PELLA REGIONAL HEALTH CENTER: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PELLA REGIONAL HEALTH CENTER (EIN 42-0842204)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-08-03
- IRS object ID
- 201542159349300844
- Schema version
- 2014v5.0
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-03T14:28:18-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1545 ASSOCIATES DR STE 101 | AddressLine1Txt |
| City | DUBUQUE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420842204 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pella Regional Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PELL | BusinessNameControlTxt |
| Phone | 6416283150 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 Jefferson Street | AddressLine1Txt |
| City | Pella | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robert Kroese | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6416283150 | PhoneNum |
| Signature | 2015-08-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carmen Krantz | PreparerPersonNm |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2015-08-03 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Robert Kroese | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 Jefferson Street | AddressLine1Txt |
| City | Pella | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $111,853,919 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pellahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1958 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | Provide healthcare and healing services with Christian compassion. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 902 | TotalEmployeeCnt |
| Total Volunteers | 245 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $153,450 | PYContributionsGrantsAmt |
| CY Contributions Grants | $406,103 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $77,103,234 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $79,137,805 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,307,537 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,762,871 | CYInvestmentIncomeAmt |
| PY Other Revenue | $217,995 | PYOtherRevenueAmt |
| CY Other Revenue | $225,586 | CYOtherRevenueAmt |
| PY Total Revenue | $79,782,216 | PYTotalRevenueAmt |
| CY Total Revenue | $82,532,365 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,101 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,411 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $44,496,735 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $44,316,257 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,822,925 | PYOtherExpensesAmt |
| CY Other Expenses | $31,753,247 | CYOtherExpensesAmt |
| PY Total Expenses | $74,324,761 | PYTotalExpensesAmt |
| CY Total Expenses | $76,072,915 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,457,455 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,459,450 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $127,991,015 | TotalAssetsBOYAmt |
| Total Assets EOY | $134,990,288 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $55,374,848 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $55,321,334 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $72,616,167 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $79,668,954 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of Pella Regional Health Center is to provide healthcare and healing services with Christian compassion. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $60,413,711 | ExpenseAmt |
| Grant | $3,411 | GrantAmt |
| Revenue | $77,801,338 | RevenueAmt |
| Desc | Pella Regional Health Center (Health Center) is a 25-bed acute care hospital located in Pella, Iowa. The Health Center also operates clinics in Monroe, Sully, Knoxville, Newton, Bussey, Albia and Ottumwa, Iowa. Annually, the Health Center has over 1,500 admissions, over 490 live births; over 12,700 Emergency Center visits; and performs over 4,500 surgeries.Pella Regional Health Center leads in the delivery of healthcare services to its region with over 800 associates (including 30 physicians) which coordinate patient care as an integrated unit. PRHC and its associates work seamlessly to meet the needs of the communities they serve. The accomplishments which follow are attributable to the Health Center and its affiliates as a whole.The Health Center also makes medical care accessible to the entire region it serves. Pella Regional Health Center operates a full-time emergency room and provides emergency care regardless of ability to pay. The Health Center provides the clinical/ancillary services required to operate the Emergency Center and provides full-time on-site emergency medical services. In addition, Pella Regional Health Center, through its integrated network of providers, provides non-emergency services to the region it serves. It makes these services accessible to the region through participation in government programs like Medicare and Medicaid and by offering assistance through the Health Center's Charity Care program. The Health Center provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Health Center does not pursue collection of amounts, determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Health Center's charity care policy was approximately $666,000 for the year ended December 31, 2014. Total direct and indirect costs related to these forgone charges were $317,000 at December 31, 2014 based on an average ratio of cost to gross charges.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.Pella Regional Health Center takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the region it serves. The Health Center strives to identify the needs of the region beyond basic healthcare, and then responds to them by aiming to make a positive, life-enhancing difference in the region. Pella Regional Health Center takes a strategic, regional needs based approach to delivering benefits to the region. Administration has responsibility for leading the organization to achieve the following objectives: 1. To collaborate with local leadership committees to identify unmet community health needs and under-served populations throughout the region2. To address underserved populations with unmet needs throughout the region3. To implement, coordinate and provide strategic management of the Health Center's community benefit efforts4. To improve the overall health of all communities served throughout the region. This position links all community benefit activities under one management umbrella with a consistent contact point. Organizational focus on community benefit has been elevated by strengthening infrastructure to support and communicate community benefit work. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,122,974 | ExpenseAmt |
| Revenue | $1,336,467 | RevenueAmt |
| Desc | Pella Regional Health Center operates a 63-bed skilled nursing facility located in Pella, Iowa. The facility offers long and short term care for individuals who need rehabilitation services or who suffer from serious or persistent health issues that are too complicated to be tended to at home or at an assisted living facility. Skilled care provides patients with the opportunity to transition smoothly and safely from an acute hospital setting to skilled care and finally to their homes or previous living environment.Staff provides:-24 hour nursing care under the supervision of a registered nurse. -Medications and treatments administered as prescribed by physician. -Individualized case management for all patients. -Rehabilitation services-physical therapy, occupational therapy, speech therapy, respiratory therapy, certified wound nurses, intravenous therapy. -Nutrition and pharmaceutical counseling. -Social services and spiritual services. -Laboratory, emergency and medical imaging is available within hospital. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $62,536,685 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 902 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bruce Heifner | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6416286603 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 Jefferson Street | AddressLine1Txt |
| City | Pella | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| James Brandl | ||||||||
| President | 0.50 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Rod Braun | ||||||||
| Vice President | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Randy Stravers | ||||||||
| Treasurer | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Vivian Rippentrop | ||||||||
| Secretary | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Timothy Yoder DVM | ||||||||
| Director | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Craig Wittenberg MD | ||||||||
| Director | 40.00 | 0.00 | Yes (X) | $454,537 | $0 | $37,887 | ||
| John Koolstra | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| David Smart | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mike Morgan | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Michael Thompson DO | ||||||||
| Director | 40.00 | 0.00 | Yes (X) | $349,951 | $0 | $37,887 | ||
| John Vander Wert | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Anne Hellbusch DO | ||||||||
| Director/Chief of Staff | 40.00 | 0.00 | Yes (X) | $317,272 | $0 | $32,453 | ||
| Mike Lind | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Robert Kroese | ||||||||
| CEO | 40.00 | 2.00 | Yes (X) | $359,588 | $0 | $33,390 | ||
| Ronald Wauters | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $181,363 | $0 | $26,879 | ||
| Dale Lensing MD | ||||||||
| Gynecologist | 40.00 | 0.00 | $361,653 | $0 | $40,386 | Yes (X) | ||
| Joseph Coleman MD | ||||||||
| Gynecologist | 40.00 | 0.00 | $364,743 | $0 | $37,582 | Yes (X) | ||
| Doug Kanis DO | ||||||||
| Emergency physician | 40.00 | 0.00 | $397,257 | $0 | $37,287 | Yes (X) | ||
| Spencer Carlstone MD | ||||||||
| General Surgery | 40.00 | 0.00 | $360,863 | $0 | $37,503 | Yes (X) | ||
| Matthew Morgan DO | ||||||||
| General Surgery | 40.00 | 0.00 | $415,690 | $0 | $37,503 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,562,917 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $358,757 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 48 | 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 |
|---|---|---|---|---|---|
| Siemens Financial Services Inc | |||||
| PO Box 2083 | Carol Stream | IL | 601322083 | Radiology contract | $586,386 |
| Medical Information Technology | |||||
| PO Box 74569 | Chicago | IL | 60696 | Maintenance contract | $438,843 |
| Cassling Diagnostic Imaging | |||||
| PO Box 3045 | Omaha | NE | 681030045 | Radiology | $310,341 |
| United Shockwave Services | |||||
| PO Box 2178 | Des Plaines | IL | 600172178 | Technical contract | $307,300 |
| Lamair-Mulock-Condon | |||||
| 4200 University Ave Suite 200 | Des Moines | IA | 502665945 | Insurance risk management provider | $266,196 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $5,900 | FederatedCampaignsAmt |
| Related Organizations | $320,000 | RelatedOrganizationsAmt |
| Government Grants | $7,416 | GovernmentGrantsAmt |
| All Other Contributions | $72,787 | AllOtherContributionsAmt |
| Total Contributions | $406,103 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $74,557,943 | $74,557,943 |
| Long-term care revenue | 623990 | $1,336,467 | $1,336,467 |
| Medicare/Medicaid incentive payme | 900099 | $301,525 | $301,525 |
| Vermeer Clinic | 621110 | $90,000 | $90,000 |
| Meaningful use revenue | 900099 | $77,231 | $77,231 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,774,639 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,774,639 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $79,137,805 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,120,338 | TotalRevenueColumnAmt |
| Exclusion | $1,120,338 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $234,008 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,422 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $225,586 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $225,586 | TotalRevenueColumnAmt |
| Exclusion | $225,586 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $30,863,554 | SecuritiesAmt |
| Other | $92,111 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $28,556,814 | SecuritiesAmt |
| Other | $756,318 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,306,740 | SecuritiesAmt |
| Other | -$664,207 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,642,533 | TotalRevenueColumnAmt |
| Exclusion | $1,642,533 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $82,532,365 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $79,137,805 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,988,457 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,411 | TotalAmt |
| Program Services | $3,411 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,831,207 | TotalAmt |
| Program Services | $1,229,987 | ProgramServicesAmt |
| Management And General | $601,220 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,079,527 | TotalAmt |
| Program Services | $28,308,754 | ProgramServicesAmt |
| Management And General | $5,770,773 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,760,428 | TotalAmt |
| Program Services | $1,441,949 | ProgramServicesAmt |
| Management And General | $318,479 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,359,211 | TotalAmt |
| Program Services | $2,600,378 | ProgramServicesAmt |
| Management And General | $1,758,833 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,285,884 | TotalAmt |
| Program Services | $1,852,802 | ProgramServicesAmt |
| Management And General | $433,082 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,901 | TotalAmt |
| Management And General | $94,901 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,278 | TotalAmt |
| Management And General | $86,278 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,837,428 | TotalAmt |
| Program Services | $3,557,166 | ProgramServicesAmt |
| Management And General | $2,280,262 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,003 | TotalAmt |
| Program Services | $253,032 | ProgramServicesAmt |
| Management And General | $88,971 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,721,135 | TotalAmt |
| Program Services | $2,696,078 | ProgramServicesAmt |
| Management And General | $1,025,057 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,217,640 | TotalAmt |
| Program Services | $1,147,680 | ProgramServicesAmt |
| Management And General | $69,960 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,270 | TotalAmt |
| Program Services | $172,787 | ProgramServicesAmt |
| Management And General | $5,483 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,365 | TotalAmt |
| Program Services | $197,074 | ProgramServicesAmt |
| Management And General | $100,291 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,457,281 | TotalAmt |
| Program Services | $2,457,281 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,071,246 | TotalAmt |
| Program Services | $5,071,246 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $655,242 | TotalAmt |
| Program Services | $162,141 | ProgramServicesAmt |
| Management And General | $493,101 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $9,737,704 | $9,737,704 | |
| Provision for bad debts | $1,583,195 | $1,583,195 | |
| Food | $372,601 | $5,579 | $367,022 |
| Dues and memberships | $99,193 | $58,441 | $40,752 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,765 | TotalAmt |
| Management And General | $1,765 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,072,915 | TotalAmt |
| Program Services | $62,536,685 | ProgramServicesAmt |
| Management And General | $13,536,230 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,546,158 | BOYAmt |
| EOY | $2,700,154 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,491,867 | BOYAmt |
| EOY | $9,555,158 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $494,625 | BOYAmt |
| EOY | $497,416 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $810,458 | BOYAmt |
| EOY | $862,427 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $106,080,631 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $54,498,207 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,671,149 | BOYAmt |
| EOY | $51,582,424 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,247,663 | BOYAmt |
| EOY | $67,225,690 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,600 | BOYAmt |
| EOY | $1,600 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,727,495 | BOYAmt |
| EOY | $2,565,419 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,991,015 | BOYAmt |
| EOY | $134,990,288 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,955,273 | BOYAmt |
| EOY | $5,074,162 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $335,292 | BOYAmt |
| EOY | $150,741 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,549,649 | BOYAmt |
| EOY | $47,500,592 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $900 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,134 | BOYAmt |
| EOY | $1,044,240 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,476,600 | BOYAmt |
| EOY | $1,551,599 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,374,848 | BOYAmt |
| EOY | $55,321,334 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,608,667 | BOYAmt |
| EOY | $79,661,454 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,500 | BOYAmt |
| EOY | $7,500 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,616,167 | BOYAmt |
| EOY | $79,668,954 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,991,015 | BOYAmt |
| EOY | $134,990,288 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $6,459,450 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,095,522 | NetUnrlzdGainsLossesInvstAmt |
| Investment Expense | -$502,185 | InvestmentExpenseAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $158 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $158 | OtherExpendituresAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,500 | BeginningYearBalanceAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,348,500 | BeginningYearBalanceAmt |
| Other Expenditures | $1,341,000 | OtherExpendituresAmt |
| End Year Balance | $7,500 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,830,983 | OtherCostOrOtherBasisAmt |
| Book Value | $4,830,983 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $207,671 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $76,332,059 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,817,202 | DepreciationAmt |
| Book Value | $40,722,528 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,608,703 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,032,581 | DepreciationAmt |
| Book Value | $5,576,122 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,101,215 | OtherCostOrOtherBasisAmt |
| Depreciation | $648,424 | DepreciationAmt |
| Book Value | $452,791 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $51,582,424 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated health claims payable | $480,000 |
| Annuity payable | $599 |
| Estimated third-party payor settlements | $1,071,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,551,599 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | House rent deposits held by the organization. |
| Part V, Line 4: | The intended use of the endowment funds is to serve the purpose of the restrictions placed on the funds by the respective donors. |
| Part X, Line 2: | The Health Center is organized as an Iowa non-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Health Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Health Center has determined that they are not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Health Center believes it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | 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 | $317,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $317,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,312,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,601,291 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $710,889 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00950 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,629,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,601,291 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,027,889 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,308,636 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,569,848 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,738,788 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10390 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,308,636 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,569,848 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,738,788 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10390 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,937,816 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,171,139 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,766,677 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11770 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,583,195 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $6,333 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,567,976 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,859,218 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,291,242 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pella Regional Health Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 Jefferson Street | AddressLine1Txt |
| City | Pella | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.pellahealth.org | WebsiteAddressTxt |
| State License | 630165H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 3 provider based RHCs - Ottumwa, Monroe and Sully | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pella Regional Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.pellahealth.org/about-us/community/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.pellahealth.org/about-us/community/ | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pella Regional Health Center | Part V, Section B, Line 5: Each community has a wealth of expertise to be tapped for CHNA development. For this reason, a town hall is the perfect forum to gather community insight and provide an atmosphere to objectively build consensus and prioritize county health issues.All Town Hall priority-setting and scoring processes involve the input of key stakeholders in attendance. Individuals and organizations attending the Town Halls were critically important to the success of the CHNA.The following list outlines partners invited to Town Hall: local hospital, public health community, mental health community, free clinics, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. |
| Pella Regional Health Center | Part V, Section B, Line 11: The 2014 Implementation Plan describes the following needs that will be addressed in the future.1. Increase outpatient mental health services and substance abuse. The Health Center will continue partnerships with mental health agencies, explore grants, increase patient and staff knowledge, and recruit psychiatric providers in the immediate area.2. Increase inpatient mental health services. The Health Center will increase outpatient services to prevent the need for inpatient services and increase patients' and provider/staff awareness of available services.3. Fight obesity and focus on fitness, nutrition and prevention actions. Pella Regional will promote fitness and healthy lifestyles focusing on accessible fitness facilities, health fairs and classes. The Health Center will also promote existing walking trails to neighboring communities, increase access to healthy food for seniors, including education on reading labels, and continue to promote WIC and SNAP programs.4. Provide insurance price transparency. The Health Center will maintain and distribute contact information of Patient Advocacy Program and increase web presence of patient advocate information.5. Improve local cardiac services. Two physicians collaborate with Iowa Clinic Cardiology to increase the number of days and services provided at PRHC. A physician will collaborate with the Iowa Clinic Cardiology to manage a CHF clinic at PRHC. The hours and days per week a cardiologist is available at PRHC will increase to 5 days per week. Capital equipment will be considered for testing and diagnostics. RN staff and mid-level providers will be trained to supervise stress tests to increase the available times for services to our patients.6. Explore/develop a stand alone Urgent Care. Extend after our call center and provide mid-level support for extended hours.7. Address dementia services. Educate individuals on current services available in Pella, research opportunities for collaboration with Alzheimer's Research Universities for standardized testing, results and provide physicians with screening tools. The needs to provide more affordable nursing home options and improve water quality are not part of Pella Regional's mission or core business operations. PRHC will partner with Hearthstone and Vriendschap Village on actions for nursing home options and Central College on actions to address water quality. |
| Pella Regional Health Center | Part V, Section B, Line 13h: Pella Regional Health Center also reviews a patient's monthly income, expenses, assets, liabilities, prior health history and total outstanding bills in addition to providing free or discounted care based on the Federal Poverty Guidelines. The Federal Poverty Guidelines are used as a starting point to determine financial assistance, but several other factors are taken into consideration before determining how much of a patient's bill will be written off to charity care if the patient's earnings are above the 200% Federal Poverty Guideline base amount.The Health Center also offers uninsured patients a 20% cash discount for final bills paid in full within 60 days. The Health Center does not charge interest on unpaid balances when payment plans are set up within 60 days of patients receiving their final bill. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 11 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Pella Medical Clinic | ||||
| 405 Monroe | Pella | IA | 50219 | Physician clinic |
| Pella Regional Health Center ICF | ||||
| 404 Jefferson Street | Pella | IA | 50219 | Intermediary care facility |
| Convenient Care | ||||
| 404 Jefferson Street | Pella | IA | 50219 | Acute care |
| Knoxville Medical Clinic | ||||
| 1208 N Lincoln | Knoxville | IA | 50138 | Physician clinic |
| Hospice of Pella (Comfort House) | ||||
| 505 Union Street | Pella | IA | 50219 | Hospice |
| Home Health | ||||
| 1119 E 2nd Street | Pella | IA | 50219 | Home health care |
| Vermeer Health Services Center | ||||
| 1210 Vermeer Road East | Pella | IA | 50219 | Physician clinic |
| Bussey Medical Clinic | ||||
| 411 Merrill Street | Bussey | IA | 50044 | Physician clinic |
| Diamond Trail Fitness Center | ||||
| 12498 Highway F62E | Sully | IA | 50251 | Physical therapy |
| Newton Occupational Health Clinic | ||||
| 321 E Third St N | Newton | IA | 50208 | Occupational health - closed March 2014 |
| Clow Occupational Health Clinic | ||||
| 902 S 2nd Street | Oskaloosa | IA | 52577 | Occupational health |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Pella Regional Health Center also reviews a patient's monthly income, expenses, assets, liabilities, prior health history and total outstanding bills in addition to providing free or discounted care based on the Federal Poverty Guidelines. The Federal Poverty Guidelines are used as a starting point to determine financial assistance, but several other factors are taken into consideration before determining how much of a patient's bill will be written off to charity care if the patient's earnings are above the 200% Federal Poverty Guideline base amount.The Health Center also offers uninsured patients a 20% cash discount for final bills paid in full within 60 days. The Health Center does not charge interest on unpaid balances when payment plans are set up within 60 days of patients receiving their final bill. |
| Part I, Line 6a: | Pella Regional Health Center's community benefit report can be found on their website at www.pellahealth.org. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services, line 7e, health professions education, line 7f, and cash and in-kind contributions, line 7i are reported based on actual expense and revenue amounts recorded from the events in the general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. |
| Part I, Line 7g: | Costs of $403,041 were included in subsidized health services reported on Line 7g. These are the costs to operate a physician clinic, Bussey Medical Clinic. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $1,583,195. |
| Part III, Line 2: | Patient accounts are written off to bad debt after every effort is made to collect the balance and patients are given opportunities to complete charity care applications or set up payment plans. All discounts and contractual adjustments are applied to accounts before they are written off to bad debt. Current payments on accounts previously written off as bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on an estimate of charges foregone to gross patient charges. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. |
| Part III, Line 8: | The entire Medicare shortfall would be considered a community benefit. Pella Regional Health Center provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare Cost Report for the year.Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | Pella Regional Health Center's collection policy has provisions for patients that qualify for financial assistance or charity care and for patients in the process of applying for assistance. Pella Regional Health Center does not pursue collection efforts while a patient is in the process of applying for any type of assistance or for any portion of a patient's bill considered charity care. After assistance is determined, any personal portion due would follow the same collection procedures as other patients. If a payment plan is established and the patient defaults, their charity care status is revoked and the remaining balance is sent to collections. |
| Part VI, Line 2: | Pella Regional Health Center participated in a community engagement project in 2011. This project included a community health needs assessment, key informant interviews, and secondary data analysis administered by the National Rural Health Resource Center of Duluth, Minn. The Health Implementation Plan (HIP) from the 2011 CHNA will be closed as of Dec. 31, 2014. A new CHNA was completed in 2014. This project included a community health needs survey, community leaders focus group, and secondary data analysis administered by the VVV Marketing & Development INC of Olathe, Kansas.In April 2014, Pella Regional began its second Community Health Needs Assessment process. Over the summer, a random, stratified sample of 1,000 residents within Pella Regional's service area was surveyed, and 225 surveys were returned providing a 22.5 percent response rate. In addition, a focus group with 50 community leaders including senior citizens, consumers, health care providers/clinicians, educators, business owners, clergy and law enforcement offered qualitative information to supplement the survey. The community health needs assessment identified community health strengths and weaknesses. Our formal community health needs assessment and health implementation plan was posted to our website in December 2014. |
| Part VI, Line 3: | Pella Regional Health Center's Patient Advocates are available to work with patients prior to non-emergency services to review specific insurance situations and the doctor's recommended service for the patient. The advocate estimates each patient's actual cost and works with them to find the best method of payment, or help determine eligibility for charity care from Pella Regional or through government programs. Patients are encouraged and receive assistance in completing charity care forms, and payment plans are presented as options. Pella Regional Health Center works with patients to establish payment plans that are tailored to their ability to pay. |
| Part VI, Line 4: | Pella Regional Health Center is a critical access hospital that offers a large array of both inpatient and outpatient services. PRHC has a racially homogenous service area that covers Marion, Mahaska, Jasper and Wapello counties in Iowa. Pella is a thriving community approximately 40 miles southeast of Des Moines, Iowa and is home to not only Pella Regional Health Center (PRHC) but also the corporate headquarters for Pella Corp, a large manufacturer of windows and doors, and Vermeer Corporation, the manufacturer of industrial and agricultural equipment. Both companies are known worldwide. Pella is very fortunate to have this type of industrial and financial base. The population in Pella, IA for 2013 was 10,344. Median household income in 2012 was $58,241 and there were 8.8% of people living in poverty. The unemployment rate population 25 years and over was 2.9%. This information was obtained from www.city-data.com/city/Pella-Iowa.html. |
| Part VI, Line 5: | The Board members all reside in the service area. A majority of the board members are not employed by Pella and none are family members. Physicians are encouraged to participate on the Board as they have direct contact with our patients and know firsthand the needs of the community. Pella Regional Health Center extends medical staff privileges to all qualified physicians in its community except for physicians with pending quality issues. The organization applies surplus funds to improve patient care, medical education, and research through the normal budget and capital budget processes. Also, Pella Regional Health Center promotes the health of the community by operating an emergency room available to all regardless of ability to pay, participating in government-sponsored health programs and volunteering in the community. |
| Part VI, Line 7, Reports Filed With States | IA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Craig Wittenberg MD | ||||||||||||||
| Director | $120,824 | $0 | $331,366 | $0 | $2,347 | $0 | $15,600 | $0 | $22,287 | $0 | $492,424 | $0 | $0 | $0 |
| Michael Thompson DO | ||||||||||||||
| Director | $336,309 | $0 | $11,374 | $0 | $2,268 | $0 | $15,600 | $0 | $22,287 | $0 | $387,838 | $0 | $0 | $0 |
| Anne Hellbusch DO | ||||||||||||||
| Director/Chief of Staff | $17,189 | $0 | $298,078 | $0 | $2,005 | $0 | $15,600 | $0 | $16,853 | $0 | $349,725 | $0 | $0 | $0 |
| Robert Kroese | ||||||||||||||
| CEO | $252,351 | $0 | $105,614 | $0 | $1,623 | $0 | $15,600 | $0 | $17,790 | $0 | $392,978 | $0 | $0 | $0 |
| Ronald Wauters | ||||||||||||||
| CFO | $166,511 | $0 | $12,726 | $0 | $2,126 | $0 | $10,993 | $0 | $15,886 | $0 | $208,242 | $0 | $0 | $0 |
| Dale Lensing MD | ||||||||||||||
| Gynecologist | $348,154 | $0 | $11,374 | $0 | $2,125 | $0 | $15,600 | $0 | $24,787 | $0 | $402,040 | $0 | $0 | $0 |
| Joseph Coleman MD | ||||||||||||||
| Gynecologist | $350,948 | $0 | $11,374 | $0 | $2,421 | $0 | $15,600 | $0 | $21,982 | $0 | $402,325 | $0 | $0 | $0 |
| Doug Kanis DO | ||||||||||||||
| Emergency physician | $96,923 | $0 | $298,078 | $0 | $2,256 | $0 | $15,600 | $0 | $21,687 | $0 | $434,544 | $0 | $0 | $0 |
| Spencer Carlstone MD | ||||||||||||||
| General Surgery | $13,239 | $0 | $345,441 | $0 | $2,183 | $0 | $15,600 | $0 | $21,903 | $0 | $398,366 | $0 | $0 | $0 |
| Matthew Morgan DO | ||||||||||||||
| General Surgery | $402,048 | $0 | $11,374 | $0 | $2,268 | $0 | $15,600 | $0 | $21,903 | $0 | $453,193 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | Bonuses are determined and paid out based on a percentage of the employee's annual income. The percentage utilized is derived from meeting the overall quality, service, people, growth and financial strategic plan benchmarks set specifically for the organization. We also benchmark against the Iowa Hospital Association's salary and benefit guidelines. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Iowa Finance Authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 521699886 | BondIssuerEIN |
| CUSIP | 462466BL6 | CUSIPNum |
| Bond Issued | 2006-09-28 | BondIssuedDt |
| Issue Price | $46,610,641 | IssuePriceAmt |
| Purpose | Remodeling project & refund bonds issued 12/26/2000 & 1/1/2002 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $46,611,824 | TotalProceedsAmt |
| In Reserve Fund | $3,286,830 | InReserveFundAmt |
| Capitalized Interest | $11 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $601,579 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $1,916,534 | CreditEnhancementAmt |
| Capital Expenditures | $33,346,715 | CapitalExpendituresAmt |
| Other Spent Proceeds | $7,460,496 | OtherSpentProceedsAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Date Rebate Computation Performed | Issuer Name: Iowa Finance Authority Date the Rebate Computation was Performed: 12/01/2010 |
| Schedule K, Part II, Line 11: | The other spent proceeds were used to currently refund bonds on September 28, 2006. |
| Schedule K, Part II, Line 3: | Total proceeds of issue includes $843 in interest earned on bond proceeds. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | Occupational Health began in Ottumwa, IA in March 2014. |
| Form 990, Part III, line 3 | The Intermediate care facility closed in February 2014. Occupational Health closed in Newton, IA in February 2014. |
| Form 990, Part VI, Section A, line 1 | The Executive Committee is composed of the President, Vice President, Secretary and Treasurer. The Committee acts for the Board of Trustees and directs and controls the affairs of the Corporation during the interim between Board meetings but subject to the supervision of the Board and provided any action taken does not conflict with the policies and expressed wishes of the Board. The Executive Committee keeps an accurate and complete record of all of its proceedings and the record must be submitted for confirmation to the Board of Trustees at the Board's next meeting and made a part of the minutes. The Executive Committee has the right to approve or reject the CEO's recommendations on employment of personnel, plan of internal organization of the Corporation, and rules and regulations defining duties, hours and interdepartmental relationships of personnel. |
| Form 990, Part VI, Section A, line 7a | Any vacancy in the position of the Appointed Trustee who is the Chief of Staff should be filled by the successor Chief of Staff, or if none at the time, then the vacancy should be filled by the Vice President of the Medical Staff. Any vacancy in the position of the voting Appointed Trustee who is the Medical Director should be filled by a physician selected by the CEO and approved by the Medical Executive Committee and the Board. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is distributed to the Board's Finance Committee and provided to all Board Members prior to filing. It is also reviewed by the CEO and CFO. |
| Form 990, Part VI, Section B, line 12c | Pella Regional Health Center has conflict of interest policies completed each year by all Board Members and officers thus monitoring any potential conflicts of interest. The CEO and CFO review the completed statements. If a potential conflict is identified, the CEO follows up. Any actual or potential duality or conflict of interest including, but not limited to, ownership or control of any entity that contracts with the Pella Regional Health Center for any products or services must be disclosed to the other Members of the Board and made a matter of record in the minutes when the subject of such interest becomes a matter of Board action. When a conflict arises, the Member is asked to be excused from the meeting. |
| Form 990, Part VI, Section B, line 15a | The CEO's compensation is set by the Executive Committee of the Board with salary adjustment recommendations based on an annual evaluation and input from Human Resources. The compensation for other officers and key employees is set by the CEO with salary adjustments based on annual evaluations and direction from Human Resources. Comparability data is used to determine compensation for top management officials, officers, and employees in non-management positions. Several surveys are used for comparability including Iowa Hospital Association, Iowa Health System, Integrated Healthcare Strategies, CompData Surveys, Iowa Association of Homes and Services for the Aging, Iowa Medical Group Management Association, and Southeast Iowa Comp Club. The organization documents and provides substantiation for their compensation process for all employees. The process was last undertaken in 2014. |
| Form 990, Part VI, Section C, line 19 | The governing documents and conflict of interest policy are available to the public upon written request. Financial statements are available to the public as they are attached to the Form 990. |
| Form 990, Part VII, Section A: | The physicians/directors are compensated for their services as physicians. Their time served as Board Members is on a volunteer basis and no compensation is received for those services. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pella Hospital Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 Jefferson Street | AddressLine1Txt |
| City | Pella | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421430122 | EIN |
| Primary Activities | To solicit funds and support Pella Regional Health Center | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pella Regional Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pella Hospital Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $320,000 | InvolvedAmt |
| Method Of Amount Determination | General ledger | MethodOfAmountDeterminationTxt |