STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

PALMER LUTHERAN HEALTH CENTER INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
PALMER LUTHERAN HEALTH CENTER INC (EIN 42-1320763)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-30
IRS object ID
202143349349300839
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-30T13:47:51-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1155 N Wacker DriveAddressLine1Txt
CityChicagoCityNm
State AbbreviationILStateAbbreviationCd
ZIP60606ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN421320763EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PALMER LUTHERAN HEALTH CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% BRENDA MOSERInCareOfNm
Business Name ControlPALMBusinessNameControlTxt
Phone5634223811PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1112 JEFFERSON STAddressLine1Txt
CityWEST UNIONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52175ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBRENDA MOSERPersonNm
Person TitleCFOPersonTitleTxt
Phone5634223811PhoneNum
Signature2021-11-30SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstBRENDAPersonFirstNm
Person LastMOSERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJESS WAGENERPreparerPersonNm
PTINP01622613PTIN
Phone3128792000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1SEE SCHEDULE OBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerBRENDA MOSERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1112 JEFFERSON STAddressLine1Txt
CityWEST UNIONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52175ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$31,462,844GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.GUNDERSENHEALTH.ORG/PALMER/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1949FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionSEE SCHEDULE OActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee239TotalEmployeeCnt
Total Volunteers3TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$28,253PYContributionsGrantsAmt
CY Contributions Grants$686,691CYContributionsGrantsAmt
PY Program Service Revenue$30,904,782PYProgramServiceRevenueAmt
CY Program Service Revenue$30,673,211CYProgramServiceRevenueAmt
PY Investment Income$10,303PYInvestmentIncomeAmt
CY Investment Income$20,807CYInvestmentIncomeAmt
PY Other Revenue$168,986PYOtherRevenueAmt
CY Other Revenue$82,135CYOtherRevenueAmt
PY Total Revenue$31,112,324PYTotalRevenueAmt
CY Total Revenue$31,462,844CYTotalRevenueAmt
PY Grants And Similar Paid$20,039PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$8,850CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,318,259PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,310,249CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$17,519,877PYOtherExpensesAmt
CY Other Expenses$17,329,664CYOtherExpensesAmt
PY Total Expenses$29,858,175PYTotalExpensesAmt
CY Total Expenses$29,648,763CYTotalExpensesAmt
PY Revenues Less Expenses$1,254,149PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,814,081CYRevenuesLessExpensesAmt
Total Assets BOY$20,024,623TotalAssetsBOYAmt
Total Assets EOY$33,192,593TotalAssetsEOYAmt
Total Liabilities BOY$12,514,510TotalLiabilitiesBOYAmt
Total Liabilities EOY$23,805,643TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,510,113NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$9,386,950NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES, WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$25,639,468ExpenseAmt
Grant$8,850GrantAmt
Revenue$30,721,303RevenueAmt
DescPALMER LUTHERAN HEALTH CENTER IS A 25-LICENSED BED CRITICAL ACCESS HOSPITAL. THE ONLY HOSPITAL IN WEST UNION, IOWA AND EMPLOYS ABOUT 240 EMPLOYEES. PALMER LUTHERAN HEALTH CENTER ALSO HAS THREE RURAL HEALTH CLINICS IN THE COMMUNITIES OF WEST UNION, FAYETTE AND POSTVILLE, A HOME CARE DEPARTMENT, HOSPICE DEPARTMENT, AND HOME MEDICAL EQUIPMENT DEPARTMENT. IN ADDITION, PALMER OPERATES AN AFTERHOURS AND WEEKEND WALK-IN CLINIC, ALLOWING PATIENTS TO BE SEEN 7 DAYS A WEEK IN THIS SETTING. THIS IS OFFERED TO SPECIFICALLY MEET COMMUNITY HEALTH NEEDS OF WORKING FAMILIES. ANNUALLY, PALMER HAS OVER 380 ADMISSIONS, ABOUT 100 LIVE BIRTHS; OVER 2,800 EMERGENCY CENTER VISITS, ABOUT 29,000 PATIENT VISITS IN THE CLINICS AND PERFORMS OVER 430 SURGERIES (INCLUDING AMBULATORY). ACCOMPLISHMENTS: WHEN RENOVATED, THE HOSPITAL WAS DESIGNED TO ACHIEVE THREE GOALS - CREATE A HEALING ENVIRONMENT THAT WELCOMES AND SUPPORTS PATIENTS/FAMILIES, DESIGN WORK AREAS TO BETTER ACCOMMODATE CURRENT AND FUTURE TECHNOLOGIES, SYSTEMS AND APPROACHES TO CARE, AND TO COMPLY MORE FULLY WITH HIPPA REGULATIONS. PALMER LUTHERAN HEALTH CENTER LEADS DELIVERY OF HEALTHCARE TO ITS REGION THROUGH OVER 215 ASSOCIATES (INCLUDING 4 PHYSICIANS, 5 PHYSICIANS ASSISTANTS, 4 NURSE PRACTITIONER AND 1 CERTIFIED NURSE MIDWIFE ON STAFF) WHICH COORDINATE CARE TO DELIVER PATIENT CARE AS AN INTEGRATED UNIT. PALMER LUTHERAN HEALTH CENTER AND ITS AFFILIATES ALSO WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARDS FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO PALMER LUTHERAN HEALTH CENTER'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLY, PALMER LUTHERAN HEALTH CENTER IS GOVERNED BY A BOARD THAT INCLUDES 3 INDEPENDENT BOARD MEMBERS WHO ARE COMMUNITY LEADERS, CONSUMER REPRESENTATIVES, BUSINESS EXPERTS, AND CLINICAL HEALTHCARE EXPERTS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST OF INTEGRITY FOR THE BENEFIT OF THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER ALSO MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. PALMER OPERATES A FULL-TIME EMERGENCY ROOM AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. PALMER PROVIDES CLINICAL SERVICES NEEDED TO OPERATE THE EMERGENCY CENTER AND PROVIDES ON-SITE EMERGENCY MEDICAL, RESCUE AND MEDICAL TRANSPORTATION SERVICES. IN ADDITION, PALMER LUTHERAN HEALTH CENTER, THROUGH ITS INTEGRATED NETWORK OF PROVIDERS, PROVIDES NON-EMERGENCY SERVICES TO THE COMMUNITY IT SERVES. IT MAKES THESE SERVICES ACCESSIBLE TO THE COMMUNITY THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS LIKE MEDICARE AND MEDICAID AND BY OFFERING ASSISTANCE THROUGH PALMER'S CHARITY CARE POLICY, AND SOCIAL SERVICES DEPARTMENT. PALMER LUTHERAN HEALTH CENTER UTILIZES TECHNOLOGY THAT PROVIDES A COMPLETE ELECTRONIC MEDICAL RECORD. OUR ELECTRONIC HEALTH RECORD IS CONNECTED TO GUNDERSEN HEALTH SYSTEM, WHICH ALLOWS US TO SHARE TEST RESULTS AND OTHER PATIENT INFORMATION. THIS ENHANCES THE PATIENT CARE AT OUR FACILITY, AS WELL AS OTHER GUNDERSEN ENTITIES THROUGHOUT THE REGION. THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNTS OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE HEALTH CENTER'S CHARITY CARE POLICY WERE $885,585 FOR THE YEAR ENDED DECEMBER 31, 2020. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION WERE $542,082. THE HEALTH CENTER ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. PALMER LUTHERAN HEALTH CENTER TAKES ITS MISSION TO IMPROVE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVICES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE COMMUNITY. IT STRIVES TO IDENTIFY COMMUNITY NEEDS BEYOND BASIC HEALTHCARE, THEN RESPOND TO THEM, AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE COMMUNITY. PALMER LUTHERAN HEALTH CENTER TAKES A STRATEGIC, COMMUNITY NEEDS BASED APPROACH TO DELIVERING BENEFITS TO THE COMMUNITY.Desc
Total Program Service Expenses$25,639,468TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document51IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee239EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBRENDA MOSERPersonNm
Phone5634223811PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1112 JEFFERSON STAddressLine1Txt
CityWEST UNIONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52175ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
DR MORDECHAI LEDERMAN
SECRETARY0.540.0Yes (X)Yes (X)$0$316,143$67,797
LISA WIED
DIRECTOR0.539.5Yes (X)$0$231,342$57,825
KEN BEACH
CRNA40.00.0$198,443$0$32,479Yes (X)
PATRICE KUENNEN
CEO40.00.0Yes (X)$0$151,477$46,556
SARA CARPENTER
DIRECTOR AS OF JAN 20200.539.5Yes (X)$0$132,141$46,169
CHUCK JOHNSON
DIRECTOR AS OF JAN 20200.539.5Yes (X)$0$114,186$45,630
BRENDA MOSER
Finance Administrator32.08.0Yes (X)$0$114,907$40,220
SARA SNITKER
PHARMACIST40.00.0$118,505$0$34,173Yes (X)
HEATHER SANDS
DIRECTOR OF IP SERVICES40.00.0$104,716$0$40,827Yes (X)
DEBBIE BRINK
RN40.00.0$101,071$0$15,735Yes (X)
LYNN LAUER
CHAIR0.50.0Yes (X)Yes (X)$0$0$0
ANDREW WENTHE
DIRECTOR AS OF JUL 20200.50.0Yes (X)$0$0$0
KRISTI FLACK
VICE CHAIR0.50.0Yes (X)Yes (X)$0$0$0
KARLA GAVIN
DIRECTOR UNTIL JUN 20200.50.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$522,735TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,060,196TotReportableCompRltdOrgAmt
Total Other Compensation$427,411TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
IOWA EMERGENCY PHYSICIANS
PO BOX 677979DALLASTX752677979ER & HOSP PROVIDERS$1,829,479
PSYCHIATRIC MEDICAL CARE LLC
PO BOX 734606DALLASTX753734606CONTRACTED PSYCH SVC$425,368
PERFORMANCE REHAB
204 E CHARLES STOELWEINIA506621940CONTRACTED THERAPY$134,381
PHARMACY SUPPORT SERVICES
3708 NW BEECHWOOD STANKENYIA50023CONTRACTED PHARMACY$102,942
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Related Organizations$22,757RelatedOrganizationsAmt
Government Grants$602,538GovernmentGrantsAmt
All Other Contributions$61,396AllOtherContributionsAmt
Total Contributions$686,691TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
PATIENT SERVICE REVENUE621110$23,279,276$23,279,276$0$0
PHARMACY REVENUE621110$7,161,586$7,161,586$0$0
ALL OTHER PROGRAM SERVICE REVENUE621110$77,376$77,376$0$0
COMMUNITY HEALTH621110$61,947$61,947$0$0
ALL OTHER PROGRAM SERVICE REVENUE900099$93,026$46,821$0$46,205
FieldValueIRS element (for citing)
Total Program Service Revenue$30,673,211TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,807TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$20,807ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$34,043RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$34,043RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,043TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$34,043ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescALL OTHER REVENUEDesc
Business900099BusinessCd
Total Revenue Column$48,092TotalRevenueColumnAmt
Related Or Exempt Func Income$48,092RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$48,092OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,462,844TotalRevenueColumnAmt
Related Or Exempt Func Income$30,675,098RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$101,055ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$2,850TotalAmt
Program Services$2,850ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$6,000TotalAmt
Program Services$6,000ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,773,417TotalAmt
Program Services$8,242,629ProgramServicesAmt
Management And General$1,530,788ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$419,629TotalAmt
Program Services$349,277ProgramServicesAmt
Management And General$70,352ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,442,535TotalAmt
Program Services$1,161,160ProgramServicesAmt
Management And General$281,375ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$674,668TotalAmt
Program Services$576,414ProgramServicesAmt
Management And General$98,254ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$66,912TotalAmt
Program Services$0ProgramServicesAmt
Management And General$66,912ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$54,090TotalAmt
Program Services$0ProgramServicesAmt
Management And General$54,090ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$4,013TotalAmt
Management And General$4,013ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$9,455,812TotalAmt
Program Services$9,105,243ProgramServicesAmt
Management And General$350,569ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$62,515TotalAmt
Program Services$1,158ProgramServicesAmt
Management And General$61,357ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$264,978TotalAmt
Program Services$143,061ProgramServicesAmt
Management And General$121,917ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$723,001TotalAmt
Program Services$6,028ProgramServicesAmt
Management And General$716,973ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$911,570TotalAmt
Program Services$878,047ProgramServicesAmt
Management And General$33,523ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$143,324TotalAmt
Program Services$138,666ProgramServicesAmt
Management And General$4,658ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$43,028TotalAmt
Program Services$17,200ProgramServicesAmt
Management And General$25,828ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$241,582TotalAmt
Program Services$177,563ProgramServicesAmt
Management And General$64,019ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$894,646TotalAmt
Program Services$651,751ProgramServicesAmt
Management And General$242,895ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$49,353TotalAmt
Program Services$500ProgramServicesAmt
Management And General$48,853ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
DRUGS$2,121,260$2,116,276$4,984$0
MEDICAL EQUIPMENT$521,475$507,813$13,662$0
PROVISION FOR BAD DEBT$318,120$318,120$0$0
DIETARY$96,093$95,839$254$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,357,892TotalAmt
Program Services$1,143,873ProgramServicesAmt
Management And General$214,019ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$29,648,763TotalAmt
Program Services$25,639,468ProgramServicesAmt
Management And General$4,009,295ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,934BOYAmt
EOY$1,934EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,115,227BOYAmt
EOY$20,721,740EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,375,814BOYAmt
EOY$3,989,028EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$992,214BOYAmt
EOY$823,292EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$111,411BOYAmt
EOY$131,553EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$14,626,519LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,913,218LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,355,142BOYAmt
EOY$6,713,301EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,072,881BOYAmt
EOY$811,745EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$20,024,623BOYAmt
EOY$33,192,593EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,709,238BOYAmt
EOY$8,427,984EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$8,801,051EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,345,760BOYAmt
EOY$5,721,332EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,459,512BOYAmt
EOY$855,276EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,514,510BOYAmt
EOY$23,805,643EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,031,403BOYAmt
EOY$8,845,467EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$478,710BOYAmt
EOY$541,483EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,510,113BOYAmt
EOY$9,386,950EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,024,623BOYAmt
EOY$33,192,593EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,814,081ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$62,756OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$4,013OtherActivitiesAmt
Total Lobbying Expenditures$4,013TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1, LOBBYING ACTIVITIESFormAndLineReferenceDesc
ExplanationPALMER LUTHERAN HEALTH CENTER PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND TO THE IOWA HOSPITAL ASSOCIATION (IHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THESE ORGANIZATIONS HAVE NOTIFIED PALMER LUTHERAN HEALTH CENTER THAT $4,013 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$168,281OtherCostOrOtherBasisAmt
Book Value$168,281BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,775,409OtherCostOrOtherBasisAmt
Depreciation$2,086,668DepreciationAmt
Book Value$5,688,741BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,682,829OtherCostOrOtherBasisAmt
Depreciation$5,826,550DepreciationAmt
Book Value$856,279BookValueAmt
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$6,713,301TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, SCHEDULE D, PART X LINE 2INCOME TAX MATTERS (IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC, WHICH IS A FOR-PROFIT ENTITY. AT DECEMBER 31, 2020 AND 2019, NET DEFERRED TAX ASSETS OF $7,948 AND $6,900, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,948 AND $6,900, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT DECEMBER 31, 2020, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $29,800, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $27,900, WHICH WILL EXPIRE BETWEEN 2029 AND 2038. THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2015 AND PRIOR YEARS.
FORM 990, SCHEDULE D, PART XI, LINE 4BOTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS - $318,120
FORM 990, SCHEDULE D, PART XII, LINE 4BOTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS - $318,120

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$542,082TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$542,082NetCommunityBenefitExpnsAmt
Total Expense0.01850TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,682,768TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,597,345DirectOffsettingRevenueAmt
Net Community Benefit Expns$85,423NetCommunityBenefitExpnsAmt
Total Expense0.00290TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,224,850TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,597,345DirectOffsettingRevenueAmt
Net Community Benefit Expns$627,505NetCommunityBenefitExpnsAmt
Total Expense0.02140TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,987TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$19,987NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,492,015TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,669,007DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,529TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,529NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,513,531TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,669,007DirectOffsettingRevenueAmt
Net Community Benefit Expns$21,516NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$8,738,381TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$9,266,352DirectOffsettingRevenueAmt
Net Community Benefit Expns$649,021NetCommunityBenefitExpnsAmt
Total Expense0.02220TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,918TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,918NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,918TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,918NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$194,721BadDebtExpenseAmt
Bad Debt Expense Attributable$97,361BadDebtExpenseAttributableAmt
Reimbursed By Medicare$9,710,868ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,700,698CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$10,170MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PALMER LUTHERAN HEALTH CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1112 JEFFERSON STREETAddressLine1Txt
CityWEST UNIONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52175ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.GUNDERSENHEALTH.ORG/PALMERWebsiteAddressTxt
State License330070HStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherRURAL HEALTH CLINICOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PALMER LUTHERAN HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE SUPPLEMENTAL INFOOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE SUPPLEMENTAL INFOStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART VFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART VFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART VFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5TOGETHER, GUNDERSEN PALMER, MERCY HOSPITAL AND FAYETTE COUNTY PUBLIC HEALTH DEVELOPED A SURVEY, WHICH WAS MADE AVAILABLE TO THE PUBLIC ON-LINE AND IN PAPER FORM. THE PUBLIC WAS INVITED THROUGH MASS EMAILING INVITATIONS, ADVERTISING, AND PUBLICITY, ON BEHALF OF THE PARTNERS, COMMUNITY CHAMBER, ORGANIZATIONS, ETC., TO TAKE THE SURVEY JULY-OCTOBER, 2019. PAPER SURVEYS WERE DISTRIBUTED AND MADE AVAILABLE AT GUNDERSEN PALMER, THE URGENT CARE CLINIC, THE EMERGENCY ROOM AND WITHIN WEST UNION, POSTVILLE (SPANISH AND SOMALIAN VERSIONS AVAILABLE) AND FAYETTE CLINICS. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, ETC. A TOTAL OF 201 ELECTRONIC AND PAPER SURVEYS WERE COLLECTED, WITH PAPER RESPONSES BEING ENTERED INTO THE ELECTRONIC SURVEY DATABASE. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY. SCHEDULE H, PART V, SECTION B, LINE 7A https://www.gundersenhealth.org/community-assessment/ SCHEDULE H, PART V, SECTION B, LINE 10A https://www.gundersenhealth.org/community-assessment/
SCHEDULE H, PART V, SECTION B, LINE 11PALMER LUTHERAN HEALTH CENTER HAS A NUMBER OF INITIATIVES IN PLACE TO HELP ADDRESS THE TOP THREE PRIORITIES SELECTED IN THE CHNA. THE HOSPITAL WORKS WITH A VARIETY OF COMMUNITY PARTNERS TO DEVELOP, IMPLEMENT AND SUSTAIN THESE PROGRAMS AND ACTIVITIES. A LIST OF THE CURRENT ACTIONS AND GOALS FOR EACH OF THE TOP THREE PRIORITIES IS INCLUDED IN THE IMPLEMENTATION PLAN POSTED ON THE HOSPITAL'S WEBSITE. AS WITH ALL HEALTH CARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES PALMER LUTHERAN HEALTH CENTER SERVES. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED; HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, THE HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION.
SCHEDULE H, PART V, SECTION B, LINE 13HTHE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY.
SCHEDULE H, PART V, SECTION B, LINE 15EALL SELF-PAY PATIENTS ARE GIVEN INFORMATION ON THE HOSPITAL'S CHARITY CARE POLICY AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY.
SCHEDULE H, PART V, SECTION B, LINE 16AFAP WEBSITE: WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16BFAP APPLICATION WEBSITE: WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16CFAP PLAIN LANGUAGE SUMMARY WEBSITE: WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16JOUR SELF-PAY COLLECTION AGENCY UTILIZES INFORMATION TO IDENTIFY ACCOUNTS THAT SHOULD QUALIFY FOR THE FAP. WE WRITE THESE ACCOUNTS OFF WITHOUT REQUIRING ANY PAPERWORK OR APPLICATION.
FieldValueIRS element (for citing)
Facility10FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
GUNDERSEN PALMER - WEST UNION CLINIC
112 JEFFERSON STREETWEST UNIONIA52175RURAL HEALTH CLINIC
GUNDERSEN PALMER - FAYETTE CLINIC
110 KING STREETFAYETTEIA52142RURAL HEALTH CLINIC
GUNDERSEN PALMER - POSTVILLE CLINIC
111 SOUTH REYNOLDS STREETPOSTVILLEIA52162RURAL HEALTH CLINIC
GUNDERSEN PALMER HOME HEALTH
200 JEFFERSON STREETWEST UNIONIA52175HOME HEALTH
GUNDERSEN PALMER HOME HEALTH - OELWEIN
230 2ND AVE SEOELWEINIA50662HOME HEALTH
GUNDERSEN PALMER MEDICAL SUPPLY -W UNION
200 JEFFERSON STREETWEST UNIONIA52175MEDICAL SUPPLY AND EQUIPMENT
GUNDERSEN PALMER MEDICAL SUPPLY -OELWEIN
230 2ND AVE SEOELWEINIA50662MEDICAL SUPPLY AND EQUIPMENT
GUNDERSEN PALMER HOSPICE - OELWEIN
230 2ND AVE SEOELWEINIA50662HOSPICE SERVICES
GUNDERSEN PALMER COMMUNITY HEALTH
200 JEFFERSON STREETWEST UNIONIA52175PUBLIC HEALTH SERVICES
GUNDERSEN PALMER HOSPICE - WEST UNION
200 JEFFERSON STREETWEST UNIONIA52175HOSPICE SERVICES

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
SCHEDULE H, PART I, LINE 7GSUBSIDIZED HEALTH SERVICES AT PALMER LUTHERAN HEALTH CENTER INCLUDE THE OPERATION OF THE EMERGENCY ROOM AS WELL AS THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE EMERGENCY ROOM OPERATES 24-HOURS PER DAY SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED STAFF. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE SURROUNDING AREA. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF THE HOSPITAL AND SHARE MANY OF THE SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON A COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF PALMER LUTHERAN HEALTH CENTER TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATE TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR FORM 990 PURPOSES. SCHEDULE H, PART I, LINE 7, COLUMN F AMOUNT OF BAD DEBT EXCLUDED FROM TOTAL EXPENSE $318,120
SCHEDULE H, PART II, COMMUNITY BUILDING ACTIVITIESCOMMUNITY HEALTH IMPROVEMENT ADVOCACY PROMOTES THE HEALTH OF THE COMMUNITY BY ADDRESSING THE NEEDS OF THE COMMUNITY, SUCH AS JOBS, CLEAN WATER/SEWER, INDUSTRY ATTRACTION, ADDRESSING THE NEEDS OF THE SCHOOL AND COUNTY, AND INSURING WE OFFER THE SERVICES THAT ARE IMPORTANT TO THE COMMUNITY. WE ALSO PROVIDE EDUCATION FOR SCHOOL AGE CHILDREN HOPING TO REACH THOSE THAT DON'T HAVE ACCESS TO HEALTH INFORMATION.
SCHEDULE H, PART III, LINE 2THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
SCHEDULE H, PART III, LINE 3MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE.
SCHEDULE H, PART III, LINE 4ACCOUNTS RECEIVABLE AND CREDIT POLICY: PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. THE ORGANIZATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
SCHEDULE H, PART III, LINE 8PALMER LUTHERAN HEALTH CENTER IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS URGENT CARE OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT PALMER LUTHERAN HEALTH CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
SCHEDULE H, PART III, LINE 9BBEFORE BILLS ARE SENT TO COLLECTION, PALMER LUTHERAN HEALTH CENTER UTILIZES A "FAST TAX" PROGRAM TO SEE WHAT PATIENT ACCOUNTS ARE "PRESUMPTIVE CHARITY." ANY PATIENT THAT QUALIFIES FOR PRESUMPTIVE CHARITY IS ABLE TO RECEIVE A WRITE-OFF WITHOUT HAVING TO FILE ANY PAPERWORK. ONCE AN ACCOUNT IS IDENTIFIED, ALL COLLECTION PROCEEDINGS STOP, AND THE APPROPRIATE CHARITY PERCENTAGE IS APPLIED. ALSO, COLLECTION EFFORTS CEASE ON ACCOUNTS THAT ARE SENT TO COLLECTIONS AND LATER FOUND TO BE ELIGIBLE FOR ASSISTANCE. ONLY THEIR PERSONAL PORTION DUE WOULD FOLLOW NORMAL COLLECTION PROCEDURES.
SCHEDULE H, PART VI, LINE 2TOGETHER, GUNDERSEN PALMER, MERCY HOSPITAL AND FAYETTE COUNTY PUBLIC HEALTH DEVELOPED A SURVEY, WHICH WAS MADE AVAILABLE TO THE PUBLIC ON-LINE AND IN PAPER FORM. THE PUBLIC WAS INVITED THROUGH PERSONAL INVITATION, MASS EMAILING INVITATIONS, ADVERTISING, AND PUBLICITY, ON BEHALF OF THE PARTNERS, COMMUNITY CHAMBER, ORGANIZATIONS, ETC., TO TAKE THE SURVEY JULY-OCTOBER 2019. PAPER SURVEYS WERE DISTRIBUTED AND MADE AVAILABLE AT GUNDERSEN PALMER, LOCAL HEALTH FAIRS, VARIOUS ORGANIZATIONAL MEETINGS, WALK-IN CLINIC AND WITHIN WEST UNION, POSTVILLE (SPANISH AND SOMALIAN VERSIONS AVAILABLE) AND FAYETTE CLINICS. INFORMATION ON HOW TO ACCESS THE ON-LINE SURVEY WAS PROMOTED AND EMAILED TO INTERNAL AND EXTERNAL AUDIENCES, CHAMBER MEMBERS, PERSONAL CONTACTS, ETC. ATTEMPTS WERE MADE TO ENSURE A CROSS-SECTION OF RESIDENTS COMPLETED THE SURVEY. AS A CRITICAL ACCESS HOSPITAL, WE HAVE AN ADVISORY BOARD THAT INCLUDES A MEMBER OF THE COMMUNITY. THIS GROUP REVIEWS ALL SERVICES OF THE CAH TO ASSURE SERVICES OFFERED ARE EFFECTIVE AND EFFICIENT AND MEET THE COMMUNITY'S NEEDS. OUR CAH HAS BEEN DESIGNATED AS BEING IN A HPSA REGION. WE ALSO HAVE A PATIENT SATISFACTION COMMITTEE THAT MEETS QUARTERLY. THIS COMMITTEE INCLUDES REPRESENTATIVES FROM ALL OF THE COMMUNITIES IN OUR COUNTY, AND PROVIDES FEEDBACK REGARDING SERVICES, HEALTH CARE CONCERNS, ETC.
SCHEDULE H, PART VI, LINE 3THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM AREA. PALMER LUTHERAN HEALTH CENTER DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. ALL SELF-PAY PATIENTS ARE REFERRED TO SOCIAL SERVICES FOR INFORMATION ON ABOVE PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY, AS PART OF THE DISCHARGE PROCESS. IN ADDITION, PATIENTS IDENTIFIED BY OUR OUTSOURCED COLLECTORS AS BEING POTENTIALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. ALL PATIENT STATEMENTS REFERENCE THE AVAILABILITY OF FINANCIAL ASSISTANCE.
SCHEDULE H, PART VI, LINE 4PALMER LUTHERAN HEALTH CENTER IS A 25-BED ACUTE CARE HEALTH CENTER SERVING A RURAL POPULATION OF 2,490 PER THE 2020 U.S. CENSUS. AS THE ONLY HOSPITAL IN WEST UNION, IOWA, IT ALSO SERVES A 30 TO 40-MILE RADIUS AROUND WEST UNION. THE CLOSEST HOSPITAL IS MERCY ONE OELWEIN MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL, LOCATED ABOUT 19 MILES FROM WEST UNION. IN ADDITION, OUR HOMECARE DEPARTMENT SERVES A POPULATION IN A 50-MILE RADIUS. WE ARE A MEDICARE DEPENDENT HOSPITAL AND HAVE A LARGE MEDICAID POPULATION AS WELL. THE MOST COMMON INDUSTRIES IN WEST UNION ARE MANUFACTURING AND CONSTRUCTION. 15.9% OF RESIDENTS IN WEST UNION HAD INCOME BELOW THE POVERTY LEVEL IN 2020. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2020 WAS $48,250 WHICH IS DOWN COMPARED TO THE STATE OF IOWA MEDIAN OF $68,469. UNEMPLOYMENT WAS 5.6% IN 2020 COMPARED TO THE NATIONAL AVERAGE OF 6.7%.
SCHEDULE H, PART VI, LINE 53 OF THE 7 MEMBERS OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE ORGANIZATION APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE BY PURCHASING UP-TO-DATE EQUIPMENT, AND A STATE OF THE ART FACILITY. MORE COMMUNITY OUTREACH, AWARENESS AND EDUCATION" IS ONE OF OUR STRATEGIC OBJECTIVES. TO MEET THAT OBJECTIVE, WE HAVE AN ONGOING PROCESS IN PLACE TO MONITOR OUR THREATS AND OUR OPPORTUNITIES IN OUR SERVICE AREA. WE UTILIZE THE IOWA HOSPITAL ASSOCIATION DIMENSIONS SOFTWARE TO DETERMINE THE ORIGIN AND DESTINATION OF OUR PATIENT POPULATION. OUR STRATEGIC PLANNING TEAM INCLUDES OUR GOVERNING BOARD AND SENIOR MANAGEMENT WHO HAVE AN EXTENSIVE KNOWLEDGE BASE OF THE ORGANIZATION. THE SENIOR MANAGEMENT TEAM INCLUDES REPRESENTATION FROM FINANCE, NURSING, HR, MARKETING, FAMILY PRACTICE PROVIDERS AND DIRECTORS OF HOSPITAL OUTPATIENT SERVICES. THE GOVERNING BOARD HAS AN ACTIVE ROLE IN THIS PROCESS AS WELL. THEY HAVE THE BENEFIT OF BEING OUT IN THE COMMUNITY AND GAINING A UNIQUE INSIGHT AND THE PULSE OF THE COMMUNITY. IN ADDITION, WE ARE A CLINICAL SITE FOR STUDENTS OF PHARMACY, NURSING, HIM, PA, AND MEDICAL STUDENTS.
SCHEDULE H, PART VI, LINE 6PALMER LUTHERAN HEALTH CENTER IS AN AFFILIATE HOSPITAL OF THE GUNDERSEN HEALTH SYSTEM IN LACROSSE, WISCONSIN. GUNDERSEN HEALTH SYSTEM PROVIDES THE PRIMARY CARE PROVIDERS WHO SEE PATIENTS IN OUR THREE CLINICS. THEY ALSO PROVIDE A NUMBER OF SPECIALISTS WHO TRAVEL TO THE CLINICS IN OUR SERVICE AREA AND UTILIZE TELEMEDICINE OPPORTUNITIES TO MEET THE NEEDS OF THE POPULATION. PATIENTS ARE TRANSFERRED TO THE TERTIARY LEVEL OF CARE AS INDICATED. GUNDERSEN HEALTH SYSTEM IS INVOLVED IN OUR COMMUNITY, BEING A COMMUNITY PARTNER TO FURTHER HEALTH CARE INITIATIVES.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient2RecipientCnt
Cash Grant$6,000CashGrantAmt
Valuation Method UsedFMVValuationMethodUsedDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART I LINE 2FormAndLineReferenceDesc
ExplanationDescription of Organization's Procedures for Monitoring the Use of Grants In order to receive the grant funds, the grantee must have already met the required criteria outlined in the grant application.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
SARA CARPENTER
DIRECTOR AS OF JAN 2020$0$131,276$0$0$0$865$0$19,954$0$26,215$0$178,310$0$0
DR MORDECHAI LEDERMAN
SECRETARY$0$311,703$0$0$0$4,440$0$41,325$0$26,472$0$383,940$0$0
CHUCK JOHNSON
DIRECTOR AS OF JAN 2020$0$107,642$0$0$0$6,544$0$17,833$0$27,797$0$159,816$0$0
LISA WIED
DIRECTOR$0$227,493$0$500$0$3,349$0$33,126$0$24,699$0$289,167$0$0
BRENDA MOSER
Finance Administrator$0$113,902$0$250$0$755$0$17,415$0$22,805$0$155,127$0$0
PATRICE KUENNEN
CEO$0$148,996$0$250$0$2,231$0$22,475$0$24,081$0$198,033$0$0
KEN BEACH
CRNA$197,226$0$0$0$1,217$0$9,070$0$23,409$0$230,922$0$0$0
SARA SNITKER
PHARMACIST$117,101$0$150$0$1,254$0$5,658$0$28,515$0$152,678$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART I, LINE 3FormAndLineReferenceDesc
ExplanationFOR THE PURPOSES OF DETERMINING EXECUTIVE COMPENSATION, PALMER LUTHERAN HEALTH CENTER, INC. RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND OTHER HIGHLY COMPENSATED EMPLOYEES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1FAYETTE COUNTY IOWABusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN426005367BondIssuerEIN
Bond Issued2013-08-29BondIssuedDt
Issue Price$8,382,387IssuePriceAmt
PurposeHOSPITAL FACILITY IMPROVEMENTSPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$2,652,812RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$8,382,387TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$0IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$8,382,387OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2007SubstantialCompletionYr
Refunding Tax Exempt BondsfalseRefundingTaxExemptBondsInd
Refunding Taxable BondsfalseRefundingTaxableBondsInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0PrivateBusUseByOthersPct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebateYes (true)ExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, SCHEDULE K, PART IV, LINE 2BFormAndLineReferenceDesc
ExplanationBONA FIDE DEBT SERVICE FUND EXCEPTIONExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, DOING BUSINESS ASGUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS FORM 990, PART I, LINE 1 WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES, WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF.
FORM 990, PART VI, SECTION A, LINE 6THE ARTICLES OF INCORPORATION OF PALMER LUTHERAN HEALTH CENTER PROVIDE FOR ONE MEMBER OF THE CORPORATION. THE SOLE CORPORATE MEMBER OF PALMER LUTHERAN HEALTH CENTER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION A, LINE 7AAS THE SOLE CORPORATE MEMBER AND UNDER TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT FOUR MEMBERS TO THE BOARD OF DIRECTORS OF PALMER LUTHERAN HEALTH CENTER.
FORM 990, PART VI, SECTION A, LINE 7BTHE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN THE APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES.
FORM 990, PART VI, SECTION B, LINE 11BTHE CFO AND PRESIDENT/CEO REVIEW THE 990 BEFORE IT IS FILED. THE ENTIRE BOARD OF DIRECTORS RECEIVES A COPY OF THE 990 AFTER IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT-OF-INTEREST POLICY IS REQUIRED TO BE SIGNED ANNUALLY BY OFFICERS, DIRECTORS AND KEY EMPLOYEES. THE SIGNED POLICIES ARE THEN REVIEWED AT THE BOARD LEVEL AND ADMINISTRATION LEVEL. BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON AREAS WHERE THERE IS A CONFLICT.
FORM 990, PART VI, SECTION B, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990.
FORM 990, PART XI, LINE 9CHANGES IN NET ASSETS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION $62,756.
FORM 990, PART XII, LINE 2C, OVERSIGHT OF THE AUDITGUNDERSEN HEALTH SYSTEM'S FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE CONSOLIDATED AUDIT OF THE FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE FINANCE COMMITTEE GIVES THE FINAL APPROVAL OF THE AUDIT FIRM AND AUDIT REPORTS.
FORM 990 PART IX LINE 11GDESCRIPTION:FAMILY MEDICINE TOTAL FEES:1637001
FORM 990 PART IX LINE 11GDESCRIPTION:EMERGENCY ROOM PURCHASED SVCS TOTAL FEES:1221756
FORM 990 PART IX LINE 11GDESCRIPTION:LAB SERVICES TOTAL FEES:922331
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICAL THERAPY TOTAL FEES:801195
FORM 990 PART IX LINE 11GDESCRIPTION:HOME HEALTH SERVICES TOTAL FEES:361826
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PROFESSIONAL SERVICES TOTAL FEES:4511703

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (24 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
GUNDERSEN LUTHERAN HEALTH SYSTEMS INC
1836 SOUTH AVENUELA CROSSEWI54601391866425SUPTNG ORG.WI501(C)(3)LINE 12B IINAfalse
GUNDERSEN LUTHERAN ADM SERVICES INC
1910 SOUTH AVENUELA CROSSEWI54601391606449SUPTNG ORG.WI501(C)(3)LINE 12B IIGLHSfalse
GUNDERSEN LUTHERAN MEDICAL CENTER INC
1910 SOUTH AVENUELA CROSSEWI54601390813416HEALTHCAREWI501(C)(3)Line 3GLHSfalse
GUNDERSEN CLINIC LTD
1910 SOUTH AVENUELA CROSSEWI54061391028657HEALTHCAREWI501(C)(3)Line 3GLHSfalse
GUNDERSEN LUTHERAN MEDICAL FOUNDATION I
1836 SOUTH AVENUELA CROSSEWI54061391249705FOUNDATIONWI501(C)(3)Line 7GLHSfalse
GUNDERSEN LUTHERAN CREDENTIALING SVC IN
1910 SOUTH AVENUELA CROSSEWI54061391856898CREDENTIALINGWI501(C)(3)LN 12C IIiGLHSfalse
TRI-COUNTY MEMORIAL HOSPITAL
18601 LINCOLN STREETWHITEHALLWI54773390704510HEALTHCAREWI501(C)(3)Line 3GLHSfalse
HARMONY COMMUNITY HEALTHCARE INC
815 MAIN AVENUESOUTH HARMONYMN55939410711606HEALTHCAREMN501(C)(3)Line 10GLHSfalse
TWEETEN LUTHERAN HEALTHCARE CENTER INC
125 FIFTH AVENUESE SPRING GROVEMN55974411565003HEALTHCAREMN501(C)(3)Line 10GLHSfalse
TRI-STATE AMBULANCE INC
235 CAUSEWAY BOULEVARDLA CROSSEWI54601391965415MDCL TRANSPOWI501(C)(3)Line 3GLHSfalse
TRI-STATE REGIONAL AMBULANCE INC
235 CAUSEWAY BOULEVARDLA CROSSEWI54601391962965MDCL TRANSPOWI501(C)(3)Line 10GLHSfalse
LUTHERAN REAL ESTATE HOLDING CORP
1910 SOUTH AVENUELA CROSSEWI54601391480826HOUSINGWI501(C)(3)LN 12C IIIGLHSfalse
COMMUNITY HOUSING OF LA CROSSE INC
1900 SOUTH AVENUELA CROSSEWI54601391586700INDP LIVINGWI501(C)(3)Line 10LRHCfalse
LUTHERAN HOUSING OF LA CROSSE
1900 SOUTH AVENUELA CROSSEWI54601391751934INDP LIVINGWI501(C)(3)Line 10LRHCfalse
ST JOSEPH'S HEALTH SERVICES INC
400 WATER AVENUEHILLSBOROWI54634390929538HEALTHCAREWI501(C)(3)Line 3GLHSfalse
ST JOSEPH'S MEMORIAL FOUNDATION INC
400 WATER AVENUEHILLSBOROWI54634391455787FOUNDATIONWI501(C)(3)Line 12A ISJHSfalse
TRI-COUNTY MEMORIAL FOUNDATION INC
18601 LINCOLN STREETWHITEHALLWI54773300093022FOUNDATIONWI501(C)(3)Line 12A ITCMHfalse
MEMORIAL HOSPITAL OF BOSCOBEL
205 PARKER STREETBOSCOBELWI53805390845590HEALTHCAREWI501(C)(3)Line 3GLHSfalse
MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION
205 PARKER STREETBOSCOBELWI53805391688793FUNDRAISINGWI501(C)(3)Line 7MHBfalse
BOSCOBEL AREA HEALTHCARE PARTNERS
205 PARKER STREETBOSCOBELWI53805450498844FUNDRAISINGWI501(C)(3)Line 7MHBfalse
PALMER MEMORIAL FOUNDATION
112 JEFFERSON STREETWEST UNIONIA52175421032878FOUNDATIONIA501(C)(3)Line 7PLHCYes (true)
MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS
402 WEST LAKE STREETFRIENDSHIPWI53934390944012HEALTHCAREWI501(C)(3)Line 3GLHSfalse
MEMORIAL HEALTHCARE FOUNDATION OF ADAMS
402 WEST LAKE STREETFRIENDSHIPWI53934391775074FOUNDATIONWI501(C)(3)Line 12A IMMHCfalse
SAINT ELIZABETH'S HOSPITAL OF WABASHA
1200 5TH GRANT BOULEVARD WESTWABASHAMN55981410693877HEALTHCAREMN501(C)(3)LINE 3GLHSfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1GUNDERSEN LUTHERAN ENVISION LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11836 SOUTH AVENUEAddressLine1Txt
CityLA CROSSECityNm
State AbbreviationWIStateAbbreviationCd
ZIP54601ZIPCd
FieldValueIRS element (for citing)
EIN264706546EIN
Primary ActivitiesRENEWABLE ENERGYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1GLHSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Share Of Total Income$0ShareOfTotalIncomeAmt
Share Of EOY Assets$0ShareOfEOYAssetsAmt
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd