2014-08-12T15:59:12-05:00 2013-12-31 450250958 EIDE BAILLY LLP 3999 PENNSYLVANIA AVE SUITE 100 DUBUQUE IA 52002 990 2013-01-01 420842204 Pella Regional Health Center PELL 6416283150 404 Jefferson Street Pella IA 50219 Robert Kroese CEO 6416283150 2014-08-12 1 Carmen Krantz P00031958 5635561790 2014-08-12 2013 2015-11-30 17:44:51Z Robert Kroese 404 Jefferson Street Pella IA 50219 118049587 0 X www.pellahealth.org X 1958 IA Provide healthcare and healing services with Christian compassion. 10 8 935 215 0 0 42899 153450 74538201 77103234 1124712 2307537 196757 217995 75902569 79782216 2762 5101 0 0 42696925 44496735 0 0 0 29986746 29822925 72686433 74324761 3216136 5457455 119125806 127991015 56352865 55374848 62772941 72616167 X The mission of Pella Regional Health Center is to provide healthcare and healing services with Christian compassion. 0 1 60859784 5101 77103234 Pella Regional Health Center (PRHC) owns and operates a 25-bed critical access hospital, seven medical clinics, a dialysis unit, physical therapy center, a dedicated hospice facility, home health care, and long-term care facilities totaling 63 beds. Annually, PRHC has over 1,360 admissions, over 410 live births; over 20,000 Emergency Center visits; and performs over 4,100 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 PRHC and its affiliates as a whole.PRHC also makes medical care accessible to the entire region it serves. PRHC operates a full-time emergency room and provides emergency care regardless of ability to pay. PRHC provides the clinical/ancillary services required to operate the Emergency Center and provides full-time on-site emergency medical services. In addition, PRHC, 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 PRHC 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 $317,000 for the year ended December 31, 2013. Total direct and indirect costs related to these forgone charges were $157,000 at December 31, 2013 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.PRHC 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. PRHC 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. PRHC takes a strategic, regional needs based approach to delivering benefits to the region. PRHC 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 PRHC'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. 60859784 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 37 0 1 935 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Ronald Wauters 6416286603 404 Jefferson Street Pella IA 50219 X Jim Brandl President 0.50 0.20 X X 0 0 0 Rod Braun Vice President 0.50 0.00 X X 0 0 0 Randy Stravers Treasurer 0.50 0.00 X X 0 0 0 Vivian Rippentrop Secretary 0.50 0.00 X X 0 0 0 Timothy Yoder DVM Director 0.50 0.20 X 0 0 0 Craig Wittenberg MD Medical Director 40.00 0.00 X 379698 0 36844 John Koolstra Director 0.50 0.00 X 0 0 0 David Smart Director 0.50 0.00 X 0 0 0 Spencer Carlstone MD Director/Chief of Staff 40.00 0.00 X 313679 0 37132 John Vander Wert Director 40.00 0.00 X 0 0 0 Robert Kroese CEO 40.00 2.00 X 339123 0 32857 Ronald Wauters CFO 40.00 0.00 X 170335 0 32909 Matthew Morgan DO General Surgery 40.00 0.00 X 461109 0 36382 Dale Lensing MD Gynecologist 40.00 0.00 X 386458 0 39344 Joseph Coleman MD Gynecologist 40.00 0.00 X 396040 0 26980 Ryan Thoreson DO Emergency physician 40.00 0.00 X 341653 0 36780 Michael Thompson DO General Surgery 40.00 0.00 X 342566 0 36238 3130661 0 315466 45 0 1 0 Siemens Financial Services Inc PO Box 2083 Carol Stream IL 601322083 Radiology contract 631745 Graham Construction Company 421 Grand Avenue Des Moines IA 503092309 Construction 316609 McKesson Technologies Inc PO Box 98347 Chicago IL 606938347 Radiology contract 311840 Cassling Diagnostic Imaging PO Box 3045 Omaha NE 681030045 Radiology 254500 Medical Information Technology PO Box 74569 Chicago IL 60696 Maintenance contract 252184 19 21675 66111 65664 153450 Patient service revenue 622110 69856460 69856460 Long-term care revenue 623990 4428198 4428198 Supporting revenue 900099 2728576 2728576 Vermeer Clinic 621110 90000 90000 77103234 1010219 1010219 228684 10689 217995 217995 217995 39554000 38256682 1297318 1297318 1297318 79782216 77103234 0 2525532 5101 5101 1342577 767353 575224 34632462 28847663 5784799 1745161 1433907 311254 4456013 2589765 1866248 2320522 1883507 437015 156481 156481 59850 59850 6794755 4457129 2337626 322192 269352 52840 2263999 1573494 690505 1268927 1206546 62381 200748 192635 8113 301230 217452 83778 2409222 2409222 5109214 5109214 630179 158017 472162 Medical supplies 7630924 7630924 Provision for bad debts 2046332 2046332 Food 527694 1097 526597 Dues and memberships 99627 59702 39925 1551 1372 179 74324761 60859784 13464977 0 1658082 2546158 9989406 9491867 447162 494625 715891 810458 105915768 51244619 58575995 54671149 44831078 57247663 2908192 2729095 119125806 127991015 5759053 4955273 554768 335292 47598707 47549649 900 900 164837 57134 2274600 2476600 56352865 55374848 X 62765441 72608667 7500 7500 62772941 72616167 119125806 127991015 5457455 4827919 -442148 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 7500 158 158 7500 7500 7500 7500 7500 1348500 1341000 7500 1348500 1348500 1.00000 0 0 4899698 4899698 88511 77502775 33572154 44019132 21928008 16964784 4963224 1496776 707681 789095 54671149 Estimated health claims payable 622000 Annuity payable 600 Estimated third-party payor settlements 1854000 2476600 X 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, they are subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Health Center has determined that they are not subject to unrelated business income tax and have 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. 1 1 X 1 X 1 X 0 1 0 1 1 157000 157000 0.00220 6061960 5653964 407996 0.00560 6218960 5653964 564996 0.00780 37971 44194 1534 42660 0.00060 233 193760 26790 166970 0.00230 19760206 14368858 5391348 0.07460 500 62016 62016 0.00090 38704 20060176 14397182 5662994 0.07840 38704 26279136 20051146 6227990 0.08620 0 2046332 4502 16023281 16331861 -308580 X 1 1 1 1 Pella Regional Health Center 404 Jefferson Street Pella IA 50219 www.pellahealth.org 630165H X X X X 2 provider based RHCs - Monroe and Sully Pella Regional Health Center 1 1 X X X X X X X X 12 1 0 1 X www.pellahealth.org X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X X X 1 1 X X 1 0 X X X X 1 X 0 0 Pella Regional Health Center Part V, Section B, Line 3: A survey was sent to individuals in counties representing the top 75% of admissions. Zip codes with the greatest number of admissions were stratified in the initial sample selection. Each area was represented in the sampling proportionately to both the overall served population and the number of past admissions. Eight hundred residents were selected randomly from Prime NetData Source, a marketing organization. The assessment also included surveying, key informant interviews and secondary data analysis. Twelve individuals were invited to participate in a key informant interview. Key informant participants were identified as people living in Pella and the surrounding area. The key informants were selected to represent various consumer groups of local health services included senior citizens, caregivers, business leaders, young professionals, and health care providers. Pella Regional Health Center Part V, Section B, Line 6i: Pella Regional Health Center has adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to the Hospital's website at www.pellahealth.org. Pella Regional Health Center Part V, Section B, Line 7: Considering the feasibility of a helpline for patients who have difficulty finding a physician or getting an appointment will not be addressed due to lack of resources. After consideration, the helpline was not established. Physician availability is posted on our website at www.pellahealth.org. Requests for help with appointments can be given by calling the main phone line for clinics.Promote disease prevention, increase community education efforts, add information to the Hospital's website for prevention of cancer, heart disease and obesity including risk factors, recommended screenings and links to services were not addressed during the year due to time constraints but will be in the future. The Hospital's website, www.pellahealth.org, is in the process of integrating Krames StayWell patient education information which will include information on the prevention of cancer, heart disease, and obesity as well as risk factors, recommended screenings and links to services. Pella Regional Health Center Part V, Section B, Line 11: 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, effective August 20, 2013.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. Pella Regional Health Center Part V, Section B, Line 14g: Patients are informed of the charity care policy and financial assistance at discharge. An application for charity care and contact information for patients is available on our website. Pella Regional Health Center works with patients to establish payment plans that are tailored to their ability to pay. 13 Pella Medical Clinic 405 Monroe Pella IA 50219 Physician clinic Pella Regional Health Center LTC 404 Jefferson Street Pella IA 50219 Long term 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 Hilltop Manor 408 Jefferson Street Pella IA 50219 Residential care facility 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 Ottumwa Medical Clinic 920 N Quincy Avenue Ottumwa IA 52501 Physician clinic Newton Occupational Health Clinic 321 E Third St N Newton IA 50208 Occupational health Clow Occupational Health Clinic 902 S 2nd Street Oskaloosa IA 52577 Occupational health 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, effective August 20, 2013.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 $389,266 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 $2,046,332. Part III, Line 4: 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.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. 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.In the summer of 2011, a random, stratified sample of 800 residents within Pella Regional's service area, and 224 surveys were returned providing a 30 percent response rate. Based on sample size, surveyors were 95 percent confident that the responses were representative of the service area population, with a margin of error of 5.05 percent. In addition, 12 key informant interviews with senior citizens, caregivers, business leaders, young professionals and health care providers offered qualitative information to supplement the survey.The community health needs assessment found access to health care rated as the primary factor for a healthy community, cancer, heart disease, and obesity were the top concerns for health related risks, and increased access to exercise/nutrition programs would make Pella a healthier place to live, work and play. Our formal community health needs assessment was posted to our website in 2012. Part VI, Line 3: Pella Regional Health Center works with patients at discharge discussing the availability of various government benefits, such as Medicaid or other state programs, and also assists the patient with qualification for such programs where applicable. At this time patients are also informed of the Pella Regional Health Center charity care policy and financial assistance contact information in the business office.Patients are encouraged to complete 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, and Jasper 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 Manufacturing, 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 2010 was 10,352. Median household income was $55,182 and there were 8.7% of people living in poverty. The unemployment rate for 2010 was 7.70%, with a job growth of -1.16%. This information was obtained from the 2010 U.S. Census. 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 1 Part I, Line 2: Pella Regional Health Center has an application for funding that can be completed however, some requests come in letters and flyers that includes all the information on the application. If the request is $500 or less, based in a clinic location area, affects youth and families and has a relationship to health and well-being, the answer is usually yes. Any request over $500 is reviewed by the Administration team. These are usually funded through our related Foundation. We do not give to individuals. All information is retained in a file. Because the grants are small amounts funded locally, we do not have a process for monitoring the use of the grant funds. X X X X 0 0 0 0 0 0 0 1 0 Craig Wittenberg MD Medical Director 358328 0 19315 0 2055 0 15300 0 21544 0 416542 0 0 0 Spencer Carlstone MD Director/Chief of Staff 292354 0 19315 0 2010 0 15300 0 21832 0 350811 0 0 0 Robert Kroese CEO 253074 0 83732 0 2317 0 15300 0 17557 0 371980 0 0 0 Ronald Wauters CFO 159914 0 8277 0 2144 0 10725 0 22184 0 203244 0 0 0 Matthew Morgan DO General Surgery 406856 0 51985 0 2268 0 15300 0 21082 0 497491 0 0 0 Dale Lensing MD Gynecologist 374092 0 11000 0 1366 0 15300 0 24044 0 425802 0 0 0 Joseph Coleman MD Gynecologist 382712 0 11000 0 2328 0 5699 0 21281 0 423020 0 0 0 Ryan Thoreson DO Emergency physician 339385 0 0 0 2268 0 15300 0 21480 0 378433 0 0 0 Michael Thompson DO General Surgery 329298 0 11000 0 2268 0 15300 0 20938 0 378804 0 0 0 Part I, Line 7 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. A Iowa Finance Authority 521699886 462466BL6 2006-09-28 46610641 Remodeling project & refund bonds issued 12/26/2000 & 1/1/2002 0 0 0 A 46611484 3286830 601579 1916534 33346375 7460496 2009 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 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. Form 990, Part III, line 3 Hilltop residential services closed in December 2013. 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 and 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 2013. 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. Pella Hospital Foundation 404 Jefferson Street Pella IA 50219 421430122 To solicit funds and support Pella Regional Health Center IA 501(c)(3) Line 7 Pella Regional Health Center 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0