FORT MADISON COMMUNITY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- FORT MADISON COMMUNITY HOSPITAL (EIN 42-1081055)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-06-14
- IRS object ID
- 201321669349300812
- Schema version
- 2011v1.5
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-06-14T11:37:23-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 N HARRISON STREET SUITE 300 | AddressLine1 |
| City | DAVENPORT | City |
| State | IA | State |
| ZIP Code | 528011999 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421081055 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FORT | NameControl |
| Phone | 3193726530 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5445 AVENUE O | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRADLEY J KOKJOHN | Name |
| Title | CFO | Title |
| Phone | 3193762125 | Phone |
| Date Signed | 2013-06-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN J ROMANO | Name |
| PTIN | P00227323 | PTIN |
| Phone | 5638884000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | C JAMES PLATT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5445 AVENUE O | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 55580924 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FMCHOSP.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | TO ADVANCE THE HEALTH AND WELL BEING OF ALL PEOPLE THROUGH COMPASSIONATE QUALITY CARE, EDUCATION AND COMMUNITY SERVICE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 499 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 17893 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -17772 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 200000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 270000 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48811847 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 54266323 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 242098 | InvestmentIncomePriorYear |
| Investment Income Current Year | 239802 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 308996 | OtherRevenuePriorYear |
| Other Revenue Current Year | 801073 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 49562941 | TotalRevenuePriorYear |
| Total Revenue Current Year | 55577198 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 59927 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 66980 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 29604451 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 31208880 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 19335916 | OtherExpensePriorYear |
| Other Expenses Current Year | 20939445 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 49000294 | TotalExpensesPriorYear |
| Total Expenses Current Year | 52215305 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 562647 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3361893 | RevenuesLessExpensesCY |
| Total Assets BOY | 49410754 | TotalAssetsBOY |
| Total Assets EOY | 59520859 | TotalAssetsEOY |
| Total Liabilities BOY | 10016611 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 16825522 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 39394143 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 42695337 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO ADVANCE THE HEALTH AND WELL BEING OF ALL PEOPLE THROUGH COMPASSIONATE QUALITY CARE, EDUCATION AND COMMUNITY SERVICE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 45617805 | Expense |
| Grants | 66980 | Grants |
| Revenue | 54852359 | Revenue |
| Description | FORT MADISON COMMUNITY HOSPITAL (FMCH) IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, LOCATED IN FORT MADISON, IOWA, TO MEET THE HEALTHCARE NEEDS OF ITS COMMUNITIES AS WELL AS PROVIDE PROGRAMS AND SERVICES AIMED AT HEALTH, SAFETY, EDUCATION, PREVENTION, AND OVERALL HEALTH AND WELLNESS. IN SO DOING, THEY STRENGTHEN THEIR ROLE AS A PARTNER IN THE COMMUNITY BY IMPROVING THE HEALTH OF AREA CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES THEY SERVE. FORT MADISON COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO AREA RESIDENTS. FMCH SERVES THE RESIDENTS OF SOUTHEAST IOWA AND WEST CENTRAL ILLINOIS. THE 50 BED HOSPITAL HAD 2,285 PATIENT ADMISSIONS AND 7,600 PATIENT DAYS OF MEDICAL CARE. THIS INCLUDED 907 PATIENT ACCOUNTS WHO RECEIVED UNCOMPENSATED CARE. HEALTH SERVICES AND CARE PROVIDED BY FMCH INCLUDE: PHYSICIANS AND SURGEONS PRACTICING IN THE FOLLOWING AREAS: FAMILY PRACTICE, INTERNAL MEDICINE, OBSTETRICS & GYNECOLOGY, ORTHOPEDICS & SPORTS MEDICINE, PEDIATRICS, PSYCHIATRY, SURGERY AND UROLOGY; BIRTHPLACE SERVICES; SPECIALTY CLINICS IN THE FOLLOWING AREAS: CARDIOLOGY, DERMATOLOGY, OTOLARYNGOLOGY, GASTROENTEROLOGY AND NEUROLOGY; EMERGENCY DEPARTMENT SERVICES; HOME HEALTH CARE; REHABILITATION/THERAPY SERVICES; LABORATORY AND PATHOLOGY SERVICES; AND WOUND HEALING CARE. | Description |
| Total Program Service Expense | 45617805 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 57 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 499 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRADLEY J KOKJOHN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3193726530 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5445 AVENUE O | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 526270174 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JOHN MCKILLIP | |||||||
| PAST PRESIDENT | 2.00 | X | 2427 | 0 | 0 | ||
| DEANNA BARR | |||||||
| PRESIDENT | 2.00 | X | 1135 | 0 | 0 | X | |
| JAMES GERDES | |||||||
| DIRECTOR | 2.00 | X | 711 | 0 | 0 | ||
| BOB BONTA | |||||||
| VICE PRESIDENT | 2.00 | X | 0 | 0 | 0 | X | |
| JEANNINE HANEY | |||||||
| DIRECTOR | 2.00 | X | 98 | 0 | 0 | ||
| VICKI STEPHENSON | |||||||
| DIRECTOR | 2.00 | X | 15 | 0 | 0 | ||
| ANN MENKE | |||||||
| DIRECTOR | 2.00 | X | 598 | 0 | 0 | ||
| C JAMES PLATT | |||||||
| CEO/SECRETARY | 40.00 | 299056 | 0 | 65891 | X | ||
| BRADLEY KOKJOHN | |||||||
| CFO/TREASURER | 40.00 | 226383 | 0 | 46191 | X | ||
| MITCHELL PAUL MD | |||||||
| PHYSICIAN | 40.00 | 542872 | 0 | 26864 | X | ||
| ROY J TINGUELY MD | |||||||
| PHYSICIAN | 40.00 | 392667 | 0 | 31736 | X | ||
| MARK S CALKINS MD | |||||||
| PHYSICIAN | 40.00 | 694763 | 0 | 25426 | X | ||
| TIMOTHY S STAUDTE MD | |||||||
| PHYSICIAN | 40.00 | 473649 | 0 | 34061 | X | ||
| TODD W GRAY MD | |||||||
| PHYSICIAN | 40.00 | 384327 | 0 | 31736 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3018701 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 261905 | TotalOtherCompensation |
| Number Individuals GT100 K | 25 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| UNITED HEALTHCARE PLAN | |||||
| PO BOX 88832 | CHICAGO | IL | 60695 | HEALTH EE INSURANCE | 3366830 |
| CARDINAL HEALTH 110 INC | |||||
| 2840 ELM POINT DRIVE | ST CHARLES | MO | 63301 | PHARMACY DRUGS AND SUPPLIES | 2071183 |
| EMCARE PHYSICIAN SERVICES INC | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | EMERGENCY ROOM PHYSICIAN STAFFING | 1688673 |
| ABOLT INCORPORATED | |||||
| 2887 CHALK RIDGE ROAD | FORT MADISON | IA | 52627 | GENERAL CONTRACTOR | 1242216 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | SOFTWARE VENDOR | 1020187 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 51 | NumberOfContractorsGT100K |
| Related Organizations | 270000 | RelatedOrganizations |
| Total Contributions | 270000 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE RE | 621110 | 53943863 | 53943863 |
| SE RENAL DIALYSIS | 621300 | 322460 | 322460 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 54266323 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 243528 | TotalRevenueColumn |
| Exclusion | $243,528 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70339 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70339 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 70339 | TotalRevenueColumn |
| Exclusion | $70,339 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3726 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -3726 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3726 | TotalRevenueColumn |
| Exclusion | -$3,726 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| MISCELLANEOUS | 900099 | 536551 | 536551 | ||
| CAFETERIA REVENUE | 722210 | 126805 | $126,805 | ||
| HOUSEKEEPING, MAINTENA | 811000 | 42656 | 24763 | 17893 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24722 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24722 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 730734 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55577198 | TotalRevenueColumn |
| Related Or Exempt Function Income | 54852359 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 17893 | UnrelatedBusinessRevenue |
| Exclusion | $436,946 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66980 | Total |
| Program Services | 66980 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 603726 | Total |
| Management And General | 603726 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24017101 | Total |
| Program Services | 21628094 | ProgramServices |
| Management And General | 2389007 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 779352 | Total |
| Program Services | 701829 | ProgramServices |
| Management And General | 77523 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4321161 | Total |
| Program Services | 3891330 | ProgramServices |
| Management And General | 429831 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1487540 | Total |
| Program Services | 1339573 | ProgramServices |
| Management And General | 147967 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 295925 | Total |
| Management And General | 295925 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40220 | Total |
| Management And General | 40220 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69815 | Total |
| Management And General | 69815 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3008251 | Total |
| Program Services | 2440405 | ProgramServices |
| Management And General | 567846 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256910 | Total |
| Program Services | 380 | ProgramServices |
| Management And General | 256530 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6273162 | Total |
| Program Services | 6158649 | ProgramServices |
| Management And General | 114513 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 938395 | Total |
| Program Services | 928072 | ProgramServices |
| Management And General | 10323 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 166274 | Total |
| Program Services | 124762 | ProgramServices |
| Management And General | 41512 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 124930 | Total |
| Program Services | 90824 | ProgramServices |
| Management And General | 34106 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3141977 | Total |
| Program Services | 2284219 | ProgramServices |
| Management And General | 857758 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 488455 | Total |
| Program Services | 120154 | ProgramServices |
| Management And General | 368301 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PROVISION FOR BAD DEBTS | 2398285 | 2398285 |
| PHYSICIAN FEES | 2291917 | 2291917 |
| MEDICAID ASSESSMENT | 394422 | 394422 |
| RECRUITMENT | 325045 | 325045 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 725462 | Total |
| Program Services | 432865 | ProgramServices |
| Management And General | 292597 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52215305 | Total |
| Program Services | 45617805 | ProgramServices |
| Management And General | 6597500 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1322056 | BOY |
| EOY | 4637326 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3476857 | BOY |
| EOY | 1589605 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5956166 | BOY |
| EOY | 9748372 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 4165 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1320 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 692912 | BOY |
| EOY | 709861 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 970294 | BOY |
| EOY | 996178 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 59928526 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 34412199 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23043657 | BOY |
| EOY | 25516327 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9891467 | BOY |
| EOY | 11992084 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4018656 | BOY |
| EOY | 4180490 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37369 | BOY |
| EOY | 146451 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49410754 | BOY |
| EOY | 59520859 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5897649 | BOY |
| EOY | 9832628 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4030533 | BOY |
| EOY | 6992894 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88429 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10016611 | BOY |
| EOY | 16825522 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39192891 | BOY |
| EOY | 42470132 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3934 | BOY |
| EOY | 25387 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 197318 | BOY |
| EOY | 199818 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39394143 | BOY |
| EOY | 42695337 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49410754 | BOY |
| EOY | 59520859 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3361893 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -60699 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1139463 | OtherCostOrOtherBasis |
| Book Value | 1139463 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27663006 | OtherCostOrOtherBasis |
| Depreciation | 13185583 | Depreciation |
| Book Value | 14477423 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27359636 | OtherCostOrOtherBasis |
| Depreciation | 20902417 | Depreciation |
| Book Value | 6457219 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3766421 | OtherCostOrOtherBasis |
| Depreciation | 324199 | Depreciation |
| Book Value | 3442222 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 25516327 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| SE RENAL DIALYSIS, LC | 1007138 | C |
| INVESTMENT IN SUBSIDIARIES | 3173352 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 4180490 | TotalOfBookValueProgramRelated |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE HOSPITAL AND AFFILIATES, EXCEPT FOR RENAISSANCE HEALTH SERVICES, INC., ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. RENAISSANCE HEALTH SERVICES, INC. IS A FOR PROFIT CORPORATION SUBJECT TO FEDERAL AND STATE INCOME TAXES, HOWEVER THERE WERE NO MATERIAL INCOME TAX PROVISIONS FOR THE YEARS ENDED SEPTEMBER 30, 2012 AND 2011. THE HOSPITAL, FOUNDATION AND FORT MADISON PROFESSIONAL BUILDING ASSOCIATION FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO ORGANIZATIONS SUCH AS THIS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE CONTINUED TAX EXEMPT STATUS OF BONDS ISSUED BY THE HOSPITAL, THE NATURE, THE CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. HOWEVER, AS OF SEPTEMBER 30, 2012 AND 2011, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY AS MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS TAKEN ANY TAX POSITIONS THAT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES. FORMS 990 AND 990T FILED BY THE HOSPITAL, FOUNDATION AND FORT MADISON PROFESSIONAL BUILDING ASSOCIATION ARE GENERALLY SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. THE HOSPITAL'S IRS FORMS 990 AND 990T ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED SEPTEMBER 30, 2008 AND PRIOR. RENAISSANCE HEALTH SERVICES, INC. IS A TAXABLE ORGANIZATION AND CURRENTLY FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE APPLICABLE STATE JURISDICTIONS. THIS ENTITY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED SEPTEMBER 30, 2008 AND PRIOR. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1120896 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1120896 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02250 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4358199 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3955685 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 402514 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5479095 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3955685 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1523410 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03060 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 494278 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 494278 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00990 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 95362 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 95362 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11274405 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9433797 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1840608 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03690 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 66980 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 66980 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11931025 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9433797 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2497228 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05000 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17410120 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13389482 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4020638 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08060 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,398,285 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10974734 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11384226 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -409492 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 SE RENAL DIALYSIS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | DIALYSIS SERVICES | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.20000 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.00000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5445 AVENUE O | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Er Other | X | ErOther |
| Other | TRAUMA CENTER | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 350.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: NOT APPLICABLE | ||
| PART I, LINE 6A: NOT APPLICABLE | ||
| PART I, LINE 7: THE ORGANIZATION CALCULATED THE COST AMOUNTS NOTED IN PART 1, LINE 7 BY UTILIZING ITS CURRENT COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS REPORTED ON, INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, MEDICAID, UNINSURED, AND MEDICARE. WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, AS PROVIDED IN THE IRS INSTRUCTIONS, WAS USED TO DETERMINE THE APPROPRIATE RATIO. | ||
| PART I, LINE 7G: THE AMOUNTS REPORTED ON LINE 7G ARE ASSOCIATED WITH PHYSICIAN CLINICS. | ||
| PART I, L7 COL(F): $2,398,285 OF BAD DEBT EXPENSE IS SUBTRACTED FOR PURPOSES OF COMPUTING THE PERCENTAGE IN PART I, LINE 7K, COLUMN F. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES, LESS BAD DEBT, IS 34.95%, AND THE PERCENTAGE INCREASES TO 57.80% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE. | ||
| PART III, LINE 4: THE ORGANIZATION USED ITS AUDITED FINANCIAL STATEMENTS TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE TO REPORT ON LINE 2. THE ORGANIZATION DOES NOT ISSUE A STANDALONE FINANCIAL STATEMENT; HOWEVER, IT IS INCLUDED AS A PART OF THE FORT MADISON COMMUNITY HOSPITAL AND AFFILIATES CONSOLIDATED FINANCIAL STATEMENTS. THE FOOTNOTE FROM THE CONSOLIDATED FINANCIAL STATEMENT IS AS FOLLOWS: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY AND CURRENT ECONOMIC CONDITIONS. THE HOSPITAL DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT WHEN RECEIVED. THE CHARITY CARE FOOTNOTE DISCLOSURE AS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENT IS AS FOLLOWS: THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE ORGANIZATION 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 AND SUPPLIES FURNISHED UNDER THE ORGANIZATION'S CHARITY CARE POLICY AGGREGATED TO APPROXIMATELY $1,483,000 FOR THE YEAR ENDED SEPTEMBER 30, 2012. COMMENCING IN THE YEAR ENDED SEPTEMBER 30, 2012, THE ORGANIZATION PROVIDED A SELF-PAY DISCOUNT TO PATIENTS THAT DID NOT HAVE INSURANCE COVERAGE. THE AMOUNT OF ADJUSTMENTS APPROXIMATED $583,000 FOR THE YEAR ENDED SEPTEMBER 30, 2012. | ||
| PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. ROUTINE AND ICU COSTS ARE DETERMINED BASED ON AN AVERAGE COST PER DAY MULTIPLIED BY THE NUMBER OF MEDICARE ALLOWABLE DAYS. MEDICARE ANCILLARY COSTS ARE DETERMINED BY THE RATIO OF DEPARTMENT COSTS TO DEPARTMENT CHARGES, THEN THE RESULTING PERCENT IS APPLIED TO MEDICARE ALLOWABLE CHARGES. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL ON FEE SCHEDULE REIMBURSED SERVICES TOTALED $532,614 FOR THE REPORTABLE YEAR. THIS SHORTFALL IS NOT INCLUDED ON SCH H, PART III, LINE 7.THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE: ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WHOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. | ||
| PART III, LINE 9B: THE FORT MADISON COMMUNITY HOSPITAL (FMCH) CHARITY PROGRAM IS DESIGNED TO IDENTIFY THOSE ACCOUNTS WHERE THE GUARANTOR IS NOT ABLE TO MAKE PAYMENT, OR ONLY LIMITED PAYMENTS THAT WOULD WORK A DEFINITE HARDSHIP ON THE HOUSEHOLD, AND "ADJUST" THOSE ACCOUNTS AS EARLY AS POSSIBLE.FINANCIAL EVALUATION OF PATIENT - IF THE PRIMARY PAYOR IS OTHER THAN AN INSURANCE COMPANY, FMCH EVALUATES THE ABILITY OF THE GUARANTOR TO: 1) HANDLE THE PROJECTED FINANCIAL OBLIGATION PERSONALLY; 2) QUALIFY FOR COUNTY, STATE OR FEDERAL ASSISTANCE. ASSISTANCE MAY BE AVAILABLE IF: A) THERE ARE DEPENDENT CHILDREN IN THE HOME (MEDICAID); B) POSSIBLE DETERMINATION OF DISABILITY BY THE SOCIAL SECURITY ADMINISTRATION; AND C) PATIENT IS PREGNANT (MEDICAID); 3) IF PATIENT APPEARS TO QUALIFY FOR ASSISTANCE IN ONE OF THE ABOVE CATEGORIES, FMCH EVALUATES HOW LIKELY IT IS THAT THE PATIENT WILL FOLLOW THROUGH WITH THE APPLICATION PROCESS. IF THE PATIENT IS NOT LIKELY TO FOLLOW THROUGH, ASSISTANCE IS OBTAINED FROM AN OUTSIDE AGENCY TO HELP THE PATIENT THROUGH THE APPLICATION PROCESS; 4) IF THE INITIAL REVIEW INDICATES THERE IS NO OTHER PAYOR THAN THE INDIVIDUAL GUARANTOR, AND AN ASSESSMENT OF THE GUARANTOR'S MEANS (INCOME, ASSETS AND LIABILITIES) LEAVES CONSIDERABLE QUESTIONS AS TO HOW HE/SHE WILL RESOLVE THE IMPENDING DEBT, FMCH THEN DETERMINES IF FULL OR PARTIAL CHARITY IS APPROPRIATE; 5) RESIDENCY TEST - TO BE ELIGIBLE FOR CHARITY CARE, THE PATIENT'S HOME MUST BE WITHIN THE PRIMARY OR SECONDARY SERVICE AREA OF FMCH. THESE AREAS ARE DEFINED BY ZIP CODES; 6) USING THE COMPLETED PERSONAL FINANCIAL STATEMENT, A COPY OF THE MOST RECENT TAX RETURN, A COPY OF THE MOST RECENT PAYROLL STUBS AND ANY OTHER INFORMATION THAT MAY BE APPROPRIATE, THE GUARANTOR'S INCOME MUST BE EVALUATED ON A SLIDING SCALE BASED ON POVERTY GUIDELINES; 7) ADDITIONAL CIRCUMSTANCES SUCH AS, BUT NOT LIMITED TO, IF THE GUARANTOR HAS LIMITED CASH INCOME BUT HAS SIGNIFICIANT PROPERTY HOLDINGS (PERSONAL OR BUSINESS), THOSE ASSETS MUST BE TAKEN INTO ACCOUNT AND MAY SUPERSEDE THE APPLICATION OF THE ABOVE DISCOUNT GUIDELINES;NEGOTIATIONS - DEPENDENT UPON THE GUARANTOR'S MEANS, FMCH MAY NEGOTIATE A SETTLEMENT. IF A RESONABLE MONTHLY PAYMENT FOR THE BALANCE OWED CAN NOT BE AGREED UPON, IT IS IN EVERYONE'S BEST INTEREST TO RESOLVE THE DEBT EARLIER BY AGREEING TO A NEGOTIATED AMOUNT. RECOMMENDATIONS FROM STAFF SUCH AS THE CEO, CFO, DON, RU, DOCTORS AND DEPARTMENT HEADS TO ASSIST WITH PATIENTS THAT ARE HAVING FINANCIAL DIFFICULTY IS ALWAYS CONSIDERED. FOLLOWING DISCHARGE OR BILLING, A DETERMINATION OF CHARITY MAY BE MADE BY USING THE ABOVE PROCESS AS SOON AS THE QUESTION OF POSSIBLE CHARITY IS RAISED. THIS DETERMINATION SHOULD ALWAYS BE MADE AT THE EARLIEST POSSIBLE TIME IN THE LIFE OF THE ACCOUNT. | ||
| PART VI, LINE 2: FORT MADISON COMMUNITY HOSPITAL UTILIZES A COMMUNITY HEALTH NEEDS ASSESSMENT PERFORMED BY THE LOCAL UNITED WAY. IN ADDITION TO THIS NEEDS ASSESSMENT, THE HOSPITAL BOARD OF DIRECTORS HOLD AN ANNUAL PLANNING MEETING WITH REPRESENTATIVES FROM THE MEDICAL STAFF IN ATTENDANCE. THIS PHYSICIAN REPRESENTATION ALLOWS FOR GOOD INPUT OF THE COMMUNITY MEDICAL NEEDS BY THOSE THAT ARE CLOSEST TO THE ISSUES. | ||
| PART VI, LINE 3: THE HOSPITAL HAS A WRITTEN CHARITY CARE POLICY IN PLACE TO ENSURE THAT NECESSARY HEALTH CARE SERVICES ARE NOT DENIED BASED ON ABILITY TO PAY AND THAT ALL PATIENTS ARE TREATED FAIRLY AND EQUITABLY, AND WITH RESPECT AND COMPASSION. THE HOSPITAL ASSISTS PERSONS WITHOUT INSURANCE COVERAGE BY WAIVING ALL OR PART OF THE CHARGES FOR SERVICES IT PROVIDES. CHARGES FOR SERVICES ARE DISCOUNTED ON A SLIDING FEE SCALE BASED ON FEDERAL POVERTY GUIDELINES. INDIVIDUALS WHOSE INCOME IS WITHIN 0% TO 350% OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE FOR FREE OR DISCOUNTED SERVICES. THE FINANCIAL ASSISTANCE CONTACT INFORMATION IS AVAILABLE AT ALL OF THE REGISTRATION POINTS IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. IN ADDITION, FINANCIAL ASSISTANCE CONTACT INFORMATION IS INCLUDED IN THE PATIENT BILLS, INCLUDED IN A PATIENT'S HANDBOOK GIVEN UPON ADMISSION, ADDRESSED IN LETTER FORM TO PATIENTS THAT APPEAR TO BE HAVING DIFFICULTY PAYING THEIR BILL AND/OR A DISCUSSION IS HAD WITH THE PATIENT ON THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS. WHERE APPLICABLE, THE PATIENT IS ASSISTED WITH QUALIFICATION FOR SUCH PROGRAMS.ADDITIONALLY, A CONCERTED EFFORT IS MADE TO INFORM NON-ENGLISH SPEAKING PATIENTS ABOUT FINANCIAL ASSISTANCE POLICIES. MULTILINGUAL SIGNS ARE POSTED IN THE REGISTRATION AND WAITING AREAS SO THAT THE POLICIES ARE CLEARLY COMMUNICATED TO PATIENTS AND PROSPECTIVE PATIENTS. THE ROLE AND RESPONSIBILITIES OF THE FINANCIAL ASSISTANCE COUNSELOR INCLUDE HOW TO QUALIFY PATIENTS FOR MEDICAID, SCHIP AND OTHER GOVERNMENT PROGRAMS. | ||
| PART VI, LINE 4: FORT MADISON COMMUNITY HOSPITAL SERVES A COMMUNITY OF APPROXIMATELY 12,916 AND A COMBINED SERVICE AREA OF APPROXIMATELY 39,879. THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES MOST OF LEE COUNTY, IA AS WELL AS PORTIONS OF HANCOCK COUNTY, IL. THE PRIMARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 22,505 AND A MEDIAN AGE OF 43.6. FORT MADISON COMMUNITY HOSPITAL RECEIVES 50.8% OF THE PRIMARY SERVICE AREA INPATIENT MARKET SHARE. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES PORTIONS OF LEE COUNTY, IA, VAN BUREN COUNTY, IA AND HANCOCK COUNTY, IL. THE SECONDARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 17,374 AND A MEDIAN AGE OF 42. FORT MADISON COMMUNITY HOSPITAL RECEIVES 10.2% OF THE SECONDARY SERVICE AREA INPATIENT MARKET SHARE. | ||
| PART VI, LINE 5: FORT MADISON COMMUNITY HOSPITAL FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH. THE ORGANIZATION ALSO EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. FORT MADISON COMMUNITY HOSPITAL IS COMMITTED TO SERVING THE RESIDENTS OF AREA COMMUNITIES. THE HOSPITAL CONTINUES THESE EFFORTS BY USING EXCESS FUNDS TO EXPAND ITS FACILITIES AND SERVICES TO BETTER SERVE THE COMMUNITY. FURTHERMORE, THE ORGANIZATION HAS PARTNERED WITH JEFFERSON ELEMENTARY SCHOOL TO IMPROVE THE HEALTH AND WELL-BEING OF THE YOUNGEST MEMBERS OF OUR COMMUNITY. FORT MADISON COMMUNITY HOSPITAL IS A DISPROPORTIONATE SHARE (FOR MEDICAID) HOSPITAL WHICH PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. PAYMENTS FOR SERVICES PROVIDED TO BENEFICIARIES OF THESE PROGRAMS ARE BASED ON PRE-ESTABLISHED AND UNILATERALLY SET FEE SCHEDULES IN ACCORDANCE WITH THE PATIENT'S DIAGNOSIS OR TEST OR PROCEDURE PERFORMED. THE DIFFERENCE BETWEEN THE SERVICE PRICE AND THE CONTRACTED PRICE IS WRITTEN-OFF BY THE HOSPITAL. THE CONTRACTED AMOUNT RECEIVED FROM THESE PROGRAMS IS OFTEN LESS THAN THE ACTUAL COST OF THE SERVICE, THE DIFFERENCE OF WHICH REPRESENTS A BENEFIT TO THE PATIENT AND THE COMMUNITY.FORT MADISON COMMUNITY HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS OPEN 24 HOURS PER DAY, 365 DAYS PER YEAR. THE EMERGENCY ROOM HAS A TRAUMA CENTER WITH A CERTIFICATION LEVEL OF III. THE HOSPITAL'S EMERGENCY ROOM PROVIDES SERVICES TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY AND DENIES SERVICES TO NO ONE.FORT MADISON COMMUNITY HOSPITAL PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES IN A VARIETY OF WAYS. FMCH EMPLOYEES ROUTINELY PARTICIPATE IN COMMUNITY ACTIVITIES SUCH AS PARADES, FIRST AID TENTS AT COMMUNITY EVENTS AND BIG BROTHER-BIG SISTER ACTIVITIES. THEY ALSO PARTICIPATE IN COMMUNITY HEALTH IMPROVEMENT ADVOCACY EFFORTS. THE HOSPITAL MARKETING DIRECTOR IS ON THE LOCAL CHAMBER OF COMMERCE BOARD OF DIRECTORS AND THE CEO IS A MEMBER OF THE SOUTHEAST IOWA REGIONAL RIVERBOAT COMMISSION THAT AWARDS GRANTS TO LOCAL COMMUNITY BENEFIT PROJECTS.IN ADDITION TO THE ABOVE, THE HOSPITAL BUILD A NEW OUTPATIENT REHABILITATION CENTER. THE BUILDING INCLUDES SPACE FOR PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES, INCLUDING A SMALL POOL. THE DESIGN INCLUDES A WALKING TRACK FOR USE BY THE PUBLIC. THE WALKING TRACK IS USED TO PROMOTE WELLNESS WITH ALL OF OUR CLIENT GROUPS: BUSINESS, PATIENTS, EMPLOYEES. THE HOSPITAL PROVIDES VARIOUS PROGRAMS AND SERVICES TO INFORM AND TRAIN MEMBERS OF THE COMMUNITY ON SAFETY, HEALTH AND LIFESTYLE TOPICS, AS WELL AS PROVIDE OPPORTUNITIES FOR LEARNING IN A SAFE ENVIRONMENT. THE PROGRAMS ARE FREE OR A NOMINAL FEE IS CHARGED TO DEFRAY A PORTION OF THE COST. EXAMPLES OF THE PROGRAMS ARE EDUCATION PROGRAMS FOR ADVANCED DIRECTIVES, DIABETES, CPR/FIRST AID, PRENATAL, FAMILY/PARENTING AND SIBLING RELATIONSHIPS, AS WELL AS TRAINING TO STUDENTS OF A VARIETY OF AGES. THE HOSPITAL ORGANIZED SUPPORT GROUPS FOR VARIOUS GROUPS INCLUDING CANCER, DIABETES, OSTOMY AND OTHER HEALTH TOPICS.FITNESS, EXERCISE AND SELF-HELP PROGRAMS WERE OFFERED TO PROMOTE AND SUPPORT THE BENEFITS OF PHYSICAL FITNESS, EXERCISE, HEALTHY LIFESTYLES AND STRESS MANAGEMENT. THE HOSPITAL SPONSORED OR PARTICIPATED IN COMMUNITY HEALTH FAIRS AND THE COMMUNITY HEALTH AND FITNESS FAIR IS HELD ANNUALLY BY THE HOSPITAL FOR THE COMMUNITY CONSISTING OF VARIOUS EXHIBITS ON HEALTH RELATED TOPICS. IT IS OPEN TO ALL AGES. ANOTHER ANNUAL EVENT IS THE WOMEN'S HEALTH CONFERENCE FOR AREA WOMEN OF ALL AGES. THE CONFERENCE INCLUDES SPEAKERS ON WOMEN RELATED HEALTH ISSUES. THE HOSPITAL ALSO SPONSORS A KID'S DAY AT THE LEE COUNTY FAIR, THE LEE COUNTY FAIR SENIOR DAY, LEE COUNTY SAFETY DAY AND THE LOCAL RELAY FOR LIFE. THE HOSPITAL PROVIDES A COURTESY TRANSPORTATION SERVICE TO RESIDENTS OF SEVERAL AREA COMMUNITIES. VARIOUS PICK-UP TIMES AND LOCATIONS ARE PROVIDED.FORT MADISON COMMUNITY HOSPITAL MAINTAINS A WEBSITE TO PROVIDE THE COMMUNITY WITH FREE INFORMATION ON HEALTH AND WELLNESS TOPICS, PHYSICIANS, COMMUNITY PROGRAMS, HEALTH SERVICES AND EMPLOYMENT OPPORTUNITIES.THE HOSPITAL PROVIDES VARIOUS SERVICES TO AREA BUSINESSES ON A CONTRACT BASIS INCLUDING EDUCATION PROGRAMS ON WELLNESS AND WORKPLACE INJURY PREVENTION, ON-SITE ERGONOMIC EVALUATIONS, DRUG/ALCOHOL TESTING/SCREENING, EVALUATION OF WORK RELATED INJURIES AND BACK ASSESSMENTS. THE HOSPITAL UNDERWRITES A PORTION OF THE COST OF THESE SERVICES. | ||
| PART VI, LINE 6: NOT APPLICABLE | ||
| IA | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| FORT MADISON RODEO CORP | |||||||
| PO BOX 80 | FORT MADISON | IA | 52627 | 420658297 | 501(C)(4) | 11000 | PROMOTE COMMUNITY ACTIVE LIFESTYLE |
| LEE COUNTY ECONOMIC DEVELOPMENT GROUP | |||||||
| 110 MAIN STREET SUITE 200 | MONTROSE | IA | 52639 | 043605260 | 501(C)(3) | 5000 | PROMOTE ENTITIES MISSION AND ACTIVITIES |
| FORT MADISON ECONOMIC DEVELOPMENT CORP | |||||||
| PO BOX 427 | FORT MADISON | IA | 52627 | 421300666 | 501(C)(3) | 10000 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: AS DONATION REQUESTS ARE RECEIVED BY THE HOSPITAL, AN INDEPENDENT SENIOR LEADERSHIP TEAM EVALUATES AND APPROVES THE RECIPIENTS FOR THE CHARITABLE/COMMUNITY BENEFIT DONATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C JAMES PLATT | |||||||||||||
| 250375 | 0 | 41421 | 0 | 7260 | 0 | 11962 | 0 | 53929 | 0 | 364947 | 0 | 0 | 0 |
| BRADLEY KOKJOHN | |||||||||||||
| 180610 | 0 | 45773 | 0 | 0 | 0 | 9055 | 0 | 37136 | 0 | 272574 | 0 | 0 | 0 |
| MITCHELL PAUL MD | |||||||||||||
| 542872 | 0 | 0 | 0 | 0 | 0 | 12250 | 0 | 14614 | 0 | 569736 | 0 | 0 | 0 |
| ROY J TINGUELY MD | |||||||||||||
| 235019 | 0 | 157648 | 0 | 0 | 0 | 12250 | 0 | 19486 | 0 | 424403 | 0 | 0 | 0 |
| MARK S CALKINS MD | |||||||||||||
| 600018 | 0 | 94745 | 0 | 0 | 0 | 8373 | 0 | 17053 | 0 | 720189 | 0 | 0 | 0 |
| TIMOTHY S STAUDTE MD | |||||||||||||
| 230006 | 0 | 243643 | 0 | 0 | 0 | 12250 | 0 | 21811 | 0 | 507710 | 0 | 0 | 0 |
| TODD W GRAY MD | |||||||||||||
| 230006 | 0 | 154321 | 0 | 0 | 0 | 12250 | 0 | 19486 | 0 | 416063 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | AMOUNTS REPORTED IN PART II FOR C JAMES PLATT AND BRADLEY KOKJOHN WERE PAID BY QUORUM HEALTH RESOURCES, A HEALTHCARE MANAGEMENT SERVICES COMPANY. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| CITY OF FORT MADISON IOWA | |||||||
| 426004688 | NONEAVAIL | 2002-03-01 | 6010000 | REFUND THE ISSUER'S PREVIOUS ISSUE OF HOSPITAL REFUNDING REVENUE BONDS (FORT | 0 | 1 | 0 |
| CITY OF FORT MADISON IOWA | |||||||
| 426004688 | NONEAVAIL | 2003-08-01 | 5810000 | (1) PAYING A PORTION OF THE COSTS OF CONSTRUCTING AND EQUIPPING A 30,225 SQU | 0 | 1 | 0 |
| CITY OF FORT MADISON IOWA | |||||||
| 426004688 | NONEAVAIL | 2011-10-01 | 8500000 | FINANCE A PORTION OF COSTS OF REMODELING, CONSTRUCTING, EQUIPPING AND FURNIS | 0 | 1 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Total ProceedsTotalProceeds | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion |
|---|---|---|---|---|---|---|---|---|
| 6010000 | 5906320 | 103680 | 1 | 0 | 1 | 1 | ||
| 5810000 | 1710500 | 99500 | 1 | 0 | 1 | 1 | 4000000 | 2004 |
| 8500000 | 0 | 0 | 0 | 1 | 8500000 | 2013 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 1 | 0 | 0 | 0 | 0 | 0 |
| 1 | 0 | 0 | 0 | 0 | 0 |
| 1 | 1 | 0 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | TODD W GRAY MD | NamePerson |
| Purpose Of Loan | EDUCATIONAL | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $4,167 | OriginalPrincipalAmount |
| Balance Due | 4165 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 4165 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | C. JAMES PLATT AND BRADLEY J. KOKJOHN HAVE A BUSINESS RELATIONSHIP AS BOTH ARE BOARD MEMBERS OF RENAISSANCE HEALTH SERVICES, INC., A RELATED ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 3 | C. JAMES PLATT, CEO AND BRAD KOKJOHN, CFO ARE EMPLOYED BY QUORUM HEALTH RESOURCES, A HEALTHCARE MANAGEMENT SERVICES COMPANY, WHICH PROVIDES MANAGEMENT SERVICES TO THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 IS REVIEWED BY THE CFO WITH THE EXTERNAL ACCOUNTANTS FOR COMPLETENESS AND ACCURACY PRIOR TO FILING THE FORM 990. A COPY OF THE FINAL VERSION IS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. | |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, 2) HAS READ AND UNDERSTANDS THE POLICY, 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. UPON ANY DISCLOSURE OF THE FINANCIAL INTEREST, THE INTERESTED PERSON LEAVES THE BOARD OR COMMITTEE WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. ALL SUCH ACTIONS ARE RECORDED IN THE MINUTES OF THE BOARD OR COMMITTEE MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE, ACTING ON BEHALF OF THE BOARD OF DIRECTORS, MEETS AT LEAST ANNUALLY TO ASSIST THE BOARD OF DIRECTORS IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR EXECUTIVE COMPENSATION. QUORUM HEALTH RESOURCES, AN INDEPENDENT MANAGEMENT CONSULTANT, PRESENTS TO THE FULL BOARD OF DIRECTORS COMPENSATION INFORMATION WHICH INCLUDES COMPARABLES AND INDUSTRY GUIDELINES ALONG WITH RECOMMENDATIONS FOR THE BOARD'S APPROVAL FOR COMPENSATION OF THE CEO AND CFO. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION DATA AND RELATED POLICIES AND DETERMINES WHETHER SUCH COMPENSATION IS REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE IN ORDER TO RECOMMEND TO THE FULL BOARD OF DIRECTORS COMPENSATION AMOUNTS FOR APPROVAL. COMPENSATION OF PHYSICIANS EMPLOYED OR CONTRACTED BY FMCH OR AN AFFILIATE ARE REVIEWED ANNUALLY USING THE MGMA DATA FOR COMPARISON. THE COMPENSATION COMMITTEE MAINTAINS DOCUMENTATION, CONSISTENT WITH THE RECORD RETENTION POLICY, OF ITS ACTIVITIES AND THE BASIS FOR ITS DECISIONS. THIS PROCESS OCCURS ANNUALLY. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -30,073. EQUITY IN SUBSIDIARY EARNINGS 239,374. CONTRIBUTION FROM SUBSIDIARY REPORTED AS NET ASSET TRANSFER ON REPORT -200,000. CONTRIBUTION FROM SUBSIDIARY -70,000. TOTAL TO FORM 990, PART XI, LINE 5: -60,699. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE FORT MADISON COMMUNITY HOSPITAL GOVERNING BOARD MEETS WITH THE AUDITORS TO REVIEW THE AUDIT REPORT AND MANAGEMENT LETTER. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | |
| FORM 990, PART VII, LINE 1A | FORT MADISON COMMUNITY HOSPITAL (FMCH), FORT MADISON COMMUNITY HOSPITAL FOUNDATION (FMCHF), AND FORT MADISON PROFESSIONAL BUILDING ASSOCIATION (FMPBA) ARE RELATED ENTITIES. AS A RESULT, BOARD OVERLAP EXISTS AMONG THESE ENTITIES, AND THEIR RESPECTIVE POSITION AND TIME DEVOTED TO EACH ENTITY IS AS FOLLOWS: C. JAMES PLATT: OFFICER OF FMCHF AND FMPBA; 1 HOUR DEVOTED TO EACH ORGANIZATION BRADLEY KOKJOHN: OFFICER OF FMCHF AND FMPBA; 1 HOUR DEVOTED TO EACH ORGANIZATION JAMES GERDES: DIRECTOR OF FMCHF AND OFFICER OF FMPBA; 1 HOUR DEVOTED TO EACH ORGANIZATION |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | ||||||||||
| 5445 AVENUE O | FORT MADISON | IA | 52627 | 421298064 | SUPPORT FORT MADISON COMMUNITY HOSPITAL | IA | 501(C)(3) | 11(A) | FORT MADISON COMMUNITY HOSPITAL | 1 |
| FORT MADISON COMMUNITY HOSPITAL FOUNDATION | ||||||||||
| 5445 AVENUE O | FORT MADISON | IA | 52627 | 421446727 | SUPPORT FORT MADISON COMMUNITY HOSPITAL | IA | 501(C)(3) | 11(A) | FORT MADISON COMMUNITY HOSPITAL | 1 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RENAISSANCE HEALTH SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5445 AVENUE O | AddressLine1 |
| City | FORT MADISON | City |
| State | IA | State |
| ZIP Code | 52627 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421298222 | EIN |
| Primary Activity | MEDICAL SERVICE | PrimaryActivity |
| Legal Domicile State | IA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | ||
| J | 469548 | FAIR MARKET VALUE |
| FORT MADISON PROFESSIONAL BUILDING ASSOCIATION | ||
| C | 200000 | FAIR MARKET VALUE |
| FORT MADISON COMMUNITY HOSPITAL FOUNDATION | ||
| C | 70000 | FAIR MARKET VALUE |