2011-11-10T15:27:48-06:00 2010-12-31 EIDE BAILLY LLP 3999 PENNSYLVANIA AVE SUITE 100 DUBUQUE IA 52002 990 2010-01-01 420842204 Pella Regional Health Center PELL 6416283150 404 Jefferson Street Pella IA 50219 Robert Kroese 6416283150 2011-11-07 1 Carmen Krantz 5635561790 2010 2016-03-07 17:11:31Z Robert Kroese 404 Jefferson Street Pella IA 50219 87053488 0 X www.pellahealth.org X 1958 IA Provide healthcare and healing services with Christian compassion. 11 8 943 250 0 0 159347 1326288 65117129 64004102 222493 -1219437 128631 205554 65627600 64316507 4155255 2022 0 0 37651006 37696800 0 0 0 25838698 25534248 67644959 63233070 -2017359 1083437 106502032 109558047 54003944 54029258 52498088 55528789 X The mission of Pella Regional Health Center is to provide healthcare and healing services with Christian compassion. 1 0 48817396 2022 64004102 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 1,400 admissions, over 330 live births; over 18,000 Emergency Center visits; and performs over 3,900 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, 2010 were $391,037. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for December 31, 2010 were $232,000.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. 48817396 1 1 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 34 0 1 943 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IA X Ronald Wauters 6416286603 404 Jefferson Street Pella IA 50219 Dave Chiles 0.50 X X 0 0 0 Randy Stravers 0.50 X X 0 0 0 James Brandl 0.50 X X 0 0 0 Vivian Rippentrop 0.50 X X 0 0 0 Dr Matthew Morgan DO 0.50 X 394395 0 35573 John Koolstra 0.50 X 0 0 0 Christoher Simpson 0.50 X 0 0 0 Dr Timothy Yoder 0.50 X 0 0 0 John Vander Wert 0.50 X 0 0 0 Dr Craig Wittenberg MD 0.50 X 279685 0 32642 Dr David Fredrickson 0.50 X 183436 0 27591 Roger Stoll 0.50 X 0 0 0 Rodney Braun 0.50 X 0 0 0 Dr Matthew Doty MD 0.50 X 342114 0 32996 Robert Kroese 40.00 X 271261 0 32517 Ronald Wauters 40.00 X 153266 0 36573 Dr Jeffrey Hartung DO 40.00 X 350379 0 35592 Dr Timothy Dykstra MD 40.00 X 381902 0 31301 Dr Michael Thompson DO 40.00 X 329050 0 35606 Dr Matthew Gritters MD 40.00 X 339034 0 35373 Dr Ryan Thoreson DO 40.00 X 334946 0 35792 3359468 0 371556 34 0 1 0 Cassling Diagnostic Imaging PO Box 3045 Omaha NE 681030045 Radiology 550019 Graham Construction Company 421 Grand Avenue Des Moines IA 503092309 Construction 544889 Medical Information Technology PO Box 74569 Chicago IL 60696 Maintenance contract 474957 Universal Hospital Services Inc PO Box 86 Minneapolis MN 554860940 Maintenance contract 368415 Skyline Enterprises 344 Hwy T14 Pella IA 50219 Demolition services 327040 18 1185290 16253 124745 1326288 Patient service revenu 622110 60944262 60944262 Resident revenue 623990 2047657 2047657 Other supporting reven 900099 922183 922183 Vermeer Clinic 621110 90000 90000 64004102 694332 694332 311686 106132 205554 205554 205554 20691062 26018 22514186 116663 -1823124 -90645 -1913769 -1913769 64316507 64004102 0 -1013883 2022 2022 1822050 1328433 493617 29336459 24139523 5196936 1329764 1196283 133481 3208330 2314369 893961 2000197 1610768 389429 78120 78120 56515 56515 5873643 4091694 1781949 119754 87355 32399 8372434 7304565 1067869 1115431 1081775 33656 163152 159219 3933 267153 223434 43719 2428630 2428630 5193141 5193141 581620 84815 496805 Provision for bad debts 1281083 1281083 3572 3572 63233070 48817396 14415674 0 1165731 1738256 18949 6241308 8107563 383560 507088 658871 705061 108746270 47529918 63334845 61216352 31240915 34138252 10000 10000 3447853 3135475 106502032 109558047 4548583 4855806 47745881 47696823 4400 3850 53704 31482 1651376 1441297 54003944 54029258 X 50800666 55516268 153269 5021 1544153 7500 52498088 55528789 106502032 109558047 X 1083437 1947264 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 1348500 1341000 7500 1348500 1348500 1348500 1348500 0.00000 1.00000 0.00000 0 0 5334909 5334909 350171 72538247 24307513 48580905 28959693 22582902 6376791 1563250 639503 923747 61216352 Construction accounts payable 55278 Estimated health claims payable 260000 Annuity payable 600 Capitalized lease obligation 363419 Estimated third-party payor settlements 762000 1441297 Part IV, Line 2b: House rent deposits held by the organization. Description of Intended Use of Endowment Funds: 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 Uncertain Tax Positions Under FIN 48: Part X: The Health Center has adopted the provisions of FASB Accounting Standards Codification Topic ASC 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes) on January 1, 2009. The implementation of this standard had no impact on the financial statements. As of both the date of adoption, and as of December 31, 2010 and 2009, the unrecognized tax benefit accrual was zero. The Health Center will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense, if incurred. The Health Center is no longer subject to Federal or state tax examinations by tax authorities for years before 2006. 1 1 X 1 X 400.000000000000 1 X 0 1 0 1 1 232000 232000 0.00370 5689052 5264100 424952 0.00690 5921052 5264100 656952 0.01060 17 10166 46897 18540 28357 0.00050 3 202 141476 34700 106776 0.00170 22293406 14874278 7419128 0.11980 16 1160 54722 0 54722 0.00090 36 11528 22536501 14927518 7608983 0.12290 36 11528 28457553 20191618 8265935 0.13350 0 760684 1923 13666768 13618893 47875 X 1 1 1 1 Pella Regional Health Center

404 Jefferson Street Pella IA 50219

X X X X Not Required 1 12 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 Sully Medical Clinic

704 Third Street Sully IA 50251

Physician clinic Monroe Medical Clinic

100 E Sherman Monroe IA 50170

Physician clinic Diamond Trail Fitness Center

12498 Highway F62E Sully IA 50251

Physical therapy 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. 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 $14,540,463 were included in subsidized health services reported on Line 7g. These are the costs to operate two rural health clinics, a satellite clinic, and an on-site provider-based clinic. Part I, L7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $1,281,083. Part III, Line 4: The organization's bad debt expense at cost was calculated using the expense reported on the financial statements and applying an overall cost-to-charge ratio calculated from Worksheet 2.Patient accounts are written off to bad debt after every effort is made to collect the balance and patients are given opportunities to complete charity care applications or set up payment plans. All discounts and contractual adjustments are applied to accounts before they are written off to bad debt. Current payments on accounts previously written off as bad debt reduces bad debt expense.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: 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. 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. In the coming year, assessments will be completed to determine more specific needs of the community. 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 36% and 9% respectively, of the Health Center's net patient and resident service revenue. Part VI, Line 6: 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. X X X X 0 0 0 0 0 0 0 0 0 Dr Matthew Morgan DO 392139 0 0 0 2256 0 14700 0 20873 0 429968 0 0 0 Dr Craig Wittenberg MD 277637 0 0 0 2048 0 14700 0 17942 0 312327 0 0 0 Dr David Fredrickson 181925 0 0 0 1511 0 11149 0 16442 0 211027 0 0 0 Dr Matthew Doty MD 339979 0 0 0 2135 0 14700 0 18296 0 375110 0 0 0 Robert Kroese 229156 0 39789 0 2316 0 14700 0 17817 0 303778 0 0 0 Ronald Wauters 144287 0 6747 0 2232 0 14700 0 21873 0 189839 0 0 0 Dr Jeffrey Hartung DO 348111 0 0 0 2268 0 14700 0 20892 0 385971 0 0 0 Dr Timothy Dykstra MD 379678 0 0 0 2224 0 14700 0 16601 0 413203 0 0 0 Dr Michael Thompson DO 326794 0 0 0 2256 0 14700 0 20906 0 364656 0 0 0 Dr Matthew Gritters MD 336784 0 0 0 2250 0 14700 0 20673 0 374407 0 0 0 Dr Ryan Thoreson DO 332721 0 0 0 2225 0 14700 0 21092 0 370738 0 0 0 Iowa Finance Authority 521699886 462466BL6 2006-09-28 46610641 Major remodeling project for all departments that offer patient care 0 0 0 46610641 3286500 7460496 601579 1916534 33345532 2009 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 New Program Services Form 990, Part III, line 2 The da Vinci robotic surgery is a new service for patients in gynecology, urology or general surgery. This service became available in April 2010. These services are in furtherance of their tax exempt purpose to provide healthcare and healing services. Form 990, Part VI, Section A, line 1 The Executive Committee is composed of the President (who can act as Chairman), 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. The actions of the Committee are subject to the supervision of the Board to ensure the actions do not conflict with the policies and expressed wishes of the Board. The Executive Committee keeps an accurate and complete record of all of its proceedings. The minutes are submitted for confirmation, as well as to record in the Board minutes. Form 990, Part VI, Section A, line 4 The amended Articles of Incorporation states there are no members and all corporate power and authority should be vested in the Board of Trustees. 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. The process was last undertaken in 2010. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon written request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 3,292,561. Transfer to Pella Hospital Foundation -1,341,000. Correction to beginning balance net assets -4,297. Total to Form 990, Part XI, Line 5: 1,947,264. Form 990, Part VII, Officer and director compensation 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 .2 hours per week Dr. Timothy Yoder, Board member .2 hours per week Dr. Robert Bruxvoort, Board member .2 hours per week Pella Hospital Foundation 404 Jefferson Street Pella IA 50219 421430122 To solicit funds and support Pella Regional Health Center IA 501(c)(3) 7 Pella Regional Health Center 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 Pella Hospital Foundation C 1185290 Actual amount transferred Pella Hospital Foundation Q 1341000 FMV of the endowment