2018-11-13T17:20:01-06:00 2017-12-31 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-01-01 421320763 PALMER LUTHERAN HEALTH CENTER INC PALM 5634223811 112 JEFFERSON ST WEST UNION IA 52175 BRENDA MOSER REGIONAL CFO 5634223811 2018-11-13 1 PAUL M TRACZEK CPA P01368830 7158323407 2018-11-13 137.26.200.211 2018-11-13 16:20:29 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 558C6F47C777A73CECB93EB9107DCB0C387663C8 2017 2019-02-21 02:37:17Z GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINIC LYNN LAUER 112 JEFFERSON ST WEST UNION IA 52175 28364720 0 X WWW.GUNDERSENHEALTH.ORG/PALMER/ X 1949 IA 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. 7 3 250 330 0 0 81856 14862 27096468 28297550 7512 8173 31300 44135 27217136 28364720 6258 9925 0 0 9804200 12231032 0 0 0 15604403 17379587 25414861 29620544 1802275 -1255824 24162955 20941843 16214705 14232293 7948250 6709550 X WE WILL PROVIDE THE HEALTHCARE AND EDUCATION WE WOULD WANT OUR LOVED ONES TO RECEIVE. 0 0 26052260 9925 28287625 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. 26052260 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 72 0 1 250 1 0 0 0 0 0 0 0 0 0 0 X 7 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X BRENDA MOSER 5634223811 112 JEFFERSON ST WEST UNION IA 52175 TOBIN BRITT CHAIR 0.50 X X 0 0 0 LYNN LAUER SECRETARY/TREASURER 0.50 X X 0 0 0 DR MARY KUFFEL DIRECTOR 0.50 39.50 X 0 487500 43488 DR MORDECHAI LEDERMAN DIRECTOR 40.00 X 0 337984 67235 JEAN KRAUSE DIRECTOR 0.50 39.50 X 0 240302 46954 SCOTT KNIPRATH DIRECTOR 0.50 39.50 X 0 155624 42945 KARLA GAVIN DIRECTOR 0.50 X 0 0 0 TANYA TYSLAND CEO 40.00 X 0 171332 39868 BRENDA MOSER REGIONAL CFO 32.00 8.00 X 0 107632 33711 KENNETH BEACH CRNA 40.00 X 179592 0 29136 BETH JACKSON CRNA 40.00 X 181464 0 21636 361056 1500374 324973 6 0 1 0 IOWA EMERGENCY PHYSICIANS PO BOX 677979 DALLAS TX 752677979 ER & HOSPITALIST PROVIDERS 1154438 PERFORMANCE REHAB 204 E CHARLES ST OELWEIN IA 506621940 CONTRACTED THERAPY 187266 TOTAL MSP LLC 10 E COLLEGE AVE STE 300 APPLETON WI 549115759 CONTRACTED NURSING & LAB TECHS 165452 HEALTH ENTERPRISES 5825 DRY CREEK LANE CEDAR RAPIDS IA 52402 CRNA SERVICES 149205 PSYCHIATRIC MEDICAL CARE LLC PO BOX 305172 DEPT 141 NASHVILLE TN 372305172 GERIATRIC PSYCH SERVICES 135604 5 14862 14862 PATIENT SERVICE REVENUE 621110 27879905 27879905 OTHER REVENUE 621110 417645 417645 28297550 8173 8173 44135 0 44135 44135 44135 28364720 28297550 0 52308 X 9925 9925 9176283 7794368 1381915 429761 370847 58914 2111207 1761441 349766 513781 433202 80579 118001 118001 58950 58950 7125056 6886778 238278 48324 48324 259859 154676 105183 672979 672979 1502088 1469652 32436 657775 642550 15225 188 10 178 1257430 1026115 231315 61640 61640 SUPPLIES 4496797 4382196 114601 PROVISION FOR BAD DEBTS 1120500 1120500 29620544 26052260 3568284 0 1310 1335 3493999 2119198 8719794 5807581 844586 926376 80496 110538 14301764 4575982 10661060 9725782 361710 2251033 24162955 20941843 5309829 5231972 324199 161731 8500781 7801747 1153896 1033843 36000 3000 890000 0 16214705 14232293 X 7574540 6318717 373710 390833 7948250 6709550 24162955 20941843 X -1255824 17123 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4688 4688 0 PART II-B, LINE 1: 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. 168281 168281 7714655 922512 6792143 6418828 3653470 2765358 9725782 INTEREST IN NET ASSETS OF FOUNDATION 345333 OTHER 33500 AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 1872200 2251033 27229358 0 27229358 1135362 1135362 28364720 28500043 0 28500043 1120500 1120500 29620543 1 1 1 X 1 X 0 1 0 1 1 455524 455524 0.01540 6551911 3717614 2834297 0.09570 7007435 3717614 3289821 0.11110 151298 7718 143580 0.00480 5084304 4484460 599844 0.02030 2446 2446 0.00010 5238048 4492178 745870 0.02520 12245483 8209792 4035691 0.13630 70770 5000 65770 0.00220 70770 5000 65770 0.00220 0 1117967 558984 12036368 12136681 -100313 X 1 1 1 1 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 WWW.GUNDERSENHEALTH.ORG/PALMER X X X X RURAL HEALTH CLINIC PALMER LUTHERAN HEALTH CENTER 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ X 1 16 1 HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 0 1 X 400.000000000000 200.000000000000 X X X X 1 1 X X X X X 1 X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X 1 X 0 0 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. 10 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 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 0 0 0 0 0 0 0 0 0 DR MARY KUFFEL DIRECTOR 0 487500 0 0 0 0 0 39150 0 4338 0 530988 0 0 DR MORDECHAI LEDERMAN DIRECTOR 0 337984 0 0 0 0 0 39150 0 28085 0 405219 0 0 JEAN KRAUSE DIRECTOR 0 240302 0 0 0 0 0 32894 0 14060 0 287256 0 0 SCOTT KNIPRATH DIRECTOR 0 155624 0 0 0 0 0 19929 0 23016 0 198569 0 0 TANYA TYSLAND CEO 0 171332 0 0 0 0 0 23561 0 16307 0 211200 0 0 KENNETH BEACH CRNA 179592 0 0 0 0 0 8388 0 20748 0 208728 0 0 0 BETH JACKSON CRNA 181464 0 0 0 0 0 8388 0 13248 0 203100 0 0 0 SCHEDULE J, PART 1, LINE 3 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. A CITY OF WEST UNION IOWA 426005366 2006-08-31 1815000 HOSPITAL FACILITY IMPROVEMENTS 0 0 0 B FAYETTE COUNTY IOWA 426005367 2006-08-31 10000000 HOSPITAL FACILITY IMPROVEMENTS 0 0 0 A 1538927 1815000 36300 1778700 2007 0 0 1 1 B 2427744 10000000 200000 9800000 2007 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 0 A 1 B 1 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. 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