PALMER LUTHERAN HEALTH CENTER INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- PALMER LUTHERAN HEALTH CENTER INC (EIN 42-1320763)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-13
- IRS object ID
- 201823179349307367
- Schema version
- 2017v2.3
- 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 | 2018-11-13T17:20:01-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4890 OWEN AYRES COURT SUITE 200 | AddressLine1Txt |
| City | EAU CLAIRE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421320763 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PALMER LUTHERAN HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PALM | BusinessNameControlTxt |
| Phone | 5634223811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON ST | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDA MOSER | PersonNm |
| Person Title | REGIONAL CFO | PersonTitleTxt |
| Phone | 5634223811 | PhoneNum |
| Signature | 2018-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PAUL M TRACZEK CPA | PreparerPersonNm |
| PTIN | P01368830 | PTIN |
| Phone | 7158323407 | PhoneNum |
| Preparation | 2018-11-13 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 137.26.200.211 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-13 | IPDt |
| IP Tm | 16:20:29 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 558C6F47C777A73CECB93EB9107DCB0C387663C8 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LYNN LAUER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON ST | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,364,720 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/PALMER/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. IN PARTNERSHIP WITH GUNDERSEN HEALTH SYSTEM, WE WILL BE THE FIRST CHOICE OF PATIENTS AND A LEADER IN COMMUNITY HEALTH AND WELLNESS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 250 | TotalEmployeeCnt |
| Total Volunteers | 330 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $81,856 | PYContributionsGrantsAmt |
| CY Contributions Grants | $14,862 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $27,096,468 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $28,297,550 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,512 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,173 | CYInvestmentIncomeAmt |
| PY Other Revenue | $31,300 | PYOtherRevenueAmt |
| CY Other Revenue | $44,135 | CYOtherRevenueAmt |
| PY Total Revenue | $27,217,136 | PYTotalRevenueAmt |
| CY Total Revenue | $28,364,720 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $6,258 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $9,925 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,804,200 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,231,032 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,604,403 | PYOtherExpensesAmt |
| CY Other Expenses | $17,379,587 | CYOtherExpensesAmt |
| PY Total Expenses | $25,414,861 | PYTotalExpensesAmt |
| CY Total Expenses | $29,620,544 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,802,275 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,255,824 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,162,955 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,941,843 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,214,705 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,232,293 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,948,250 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,709,550 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $26,052,260 | ExpenseAmt |
| Grant | $9,925 | GrantAmt |
| Revenue | $28,287,625 | RevenueAmt |
| Desc | PALMER 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 A HOME CARE DEPARTMENT, HOSPICE DEPARTMENT, AND HOME MEDICAL EQUIPMENT DEPARTMENT. ON JULY 1, 2016, PALMER LUTHERAN MEDICAL CENTER ACQUIRED 3 RURAL HEALTH CLINICS IN THE COMMUNITIES OF WEST UNION, FAYETTE AND POSTVILLE. IN ADDITION, PALMER OPERATES AN AFTERHOURS AND WEEKEND WALK-IN CLINIC. THIS WALK-IN CLINIC WAS PREVIOUSLY HELD IN OUR ER AS AN URGENT CARE CLINIC, BUT IN OCTOBER 2017 THIS CLINIC WAS MOVED INTO THE WEST UNION RURAL HEALTH CLINIC AND THE HOURS AND DAYS OF OPERATION WERE EXPANDED TO ALLOW PATIENTS TO BE SEEN 7 DAYS A WEEK IN THIS SETTING. THIS WAS DONE SPECIFICALLY TO MEET COMMUNITY HEALTH NEEDS OF WORKING FAMILIES. ANNUALLY, PALMER HAS OVER 340 ADMISSIONS, ABOUT 90 LIVE BIRTHS; OVER 3,800 EMERGENCY CENTER VISITS, OVER 31,000 PATIENT VISITS IN THE CLINICS AND PERFORMS OVER 525 SURGERIES (INCLUDING AMBULATORY).THE NEWLY RENOVATED 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 35 ASSOCIATES (INCLUDING 4 PHYSICIANS, 6 PHYSICIANS ASSISTANTS, AND 4 NURSE PRACTITIONER 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 $456,556 FOR THE YEAR ENDED DECEMBER 31, 2017. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION WERE $302,000. 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 | $26,052,260 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 72 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 250 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 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 | 0 | 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 | BRENDA MOSER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5634223811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON ST | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TOBIN BRITT | ||||||||
| CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LYNN LAUER | ||||||||
| SECRETARY/TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DR MARY KUFFEL | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $487,500 | $43,488 | 39.50 | ||
| DR MORDECHAI LEDERMAN | ||||||||
| DIRECTOR | 40.00 | Yes (X) | $0 | $337,984 | $67,235 | |||
| JEAN KRAUSE | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $240,302 | $46,954 | 39.50 | ||
| SCOTT KNIPRATH | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $155,624 | $42,945 | 39.50 | ||
| KARLA GAVIN | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| TANYA TYSLAND | ||||||||
| CEO | 40.00 | Yes (X) | $0 | $171,332 | $39,868 | |||
| BRENDA MOSER | ||||||||
| REGIONAL CFO | 32.00 | Yes (X) | $0 | $107,632 | $33,711 | 8.00 | ||
| KENNETH BEACH | ||||||||
| CRNA | 40.00 | $179,592 | $0 | $29,136 | Yes (X) | |||
| BETH JACKSON | ||||||||
| CRNA | 40.00 | $181,464 | $0 | $21,636 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $361,056 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,500,374 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $324,973 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | 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 |
|---|---|---|---|---|---|
| IOWA EMERGENCY PHYSICIANS | |||||
| PO BOX 677979 | DALLAS | TX | 752677979 | ER & HOSPITALIST PROVIDERS | $1,154,438 |
| PERFORMANCE REHAB | |||||
| 204 E CHARLES ST | OELWEIN | IA | 506621940 | CONTRACTED THERAPY | $187,266 |
| TOTAL MSP LLC | |||||
| 10 E COLLEGE AVE STE 300 | APPLETON | WI | 549115759 | CONTRACTED NURSING & LAB TECHS | $165,452 |
| HEALTH ENTERPRISES | |||||
| 5825 DRY CREEK LANE | CEDAR RAPIDS | IA | 52402 | CRNA SERVICES | $149,205 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 305172 DEPT 141 | NASHVILLE | TN | 372305172 | GERIATRIC PSYCH SERVICES | $135,604 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $14,862 | RelatedOrganizationsAmt |
| Total Contributions | $14,862 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $27,879,905 | $27,879,905 |
| OTHER REVENUE | 621110 | $417,645 | $417,645 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $28,297,550 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,173 | TotalRevenueColumnAmt |
| Exclusion | $8,173 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,135 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,135 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,135 | TotalRevenueColumnAmt |
| Exclusion | $44,135 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,364,720 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,297,550 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $52,308 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,925 | TotalAmt |
| Program Services | $9,925 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,176,283 | TotalAmt |
| Program Services | $7,794,368 | ProgramServicesAmt |
| Management And General | $1,381,915 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $429,761 | TotalAmt |
| Program Services | $370,847 | ProgramServicesAmt |
| Management And General | $58,914 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,111,207 | TotalAmt |
| Program Services | $1,761,441 | ProgramServicesAmt |
| Management And General | $349,766 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $513,781 | TotalAmt |
| Program Services | $433,202 | ProgramServicesAmt |
| Management And General | $80,579 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,001 | TotalAmt |
| Management And General | $118,001 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,950 | TotalAmt |
| Management And General | $58,950 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,125,056 | TotalAmt |
| Program Services | $6,886,778 | ProgramServicesAmt |
| Management And General | $238,278 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,324 | TotalAmt |
| Management And General | $48,324 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $259,859 | TotalAmt |
| Program Services | $154,676 | ProgramServicesAmt |
| Management And General | $105,183 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $672,979 | TotalAmt |
| Management And General | $672,979 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,502,088 | TotalAmt |
| Program Services | $1,469,652 | ProgramServicesAmt |
| Management And General | $32,436 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $657,775 | TotalAmt |
| Program Services | $642,550 | ProgramServicesAmt |
| Management And General | $15,225 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188 | TotalAmt |
| Program Services | $10 | ProgramServicesAmt |
| Management And General | $178 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,257,430 | TotalAmt |
| Program Services | $1,026,115 | ProgramServicesAmt |
| Management And General | $231,315 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,640 | TotalAmt |
| Management And General | $61,640 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $4,496,797 | $4,382,196 | $114,601 |
| PROVISION FOR BAD DEBTS | $1,120,500 | $1,120,500 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,620,544 | TotalAmt |
| Program Services | $26,052,260 | ProgramServicesAmt |
| Management And General | $3,568,284 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,310 | BOYAmt |
| EOY | $1,335 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,493,999 | BOYAmt |
| EOY | $2,119,198 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,719,794 | BOYAmt |
| EOY | $5,807,581 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $844,586 | BOYAmt |
| EOY | $926,376 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,496 | BOYAmt |
| EOY | $110,538 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,301,764 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,575,982 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,661,060 | BOYAmt |
| EOY | $9,725,782 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $361,710 | BOYAmt |
| EOY | $2,251,033 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,162,955 | BOYAmt |
| EOY | $20,941,843 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,309,829 | BOYAmt |
| EOY | $5,231,972 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $324,199 | BOYAmt |
| EOY | $161,731 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,500,781 | BOYAmt |
| EOY | $7,801,747 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,153,896 | BOYAmt |
| EOY | $1,033,843 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,000 | BOYAmt |
| EOY | $3,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $890,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,214,705 | BOYAmt |
| EOY | $14,232,293 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,574,540 | BOYAmt |
| EOY | $6,318,717 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $373,710 | BOYAmt |
| EOY | $390,833 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,948,250 | BOYAmt |
| EOY | $6,709,550 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,162,955 | BOYAmt |
| EOY | $20,941,843 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,255,824 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $17,123 | 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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
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 | $4,688 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,688 | 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 | PALMER 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 $4,688 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $168,281 | OtherCostOrOtherBasisAmt |
| Book Value | $168,281 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,714,655 | OtherCostOrOtherBasisAmt |
| Depreciation | $922,512 | DepreciationAmt |
| Book Value | $6,792,143 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,418,828 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,653,470 | DepreciationAmt |
| Book Value | $2,765,358 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,725,782 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN NET ASSETS OF FOUNDATION | $345,333 |
| OTHER | $33,500 |
| AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | $1,872,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,251,033 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $27,229,358 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,229,358 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,135,362 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,135,362 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $28,364,720 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $28,500,043 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $28,500,043 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,120,500 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,120,500 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $29,620,543 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $455,524 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $455,524 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01540 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,551,911 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,717,614 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,834,297 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,007,435 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,717,614 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,289,821 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11110 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $151,298 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,718 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $143,580 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,084,304 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,484,460 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $599,844 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02030 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,446 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,238,048 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,492,178 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $745,870 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02520 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,245,483 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,209,792 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,035,691 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13630 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $65,770 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $65,770 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,117,967 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $558,984 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,036,368 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,136,681 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$100,313 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | PALMER LUTHERAN HEALTH CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 JEFFERSON STREET | AddressLine1Txt |
| City | WEST UNION | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52175 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GUNDERSENHEALTH.ORG/PALMER | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PALMER LUTHERAN 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 | 16 | 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 | HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ | 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 | 400.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 5: TOGETHER, 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 NOVEMBER 11-30, 2016.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 212 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. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 11: PALMER 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 STRATEGY 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. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 13H: THE 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. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 15E: ALL 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 OURTSOURCED COLLECTORS AS BEING POTENITALLY ELIGIBLE FOR ASSISTANCE ARE ALSO PROVIDED APPLICATION FORMS AND INFORMATION ON HOW TO APPLY. |
| PALMER LUTHERAN HEALTH CENTER | PART V, SECTION B, LINE 16J: OUR 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 10 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - GUNDERSEN PALMER - WEST UNION CLINIC | ||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | RURAL HEALTH CLINIC |
| 2 - GUNDERSEN PALMER - FAYETTE CLINIC | ||||
| 110 KING STREEET | FAYETTE | IA | 52142 | RURAL HEALTH CLINIC |
| 3 - GUNDERSEN PALMER - POSTVILLE CLINIC | ||||
| 111 SOUTH REYNOLDS STREET | POSTVILLE | IA | 52162 | RURAL HEALTH CLINIC |
| 4 - GUNDERSEN PALMER HOME HEALTH | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | HOME HEALTH |
| 5 - GUNDERSEN PALMER HOME HEALTH - OELWEIN | ||||
| 1602 SOUTH FREDERICK | OELWEIN | IA | 50662 | HOME HEALTH |
| 6 - GUNDERSEN PALMER MEDICAL SUPPLY-W UNION | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | MEDICAL SUPPLY AND EQUIPMENT |
| 7 - GUNDERSEN PALMER MEDICAL SUPPLY-OELWEIN | ||||
| 1602 SOUTH FREDERICK | OELWEIN | IA | 50662 | MEDICAL SUPPLY AND EQUIPMENT |
| 8 - GUNDERSEN PALMER HOSPICE - OELWEIN | ||||
| 1602 SOUTH FREDERICK | OELWEIN | IA | 50662 | HOSPICE SERVICES |
| 9 - GUNDERSEN PALMER COMMUNITY HEALTH | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | PUBLIC HEALTH SERVICES |
| 10 - GUNDERSEN PALMER HOSPICE - WEST UNION | ||||
| 200 JEFFERSON STREET | WEST UNION | IA | 52175 | HOSPICE SERVICES |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. |
| PART I, LINE 7: | THE 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. |
| PART I, LINE 7G: | SUBSIDIZED 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. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY 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. |
| PART III, LINE 2: | THE 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. |
| PART III, LINE 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE 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. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. |
| PART III, LINE 8: | PALMER 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 COMMMUNITY, 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. |
| PART III, LINE 9B: | BEFORE 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. |
| PART VI, LINE 2: | TOGETHER, 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 NOVEMBER. 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. 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. |
| PART VI, LINE 3: | THE 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. |
| PART VI, LINE 4: | PALMER LUTHERAN HEALTH CENTER IS A 25-BED ACUTE CARE HEALTH CENTER SERVING A RURAL POPULATION OF 2,486 PER THE 2010 US CENSUS. AS THE ONLY HOSPITAL IN WEST UNION, IOWA, IT ALSO SERVES A 30 TO 40 MILE RADIUS AROUND WEST UNION. IN ADDITION, OUR HOMECARE DEPARTMENT SERVES A POPULATION IN A 50 MILE RADIUS. PALMER LUTHERAN HEALTH CENTER IS A MEDICARE DEPENDENT HOSPITAL AND HAS A LARGE MEDICAID POPULATION AS WELL. THE HOSPITAL HAS A GROWING AMOUNT OF BAD DEBT AND CHARITY CARE, AS THE COMMUNITY HAS LOST A NUMBER OF INDUSTRIES IN THE LAST FEW YEARS. ACCORDING TO THE 2010 US CENSUS, 12.7% OF RESIDENTS IN WEST UNION HAVE INCOME BELOW THE POVERTY LEVEL. THE ESTIMATED MEDIAN HOUSEHOLD INCOME WAS $40,469, DOWN OVER $8,000 COMPARED TO THE STATE OF IOWA. |
| PART VI, LINE 5: | THREE OF THE SEVEN 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. CREATE 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. |
| PART VI, LINE 6: | PALMER 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. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR MARY KUFFEL | ||||||||||||||
| DIRECTOR | $0 | $487,500 | $0 | $0 | $0 | $0 | $0 | $39,150 | $0 | $4,338 | $0 | $530,988 | $0 | $0 |
| DR MORDECHAI LEDERMAN | ||||||||||||||
| DIRECTOR | $0 | $337,984 | $0 | $0 | $0 | $0 | $0 | $39,150 | $0 | $28,085 | $0 | $405,219 | $0 | $0 |
| JEAN KRAUSE | ||||||||||||||
| DIRECTOR | $0 | $240,302 | $0 | $0 | $0 | $0 | $0 | $32,894 | $0 | $14,060 | $0 | $287,256 | $0 | $0 |
| SCOTT KNIPRATH | ||||||||||||||
| DIRECTOR | $0 | $155,624 | $0 | $0 | $0 | $0 | $0 | $19,929 | $0 | $23,016 | $0 | $198,569 | $0 | $0 |
| TANYA TYSLAND | ||||||||||||||
| CEO | $0 | $171,332 | $0 | $0 | $0 | $0 | $0 | $23,561 | $0 | $16,307 | $0 | $211,200 | $0 | $0 |
| KENNETH BEACH | ||||||||||||||
| CRNA | $179,592 | $0 | $0 | $0 | $0 | $0 | $8,388 | $0 | $20,748 | $0 | $208,728 | $0 | $0 | $0 |
| BETH JACKSON | ||||||||||||||
| CRNA | $181,464 | $0 | $0 | $0 | $0 | $0 | $8,388 | $0 | $13,248 | $0 | $203,100 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART 1, LINE 3 | FormAndLineReferenceDesc |
| Explanation | FOR THE PURPOSE OF DETERMINING EXECUTIVE COMPENSATION, PALMER LUTHERAN HEALTH CENTER, INC. RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSON 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 COMMITEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITEE. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| CITY OF WEST UNION IOWA | |||||||
| A | 426005366 | 2006-08-31 | $1,815,000 | HOSPITAL FACILITY IMPROVEMENTS | 0 | 0 | 0 |
| FAYETTE COUNTY IOWA | |||||||
| B | 426005367 | 2006-08-31 | $10,000,000 | HOSPITAL FACILITY IMPROVEMENTS | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $1,538,927 | $1,815,000 | $36,300 | $1,778,700 | 2007 | 0 | 0 | Yes (1) | Yes (1) |
| B | $2,427,744 | $10,000,000 | $200,000 | $9,800,000 | 2007 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE 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 7A | AS 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 7B | THE 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 11B | THE ENTIRE BOARD OF DIRECTORS RECEIVES A COPY OF THE 990 BEFORE IT IS FILED. THE 990 IS ALSO REVIEWED BY THE PRESIDENT/CEO AND CFO. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE 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 15 | FOR PURPOSES OF DETERMINING COMPENSATION, PALMER LUTHERAN HEALTH CENTER RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE 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 IX, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 6,886,778. MANAGEMENT AND GENERAL EXPENSES 238,278. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,125,056. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 31,985. DISTRIBUTIONS FROM FOUNDATION -14,862. |
| FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS GIVES THE FINAL APPROVAL OF THE AUDIT FIRM AND AUDIT REPORTS AND TAKES TIME ANNUALLY TO MEET WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT. THERE WAS NO CHANGE TO THIS PROCESS DURING THE FILING PERIOD. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN ADMINISTRATIVE SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTH CARE | MN | 501(C)(3) | LINE 11 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE S | HARMONY | MN | 55939 | 410711606 | HEALTH CARE | MN | 501(C)(3) | LINE 11 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING SERVICE | WI | 501(C)(3) | LINE 12D, III-O | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12D, III-O | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| LUTHERAN HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 11 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 11 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-COUNTY MEMORIAL HOSPITAL INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12B, II | TRI-COUNTY MEMORIAL HOSPITAL INC | Yes (1) | |
| OPTIONS IN REPRODUCTIVE CARE INC | |||||||||||
| 1201 CALEDONIA STREET | LA CROSSE | WI | 54603 | 391166634 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 55939 | 391688793 | FOUNDATION | WI | 501(C)(3) | LINE 7 | MEMORIAL HOSPITAL OF BOSCOBEL | Yes (1) | |
| GUNDERSEN EXPRESS CARE INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 900102388 | HEALTH CARE | WI | 501(C)(3) | LINE 12B, II | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| BOSCOBEL AREA HEALTH CARE PARTNERS | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 55939 | 450498844 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | 0 | N/A | |
| PALMER MEMRIAL FOUNDATION | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421032878 | FOUNDATION | IA | 501(C)(3) | LINE 7 | PALMER LUTHERAN HEALTH CENTER | Yes (1) | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12B, II | ST JOSEPH'S HEALTH SERVICES INC | Yes (1) | |
| MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | |||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL HEALTHCARE FOUNDATION OF ADAMS CO | |||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12B, II | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | Yes (1) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| DEGEN BERGLUND INC | |||||||||
| 1709 LOSEY BLVD S | LA CROSSE | WI | 54601 | 390971110 | RETAIL PHARMACY | WI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | C | 0 |
| GUNDERSEN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | C | 0 |
| 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 | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |