PELLA REGIONAL HEALTH CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PELLA REGIONAL HEALTH CENTER (EIN 42-0842204)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-09
- IRS object ID
- 202123139349304882
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-09T17:05:41-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4650 E 53RD ST | AddressLine1Txt |
| City | DAVENPORT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 528073479 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420842204 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PELL | BusinessNameControlTxt |
| Phone | 6416283150 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1Txt |
| City | PELLA | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT KROESE | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 6416283150 | PhoneNum |
| Signature | 2021-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ROBERT | PersonFirstNm |
| Person Last | KROESE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JENIFER L CHASE | PreparerPersonNm |
| PTIN | P01306883 | PTIN |
| Phone | 5638884000 | PhoneNum |
| Preparation | 2021-11-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT KROESE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1Txt |
| City | PELLA | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $114,841,484 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.PELLAHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1958 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 948 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $51,286 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $921,184 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,456,386 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $90,821,165 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $89,141,314 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,843,893 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,554,424 | CYInvestmentIncomeAmt |
| PY Other Revenue | $11,105,576 | PYOtherRevenueAmt |
| CY Other Revenue | $13,522,506 | CYOtherRevenueAmt |
| PY Total Revenue | $105,691,818 | PYTotalRevenueAmt |
| CY Total Revenue | $109,674,630 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,598 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,703 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $55,988,454 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $56,449,220 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $44,380,589 | PYOtherExpensesAmt |
| CY Other Expenses | $48,581,340 | CYOtherExpensesAmt |
| PY Total Expenses | $100,373,641 | PYTotalExpensesAmt |
| CY Total Expenses | $105,036,263 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,318,177 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,638,367 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $155,992,830 | TotalAssetsBOYAmt |
| Total Assets EOY | $175,318,188 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $50,907,871 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $60,036,619 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $105,084,959 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $115,281,569 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF PELLA REGIONAL HEALTH CENTER IS TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $87,978,594 | ExpenseAmt |
| Grant | $5,703 | GrantAmt |
| Revenue | $102,454,273 | RevenueAmt |
| Desc | PELLA REGIONAL HEALTH CENTER (PRHC) IS A 25-BED ACUTE CARE HOSPITAL LOCATED IN PELLA, IOWA. THE HEALTH CENTER ALSO OPERATES CLINICS IN PELLA, SULLY, KNOXVILLE, PRAIRIE CITY, BUSSEY, AND OTTUMWA, IOWA. ANNUALLY, THE HEALTH CENTER HAS OVER 1,200 ADMISSIONS, OVER 500 LIVE BIRTHS, OVER 7,800 EMERGENCY RELATED VISITS, AND PERFORMS OVER 5,500 SURGERIES.PRHC PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE PRHC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER PRHC'S CHARITY CARE POLICY WAS APPROXIMATELY $814,000 FOR THE YEAR; ENDED DECEMBER 31, 2020. TOTAL DIRECT AND INDIRECT COSTS RELATED TO THESE FORGONE CHARGES WERE $459,000 AT DECEMBER 31, 2020, BASED ON AN AVERAGE RATIO OF COST TO GROSS CHARGES.THE 340B PROGRAM OFFERS ELIGIBLE HEALTH CARE PROVIDERS ACCESS TO LOW-COST MEDICATIONS, WHICH ALLOWS THEM TO EXPAND THE TYPE AND VOLUME OF CARE THEY PROVIDE TO THE MOST VULNERABLE PATIENT POPULATIONS. THE 340B PROGRAM REQUIRES DRUG MANUFACTURERS TO PROVIDE THE OUTPATIENT DRUGS TO ELIGIBLE HEALTH CARE ORGANIZATIONS OR COVERED ENTITIES AT SIGNIFICANTLY REDUCED PRICES. PRHC IS AN ELIGIBLE HEALTH CARE ORGANIZATION AND IS PARTICIPATING IN THE PROGRAM. THE REVENUE GENERATED FROM THIS PROGRAM WAS APPROX. $7,087,000 AND THE RELATED EXPENSES WERE APPROX $3,488,000 FOR 2020. | Desc |
| Total Program Service Expenses | $87,978,594 | 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 | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 948 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 11 | 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 | 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 | BRUCE HEIFNER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6416286603 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1Txt |
| City | PELLA | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DR RICHARD POSTHUMA | |||||||||
| BOARD MEMBER | 40.00 | Yes (X) | $524,660 | $0 | $48,549 | ||||
| STEPHEN BARNES DO | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $420,436 | $0 | $41,669 | ||||
| JIM BRANDL | |||||||||
| VICE PRESIDENT | 0.50 | Yes (X) | $0 | $0 | $0 | 0.20 | Yes (X) | ||
| ROD BRAUN | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| MARY GLENDENING | |||||||||
| BOARD SECRETARY | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| CHAD HUYSER | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| LESLIE JOHNSON | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| MIKE LIND | |||||||||
| FORMER BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| MIKE MORGAN | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| RANDY STRAVERS | |||||||||
| PRESIDENT | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| TRAVIS TURNBULL | |||||||||
| TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| JOHN VANDER WERT | |||||||||
| FORMER BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| DR CRAIG WITTENBERG | |||||||||
| BOARD MEMBER | 40.00 | Yes (X) | $624,757 | $0 | $49,087 | ||||
| ROBERT KROESE | |||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $322,477 | $0 | $40,932 | 2.00 | Yes (X) | |||
| BRUCE HEIFNER | |||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $192,820 | $0 | $32,031 | Yes (X) | ||||
| DAWNETT WILLIS | |||||||||
| CHIEF OF ANCILLARY SERVICE | 40.00 | $167,978 | $0 | $38,553 | Yes (X) | ||||
| LEZLIE MORRIS | |||||||||
| CHIEF OF CLINIC SERVICES | 40.00 | $165,579 | $0 | $15,543 | Yes (X) | ||||
| SPENCER CARLSTONE MD | |||||||||
| PHYSICIAN | 40.00 | $473,311 | $0 | $46,839 | Yes (X) | ||||
| ANNE HELLBUSCH DO | |||||||||
| PHYSICIAN | 40.00 | $469,933 | $0 | $44,429 | Yes (X) | ||||
| S DOUG KANIS DO | |||||||||
| PHYSICIAN | 40.00 | $472,538 | $0 | $46,622 | Yes (X) | ||||
| DANIEL ROWLEY MD | |||||||||
| PHYSICIAN | 40.00 | $448,450 | $0 | $46,009 | Yes (X) | ||||
| MATT MORGAN DO | |||||||||
| PHYSICIAN | 40.00 | $611,341 | $0 | $47,159 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,894,280 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $497,422 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 80 | 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 |
|---|---|---|---|---|---|
| CHANGE HEALTHCARE LLC | |||||
| PO BOX 98347 | CHICAGO | IL | 60693 | TECHNOLOGY SERVICES | $483,880 |
| CASSLING | |||||
| 13808 F ST | OMAHA | NE | 68137 | TECHNOLOGY SERVICES | $476,812 |
| MEDICAL ONCOLOGY & HEMATOLOGY | |||||
| 1221 PLEASANT STREET | DES MOINES | IA | 50309 | ONCOLOGY SERVICES | $447,563 |
| MEDICAL INFORMATION TECHNOLOGY INC | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | TECHNOLOGY SERVICES | $392,533 |
| NUMARK BUILDING CORPORATION | |||||
| 102 E 15TH ST | PELLA | IA | 50219 | BUILDING SUPPLIES | $298,085 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $20,743 | RelatedOrganizationsAmt |
| Government Grants | $5,417,249 | GovernmentGrantsAmt |
| All Other Contributions | $18,394 | AllOtherContributionsAmt |
| Total Contributions | $5,456,386 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $89,141,314 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $89,141,314 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $89,141,314 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,017,418 | TotalRevenueColumnAmt |
| Exclusion | $2,017,418 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $187,617 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,356 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $158,261 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $158,261 | TotalRevenueColumnAmt |
| Exclusion | $158,261 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,671,205 | SecuritiesAmt |
| Other | $3,299 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,137,498 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$466,293 | SecuritiesAmt |
| Other | $3,299 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$462,994 | TotalRevenueColumnAmt |
| Exclusion | -$462,994 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| OTHER OPERATING REVENUE | 900099 | $8,647,210 | $8,647,210 | |
| PHARMACY REVENUE | 446110 | $4,717,035 | $4,665,749 | $51,286 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $13,364,245 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $109,674,630 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $102,454,273 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $51,286 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,712,685 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,703 | TotalAmt |
| Program Services | $5,703 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,666,809 | TotalAmt |
| Program Services | $2,083,069 | ProgramServicesAmt |
| Management And General | $583,740 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,406,653 | TotalAmt |
| Program Services | $36,304,357 | ProgramServicesAmt |
| Management And General | $8,102,296 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,332,054 | TotalAmt |
| Program Services | $1,867,044 | ProgramServicesAmt |
| Management And General | $465,010 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,078,969 | TotalAmt |
| Program Services | $2,887,116 | ProgramServicesAmt |
| Management And General | $1,191,853 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,964,735 | TotalAmt |
| Program Services | $2,368,265 | ProgramServicesAmt |
| Management And General | $596,470 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,551 | TotalAmt |
| Management And General | $84,551 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,934 | TotalAmt |
| Management And General | $115,934 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,766 | TotalAmt |
| Management And General | $7,766 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,750 | TotalAmt |
| Management And General | $85,750 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,651,001 | TotalAmt |
| Program Services | $7,120,566 | ProgramServicesAmt |
| Management And General | $2,530,435 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,660 | TotalAmt |
| Program Services | $8,201 | ProgramServicesAmt |
| Management And General | $187,459 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,682,955 | TotalAmt |
| Program Services | $6,411,364 | ProgramServicesAmt |
| Management And General | $1,271,591 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $938,334 | TotalAmt |
| Program Services | $199,573 | ProgramServicesAmt |
| Management And General | $738,761 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,218,707 | TotalAmt |
| Program Services | $1,136,821 | ProgramServicesAmt |
| Management And General | $81,886 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,906 | TotalAmt |
| Program Services | $183,112 | ProgramServicesAmt |
| Management And General | $6,794 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,803 | TotalAmt |
| Program Services | $256,539 | ProgramServicesAmt |
| Management And General | $54,264 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,296,848 | TotalAmt |
| Program Services | $1,296,848 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,462,750 | TotalAmt |
| Program Services | $7,265,119 | ProgramServicesAmt |
| Management And General | $197,631 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $867,073 | TotalAmt |
| Program Services | $453,871 | ProgramServicesAmt |
| Management And General | $413,202 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $18,035,563 | $18,035,563 | |
| FOOD | $306,374 | $3,626 | $302,748 |
| DUES AND MEMBERSHIPS | $109,875 | $70,347 | $39,528 |
| EQUIPMENT PARTS AND REP | $19,651 | $19,651 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,839 | TotalAmt |
| Program Services | $1,839 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,036,263 | TotalAmt |
| Program Services | $87,978,594 | ProgramServicesAmt |
| Management And General | $17,057,669 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,850,032 | BOYAmt |
| EOY | $29,405,142 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,813,002 | BOYAmt |
| EOY | $11,499,934 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,331,444 | BOYAmt |
| EOY | $1,748,640 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,670,517 | BOYAmt |
| EOY | $1,390,343 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $133,685,419 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $81,352,957 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,233,681 | BOYAmt |
| EOY | $52,332,462 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,918,363 | BOYAmt |
| EOY | $78,370,097 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,175,791 | BOYAmt |
| EOY | $571,570 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,992,830 | BOYAmt |
| EOY | $175,318,188 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,513,692 | BOYAmt |
| EOY | $9,324,212 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,556,455 | BOYAmt |
| EOY | $34,364,457 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,349 | BOYAmt |
| EOY | $1,834,078 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,393,375 | BOYAmt |
| EOY | $14,513,872 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,907,871 | BOYAmt |
| EOY | $60,036,619 | 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 | $105,077,459 | BOYAmt |
| EOY | $115,274,069 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,500 | BOYAmt |
| EOY | $7,500 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,084,959 | BOYAmt |
| EOY | $115,281,569 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,992,830 | BOYAmt |
| EOY | $175,318,188 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,638,367 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $5,558,243 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,766 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,766 | 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 | LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 17.7% OF MEMBERSHIP DUES PAID TO THE IOWA HOSPITAL ASSOCIATION, OR $5,893, AND 17.7% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $1,873 | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | 0 | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,125,079 | OtherCostOrOtherBasisAmt |
| Book Value | $4,125,079 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $96,091,552 | OtherCostOrOtherBasisAmt |
| Depreciation | $57,322,537 | DepreciationAmt |
| Book Value | $38,769,015 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $717,100 | OtherCostOrOtherBasisAmt |
| Depreciation | $140,396 | DepreciationAmt |
| Book Value | $576,704 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,870,457 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,973,633 | DepreciationAmt |
| Book Value | $6,896,824 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,881,231 | OtherCostOrOtherBasisAmt |
| Depreciation | $916,391 | DepreciationAmt |
| Book Value | $1,964,840 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $52,332,462 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED CLAIMS PAYABLE | $661,310 |
| BOND ISSUANCE COSTS | -$51,321 |
| THIRD PARTY SETTLEMENTS | $731,634 |
| DEFERRED COMPENSATION | $1,921,902 |
| MEDICARE ADVANCE PAYMENT | $9,808,291 |
| PROVIDER RELIEF FUND GRANT | $1,442,056 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $14,513,872 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SERVE THE PURPOSE OF THE RESTRICTIONS PLACED ON THE FUNDS BY THE RESPECTIVE DONORS. |
| PART X, LINE 2: | PELLA REGIONAL HEALTH CENTER (THE HEALTH CENTER) AND PELLA HOSPITAL FOUNDATION (THE FOUNDATION) ARE ORGANIZED AS IOWA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HEALTH CENTER AND FOUNDATION ARE EACH ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THEY ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE HEALTH CENTER AND FOUNDATION BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HEALTH CENTER AND FOUNDATION 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. FORMS 990 AND 990T FILED BY THE HOSPITAL AND FOUNDATION ARE GENERALLY SUBJECT TO EXAMINATION BY THE IRS UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. |
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 |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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 | $368,254 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $368,254 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,093,964 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,575,678 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,518,286 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03350 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,462,218 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,575,678 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,886,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03700 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $729,897 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $729,897 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00690 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $592,288 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,875 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $579,413 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00550 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,151,040 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,049,541 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,101,499 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10570 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,650 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,650 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,479,875 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,062,416 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,417,459 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11820 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,942,093 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,638,094 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,303,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15520 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $201,122 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,031 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $193,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $201,122 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,031 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $193,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,492,764 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $23,814,348 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $24,164,005 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$349,657 | 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 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1Txt |
| City | PELLA | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PELLAHEALTH.ORG | WebsiteAddressTxt |
| State License | 630165H | 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 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 20 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.PELLAHEALTH.ORG/ABOUT-US/COMMUNITY/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.PELLAHEALTH.ORG/ABOUT-US/COMMUNITY/ | 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 | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.PELLAHEALTH.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| 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 |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PELLA REGIONAL HEALTH CENTER | PART V, SECTION B, LINE 5: EACH COMMUNITY HAS A WEALTH OF EXPERTISE TO BE TAPPED FOR CHNA DEVELOPMENT. FOR THIS REASON, A TOWN HALL IS THE PERFECT FORUM TO GATHER COMMUNITY INSIGHT AND PROVIDE AN ATMOSPHERE TO OBJECTIVELY BUILD CONSENSUS AND PRIORITIZE COUNTY HEALTH ISSUES.ALL TOWN HALL PRIORITY-SETTING AND SCORING PROCESSES INVOLVE THE INPUT OF KEY STAKEHOLDERS IN ATTENDANCE. INDIVIDUALS AND ORGANIZATIONS ATTENDING THE TOWN HALLS WERE CRITICALLY IMPORTANT TO THE SUCCESS OF THE CHNA.THE FOLLOWING LIST OUTLINES PARTNERS INVITED TO TOWN HALL: LOCAL HOSPITALS, PUBLIC HEALTH COMMUNITY, MENTAL HEALTH COMMUNITY, FREE CLINICS, COMMUNITY BASED CLINICS, SERVICE PROVIDERS, LOCAL RESIDENTS, COMMUNITY LEADERS, OPINION LEADERS, SCHOOL LEADERS, BUSINESS LEADERS, LOCAL GOVERNMENT, FAITH-BASED ORGANIZATIONS AND PERSONS (OR ORGANIZATIONS SERVING THEM), PEOPLE WITH CHRONIC CONDITIONS, UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS. |
| PELLA REGIONAL HEALTH CENTER | PART V, SECTION B, LINE 11: THE 2020 IMPLEMENTATION PLAN DESCRIBES THE FOLLOWING NEEDS THAT WILL BE ADDRESSED IN THE FUTURE:1) MENTAL HEALTH (ACCESS, DIAGNOSIS AND PLACEMENT). PELLA REGIONAL HEALTH CENTER (PRHC) WILL PARTNER WITH HEARTLAND CHRISTIAN COUNSELING TO INCREASE PROVIDERS AND ACCESS. PROVIDE DEPTH AND BREADTH OF SERVICES FOR MENTAL HEALTH NEEDS IN THE COMMUNITIES SERVED.2) CHILD CARE SERVICES/ACCESS. PRHC WILL PARTNER WITH CHILD CARE PROVIDERS FOR ACTIONS. INVESTIGATE THE OPTIONS AND OPPORTUNITIES WITH CHILDCARE SERVICES AND ACCESS - PARTICULARLY EXTENDED AND WEEKEND HOURS. CONTINUE TO WORK WITH PARTNERSHIP STUDY.3) EMPLOYMENT OF HEALTHCARE WORKERS. ENHANCE HIGH SCHOOL & COLLEGE STUDENT CONNECTIONS WITH PRHC. INVESTIGATE HOUSING OPTIONS FOR LOW INCOME WORKERS. ENHANCE MARKETING STRATEGIES TO SHARE OUR STORY AS IT RELATES TO EMPLOYMENT.4) ELDERLY SERVICES AND VOLUME OF SERVICES. INCREASE IN-HOME SUPPORT OPTIONS FOR ELDERLY RESIDENCE. INCREASE THE AVAILABILITY OF STAFFING OPTIONS AND HUMAN CAPITAL FOR ELDERLY SERVICES. ACCESS AND AVAILABILITY FOR ADULT DAY/ACUTE SERVICES, IMPROVEMENT FOR FUNDING RESOURCES AND OPTIONS FOR SERVICE.5) SUBSTANCE ABUSE. DRUG AND SUBSTANCE USE AND PRESENTATION SERVICES/RESPONSE. INCREASE PATIENTS AND PROVIDERS/STAFF KNOWLEDGE/AWARENESS OF AVAILABLE SERVICES. CONTINUE TO MONITOR PRESCRIPTION DRUGE ABUSE.6) TEEN HEALTH. IMPROVEMENT OF SERVICES AND ACCESS FOR TEEN HEALTH. CONTINUE TO WORK WITH COMMUNITY COALITION. |
| PELLA REGIONAL HEALTH CENTER | PART V, SECTION B, LINE 13H: PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) ALSO REVIEWS A PATIENT'S MONTHLY INCOME, EXPENSES, ASSETS, LIABILITIES, PRIOR HEALTH HISTORY, AND TOTAL OUTSTANDING BILLS IN ADDITION TO PROVIDING FREE OR DISCOUNTED CARE BASED ON THE FEDERAL POVERTY GUIDELINES. THE FEDERAL POVERTY GUIDELINES ARE USED AS A STARTING POINT TO DETERMINE FINANCIAL ASSISTANCE, BUT SEVERAL OTHER FACTORS ARE TAKEN INTO CONSIDERATION BEFORE DETERMINING HOW MUCH OF A PATIENT'S BILL WILL BE WRITTEN OFF TO CHARITY CARE IF THE PATIENT'S EARNINGS ARE ABOVE THE 200% FEDERAL POVERTY GUIDELINE BASE AMOUNT.THE HEALTH CENTER ALSO OFFERS UNINSURED PATIENTS A 20% CASH DISCOUNT FOR FINAL BILLS PAID IN FULL WITHIN 60 DAYS. THE HEALTH CENTER DOES NOT CHARGE INTEREST ON UNPAID BALANCES WHEN PAYMENT PLANS ARE SET UP WITHIN 60 DAYS OF PATIENTS RECEIVING THEIR FINAL BILL. |
| PELLA REGIONAL HEALTH CENTER | PART V, SECTION B, LINE 20E: IN ADDITION TO THE ACTIONS TAKEN IN PART V, SECTION B, LINE 20A-20D, PELLA REGIONAL HEALTH CENTER SENDS INSUFFICIENT PAYMENT LETTERS TO INDIVIDUALS FOR PAYMENTS NOT MEETING THE HOSPITAL'S MINIMUM PAYMENT REQUIREMENTS. PRHC ALSO SENDS MINIMUM PAYMENTS LETTERS THAT OUTLINED ITS MINIMUM PAYMENT REQUIREMENTS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 11 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - PELLA MEDICAL CLINIC | ||||
| 405 MONROE | PELLA | IA | 50219 | PHYSICIAN CLINIC |
| 2 - OTTUMWA MEDICAL CLINIC | ||||
| 920 N QUINCY AVE | OTTUMWA | IA | 52501 | PHYSICIAN CLINIC |
| 3 - PELLA REGIONAL PHARMACY | ||||
| 802 WASHINGTON ST | PELLA | IA | 50219 | RETAIL PHARMACY |
| 4 - KNOXVILLE MEDICAL CLINIC | ||||
| 1208 N LINCOLN | KNOXVILLE | IA | 50138 | PHYSICIAN CLINIC |
| 5 - PRAIRIE CITY CLINIC | ||||
| 100 E JEFFERSON STREET | PRAIRIE | IA | 50228 | PHYSICIAN CLINIC |
| 6 - HOSPICE OF PELLA (COMFORT HOUSE) | ||||
| 505 UNION STREET | PELLA | IA | 50219 | HOSPICE |
| 7 - OTTUMWA THERAPY AGENCY | ||||
| 611 NORTH HANCOCK STREET | OTTUMWA | IA | 52501 | PHYSICAL AND OCCUPATIONAL THERAPY |
| 8 - HOME HEALTH | ||||
| 1119 E 2ND STREET | PELLA | IA | 50219 | HOME HEALTHCARE |
| 9 - PELLA REGIONAL PHARMACY | ||||
| 405 JEFFERSON ST | PELLA | IA | 50219 | FIRSTFILL PHARMACY |
| 10 - BUSSEY MEDICAL CLINIC | ||||
| 411 MERRILL STREET | BUSSEY | IA | 50044 | PHYSICIAN CLINIC |
| 11 - SULLY CLINIC | ||||
| 704 3RD STREET | SULLY | IA | 50251 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | PELLA REGIONAL HEALTH CENTER (HEALTH CENTER) ALSO REVIEWS A PATIENT'S MONTHLY INCOME, EXPENSES, ASSETS, LIABILITIES, PRIOR HEALTH HISTORY, AND TOTAL OUTSTANDING BILLS IN ADDITION TO PROVIDING FREE OR DISCOUNTED CARE BASED ON THE FEDERAL POVERTY GUIDELINES. THE FEDERAL POVERTY GUIDELINES ARE USED AS A STARTING POINT TO DETERMINE FINANCIAL ASSISTANCE, BUT SEVERAL OTHER FACTORS ARE TAKEN INTO CONSIDERATION BEFORE DETERMINING HOW MUCH OF A PATIENT'S BILL WILL BE WRITTEN OFF TO CHARITY CARE IF THE PATIENT'S EARNINGS ARE ABOVE THE 200% FEDERAL POVERTY GUIDELINE BASE AMOUNT. THE HEALTH CENTER ALSO OFFERS UNINSURED PATIENTS A 20% CASH DISCOUNT FOR FINAL BILLS PAID IN FULL WITHIN 60 DAYS. THE HEALTH CENTER DOES NOT CHARGE INTEREST ON UNPAID BALANCES WHEN PAYMENT PLANS ARE SET UP WITHIN 60 DAYS OF PATIENTS RECEIVING THEIR FINAL BILL. |
| PART I, LINE 6A: | NOT APPLICABLE |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS USED TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSE AND REVENUE AMOUNTS RECORDED FROM THE EVENTS IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. |
| PART I, LINE 7G: | THE ORGANIZATION USED THE MEDICARE COST REPORT AS WELL AS INTERNAL FINANCIAL STATEMENTS TO CALCULATE A COST-TO-CHARGE RATIO FOR EACH DEPARTMENT THAT CONSTITUTES A SUBSIDIZED HEALTH SERVICE ACTIVITY. THE FOLLOWING PHYSICIAN CLINIC COSTS WERE INCLUDED IN COMMUNITY BENEFIT EXPENSE: PELLA MEDICAL CLINIC - $22,526,973, SULLY CLINIC - $578,054, OTTUMWA CLINIC - $4,088,808, BUSSEY AND PRAIRIE CITY CLINIC - $2,513,007, AND NEW SHARON CLINIC - $47,802. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | INFECTION CONTROL SERVES AS A COMMUNITY BENEFIT AS IT TRACKS INFECTIONS THROUGHOUT THE WORLD, NATION, AND LOCAL AREA IN AN EFFORT TO REDUCE OR PREVENT INCIDENCE OR LOCAL OCCURENCE. ALSO, IT HELPS TO PREPARE FOR THE EVENTUALITY OF INFECTION ISSUES WITHIN THE COMMUNITY AND AT OUR FACILITY. |
| PART III, LINE 2: | PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.BAD DEBT EXPENSE ON LINE 2 IS REPORTED AT CHARGES AS PRESENTED ON THE FINANCIAL STATEMENTS. |
| PART III, LINE 3: | NOT APPLICABLE |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. PELLA REGIONAL HEALTH CENTER PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THAT THEY WILL NOT RECOVER ALL OF THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE. THE ORGANIZATION REPORTED ONLY THOSE ALLOWABLE COSTS AND MEDICARE REIMBURSEMENTS REPORTED IN THE MEDICARE COST REPORT FOR THE YEAR.TOTAL REVENUE RECEIVED FROM MEDICARE (INCLUDING DSH AND IME) IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT (INCLUDING LSA). BOTH THE 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 THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | PELLA REGIONAL HEALTH CENTER'S COLLECTION POLICY HAS PROVISONS FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE OR CHARITY CARE AND FOR PATIENTS IN THE PROCESS OF APPLYING FOR ASSISTANCE. PELLA REGIONAL HEALTH CENTER DOES NOT PURSUE COLLECTION EFFORTS WHILE A PATIENT IS IN THE PROCESS OF APPLYING FOR ANY TYPE OF ASSISTANCE OR FOR ANY PORTION OF A PATIENT'S BILL CONSIDERED CHARITY CARE. AFTER ASSISTANCE IS DETERMINED, ANY PERSONAL PORTION DUE WOULD FOLLOW THE SAME COLLECTION PROCEDURES AS OTHER PATIENTS. IF A PAYMENT PLAN IS ESTABLISHED AND THE PATIENT DEFAULTS, THEIR CHARITY CARE STATUS IS REVOKED AND THE REMAINING BALANCE IS SENT TO COLLECTIONS. |
| PART VI, LINE 2: | PELLA REGIONAL HEALTH CENTER PARTICIPATED IN A COMMUNITY ENGAGEMENT PROJECT IN 2020. THIS PROJECT INCLUDED A COMMUNITY HEALTH NEEDS ASSESSMENT, KEY INFORMANT INTERVIEWS, AND SECONDARY DATA ANALYSIS ADMINISTERED BY SARAH PAVELKA, PALVELKA'S POINT CONSULTING FROM CEDAR FALLS IOWA. THE HEALTH IMPLEMENTATION PLAN (HIP) FROM THE 2020 CHNA WILL BE CLOSED AS OF DECEMBER 31, 2020. CREATING HEALTHY COMMUNITIES REQUIRES A HIGH LEVEL OF MUTUAL UNDERSTANDING AND COLLABORATION AMONG COMMUNITY LEADERS. THE DEVELOPMENT OF THIS ASSESSMENT BRINGS TOGETHER COMMUNITY HEALTH LEADERS AND PROVIDERS, ALONG WITH LOCAL RESIDENTS, TO RESEARCH AND PRIORITIZE COUNTY HEALTH NEEDS AND DOCUMENT COMMUNITY HEALTH DELIVERY SUCCESSES. THIS HEALTH ASSESSMENT WILL SERVE AS THE FOUNDATION FOR COMMUNITY HEALTH IMPROVEMENT EFFORTS FOR THE NEXT THREE YEARS. THE LAST CHNA FOR PELLA REGIONAL HEALTH CENTER (PRIMARY SERVICE AREA) WAS PUBLISHED IN 2017. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) REQUIRES NOT-FOR-PROFIT HOSPITALS TO CONDUCT A CHNA EVERY THREE YEARS AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED BY THE CHNA. THIS ASSESSMENT WAS COORDINATED AND PRODUCED BY PALVELKA'S POINT CONSULTING (CEDAR FALLS, IOWA) UNDER THE DIRECTION OF SARAH PAVELKA. A CHNA PROVIDES BENEFITS TO LOCAL HEALTH SERVICE ORGANIZATIONS, THE HOSPITAL, THE PUBLIC HEALTH DEPARTMENT, AS WELL AS OTHER COMMUNITY PROVIDERS AND STAKEHOLDERS IN THE FOLLOWING WAYS: 1) INCREASES KNOWLEDGE OF COMMUNITY HEALTH NEEDS AND RESOURCES; 2) CREATES A COMMON UNDERSTANDING OF THE PRIORITIES OF THE COMMUNITY'S HEALTH NEEDS; 3) ENHANCES RELATIONSHIPS AND MUTUAL UNDERSTANDING BETWEEN AND AMONG STAKEHOLDERS; 4) PROVIDES A BASIS UPON WHICH COMMUNITY STAKEHOLDERS CAN MAKE DECISIONS ABOUT HOW THEY CAN CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY; 5) PROVIDES RATIONALE FOR CURRENT AND POTENTIAL FUNDERS TO SUPPORT EFFORTS TO IMPROVE THE HEALTH OF THE COMMUNITY; 6) CREATES OPPORTUNITIES FOR COLLABORATION IN DELIVERY OF SERVICES TO THE COMMUNITY; AND 7) PROVIDES GUIDANCE TO THE HOSPITAL AND LOCAL HEALTH DEPARTMENT FOR HOW THEY CAN ALIGN THEIR SERVICES AND COMMUNITY BENEFIT PROGRAMS TO BEST MEET NEEDS.IN MAY 2020, PELLA REGIONAL BEGAN ITS THIRD COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. OVER THE SUMMER, A RANDOM, STRATIFIED SAMPLE OF 1,000 RESIDENTS WITHIN PELLA REGIONAL'S SERVICE AREA WAS SURVEYED, AND 420 SURVEYS WERE RETURNED PROVIDING A 28.3 PERCENT RESPONSE RATE. IN ADDITION, A FOCUS GROUP WITH 15 COMMUNITY LEADERS INCLUDING SENIOR CITIZENS, CONSUMERS, HEALTH CARE PROVIDERS/CLINICIANS, EDUCATORS, BUSINESS OWNERS, CLERGY, AND LAW ENFORCEMENT OFFERED QUALITATIVE INFORMATION TO SUPPLEMENT THE SURVEY.THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED COMMUNITY HEALTH STRENGTHS AND WEAKNESSES. OUR FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT AND HEALTH IMPLEMENTATION PLAN WAS POSTED TO OUR WEBSITE IN DECEMBER 2020. |
| PART VI, LINE 3: | PELLA REGIONAL HEALTH CENTER'S PATIENT ADVOCATES ARE AVAILABLE TO WORK WITH PATIENTS PRIOR TO NON-EMERGENCY SERVICES TO REVIEW SPECIFIC INSURANCE SITUATIONS AND THE DOCTOR'S RECOMMENDED SERVICE FOR THE PATIENT. THE ADVOCATE ESTIMATES EACH PATIENT'S ACTUAL COST AND WORKS WITH THEM TO FIND THE BEST METHOD OF PAYMENT, OR HELP DETERMINE ELIGIBILITY FOR CHARITY CARE FROM PELLA REGIONAL HEALTH CENTER OR THROUGH GOVERNMENT PROGRAMS. |
| PART VI, LINE 4: | PELLA REGIONAL HEALTH CENTER (PRHC) IS A CRITICAL ACCESS HOSPITAL THAT OFFERS A LARGE ARRAY OF BOTH INPATIENT AND OUTPATIENT SERVICES. PRHC HAS A RACIALLY HOMOGENOUS SERVICE AREA THAT COVERS MARION, MAHASKA, JASPER, AND WAPELLO COUNTIES IN IOWA. PELLA IS A THRIVING COMMUNITY APPROXIMATELY 40 MILES SOUTHEAST OF DES MOINES, IOWA AND IS HOME TO NOT ONLY PRHC BUT ALSO THE CORPORATE HEADQUARTERS FOR PELLA CORP, A LARGE MANUFACTURER OF WINDOWS AND DOORS, AND VERMEER CORPORATION, THE MANUFACTURER OF INDUSTRIAL AND AGRICULTURAL EQUIPMENT. BOTH COMPANIES ARE KNOWN WORLDWIDE. PELLA IS VERY FORTUNATE TO HAVE THIS TYPE OF INDUSTRIAL AND FINANCIAL BASE. THE POPULATION IN PELLA, IA FOR 2020 WAS 10,464. MEDIAN HOUSEHOLD INCOME IN 2019 WAS $68,963 AND THERE WERE 3.7% OF PEOPLE LIVING IN POVERTY. UNDER HEALTH, PERSONS WITH A DISABILITY, UNDER 65 YEARS WAS 8.4%, 2015-2019 AND PERSONS WITHOUT HEALTH INSURANCE UNDER AGE 65 YEARS WAS 2.7%. THIS INFORMATION WAS OBTAINED FROM HTTPS://WWW.CENSUS.GOV/QUICKFACTS/PELLACITYIOWA. |
| PART VI, LINE 5: | THE BOARD MEMBERS ALL RESIDE IN THE SERVICE AREA. A MAJORITY OF THE BOARD MEMBERS ARE NOT EMPLOYED BY PELLA AND NONE ARE FAMILY MEMBERS. PHYSICIANS ARE ENCOURAGED TO PARTICIPATE ON THE BOARD AS THEY HAVE DIRECT CONTACT WITH OUR PATIENTS AND KNOW FIRSTHAND THE NEEDS OF THE COMMUNITY. PELLA REGIONAL HEALTH CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY EXCEPT FOR PHYSICIANS WITH PENDING QUALITY ISSUES. THE ORGANIZATION APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH THROUGH THE NORMAL BUDGET AND CAPITAL BUDGET PROCESSES. ALSO, PELLA REGIONAL HEALTH CENTER PROMOTES THE HEALTH OF THE COMMUNITY BY OPERATING AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY, PARTICIPATING IN GOVERNMENT-SPONSORED HEALTH PROGRAMS AND VOLUNTEERING IN THE COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR CRAIG WITTENBERG | ||||||||||||||
| BOARD MEMBER | $624,757 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $31,987 | $0 | $673,844 | $0 | $0 | $0 |
| MATT MORGAN DO | ||||||||||||||
| PHYSICIAN | $611,341 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $30,059 | $0 | $658,500 | $0 | $0 | $0 |
| DR RICHARD POSTHUMA | ||||||||||||||
| BOARD MEMBER | $524,660 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $31,449 | $0 | $573,209 | $0 | $0 | $0 |
| SPENCER CARLSTONE MD | ||||||||||||||
| PHYSICIAN | $473,311 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $29,739 | $0 | $520,150 | $0 | $0 | $0 |
| S DOUG KANIS DO | ||||||||||||||
| PHYSICIAN | $472,538 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $29,522 | $0 | $519,160 | $0 | $0 | $0 |
| ANNE HELLBUSCH DO | ||||||||||||||
| PHYSICIAN | $469,933 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $27,329 | $0 | $514,362 | $0 | $0 | $0 |
| DANIEL ROWLEY MD | ||||||||||||||
| PHYSICIAN | $448,450 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $28,909 | $0 | $494,459 | $0 | $0 | $0 |
| STEPHEN BARNES DO | ||||||||||||||
| PHYSICIAN | $420,436 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $24,569 | $0 | $462,105 | $0 | $0 | $0 |
| ROBERT KROESE | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $322,477 | $0 | $0 | $0 | $0 | $0 | $17,100 | $0 | $23,832 | $0 | $363,409 | $0 | $0 | $0 |
| BRUCE HEIFNER | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $192,820 | $0 | $0 | $0 | $0 | $0 | $11,990 | $0 | $20,041 | $0 | $224,851 | $0 | $0 | $0 |
| DAWNETT WILLIS | ||||||||||||||
| CHIEF OF ANCILLARY SERVICE | $167,978 | $0 | $0 | $0 | $0 | $0 | $10,668 | $0 | $27,885 | $0 | $206,531 | $0 | $0 | $0 |
| LEZLIE MORRIS | ||||||||||||||
| CHIEF OF CLINIC SERVICES | $165,579 | $0 | $0 | $0 | $0 | $0 | $10,105 | $0 | $5,438 | $0 | $181,122 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2020 SPONSORED BY PELLA REGIONAL HEALTH CENTER (PRHC): ROBERT KROESE. ON DECEMBER 31, 2020, THE ACCOUNT BALANCE WAS $180,406, WHERE $40,000 REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY PRHC ON BEHALF OF THE INDIVIDUAL TO THE PLAN. | 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 | HEALTH FACILITIES REVENUE REFUNDING BOND | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 521699886 | BondIssuerEIN |
| CUSIP | NONEAVAIL | CUSIPNum |
| Bond Issued | 2017-06-08 | BondIssuedDt |
| Issue Price | $41,734,118 | IssuePriceAmt |
| Purpose | REFUND BONDS ISSUED 09/28/06 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | Yes (1) | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $41,734,118 | TotalProceedsAmt |
| Refunding Escrow | $3,836,530 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $703,275 | IssuanceCostsFromProceedsAmt |
| Working Capital Expenditures | $44,867,373 | WorkingCapitalExpendituresAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | 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 | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | Yes (1) | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PCBB | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 15.000000000000 | TermOfHedgePct |
| Superintegrated Hedge | 0 | SuperintegratedHedgeInd |
| Hedge Terminated | 0 | HedgeTerminatedInd |
| 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 | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: HEALTH FACILITIES REVENUE REFUNDING BOND DATE THE REBATE COMPUTATION WAS PERFORMED: 10/03/2017 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT, VICE PRESIDENT, SECRETARY, AND TREASURER. THE COMMITTEE ACTS FOR THE BOARD OF TRUSTEES AND DIRECTS AND CONTROLS THE AFFAIRS OF THE CORPORATION DURING THE INTERIM BETWEEN BOARD MEETINGS BUT IS SUBJECT TO THE SUPERVISION OF THE BOARD AND PROVIDED ANY ACTION TAKEN DOES NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD. THE EXECUTIVE COMMITTEE KEEPS AN ACCURATE AND COMPLETE RECORD OF ALL OF ITS PROCEEDINGS AND THE RECORD MUST BE SUBMITTED FOR CONFIRMATION TO THE BOARD OF TRUSTEES AT THE BOARD'S NEXT MEETING AND MADE A PART OF THE MINUTES. THE EXECUTIVE COMMITTEE HAS THE RIGHT TO APPROVE OR REJECT THE CEO'S RECOMMENDATIONS ON EMPLOYMENT OF PERSONNEL, PLAN OF INTERNAL ORGANIZATION OF THE CORPORATION, AND RULES AND REGULATIONS DEFINING DUTIES, HOURS AND INTERDEPARTMENTAL RELATIONSHIPS OF PERSONNEL. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS DISTRIBUTED TO THE BOARD'S FINANCE COMMITTEE AND PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. IT IS ALSO REVIEWED BY THE CEO AND CFO. |
| FORM 990, PART VI, SECTION B, LINE 12C | PELLA REGIONAL HEALTH CENTER HAS CONFLICT OF INTEREST POLICIES COMPLETED EACH YEAR BY ALL BOARD MEMBERS AND OFFICERS THUS MONITORING ANY POTENTIAL CONFLICTS OF INTEREST. THE CEO AND CFO REVIEW THE COMPLETED STATEMENTS. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE CEO FOLLOWS UP. ANY ACTUAL OR POTENTIAL DUALITY OR CONFLICT OF INTEREST, INCLUDING BUT NOT LIMITED TO, OWNERSHIP OR CONTROL OF ANY ENTITY THAT CONTRACTS WITH PELLA REGIONAL HEALTH CENTER FOR ANY PRODUCTS OR SERVICES MUST BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD IN THE MINUTES WHEN THE SUBJECT OF SUCH INTEREST BECOMES A MATTER OF BOARD ACTION. WHEN CONFLICT ARISES, THE MEMBER IS ASKED TO BE EXCUSED FROM THE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CEO'S COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY ADJUSTMENT RECOMMENDATIONS BASED ON AN ANNUAL EVALUATION AND INPUT FROM HUMAN RESOURCES. THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS SET BY THE CEO WITH SALARY ADJUSTMENTS BASED ON ANNUAL EVALUATIONS AND DIRECTION FROM HUMAN RESOURCES. COMPARABILITY DATA IS USED TO DETERMINE COMPENSATION FOR TOP MANAGEMENT OFFICIALS, OFFICERS, AND EMPLOYEES IN NON-MANAGEMENT POSITIONS. SEVERAL SURVEYS ARE USED FOR COMPARABILITY INCLUDING THE IOWA HOSPITAL ASSOCIATION, IOWA HEALTH SYSTEM, IOWA INTEGRATED HEALTHCARE STRATEGIES, COMPDATA SURVEYS, IOWA ASSOCIATION OF HOMES AND SERVICES FOR THE AGING, IOWA MEDICAL GROUP MANAGEMENT ASSOCIATION, AND SOUTHEAST IOWA COMP CLUB. THE ORGANIZATION DOCUMENTS AND PROVIDES SUBSTANTIATION FOR ITS COMPENSATION PROCESS FOR ALL EMPLOYEES. THIS PROCESS WAS LAST UNDERTAKEN IN 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AS THEY ARE ATTACHED TO THE FORM 990. |
| FORM 990, PART VII, SECTION A: | THE PHYSICIANS/DIRECTORS ARE COMPENSATED FOR THEIR SERVICES AS PHYSICIANS. THEIR TIME SERVED AS BOARD MEMBERS IS ON A VOLUNTEER BASIS AND NO COMPENSATION IS RECEIVED FOR THOSE SERVICES. |
| FORM 990, PART XII, LINE 2C: | THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM PRIOR TAX YEARS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1Txt |
| City | PELLA | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421430122 | EIN |
| Primary Activities | SOLICIT FUNDS AND SUPPORT PELLA REGIONAL HEALTH CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |