2016-09-15T15:43:16-05:00 2015-10-31 420714325 RSM US LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2014-11-01 420948420 CENTRAL IOWA HEALTHCARE CENT 6417545126 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 CAROL HIBBS CHAIR, BOARD OF TRUSTEES 6417545126 2016-09-15 1 JOHN J ROMANO P00227323 5638884000 2014 2017-02-10 21:41:12Z CAROL HIBBS 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 62772484 0 X WWW.CENTRALIOWAHEALTHCARE.COM X 1969 IA TO CREATE AND CONTINUALLY IMPROVE SERVICES THAT RESPOND TO HEALTHCARE NEEDS IN OUR COMMUNITY. 13 12 704 250 0 0 61646 61942 67966624 57707153 61618 92434 2312419 3309318 70402307 61170847 0 24647 0 0 37375001 35831927 0 0 0 34790295 44106586 72165296 79963160 -1762989 -18792313 71123105 102694171 15212072 65572738 55911033 37121433 TO CREATE AND CONTINUALLY IMPROVE SERVICES THAT RESPOND TO HEALTHCARE NEEDS IN OUR COMMUNITY. 0 0 57040558 24647 58414389 TO PROVIDE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY AND SURROUNDING COMMUNITIES REGARDLESS OF ABILITY TO PAY. CARE INCLUDES PREVENTION, DIAGNOSIS, TREATMENT, REHABILITATION AND OTHER SERVICES. CENTRAL IOWA HEALTHCARE EXPERIENCED APPROXIMATELY 196,102 OUTPATIENT VISITS; 2,717 ADMISSIONS; 480 BIRTHS; 8,388 PATIENT DAYS; 4,131 SURGICAL PROCEDURES AND 20,671 EMERGENCY ROOM VISITS. 57040558 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 119 0 1 704 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X MARY K PFANTZ 6417545126 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 TL BRIGGS FORMER TRUSTEE 1.00 X 0 0 0 JACQUE GOODMAN TRUSTEE 1.00 X 0 0 0 SHARON GREER TRUSTEE 1.00 X 0 0 0 CAROL HIBBS VICE CHAIRPERSON 3.00 X X 0 0 0 POLLY HINEMAN MD FORMER TRUSTEE/PHYSICIAN 40.00 X 170047 0 9774 JOHN C HUGHES PRESIDENT & CHIEF EXECUTIVE OFFICER 40.00 X X 276507 0 32445 JIM LOWRANCE TREASURER 3.00 X X 0 0 0 SUE MARTIN TRUSTEE 1.00 X 0 0 0 MIKE MASON CHAIRPERSON 3.00 X X 0 0 0 MIKE MCCARTY TRUSTEE 1.00 X 0 0 0 JOSEPH POLLPETER TRUSTEE 1.00 X 0 0 0 KIMBERLE SCHRYVER TRUSTEE 1.00 X 0 0 0 KEVIN SWARTZ TRUSTEE 1.00 X 0 0 0 STEPHEN VAN BUREN TRUSTEE 1.00 X 0 0 0 BRUCE WIRIN SECRETARY 3.00 X X 0 0 0 TODD BURCH CHIEF FINANCIAL OFFICER 40.00 X 0 0 0 HILARY DOLBEE FORMER V.P. OF FINANCE 40.00 X 152991 0 15169 LIZ ZUERCHER FORMER V.P. OF ADMINISTRATION 40.00 X 155386 0 27144 SADIA ASHRAF-BENSON DO PHYSICIAN 40.00 X 259705 0 14659 BONTE GBEMUDU MD PHYSICIAN 40.00 X 219148 0 27180 JOHN MCCUNE MD PHYSICIAN 40.00 X 324249 0 37889 RONALD TERRILL MD PHYSICIAN 40.00 X 234284 0 27752 YARED VAZQUEZ MD PHYSICIAN 40.00 X 204878 0 31474 ROBERT L DOWNEY FORMER CHIEF FINANCIAL OFF 40.00 X 201246 0 12501 2198441 0 235987 28 1 1 0 MACFARLAND CLINIC PC 1215 DUFF AVE AMES IA 50010 PHYSICIAN SERVICES 2307757 SQUARE WAVEFORM ANESTHESIOLOGY PO BOX 1192 MARSHALLTOWN IA 50158 ANESTHESIA SERVICES 1933500 ICE TECHNOLOGIES 411 SE 9TH ST PELLA IA 50219 IT SERVICES 1438473 ARAMARK CORPORATION 1225 E 60TH ST CHICAGO IL 60673 CLIN ENG/FACILITIES 1428524 IOWA ORTHO 1601 NW 114TH ST CLIVE IA 50325 PHYSICIAN SERVICES 1320144 23 13550 48392 61942 NET PATIENT SERVICE REVENUE 621400 57707153 57707153 57707153 14482 14482 1907026 1042759 864267 864267 864267 575660 497708 77952 77952 77952 119969 61170 58799 58799 JOINT VENTURE INCOME 900099 707236 707236 CAFETERIA INCOME 722514 487528 487528 ELECTRONIC HEALTH RECORD REVENUE 900099 227158 227158 964330 964330 2386252 61170847 58414389 0 2694516 X 24647 24647 995818 995818 27495841 22103044 5392797 1102681 879826 222855 4240868 3383776 857092 1996719 1593176 403543 3968090 3968090 466834 19195 447639 58573 58573 13902 13902 16296776 15034999 1261777 268881 268881 496665 355396 141269 1739067 1739067 954851 565615 389236 127062 78952 48110 77606 50348 27258 1243997 1243997 4131888 1570004 2561884 524942 76223 448719 MEDICAL SUPPLIES 8150940 8150940 ANCILLARY EXPENSES 2351478 2351478 ADMINISTRATIVE EXPENSES 1210760 1210760 NURSING EXPENSES 611792 611792 1412482 191147 1221335 79963160 57040558 22922602 0 11121 33545 5807597 2180843 34540 38243 16621933 9531074 58874 166774 2034951 2370281 773462 866305 141838368 64492878 38288768 77345490 180119 0 3500000 3695768 1249849 2003395 2561891 4462453 71123105 102694171 7312736 16042262 7899336 49530476 15212072 65572738 X 54422234 35579968 1488799 1541465 55911033 37121433 71123105 102694171 X -18792313 5328 -2615 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13902 13902 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 22.8% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $4,995, AND 21% OF MEMBERSHIP DUES PAID TO THE IOWA HOSPITAL ASSOCIATION, OR $8,907. 640301 5002147 5642448 19328772 69471591 38018390 50781973 16261 44884745 25253432 19647574 357295 2137256 1221056 1273495 77345490 X 60434807 0 60434807 736040 736040 61170847 79227120 -736040 -736040 79963160 0 79963160 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO ORGANIZATIONS SUCH AS THIS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE NATURE, THE CHARACTERIZATION AND THE TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. HOWEVER, AS OF OCTOBER 31, 2015 AND 2014, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY AS MANAGEMENT DOES NOT BELIEVE THE HOSPITAL HAS TAKEN ANY TAX POSITIONS THAT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES. FORMS 990 AND 990T FILED BY THE HOSPITAL ARE GENERALLY SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. THE HOSPITAL'S IRS FORMS 990 AND 990T ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED OCTOBER 31, 2012 AND PRIOR. PART XI, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD -61,170. GAIN ON SALE OF FIXED ASSETS 77,952. JOINT VENTURE INCOME 707,236. RESTRICTED INCOME 12,022. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 61,170. GAIN ON SALE OF FIXED ASSETS -77,952. JOINT VENTURE INCOME -707,236. RESTRICTED EXPENSES -12,022. 1 1 1 X 1 X 1 1 0 1 1 24647 24647 0.00030 9659661 6553967 3105694 0.03880 9684308 6553967 3130341 0.03910 436754 33143 403611 0.00500 3567378 2889126 678252 0.00850 22674 22674 0.00030 4026806 2922269 1104537 0.01380 13711114 9476236 4234878 0.05290 10025 10025 0.00010 10025 10025 0.00010 1 20096333 21042030 23661227 -2619197 X 1 1 1 1 CENTRAL IOWA HEALTHCARE 3 SOUTH 4TH AVE MARSHALLTOWN IA 50158 WWW.CENTRALIOWAHEALTHCARE.COM 640007H X X X CENTRAL IOWA HEALTHCARE 1 0 0 1 X X X X X X X X X 12 1 0 1 1 X WWW.CENTRALIOWAHEALTHCARE.COM X 1 12 1 WWW.CENTRALIOWAHEALTHCARE.COM 0 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X 1 X X X X 1 0 X X X X 1 X 0 0 CENTRAL IOWA HEALTHCARE PART V, SECTION B, LINE 5: CENTRAL IOWA HEALTHCARE UTILIZED MANY METHODS IN ORDER TO ENSURE THAT INPUT WAS RECEIVED FROM THE ENTIRE COMMUNITY, INCLUDING REPRESENTATIVES OF THE COMMUNITY WITH PUBLIC HEALTH KNOWLEDGE, THOSE WITH SPECIALIZED HEALTH KNOWLEDGE, AS WELL AS THOSE SERVED BY THE HOSPITAL. THIS WAS DONE BY HOSTING THREE COMMUNITY MEETINGS, CONDUCTING A DIRECT MAIL SURVEY OF HOUSEHOLDS IN THE SERVICE AREA, AND FORMING FOCUS GROUPS ATTENDED BY BUSINESS LEADERS, CITY AND COUNTY LEADERS, HEALTH CARE PROFESSIONALS, RELIGIOUS LEADERS, NOT-FOR-PROFIT ORGANIZATIONS AND CONSUMERS. CENTRAL IOWA HEALTHCARE PART V, SECTION B, LINE 6B: THE MARSHALL COUNTY BOARD OF HEALTH AND THE PIONEERING HEALTHIER COMMUNITY COALITION CENTRAL IOWA HEALTHCARE PART V, SECTION B, LINE 11: CENTRAL IOWA HEALTHCARE WILL FOCUS ON PROVIDING MORE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN THE CENTRAL IOWA HEALTHCARE SERVICE AREA AND WILL WORK TOWARDS GREATER UTILIZATION OF THESE SPECIALTY SERVICES THAT ARE PREVIOUSLY EXISTING IN THE COMMUNITY. CENTRAL IOWA HEALTHCARE HAS MADE A NUMBER OF ADVANCEMENTS TOWARDS THE MENTAL HEALTH GOAL. IN FISCAL YEAR 2015, WE HIRED AN EXECUTIVE DIRECTOR OF BEHAVIOR HEALTH, WITH A FOCUS ON THE MOST CRITICAL AREA - BEHAVIORAL HEALTH PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT. IN ADDITION TO BRINGING THIS RESOURCE ON BOARD, WE REMODELED AN ED PATIENT ROOM FOR THE SAFETY OF THESE PATIENTS THAT INCLUDED REMOVING ITEMS THAT COULD BE USED TO SELF HARM OR HARM CAREGIVERS, ADDED VIDEO MONITORING TO ENSURE THAT THE PATIENT IN THE ROOM IS SAFE, GROWN AN ONSITE EMPLOYED SECURITY TEAM, PARTNERED MORE CLOSELY WITH THE COUNTY SHERIFF'S DEPARTMENT TO ENSURE THE SAFETY OF INDIVIDUALS UNDER THEIR CARE, AND MODIFIED POLICIES TO ENSURE ADEQUATE CARE IS PROVIDED. WE ALSO CONTRACTED WITH OTHER ORGANIZATIONS TO PROVIDE REMOTE EVALUATIONS WHEN THE PHYSICIANS REQUEST THE SERVICE.THERE WERE NEEDS IDENTIFIED THAT CENTRAL IOWA HEALTHCARE DOES NOT HAVE THE RESOURCES TO ADDRESS AT THIS TIME. THESE NEEDS WHILE IMPORTANT TO THE HEALTH SYSTEM AND THE COMMUNITY WERE NOT CHOSEN BASED ON THE ORGANIZATION'S PRIORITIZATION PROCESS, AVAILABLE STAFF RESOURCES AND OTHER PRIORITY PROJECTS. THIS PROCESS INCLUDED THE FOLLOWING QUESTIONS: 1) THE SEVERITY OF THE PROBLEM 2) THE HEALTH SYSTEM'S ABILITY TO IMPACT AND 3) THE EXTENT TO WHICH OTHER ORGANIZATIONS WERE MEETING THE NEED AS WELL AS 4) THE HEALTH SYSTEM'S CAPACITY AT THIS TIME. CENTRAL IOWA HEALTHCARE PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USES THE RATES PAID BY COMMERCIAL INSURANCE PAYORS TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO INDIVIDUALS ELIGIBLE UNDER THE HOSPITALS FINANCIAL ASSISTANCE POLICY. 5 CIH CLINIC - STATE CENTER 503 3RD AVENUE SW STATE CENTER IA 50247 PHYSICIAN CLINIC CIH CLINIC - TAMATOLEDO 1307 SOUTH BROADWAY TOLEDO IA 52342 PHYSICIAN CLINIC CIH CLINIC - CONRAD 105 NORTH CHURCH ST CONRAD IA 50621 PHYSICIAN CLINIC CIH CLINIC - MARSHALLTOWN 405 EAST MAIN ST MARSHALLTOWN IA 50158 PHYSICIAN CLINIC CIH - URGENT CARE 55 CENTRAL IOWA DRIVE SUITE 5 MARSHALLTOWN IA 50158 URGENT CARE CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: A COMMUNITY BENEFIT REPORT IS PREPARED ANNUALLY IN A COLLABORATIVE EFFORT WITH THE IOWA HOSPITAL ASSOCIATION. THIS INFORMATION IS SHARED IN TOTAL FOR THE ENTIRE STATE THROUGH PRESS RELEASES AND FOR OUR INDIVIDUAL HOSPITAL BY INCLUDING THIS INFORMATION IN OUR ANNUAL CORPORATE REPORT, ON OUR WEBSITE AND A LOCAL PRESS RELEASE. PART I, LINE 7: AMOUNTS REPORTED IN THIS TABLE WERE CALCULATED BASED ON IRS WORKSHEETS 1-8, USING ENTITY SPECIFIC COST TO CHARGE RATIOS. PART I, LINE 7G: THE AMOUNT REPORTED ON THIS LINE INCLUDES SUBSIDIZED HEALTH SERVICES AT TWO PHYSICIAN CLINICS LOCATED IN RURAL COMMUNITIES IN OUR GEOGRAPHIC SERVICE AREA. THE PHYSICIAN CLINICS ARE PROVIDED IN THE RURAL AND MEDICALLY UNDERSERVED COMMUNITIES OF TAMA/TOLEDO, IOWA AND MARSHALLTOWN, IOWA TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY REDUCING GEOGRAPHIC AND FINANCIAL BARRIERS. COSTS OF $1,229,205 FOR TAMA/TOLEDO AND $2,338,173 WERE INCLUDED IN COMMUNITY BENEFIT EXPENSE, AS THESE COMMUNITIES WOULD BE MEDICALLY UNDERSERVED IF THESE SERVICES WERE NOT PROVIDED. PART II, COMMUNITY BUILDING ACTIVITIES: THE COMMUNITY BUILDING ACTIVITIES EXPENSE INCURRED BY CENTRAL IOWA HEALTHCARE ARE EXPENSES INCURRED TO RECRUIT PHYSICIANS WHO WOULD NOT OTHERWISE COME TO THIS MEDICALLY UNDERSERVED AREA AND TO RETAIN PHYSICIANS IN THIS MEDICALLY UNDERSERVED AREA. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) IS DETERMINED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BY AN ALLOWANCE FOR AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS 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 UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: COSTS WERE DERIVED USING THE MEDICARE COST REPORT. THE AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: 1) MANY MEDICARE RECIPIENTS ARE LOW-INCOME INDIVIDUALS AND IF NOT FOR MEDICARE, WOULD QUALIFY FOR CHARITY CARE OR OTHER MEANS TESTED GOVERNMENT PROGRAMS 2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS 3) IRS REV RULING 69-545 ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR HOSPITALS, WHICH INDICATES THAT IF A HOSPITAL SERVES PATIENTS COVERED BY GOVERNMENTAL HEALTH BENEFITS (INCLUDING MEDICARE), THEN THIS INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: AFTER A PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS EITHER PARTIALLY OR ENTIRELY WRITTEN-OFF. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. PART VI, LINE 2: CENTRAL IOWA HEALTHCARE AND THE MARSHALL COUNTY BOARD OF HEALTH AND THE PIONEERING HEALTHIER COMMUNITY COALITION PARTNERED TO COMPLETE A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT IN CALENDAR YEAR 2013. THROUGH THESE EFFORTS, PRIORITIES AND STRATEGIES HAVE BEEN DEVELOPED. REPRESENTATIVES OF CENTRAL IOWA HEALTHCARE ARE INVOLVED IN THE ABOVE MENTIONED GROUPS AND THE LARGER COALITION. THE HEALTH NEEDS OF THE COMMUNITY ARE ASSESSED THROUGH A COMMUNITY NEEDS ASSESSMENT PROCESS EVERY THREE YEARS. A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY, AND TO ASSIST OUR COMMUNITY PARTNERS IN FOCUSING ON OUR COMMUNITIES FUTURE HEALTH NEEDS. THIS ASSESSMENT SERVES AS THE BASIS FOR MARSHALL COUNTY PUBLIC HEALTH, PIONEERING HEALTHIER COMMUNITIES, AND OUR OVERALL HEALTHCARE COMMUNITY TO DEVELOP ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES. THIS NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO - GAIN INSIGHT INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY - ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS - PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNING. CENTRAL IOWA HEALTHCARE ACTIVELY CONTRIBUTES TO THE COMMUNITY NEEDS ASSESSMENT AND ENGAGES IN THE PRIORITIES THAT MATCH ITS VISION AND MISSION. MEASUREMENT AND EVALUATION TOOLS ARE COLLECTED AND MONITORED BY THE LARGER COMMUNITY COALITION ENGAGED IN THE VARIOUS EFFORTS. IN ADDITION TO THESE ORGANIZED COMMUNITY EFFORTS, CENTRAL IOWA HEALTHCARE MONITORS COMMUNITY NEEDS SPECIFIC TO ITS SERVICE LINES AND RESOURCES AVAILABLE. INDIVIDUAL DEPARTMENTS ALSO WORK TO IDENTIFY COMMUNITY NEEDS AS RELATED TO THEIR SERVICES AND THE POPULATION SERVED. PART VI, LINE 3: SIGNS STATING THAT FINANCIAL ASSISTANCE AND FREE CARE ARE AVAILABLE AND ARE POSTED IN THE HOSPITAL REGISTRATION AND CASHIER AREAS. REGISTRATION STAFF HAVE EDUCATIONAL MATERIAL AND APPLICATION FORMS THAT ARE MADE AVAILABLE TO PATIENTS WANTING INFORMATION OR AN APPLICATION FOR OUR COMMUNITY ASSISTANCE PROGRAM. PATIENT FINANCIAL SERVICE REPS CONSULT AND ADVISE SELF PAY PATIENTS ON THEIR OPTIONS FOR GOVERNMENT SPONSORED FINANCIAL ASSITANCE AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ADDITIONALLY, AN OUTSIDE VENDOR CONTACTS ADMITTED SELF PAY PATIENTS AND DISCUSSES OPTIONS FOR GOVERNMENT SPONSORED FINANCIAL ASSISTANCE AND PROVIDES ASSISTANCE TO PATIENTS APPLYING FOR A SPECIFIC PROGRAM. OUR OUTSIDE VENDOR DIRECTS PATIENTS THAT DO NOT QUALITY FOR A GOVERNMENT SPONOSORED PROGRAM TO A HOSPITAL FINANCIAL SERVICE REPRESENTATIVE TO FOLLOW UP WITH AN APPLICATION FOR COMMUNITY ASSISTANCE. WE FURTHER USE AN "EARLY OUT" SELF PAY VENDOR THAT PROVIDES INFORMATION ON GOVERNMENT PROGRAMS AND THE HOSPITAL'S COMMUNITY ASSISTANCE PROGRAM. OUR SELF PAY VENDOR PROVIDES COMMUNITY ASSISTANCE APPLICATIONS TO PATIENTS WHEN AN APPLICATION IS REQUESTED AND MAKES REFERRALS FOR POSSIBLE APPLICATION TO GOVERNMENT SPONOSORED ASSISTANCE PROGRAMS. ALSO, A STATEMENT IS INCLUDED IN THE FIRST BILLING TO PATIENTS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. PART VI, LINE 4: MARSHALL COUNTY, POPULATION 40,746, IS COMPRISED OF 13 INCORPORATED COMMUNITIES AND THEIR SURROUNDING AREAS. THE POPULATION IS SOMEWHAT CONCENTRATED IN THE CENTRAL CITY OF MARSHALLTOWN WHERE ABOUT 66% OF COUNTY RESIDENTS LIVE. THE COUNTY'S POPULATION HAS REMAINED STABLE OVER THE PAST 50 YEARS, HOWEVER, THE DEMOGRAPHICS OF THE POPULATION HAVE SHIFTED DRAMATICALLY IN THE PAST 15 YEARS. NEW IMMGRANTS RECRUITED TO THE COMMUNITY BY THE MEAT PACKING INDUSTRY HAVE DRIVEN THESE CHANGES. LARGE NUMBERS OF HISPANIC IMMIGRANTS HAVE LEFT THE SUB-MINIMUM WAGE EXISTENCE IN CENTRAL MEXICO TO TRAVEL TO THE AMERICAN MIDWEST FOR JOBS IN MEAT PACKING. THIS INDUSTRY IS THE LARGEST PRIVATE EMPLOYER IN MARSHALL COUNTY WITH PAY RANGING FROM $9 - $13 PER HOUR. THESE CHANGES HAVE RESULTED IN AN INCREASE IN THE NUMBER OF PEOPLE LIVING IN POVERTY AND AN UPSURGE IN THE NUMBER OF UNINSURED OR UNDERINSURED RESIDENTS. MARSHALL COUNTY IS DESIGNATED AS A HEALTH PROVIDER SHORTAGE AREA (HPSA). FURTHER, THE COUNTY HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVED COMMUNITY (MUC) AND THE IMMIGRANT POPULATION HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVED POPULATION (MUP) DUE TO LANGUAGE AND CULTURAL BARRIERS IN ACCESSSING HEALTH CARE SERVICES. ACCORDING TO THE 2015 US CENSUS DATA, 20.7% OF THE MARSHALL COUNTY'S POPULATION IS OF HISPANIC OR LATINO ORIGIN COMPARED TO 5.7% IN THE STATE OF IOWA; 18.8% OF MARSHALL COUNTY'S POLUATION (AGE 5+) SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME COMPARED TO 7.4% IN THE STATE OF IOWA; 84.7% OF MARSHALL COUNTY RESDIENTS ARE HIGH SCHOOL GRADUATES COMAPRED TO 91.3% IN IOWA; 20.1% OF MARSHALL COUNTY POPULATION HAD A BACHELOR'S DEGREE OR HIGHER COMPARED TO 26.4% IN IOWA (2000); THE MEDIAN HOUSEHOLD INCOME IN 2010-2014 IN MARSHALL COUNTY WAS 52,354 COMPARED TO 52,716 IN IOWA; PERSONS LIVING BELOW POVERTY IN MARSHALL COUNTY WAS 13% COMPARED TO 12.2% IN IOWA. PART VI, LINE 5: CENTRAL IOWA HEALTHCARE IS A SOLE COMMUNITY HOSPITAL AND A RURAL REFERRAL CENTER BY CMS'S DEFINITIONS. THE HOSPITAL IS LOCATED IN A RURAL, MEDICALLY UNDERSERVED AREA AND IS THE ONLY HOSPITAL WITHIN A 30 MILE RADIUS. THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES AND CONTINUALLY IMPROVING SERVICES TO RESPOND TO HEALTH CARE NEEDS. THE HOSPITAL PROVIDES A 24 HOUR EMERGENCY DEPARTMENT, INCLUDING AMBULANCE COVERAGE, AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. A MAJORITY 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, NOR FAMILY MEMBERS THEREOF AND ARE A BROAD CROSS SECTION OF COMMUNITY LEADERS. THE ORGANIZATION PROVIDES AN OPEN MEDICAL STAFF TO ALL QUALIFIED PHYSICIANS, SUBJECT TO THE NORMAL, EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, EMERGENCY DEPARTMENT, AND HEART CATHETERIZATION LAB. THE EXCLUSIVE CONTRACTS ARE NECESSARY TO ASSURE THAT THESE MUCH NEEDED SERVICES ARE PROVIDED IN THIS RURAL MEDICALLY UNDERSERVED COMMUNITY. ALL SURPLUS FUNDS ARE USED TO MEET AND TO RESPOND TO THE HEALTHCARE NEEDS OF THE COMMUNITIES THIS ORGANIZATION SERVES. 1 MARSHALL COUNTY EMERGENCY MEDICAL SERVICES 1 E MAIN STREET MARSHALLTOWN IA 50158 426004936 MARSHALL COUNTY 5609 GENERAL SUPPORT 1 0 PART I, LINE 2: THE ORGANIZATION ISSUES FUNDS DIRECTLY TO THE RECIPIENT ORGANIZATION FOR USE AT ITS DISCRETION. X X X 1 0 0 0 0 0 0 0 0 POLLY HINEMAN MD FORMER TRUSTEE/PHYSICIAN 168997 0 0 0 1050 0 8450 0 1324 0 179821 0 0 0 JOHN C HUGHES PRESIDENT & CHIEF EXECUTIVE OFFICER 267823 0 0 0 8684 0 13601 0 18844 0 308952 0 0 0 HILARY DOLBEE FORMER V.P. OF FINANCE 152796 0 0 0 195 0 7681 0 7488 0 168160 0 0 0 LIZ ZUERCHER FORMER V.P. OF ADMINISTRATION 154900 0 0 0 486 0 7944 0 19200 0 182530 0 0 0 SADIA ASHRAF-BENSON DO PHYSICIAN 234342 0 0 0 25363 0 12967 0 1692 0 274364 0 0 0 BONTE GBEMUDU MD PHYSICIAN 218908 0 0 0 240 0 11185 0 15995 0 246328 0 0 0 JOHN MCCUNE MD PHYSICIAN 309589 0 11314 0 3346 0 16316 0 21573 0 362138 0 0 0 RONALD TERRILL MD PHYSICIAN 229560 0 0 0 4724 0 11718 0 16034 0 262036 0 0 0 YARED VAZQUEZ MD PHYSICIAN 204592 0 0 0 286 0 10501 0 20973 0 236352 0 0 0 ROBERT L DOWNEY FORMER CHIEF FINANCIAL OFF 0 0 0 0 201246 0 0 0 12501 0 213747 0 0 0 PART I, LINE 4A THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT OR CHANGE OF CONTROL PAYMENT IN TAX YEAR 2014: ROBERT L. DOWNEY - $197,431. THIS AMOUNT IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS IN THIS ENTITY SHALL BE BONA FIDE CITIZENS OF THE AREA SERVED BY THIS HOSPITAL WHO ARE AT LEAST 18 YEARS OF AGE AND WHO HAVE PAID THEIR ANNUAL DUES. FORM 990, PART VI, SECTION A, LINE 7A AN ANNUAL MEETING IS HELD IN WHICH THE AGENDA INCLUDES ELECTION OF TRUSTEES. PROXY VOTES MAY BE CAST BY ELIGIBLE MEMBERS WHO ARE UNABLE TO ATTEND THE MEETING. THE BOARD MEMBERSHIP SHALL INCLUDE MEMBERS FROM THE COMMUNITIES THAT ARE SERVED BY CENTRAL IOWA HEALTHCARE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND ALL RELATED SCHEDULES AND SUPPLEMENTAL INFORMATION ARE EMAILED TO THE BOARD FOR A REVIEW PERIOD AND ALL QUESTIONS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY REQUIRES ANNUAL CERTIFICATION THAT EACH TRUSTEE HAS THE CONFLICT OF INTEREST POLICY, THAT THEY HAVE A COPY OF THE SECTION OF THE ORGANIZATIONAL BY-LAWS THAT DISCUSSES CONFLICTS OF INTEREST, AND THAT THEY AGREE TO COMPLY WITH THE POLICY. THE EXECUTIVE ASSISTANT TO THE PRESIDENT IS ASSIGNED TO ENSURE THAT ALL RECIPIENTS ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY. THE DIRECTOR OF ACCOUNTING/FINANCE REVIEWS THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE IF A CONFLICT DOES EXIST. IF A POTENTIAL CONFLICT IS DISCLOSED, THE INDIVIDUAL IS ALLOWED TO MAKE A PRESENTATION CONCERNING THE PROPOSED TRANSACTION BUT IS THEN ASKED TO LEAVE THE ROOM WHILE FURTHER DISCUSSION TAKES PLACE AND THE REST OF THE BOARD DETERMINES WHETHER OR NOT TO ENTER THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT BOARD MEMBERS WHO MEET MULTIPLE TIMES PER YEAR TO REVIEW THE IOWA HOSPITAL ASSOCIATION'S WAGE SURVEY DATA. THE COMMITTEE RECOMMENDS CHANGES BASED ON SURVEY COMPARISONS AND ANNUAL PERFORMANCE EVALUATIONS. THE RECOMMENDATIONS ARE PRESENTED TO THE FULL BOARD. NO INCREASES WERE GIVEN IN THE CURRENT YEAR. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G ER FEES: PROGRAM SERVICE EXPENSES 2,141,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,141,316. ANESTHESIA FEES: PROGRAM SERVICE EXPENSES 2,280,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,280,000. CARDIOLOGY FEES: PROGRAM SERVICE EXPENSES 220,620. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 220,620. HOSPITALIST FEES: PROGRAM SERVICE EXPENSES 1,561,696. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,561,696. ENT FEES: PROGRAM SERVICE EXPENSES 75,568. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,568. ORTHO FEES: PROGRAM SERVICE EXPENSES 1,125,241. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,125,241. PEDIATRIC CALL FEES: PROGRAM SERVICE EXPENSES 175,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,200. SURGICAL CALL FEES: PROGRAM SERVICE EXPENSES 194,025. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 194,025. ORTHO CALL FEES: PROGRAM SERVICE EXPENSES 225,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 225,000. PATHOLOGY FEES: PROGRAM SERVICE EXPENSES 150,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,000. OTHER PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 154,225. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,225. CLINICAL ENGINEERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 240,561. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 240,561. UTILIZATION REVIEW SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 189,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189,967. PURCHASED SERVICE FEES: PROGRAM SERVICE EXPENSES 1,092,962. MANAGEMENT AND GENERAL EXPENSES 147,255. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,240,217. DIAG IMAGING SERVICE FEES: PROGRAM SERVICE EXPENSES 909,899. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 909,899. CATH LAB SERVICE FEES: PROGRAM SERVICE EXPENSES 80,841. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,841. LAB SERVICE FEES: PROGRAM SERVICE EXPENSES 88,249. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 88,249. BILLING SERVICE AND COLLECTION FEES: PROGRAM SERVICE EXPENSES 311,704. MANAGEMENT AND GENERAL EXPENSES 632,841. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 944,545. STAFFING SERVICE FEES: PROGRAM SERVICE EXPENSES 4,248,453. MANAGEMENT AND GENERAL EXPENSES 51,153. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,299,606. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF CENTRAL IOWA HEALTHCARE FOUNDATION -2,615. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. FORM 990, PART VI, SECTION B, LINE 16B WHILE CENTRAL IOWA HEALTHCARE DID NOT HAVE A WRITTEN POLICY OR PROCEDURE IN PLACE TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS IN THE FISCAL YEAR-ENDED OCTOBER 31, 2015, THE ORGANIZATION IS CURRENTLY DEVELOPING SUCH POLICIES AND PROCEDURES AND PLANS TO HAVE THEM IN PLACE PRIOR TO THE YEAR-ENDING OCTOBER 31, 2016. CENTRAL IOWA PHYSIO LLC 4714 GETTYSBURG ROAD MECHANICSBURG PA 17055 364799633 PHYSICAL THERAPY REHABILITATION IA CENTRAL IOWA HEALTHCARE RELATED 58136 583136 0 0 0.50000 MARSHALLTOWN MOB 1 MANAGING MEMBER LLC 4706 BROADWAY SUITE 240 KANSAS CITY MO 64112 464821701 REAL ESTATE DE CENTRAL IOWA HEALTHCARE RELATED 195768 3695768 0 0 0.63390 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 CENTRAL IOWA PHYSIO LLC B 525000 FAIR MARKET VALUE CENTRAL IOWA PHYSIO LLC S 400000 FAIR MARKET VALUE