO ARE MINORS ARE ADMITTED WITH THE PARENT WHO CARRIES THE INSURANCE COVERAGE AS THE RESPONSIBLE PARTY OR IF NO INSURANCE, THE PARENT WHO BROUGHT THE CHILD IN FOR CARE IS LISTED AS GUARANTOR.THE BUSINESS OFFICE WILL SEND AN ITEMIZED STATEMENT OF CHARGES TO ALL PATIENTS WHO REQUEST A COPY. INSURANCE COMPANIES ARE BILLED ELECTRONICALLY THROUGH THE USE OF EMDEON SOFTWARE WHENEVER POSSIBLE. ONCE THE INSURANCE COMPANY HAS PROCESSED THE CLAIM AND PAID ITS ENTIRE SHARE OR IF THE PATIENT DOESN'T HAVE INSURANCE, THEY WILL BE ASSIGNED A FINANCIAL CLASS OF SELF-PAY. SMCH ALLOWS PATIENTS TO SET UP PAYMENT ARRANGEMENTS FOLLOWING THIS SCHEDULE USING CHECK, MONEY ORDER, MASTERCARD OR VISA:BALANCE IS: MINIMUM PAYMENT:UNDER $250 $ 25.00 $251-$500 $ 50.00$501-$1000 $ 100.00$1001 - ABOVE $ 150.00THESE LIMITS ARE SET TO INSURE BALANCES ARE PAID IN FULL WITH 18 MONTHS IF AT ALL POSSIBLE. WHEN THE PATIENT IS ASSIGNED A FINANCIAL CLASS OF P, THE ACCOUNT IS SENT TO MED-PLAN FOR EARLY OUT PRE-COLLECT PROCESSING. THE FIRST STATEMENT FROM MED-PLAN IS MAILED OUT ON DAY 1 WHEN THEY RECEIVE THE ACCOUNT AND THEN AGAIN AT 30 DAYS. ACCOUNTS THAT DO NOT MAKE PAYMENT ARRANGEMENTS OR MAKE PAYMENTS FROM THE LETTER CAMPAIGN AFTER 45 DAYS ARE MOVED INTO A TELEPHONE CAMPAIGN. THE TELEPHONE CAMPAIGN MAKES 3 ATTEMPTS OVER 15 DAYS TO SECURE PAYMENT IN FULL OR A SCHEDULED PAYMENT PLAN. IF RESOLUTION ATTEMPTS FAIL AND MED-PLAN IS UNABLE TO RESOLVE AN ACCOUNT BECAUSE (1) IT IS IMPOSSIBLE TO REACH A PATIENT BY TELEPHONE, OR (2) THE PATIENT HAS FAILED TO COOPERATE IN ESTABLISHING A PAYMENT PLAN, OR (3) THE PATIENT HAS FAILED TO HONOR AN ESTABLISHED PLAN BY NOT MAKING SATISFACTORY PAYMENT WITHIN 60-90 DAYS, A FINAL NOTICE WILL BE SENT TO THE PATIENT. ACCOUNTS UNPAID OR ARRANGEMENTS NOT MADE AT THIS POINT IN THE BILLING PROCESS ARE DETERMINED UNCOLLECTIBLE. IF NO PAYMENT IN ALLOWABLE TIME IS RECEIVED, ACCOUNTS ARE ELECTRONICALLY SENT TO A COLLECTION AGENCY. IN THE EVENT OF PARTIAL PAYMENT, A DETERMINATION ON AN INDIVIDUAL BASIS IS MADE AS TO STOP OR PROCEED WITH THE COLLECTION AGENCY. |
| PART VI, LINE 2: | SMCH COLLABORATES WITH THE COUNTY HEALTH DEPARTMENT IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES THEY SERVE. SMCH ALSO EVALUATES USAGE DATA THROUGH THE IOWA HOSPITAL ASSOCIATION TO SEE THE PRIMARY MEDICAL DIAGNOSIS IN THEIR COMMUNITIES. |
| PART VI, LINE 3: | SMCH HAS A PATIENT ACCOUNTS MANAGER AS WELL AS A SOCIAL WORKER ON STAFF THAT IDENTIFY PATIENTS THAT MAY BE ELIGIBLE FOR ASSISTANCE OR QUALIFY FOR CHARITY CARE. THEY ASSIST THE PATIENT WITH AVAILABLE OPTIONS AND/OR THE NECESSARY PAPERWORK. |
| PART VI, LINE 4: | THE SERVICE AREA IS A 35 MILE RADIUS SURROUNDING THE SMCH COMMUNITY. THIS AREA CONSISTS OF MANY SMALL, RURAL COMMUNITIES THAT ARE AGRICULTURAL BASED. THE PATIENT BASE CONSISTS OF A LARGE MEDICARE POPULATION. |
| PART VI, LINE 5: | SMCH PROVIDES THE COMMUNITIES WITH LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS ON PROMOTING HEALTHY LIFESTYLES. THEY PROVIDE CARE TO THE INDIGENT REGARDLESS OF THEIR ABILITY TO PAY. THE BOARD OF DIRECTORS ARE REPRESENTED BY THE VARIOUS COMMUNITIES THEY SERVE.THE HOSPITAL HAS ALSO JOINED WITH THE COUNTY DEPARTMENT OF HEALTH IN ESTABLISHING A PROGRAM CALLED "CARING HANDS CLOSET." CARING HANDS CLOSET IS A PROGRAM FOR EXPECTING MOTHERS AND NEW MOTHERS TO EARN POINTS TOWARDS BABY ITEMS BY ATTENDING THEIR DOCTOR APPOINTMENTS AND/OR EDUCATIONAL PROGRAMS. SMCH PROVIDES MONTHLY LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS BI-MONTHLY. |
| PART VI, LINE 6: | SMCH IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN HORNBACK | ||||||||||||||
| D.O. | $814,714 | $0 | $112,057 | $0 | $390 | $0 | $8,700 | $0 | $25,271 | $0 | $961,132 | $0 | $0 | $0 |
| DEREK DUNCAN | ||||||||||||||
| D.O. | $593,779 | $0 | $154,107 | $0 | $254 | $0 | $8,700 | $0 | $35,954 | $0 | $792,794 | $0 | $0 | $0 |
| RONALD CHENEY | ||||||||||||||
| D.O. | $449,742 | $0 | $0 | $0 | $730 | $0 | $8,700 | $0 | $35,704 | $0 | $494,876 | $0 | $0 | $0 |
| DR MARGARET VITIRITTO-KHAN | ||||||||||||||
| MEDICAL COUNSEL | $341,623 | $0 | $0 | $0 | $246 | $0 | $8,700 | $0 | $33,539 | $0 | $384,108 | $0 | $0 | $0 |
| JOSH SMITH | ||||||||||||||
| D.O. | $375,007 | $0 | $0 | $0 | $774 | $0 | $0 | $0 | $1,000 | $0 | $376,781 | $0 | $0 | $0 |
| TONJA PETERSEN-ANDERSON | ||||||||||||||
| ARNP | $124,840 | $0 | $105,042 | $0 | $389 | $0 | $4,996 | $0 | $1,000 | $0 | $236,267 | $0 | $0 | $0 |
| JIM HENKENIUS | ||||||||||||||
| CFO | $161,721 | $0 | $0 | $0 | $726 | $0 | $5,153 | $0 | $33,283 | $0 | $200,883 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII, LINE 5: | FormAndLineReferenceDesc |
| Explanation | CYNTHIA CARSTENS, CEO, RECEIVED COMPENSATION FROM UNITYPOINT HEALTH, AN UNRELATED ENTITY, WHICH PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS. MS. CARSTENS RECEIVED COMPENSATION AND BENEFITS IN THE AMOUNT OF $239,648 FOR HER SERVICES DURING THE CALENDAR YEAR 2021. HER COMPENSATION IS REPORTED IN PART IX, LINE 11A. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF LAKE CITY IOWA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 426004850 | BondIssuerEIN |
| CUSIP | 508021AQ5 | CUSIPNum |
| Bond Issued | 2016-10-24 | BondIssuedDt |
| Issue Price | $1,440,000 | IssuePriceAmt |
| Purpose | CAPITAL IMPROVEMENTS | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,440,000 | RetiredAmt |
| Total Proceeds | $1,440,000 | TotalProceedsAmt |
| In Reserve Fund | $72,000 | InReserveFundAmt |
| Capital Expenditures | $1,368,000 | CapitalExpendituresAmt |
| Substantial Completion | 2016 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART IV, LINE 2C: | FormAndLineReferenceDesc |
| Explanation | THE FINAL ARBITRAGE REBATE COMPUTATION WAS COMPLETED ON 09/16/2021. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JODI HENKENIUS | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | ORGANIZATION'S EMPLOYEE & SPOUSE OF JIM HENKENIUS, CFO | RelationshipDescriptionTxt |
| Transaction | $37,871 | TransactionAmt |
| Transaction | EMPLOYEE WAGES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | UNITYPOINT HEALTH AND STEWART MEMORIAL COMMUNITY HOSPITAL HAVE AN AGREEMENT FOR ADMINISTRATIVE SERVICES. UNITYPOINT HEALTH PROVIDED THE SERVICES OF CYNTHIA CARSTENS, CEO. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WILL BE PROVIDED ELECTRONICALLY TO THE BOARD OF DIRECTORS AND REVIEWED BY THE CEO AND CFO PRIOR TO SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST FORM ANNUALLY STATING THAT THEY WILL ABSTAIN FROM VOTING AND DISCUSSING ITEMS FOR WHICH THEY HAVE A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS MEET ANNUALLY TO DISCUSS THE TERMS OF THE CEO'S CONTRACT. THEY USE DATA FROM THE LATEST IOWA HOSPITAL ASSOCIATION SALARY SURVEY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. |