PELLA REGIONAL HEALTH CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PELLA REGIONAL HEALTH CENTER (EIN 42-0842204)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-13
- IRS object ID
- 201233189349300518
- Schema version
- 2011v1.2
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T07:25:50-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420842204 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PELL | NameControl |
| Phone | 6416283150 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1 |
| City | PELLA | City |
| State | IA | State |
| ZIP Code | 50219 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT KROESE | Name |
| Title | CEO | Title |
| Phone | 6416283150 | Phone |
| Date Signed | 2012-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CARMEN KRANTZ | Name |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | Phone |
| Date Prepared | 2012-11-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT KROESE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1 |
| City | PELLA | City |
| State | IA | State |
| ZIP Code | 50219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 95620425 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PELLAHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1958 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 903 | TotalNbrEmployees |
| Total Nbr Volunteers | 223 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1326288 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 74092 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 64004102 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 69925263 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -1219437 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1672152 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 205554 | OtherRevenuePriorYear |
| Other Revenue Current Year | 166154 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 64316507 | TotalRevenuePriorYear |
| Total Revenue Current Year | 71837661 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2022 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 768875 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 37696800 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 40780779 | 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 | 25534248 | OtherExpensePriorYear |
| Other Expenses Current Year | 27705136 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 63233070 | TotalExpensesPriorYear |
| Total Expenses Current Year | 69254790 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1083437 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2582871 | RevenuesLessExpensesCY |
| Total Assets BOY | 109558047 | TotalAssetsBOY |
| Total Assets EOY | 110622985 | TotalAssetsEOY |
| Total Liabilities BOY | 54029258 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 53728482 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 55528789 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 56894503 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF PELLA REGIONAL HEALTH CENTER IS TO PROVIDE HEALTHCARE AND HEALING SERVICES WITH CHRISTIAN COMPASSION. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 53232602 | Expense |
| Grants | 768875 | Grants |
| Revenue | 69925263 | Revenue |
| Description | PELLA REGIONAL HEALTH CENTER (PRHC) OWNS AND OPERATES A 25-BED CRITICAL ACCESS HOSPITAL, SIX MEDICAL CLINICS, A DIALYSIS UNIT, PHYSICAL THERAPY CENTER, A DEDICATED HOSPICE FACILITY, HOME HEALTH CARE, AND LONG-TERM CARE FACILITIES TOTALING 96 BEDS. ANNUALLY, PRHC HAS OVER 1,450 ADMISSIONS, OVER 370 LIVE BIRTHS; OVER 19,800 EMERGENCY CENTER VISITS; AND PERFORMS OVER 4,000 SURGERIES.PELLA REGIONAL HEALTH CENTER LEADS IN THE DELIVERY OF HEALTHCARE SERVICES TO ITS REGION WITH OVER 800 ASSOCIATES (INCLUDING 28 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. TO FULFILL ITS MISSION OF COMMUNITY SERVICE, 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 ITS ESTABLISHED RATES. REVENUE FROM SERVICES TO THESE PATIENTS AND RESIDENTS IS RECORDED IN THE ACCOUNTING SYSTEM AT THE ESTABLISHED RATES, BUT THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF THE AMOUNTS. THE RESULTING ADJUSTMENTS ARE RECORDED AS ADJUSTMENTS TO PATIENT AND RESIDENT SERVICE REVENUE, DEPENDING ON THE TIMING OF THE CHARITY DETERMINATION.THE HEALTH CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE AMOUNTS OF CHARGES FOREGONE FOR DECEMBER 31, 2011 WERE $618,000. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION, FOR DECEMBER 31, 2011 WERE $344,000.IN ADDITION, THE HEALTH CENTER PROVIDES SERVICES TO OTHER PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS, AND FOR SOME SERVICES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED.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. | Description |
| Total Program Service Expense | 53232602 | 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 | 1 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | 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 | 0 | 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 | 38 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 903 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RONALD WAUTERS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6416286603 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1 |
| City | PELLA | City |
| State | IA | State |
| ZIP Code | 50219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| RANDY STRAVERS | |||||||
| PRESIDENT | 0.50 | X | X | 0 | 0 | 0 | |
| DAVE CHILES | |||||||
| VICE PRESIDENT | 0.50 | X | X | 0 | 0 | 0 | |
| JAMES BRANDL | |||||||
| TREASURER | 0.50 | X | X | 0 | 0 | 0 | |
| VIVIAN RIPPENTROP | |||||||
| SECRETARY | 0.50 | X | X | 0 | 0 | 0 | |
| DR TIMOTHY YODER | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| DR KEVIN MACE DO | |||||||
| DIRECTOR | 0.50 | X | 279184 | 0 | 36279 | ||
| DR CRAIG WITTENBERG MD | |||||||
| DIRECTOR | 0.50 | X | 330793 | 0 | 33209 | ||
| JOHN VANDER WERT | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| JOHN KOOLSTRA | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| DAVID SMART | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| CHRISTOPHER SIMPSON | |||||||
| DIRECTOR UNTIL APRIL 2011 | 0.50 | X | 0 | 0 | 0 | ||
| DR DAVID FREDRICKSON MD | |||||||
| DIRECTOR UNTIL APRIL 2011 | 0.50 | X | 142562 | 0 | 20354 | ||
| ROBERT KROESE | |||||||
| CEO | 40.00 | X | 308780 | 0 | 32357 | ||
| RONALD WAUTERS | |||||||
| CFO | 40.00 | X | 159863 | 0 | 31914 | ||
| DR JEFFREY HARTUNG DO | |||||||
| PHYSICIAN PMC | 40.00 | 366549 | 0 | 36279 | X | ||
| DR TIMOTHY DYKSTRA MD | |||||||
| PHYSICIAN PMC | 40.00 | 346896 | 0 | 32058 | X | ||
| DR MATTHEW MORGAN DO | |||||||
| PHYSICIAN PMC | 40.00 | 377222 | 0 | 36151 | X | ||
| DR MATTHEW GRITTERS MD | |||||||
| PHYSICIAN PMC | 40.00 | 358742 | 0 | 36151 | X | ||
| DR RYAN THORESON DO | |||||||
| PHYSICIAN PMC | 40.00 | 372021 | 0 | 36479 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3042612 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 331231 | TotalOtherCompensation |
| Number Individuals GT100 K | 37 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GRAHAM CONSTRUCTION COMPANY | |||||
| 421 GRAND AVENUE | DES MOINES | IA | 503092309 | CONSTRUCTION | 1828154 |
| CASSLING DIAGNOSTIC IMAGING | |||||
| PO BOX 3045 | OMAHA | NE | 681030045 | RADIOLOGY | 508476 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | MAINTENANCE CONTRACT | 373201 |
| UNITED SHOCKWAVE SERVICES | |||||
| PO BOX 2178 | DES PLAINES | IL | 600172178 | TECHNICAL CONTRACT | 209850 |
| IKON MANAGEMENT SERVICES | |||||
| PO BOX 534777 | ATLANTA | GA | 303534777 | MAINTENANCE CONTRACT | 184621 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| Related Organizations | 29219 | RelatedOrganizations |
| Government Grants | 21216 | GovernmentGrants |
| All Other Contributions | 23657 | AllOtherContributions |
| Total Contributions | 74092 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT & RESIDENT REV | 622110 | 63883569 | 63883569 |
| LONG-TERM CARE REVENUE | 623990 | 4942893 | 4942893 |
| SUPPORTING REVENUE | 900099 | 1008801 | 1008801 |
| VERMEER CLINIC | 621110 | 90000 | 90000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 69925263 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 864697 | TotalRevenueColumn |
| Exclusion | $864,697 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 224999 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 58845 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 166154 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 166154 | TotalRevenueColumn |
| Exclusion | $166,154 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 24488555 | Securities |
| Other | 42819 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 23638401 | Securities |
| Other | 85518 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 850154 | Securities |
| Other | -42699 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 807455 | TotalRevenueColumn |
| Exclusion | $807,455 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 71837661 | TotalRevenueColumn |
| Related Or Exempt Function Income | 69925263 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,838,306 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 768875 | Total |
| Program Services | 768875 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1375296 | Total |
| Program Services | 842382 | ProgramServices |
| Management And General | 532914 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31970253 | Total |
| Program Services | 26478855 | ProgramServices |
| Management And General | 5491398 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1604296 | Total |
| Program Services | 1323735 | ProgramServices |
| Management And General | 280561 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3658345 | Total |
| Program Services | 2524489 | ProgramServices |
| Management And General | 1133856 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2172589 | Total |
| Program Services | 1756962 | ProgramServices |
| Management And General | 415627 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 208952 | Total |
| Management And General | 208952 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60007 | Total |
| Management And General | 60007 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6196865 | Total |
| Program Services | 4285633 | ProgramServices |
| Management And General | 1911232 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 213439 | Total |
| Program Services | 169236 | ProgramServices |
| Management And General | 44203 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2505157 | Total |
| Program Services | 1892142 | ProgramServices |
| Management And General | 613015 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1115213 | Total |
| Program Services | 1059630 | ProgramServices |
| Management And General | 55583 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 179543 | Total |
| Program Services | 174119 | ProgramServices |
| Management And General | 5424 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 302340 | Total |
| Program Services | 255920 | ProgramServices |
| Management And General | 46420 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2422264 | Total |
| Management And General | 2422264 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4982501 | Total |
| Program Services | 4982501 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 724009 | Total |
| Program Services | 97776 | ProgramServices |
| Management And General | 626233 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 6621150 | 6620341 | 809 |
| PROVISION FOR BAD DEBTS | 1656434 | 1656434 | |
| FOOD | 504469 | 6 | 504463 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12793 | Total |
| Management And General | 12793 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69254790 | Total |
| Program Services | 53232602 | ProgramServices |
| Management And General | 16022188 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1738256 | BOY |
| EOY | 772236 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8107563 | BOY |
| EOY | 8317236 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 507088 | BOY |
| EOY | 426796 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 705061 | BOY |
| EOY | 681103 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 111173708 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 52400551 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61216352 | BOY |
| EOY | 58773157 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34135844 | BOY |
| EOY | 38649253 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10000 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3137883 | BOY |
| EOY | 3003204 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109558047 | BOY |
| EOY | 110622985 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4855806 | BOY |
| EOY | 5288499 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 12117 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47696823 | BOY |
| EOY | 47647765 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3850 | BOY |
| EOY | 900 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31482 | BOY |
| EOY | 9259 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1441297 | BOY |
| EOY | 769942 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54029258 | BOY |
| EOY | 53728482 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55516268 | BOY |
| EOY | 56887003 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5021 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7500 | BOY |
| EOY | 7500 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55528789 | BOY |
| EOY | 56894503 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109558047 | BOY |
| EOY | 110622985 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2582871 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1217157 | ReconcilationOtherChanges |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7500 | BeginningOfYearBalance |
| End Of Year Balance | 7500 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1348500 | BeginningOfYearBalance |
| Other Expenditures | 1341000 | OtherExpenditures |
| End Of Year Balance | 7500 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1348500 | BeginningOfYearBalance |
| End Of Year Balance | 1348500 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1348500 | BeginningOfYearBalance |
| End Of Year Balance | 1348500 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4736698 | OtherCostOrOtherBasis |
| Book Value | 4736698 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 161218 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 74757106 | OtherCostOrOtherBasis |
| Depreciation | 27432248 | Depreciation |
| Book Value | 47486076 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29889675 | OtherCostOrOtherBasis |
| Depreciation | 24283768 | Depreciation |
| Book Value | 5605907 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1629011 | OtherCostOrOtherBasis |
| Depreciation | 684535 | Depreciation |
| Book Value | 944476 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 58773157 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED HEALTH CLAIMS PAYABLE | $260,000 |
| ANNUITY PAYABLE | $600 |
| CAPITALIZED LEASE OBLIGATION | $273,342 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $236,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 769942 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: |
| PART X: | THE HEALTH CENTER BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR 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. 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. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 400.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 344000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 344000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00510 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5375824 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5140076 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 235748 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5719824 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5140076 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 579748 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30561 | PersonsServed |
| Total Community Benefit Expense | 41466 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1658 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 39808 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 107782 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 30725 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 77057 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21235335 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 15046189 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6189146 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09160 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1205 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1205 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30561 | PersonsServed |
| Total Community Benefit Expense | 21385788 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 15078572 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6307216 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09330 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30561 | PersonsServed |
| Total Community Benefit Expense | 27105612 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20218648 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6886964 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10190 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 348 | PersonsServed |
| Total Community Building Expense | 2366 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2366 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 348 | PersonsServed |
| Total Community Building Expense | 2366 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2366 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,656,434 | BadDebtExpenseAmount |
| Amount Attributable To | 8613 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15030760 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15394524 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -363764 | 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 |
| 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 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1 |
| City | PELLA | City |
| State | IA | State |
| ZIP Code | 50219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | 2 PROVIDER BASED RHCS - MONROE AND SULLY | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA REGIONAL HEALTH CENTER | 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 | 400.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 10 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (10 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: PART I, LINE 3C: PELLA REGIONAL HEALTH CENTER USES 400% AS THE FAMILY INCOME LIMIT FOR ELIGIBILITY FOR FREE OR DISCOUNTED CARE BECAUSE OF DEMOGRAPHICS. THE FEDERAL TABLES ESTABLISH HOW MUCH OF A DISCOUNT PATIENTS ARE QUALIFIED TO RECEIVE, THUS THE LESS ABILITY TO PAY RESULTS IN A LARGER DISCOUNT.THE HEALTH CENTER ALSO OFFERS UNINSURED PATIENTS A 10% CASH DISCOUNT FOR PROMPT PAYMENT OF SERVICES PROVIDED AND DOES NOT CHARGE INTEREST ON UNPAID BALANCES WHEN PAYMENT PLANS ARE SET UP. |
| 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 $364,676 WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G. THESE ARE THE COSTS TO OPERATE A PHYSICIAN CLINIC, BUSSEY MEDICAL CLINIC. |
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $1,656,434. |
| PART II: COMMUNITY BUILDING EXPENSES INCLUDE SEMINARS AND TRAINING FOR ADVANCE DIRECTIVES AND SPIRITUAL SERVICES. ADVANCE DIRECTIVES LET INDIVIDUALS DECIDE ABOUT END-OF-LIFE CARE AHEAD OF TIME. SEMINARS AND TRAINING ARE PROVIDED AS A BENEFIT TO THE COMMUNITY BY GIVING THEM KNOWLEDGE TO GET THROUGH DIFFICULT ILLNESSES. PELLA REGIONAL HEALTH CENTER PROVIDES TRANSPORTATION FOR EASE OF ACCESS TO HEALTH CARE. MANY PATIENTS WOULD GO WITHOUT THE CARE THEY NEED AND SUFFER WORSE HEALTH ISSUES BECAUSE OF NOT HAVING ACCESS TO TRANSPORTATION. WE ALSO PROVIDE INFORMATION AND REFERRAL TO COMMUNITY SERVICES TO ASSIST THE COMMUNITY IN FINDING SERVICES THEY REQUIRE FOR A HEALTHIER, HAPPIER LIFE. |
| 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.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. FINANCIAL STATEMENT FOOTNOTE: THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. MANAGEMENT ALSO REVIEWS ACCOUNTS TO DETERMINE IF CLASSIFICATION AS CHARITY CARE IS APPROPRIATE. |
| 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 CMS. |
| PART III, LINE 9B: PELLA REGIONAL HEALTH CENTER'S COLLECTION POLICY HAS PROVISIONS FOR PATIENT'S 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 HAS BEEN PART OF THE UNIVERSITY OF MISSOURI-KC RESEARCH PROJECT ON THE NEED FOR CARDIAC SERVICES IN THE SERVICE AREA. THE RESEARCH WILL BE USED FOR COMMUNITY BENEFIT AND WILL EXPAND NEXT YEAR. THE ORGANIZATION IS CURRENTLY WORKING ON IMPLEMENTING A PROGRAM TO BETTER ANALYZE THE NEEDS OF THE COMMUNITY TO IMPROVE HEALTH STATUS AND INCREASE ACCESS TO HEALTH CARE. PROVIDING MEDICAL SERVICES SUCH AS DIALYSIS AND DIABETES WAS DEVELOPED FROM THE NEEDS OF THE COMMUNITY. GENERAL ACTIVITIES, SUCH AS SUPPORT GROUPS AND CLASSES, ARE IMPLEMENTED AND RUN AT A LOSS. WE HAVE BEGUN OUR NEEDS ASSESSMENT AND THE FOLLOWING ARE ALREADY IMPLEMENTED:1. INCREASE AWARENESS OF PROGRAMS THAT HELP WITH MEDICAL EXPENSES - HANDOUT IDENTIFYING FINANCIAL RESOURCES2. IMPROVE AWARENESS OF PRHC SERVICES (PRIMARY, SPECIALTY, CONVENIENT CARE, AND FREE CLINIC) - EXPAND DISTRIBUTION OF PHYSICIAN DIRECTORY THAT IDENTIFIES PHYSICIANS, SERVICES, HOURS AND LOCATIONS - PROMOTE SERVICE HOURS ON WEBSITE - BI-ANNUAL AD IN NEWSPAPER OUTLINING SERVICE LOCATIONS AND WEBSITE OR INFORMATION LINE. 3. INCREASE COMMUNITY EDUCATION EFFORTS - CONTINUE TO PROVIDE COMMUNITY EDUCATION AT HEALTH FAIRS4. TARGETED HEART DISEASE, AND OBESITY5. INCREASE EDUCATION AND SUPPORT - CONTINUE COLLABORATION WITH COMMUNITY ENTITIES FOR COMMUNITY WELLNESS PROJECT (IN PROGRESS) - OFFER SUPPORT TO LOCAL COMPANY'S WELLNESS PROGRAMS6. OFFER WELLNESS LAB DRAWS DONE AT FACILITY |
| 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. REVENUE FROM THE MEDICARE AND MEDICAID PROGRAMS ACCOUNTED FOR APPROXIMATELY 40% AND 9% RESPECTIVELY, OF THE HEALTH CENTER'S NET PATIENT AND RESIDENT SERVICE REVENUE. |
| PART VI, LINE 5: THE BOARD MEMBERS ALL RESIDE IN THE SERVICE AREA. BOARD MEMBERS ARE NOT EMPLOYED BY PELLA, WITH THE EXCEPTION OF A FEW PHYSICIANS, 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, VOLUNTEERING IN THE COMMUNITY, AND IS THE SOLE COMMUNITY PROVIDER. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESLEY RETIREMENT SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5508 NW 88TH STREET SUITE 120 | AddressLine1 |
| City | JOHNSTON | City |
| State | IA | State |
| ZIP Code | 50131 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 420680440 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Non Cash Assistance | 766347 | AmountOfNonCashAssistance |
| Method Of Valuation | BOOK VALUE | MethodOfValuation |
| Description Of Non Cash Assistance | 50 ACRES OF LAND | DescriptionOfNonCashAssistance |
| Purpose Of Grant | CONSTRUCT FACILITY TO PROVIDE ELDER CONTINUING CARE SERVICES | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | 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: DURING 2011, THE HEALTH CENTER CONTRIBUTED 50 ACRES OF LAND TO WESLEY RETIREMENT SERVICES, INC., AN IOWA NONPROFIT CORPORATION. WESLEY INTENDS TO CONSTRUCT FACILITIES TO PROVIDE ELDER CONTINUING CARE SERVICES, SUCH AS INDEPENDENT AND ASSISTED LIVING, ON THIS LAND. THE CONTRIBUTIONS INCLUDES A STIPULATION THAT THE HEALTH CENTER WOULD ACQUIRE THE LAND BACK IF A FACILITY IS NOT CONSTRUCTED WITHIN A REASONABLE PERIOD OF TIME. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR KEVIN MACE DO | |||||||||||||
| 270229 | 0 | 7257 | 0 | 1698 | 0 | 14700 | 0 | 21579 | 0 | 315463 | 0 | 0 | 0 |
| DR CRAIG WITTENBERG MD | |||||||||||||
| 306483 | 0 | 22257 | 0 | 2053 | 0 | 14700 | 0 | 18509 | 0 | 364002 | 0 | 0 | 0 |
| DR DAVID FREDRICKSON MD | |||||||||||||
| 130287 | 0 | 11282 | 0 | 993 | 0 | 8644 | 0 | 11711 | 0 | 162917 | 0 | 0 | 0 |
| ROBERT KROESE | |||||||||||||
| 237393 | 0 | 68941 | 0 | 2446 | 0 | 14700 | 0 | 17657 | 0 | 341137 | 0 | 0 | 0 |
| RONALD WAUTERS | |||||||||||||
| 149634 | 0 | 7949 | 0 | 2280 | 0 | 10070 | 0 | 21844 | 0 | 191777 | 0 | 0 | 0 |
| DR JEFFREY HARTUNG DO | |||||||||||||
| 263230 | 0 | 101051 | 0 | 2268 | 0 | 14700 | 0 | 21579 | 0 | 402828 | 0 | 0 | 0 |
| DR TIMOTHY DYKSTRA MD | |||||||||||||
| 268433 | 0 | 76195 | 0 | 2268 | 0 | 14700 | 0 | 17358 | 0 | 378954 | 0 | 0 | 0 |
| DR MATTHEW MORGAN DO | |||||||||||||
| 350366 | 0 | 24600 | 0 | 2256 | 0 | 14700 | 0 | 21451 | 0 | 413373 | 0 | 0 | 0 |
| DR MATTHEW GRITTERS MD | |||||||||||||
| 266948 | 0 | 89538 | 0 | 2256 | 0 | 14700 | 0 | 21451 | 0 | 394893 | 0 | 0 | 0 |
| DR RYAN THORESON DO | |||||||||||||
| 263030 | 0 | 106738 | 0 | 2253 | 0 | 14700 | 0 | 21779 | 0 | 408500 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IOWA FINANCE AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 521699886 | IssuerEIN |
| CUSIP Number | 462466BL6 | CUSIPNumber |
| Date Issued | 2006-09-28 | DateIssued |
| Issue Price | 46610641 | IssuePrice |
| Description Of Purpose | REMODELING PROJECT & REFUND BONDS ISSUED 12/26/2000 & 1/1/2002. | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 46610641 | TotalProceeds |
| Amount In Reserve Fund | 3286830 | AmountInReserveFund |
| Issuance Costs From Proceeds | 601579 | IssuanceCostsFromProceeds |
| Credit Enhancement | 1916534 | CreditEnhancement |
| Capital Expenditures | 33345532 | CapitalExpenditures |
| Other Spent Proceeds | 7460496 | OtherSpentProceeds |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K, PART II, LINE 11: | Identifier |
| Explanation | THE OTHER SPENT PROCEEDS WERE USED TO CURRENTLY REFUND BONDS ON SEPTEMBER 28, 2006. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 AND 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 B, LINE 11 | THE FORM 990 IS DISTRIBUTED TO THE BOARD'S FINANCE COMMITTEE AND MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. IT IS ALSO REVIEWED BY THE CFO AND DIRECTOR OF FINANCE. | |
| 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 COMPARABLES 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 2011. | |
| 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. | |
| FORM 990, PART VII, SECTION A: | THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO PELLA REGIONAL HEALTH CENTER FOUNDATION, A RELATED ORGANIZATION. ROBERT KROESE, CEO 2 HOURS PER WEEK RONALD WAUTERS, CFO 2 HOURS PER WEEK ROGER STOLL, BOARD MEMBER <1 HOUR PER WEEK DR. TIMOTHY YODER, BOARD MEMBER <1 HOUR PER WEEK DR. ROBERT BRUXVOORT, BOARD MEMBER <1 HOUR PER WEEK | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -570,049. INVESTMENT EXPENSES: -290,877. TRANSFER TO PELLA HOSPITAL FOUNDATION -356,231. TOTAL TO FORM 990, PART XI, LINE 5: -1,217,157. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 JEFFERSON STREET | AddressLine1 |
| City | PELLA | City |
| State | IA | State |
| ZIP Code | 50219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421430122 | EIN |
| Primary Activities | TO SOLICIT FUNDS AND SUPPORT PELLA REGIONAL HEALTH CENTER | PrimaryActivities |
| Legal Domicile State | IA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 7 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA REGIONAL HEALTH CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | 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 | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PELLA HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Q | TransactionType |
| Amount Involved | 356231 | AmountInvolved |
| Method Of Amt Determination | GENERAL LEDGER AMOUNT | MethodOfAmtDetermination |